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PEDIATRIC PRACTICE

Ophthalmology

NOTICE

Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example, and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.

PEDIATRIC PRACTICE

Ophthalmology

EDITOR

Gregg T. Lueder, MD, FAAO, FAAP

Professor of Ophthalmology and

Visual Sciences, and Professor of Pediatrics

St. Louis Children’s Hospital

Washington University School of Medicine

St. Louis, Missouri

Medical

New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

ISBN: 978-0-07-163965-1

MHID: 0-07-163965-9

The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-163380-2,

MHID: 0-07-163380-4.

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TERMS OF USE

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THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.

To my wife, Cindy, our four daughters, and my patients. I get up in the morning and look forward to going to work. At the end of the day I look forward to going home. You can’t ask for more than that.

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Contents

ACKNOWLEDGMENTS / ix

INTRODUCTION / xi

SECTION 1:

Evaluation of the Eye / 1

1 The Eye Examination . . . . . . . . . . . . . . . . . . . . . . . . 2

2 Ancillary Tests in Pediatric

Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

SECTION 2: Symptoms / 35

3

The Infant Who Does Not Appear To See . . . . . .

36

4

Decreased Vision in Older Children . . . . . . . . .

40

5

Red Eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

44

6

Irritated Eyes (But not Red) . . . . . . . . . . . . . . . . .

50

7

Excess Tearing in Infants . . . . . . . . . . . . . . . . . . . .

54

8

Absent Tearing in Infants . . . . . . . . . . . . . . . . . . .

60

9

Strabismus in Infants . . . . . . . . . . . . . . . . . . . . . . .

63

10

Strabismus in an Older Child. . . . . . . . . . . . . . . .

67

11

Diplopia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

73

12

Nystagmus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

78

13

Bumps Around the Eyes . . . . . . . . . . . . . . . . . . . .

82

14

Droopy Eyelids . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

88

15

Bulging Eyeball . . . . . . . . . . . . . . . . . . . . . . . . . . . .

94

16 Cloudy Cornea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

17 Bumps on the Iris . . . . . . . . . . . . . . . . . . . . . . . . . 104

18 Anisocoria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

19 Abnormal Red Reflex . . . . . . . . . . . . . . . . . . . . . . 114

20 Retinal Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . 119

21 Abnormal Optic Nerve . . . . . . . . . . . . . . . . . . . . 123

22 Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

23 Learning Disorders . . . . . . . . . . . . . . . . . . . . . . . . 133

SECTION 3: Diseases / 137

24 Disorders of the Lacrimal System . . . . . . . . . . 138

25 Disorders of the Eyelids . . . . . . . . . . . . . . . . . . . 146

26 Disorders of the Orbit . . . . . . . . . . . . . . . . . . . . . 161

27 Diseases of the Conjunctiva . . . . . . . . . . . . . . . 172

28 Diseases of the Cornea . . . . . . . . . . . . . . . . . . . . 185

29 Disorders of the Iris and Pupil. . . . . . . . . . . . . . 200

30 Disorders of the Lens . . . . . . . . . . . . . . . . . . . . . . 214

31 Disorders of the Retina . . . . . . . . . . . . . . . . . . . . 227

32 Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247

33 Disorders of the Optic Nerve . . . . . . . . . . . . . . 259

34 Strabismus, Amblyopia, and Nystagmus . . . . 274

INDEX / 293

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Acknowledgments

I want to thank Alyssa Fried, Christie Naglieri, and the people at McGraw-Hill for asking me to write this book, and for the flexibility to let me design it the way I wanted.

I have been blessed to work in an outstanding environment at St. Louis Children’s Hospital for the past 17 years. I thank my partners and the superb staff in the Children’s Eye Center. The greatest things in life are accomplished through teamwork, and these people allow us to provide excellent care to our patients. Special thanks go to Judy Stockstad for her tireless administrative work, Dave Garibaldi for his photographic skills, and Aakriti Kathuria for her production assistance.

I have been fortunate to have outstanding teachers during my career. I hope that this book carries this gift forward.

I thank my parents for their constant support during many years of education, and for providing a wonderful role model for a balanced life and loving marriage.

Most importantly, I thank my wife, Cindy, and our daughters. They have been fully supportive of this endeavor, despite my greater-than-usual underestimation of the time that it would require.

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