Q 1:
A 5-year-old child was hit in the right eye by a toy. He is rubbing at his eye, which is watering
profusely. There is a small abrasion at the corner of the eye. He is mildly photophobic, but
his pupils are equal, symmetric, and reactive to light and accommodation. His vision is normal.
Which of the following is the most appropriate next step in the management of this patient?
(A) Perform a fluorescein dye stain of the cornea to determine if there is a corneal abrasion.
(B) Refer him immediately to an ophthalmologist.
(C) Irrigate the eye with sterile normal saline.
(D) Discharge him to home with antibiotic eye ointment.
(E) Apply a patch to the eye and follow-up in a week.
Answer:
(A)
Superficial corneal injuries expose underlying layers causing pain, photophobia, tearing, and decreased vision. Irrigation is recommended only if a foreign body is suspected.
Abrasions are detected by instilling fluorescein dye and inspecting the cornea using blue-filtered light. Treatment consists of frequent applications of topical antibiotic ointment until the epithelium is healed. The use of a patch does not accelerate healing, and if improperly applied, may abrade the cornea. Referral to an
ophthalmologist should be considered if there are significant changes in vision, or signs of
deeper or more penetrating injury which often result in papillary abnormalities.
-----------------------------
Q 2:
A 5-year-old febrile child presents with swelling of the right eyelid. Proptosis and limitation
of ocular movements is noted. Which of the following is the most likely diagnosis?
(A) retinoblastoma
(B) orbital cellulitis
(C) periorbital cellulitis
(D) neuroblastoma
(E) hyphema
answer:
(B)
Orbital (also referred to as postseptal) cellulitis is a medical emergency. It is a bacterial infection of the orbit. It must be distinguished from periorbital (also referred to as preseptal) cellulitis by the presence of proptosis or limitations of extraocular movements.
When orbital cellulitis is suspected, cultures of blood and CSF should be obtained, appropriate antibiotics should be administered intravenously, an ophthalmologist should be consulted, and CT films should be obtained to delineate the extent of the infectious process.Both retinoblastoma and battered child syndrome
may present with lid edema.
Typically, these children are afebrile and nontoxic in appearance. Hyphema is hemorrhage into the anterior chamber of the eye and is caused by trauma. Twenty percent of patients with neuroblastoma present with eye symptoms from metastasis. Proptosis is one of the possible presentations and can be of relatively acute onset.
In general, other systemic symptoms are present and have developed more gradually.
-----------------------------
Q 3:
Among the conditions that cause edema of the eyelids is orbital cellulitis. This is a serious infection that must be recognized early and treated aggressively if complications are to be avoided. Which of the following features is useful in differentiating orbital cellulitis from periorbital (preseptal) cellulitis?
(A) proptosis
(B) elevated WBC count
(C) fever
(D) lid swelling
(E) conjunctival inflammation
Answer:
(A)
Proptosis and limitation of extraocular motility distinguish orbital cellulitis from periorbital cellulitis. Fever, lid swelling, redness of the eye, and leukocytosis generally are present in either condition. Orbital cellulitis (infection within the orbit) may follow directly from a wound near the orbit or may result from bacteremia,
but the most common source involves extension from the paranasal sinuses. The organisms most frequently implicated as pathogens are H. influenzae, S. aureus, group A beta-hemolytic Streptococci, and S. pneumoniae. The risk of complication is great, with extension resulting in cavernous sinus thrombosis,
meningitis, or brain abscess. Prompt hospitalization and parenteral antibiotic therapy are indicated.
Answer:
(A)
Superficial corneal injuries expose underlying layers causing pain, photophobia, tearing, and decreased vision. Irrigation is recommended only if a foreign body is suspected.
Abrasions are detected by instilling fluorescein dye and inspecting the cornea using blue-filtered light. Treatment consists of frequent applications of topical antibiotic ointment until the epithelium is healed. The use of a patch does not accelerate healing, and if improperly applied, may abrade the cornea. Referral to an
ophthalmologist should be considered if there are significant changes in vision, or signs of
deeper or more penetrating injury which often result in papillary abnormalities.
-----------------------------
Q 2:
A 5-year-old febrile child presents with swelling of the right eyelid. Proptosis and limitation
of ocular movements is noted. Which of the following is the most likely diagnosis?
(A) retinoblastoma
(B) orbital cellulitis
(C) periorbital cellulitis
(D) neuroblastoma
(E) hyphema
answer:
(B)
Orbital (also referred to as postseptal) cellulitis is a medical emergency. It is a bacterial infection of the orbit. It must be distinguished from periorbital (also referred to as preseptal) cellulitis by the presence of proptosis or limitations of extraocular movements.
When orbital cellulitis is suspected, cultures of blood and CSF should be obtained, appropriate antibiotics should be administered intravenously, an ophthalmologist should be consulted, and CT films should be obtained to delineate the extent of the infectious process.Both retinoblastoma and battered child syndrome
may present with lid edema.
Typically, these children are afebrile and nontoxic in appearance. Hyphema is hemorrhage into the anterior chamber of the eye and is caused by trauma. Twenty percent of patients with neuroblastoma present with eye symptoms from metastasis. Proptosis is one of the possible presentations and can be of relatively acute onset.
In general, other systemic symptoms are present and have developed more gradually.
-----------------------------
Q 3:
Among the conditions that cause edema of the eyelids is orbital cellulitis. This is a serious infection that must be recognized early and treated aggressively if complications are to be avoided. Which of the following features is useful in differentiating orbital cellulitis from periorbital (preseptal) cellulitis?
(A) proptosis
(B) elevated WBC count
(C) fever
(D) lid swelling
(E) conjunctival inflammation
Answer:
(A)
Proptosis and limitation of extraocular motility distinguish orbital cellulitis from periorbital cellulitis. Fever, lid swelling, redness of the eye, and leukocytosis generally are present in either condition. Orbital cellulitis (infection within the orbit) may follow directly from a wound near the orbit or may result from bacteremia,
but the most common source involves extension from the paranasal sinuses. The organisms most frequently implicated as pathogens are H. influenzae, S. aureus, group A beta-hemolytic Streptococci, and S. pneumoniae. The risk of complication is great, with extension resulting in cavernous sinus thrombosis,
meningitis, or brain abscess. Prompt hospitalization and parenteral antibiotic therapy are indicated.
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