Slit Lamp Examination on Pediatric Patients

Slit lamp examination is an important component of a pediatric eye exam. The slit lamp instrument, also known as a biomicroscope, is used to provide a stereoscopic magnified view of the ocular structures. The slit lamp facilitates the examination of both the anterior segment as well as the posterior segment of the eyes. For posterior segment examination, handheld lenses are used in conjunction with the slit lamp. Different tools and examination techniques are often needed to examine infants, toddlers, and other pediatric patients who cannot be positioned in the slit lamp. This chapter discusses the techniques and equipment used to facilitate the ocular health examination, including anterior segment structures, posterior segment structures, and intraocular pressure measurements in the pediatric population.

Lens coloboma secondary to neglected buphthalmos

A 36-year-old male presented with progressive diminution of vision OS for 3 months. He was a known case of bilateral congenital glaucoma who underwent trabeculectomy at 6 months and 5 years of age OD and OS respectively. Best corrected visual acuity was 6/24 OD and 1/60 OS. Slit lamp examination revealed bilateral Haab striae (Figure 1a) with lens subluxation OS evident by the scalloped border of the lens with broken zonules in the superonasal quadrant and lens coloboma in the inferonasal quadrant with the absence of zonules (Figure 1b,c,d). A posterior subcapsular cataract was also noted OS. Advanced glaucomatous optic nerve cupping was noted OU. An intraocular pressure of 10 mm Hg OD and 16 mm Hg OS was noted. Biometry documented an axial length of 26.30 mm OD and 28.75 mm OS with a keratometry of 42.50D/46.50D @20˚/110˚OD and 37.75D/40.00D @ 45˚/135˚OS. Ultrasound bio-microscopy depicted increased sphericity of the lens with broken zonules OS (Figure 1e).

CLINICAL PROFILE OF PAEDIATRIC PATIENTS OF VERNAL KERATOCONJUNCTIVITIS PRESENTING TO THE TERTIARY HEALTH CARE CENTRE

PURPOSE - to study the clinical prole of patients of vernal keratoconjunctivitis presenting to the tertiary health care centre. METHODS- This was a prospective observational study that involved 100 eyes of 50 patients with vernal keratoconjunctivitis complaining of itching, burning and ropy discharge. Slit lamp examination was done in all the patients. RESULTS-There were 37 males and 13 females and the age group taken was 1 to 15 years. 4 patients belonged to the age group of 1 to 5 years, out of which all 4 were males. 32 patients belonged to age group of 6 to 11 years, out of which 24 were males and 8 were females. 14 patients belonged to the age group of 12 to 15 years, out of which 9 were males and 5 were females. On slit lamp examination cobblestone papillae were seen in 46% patients, pseudogerontoxon was seen in 32% patients, Horner Tranta's spots were seen in 18% patients and shield ulcer was seen in 4% patients. CONCLUSION-VKC is a common form of allergic conjunctivitis and the disease tends to occur in males of 6 to 11 years age group. Most common is palpebral form followed by mixed and bulbar forms. Some cases showed history of dust exposure, atopy and other allergic conditions.

Iridocorneal endothelial syndrome: Short report

We report a case of a 42-year-old-woman, who presented to the ophthalmic consultation for decreased visual acuity complaints of blurred vision, altered pupillary shape since few months of her right eye. The clinical examination found a reduced visual acuity to counting fingers in the right eye and 20/20 in the left eye. intraocular pressures was 38 mm Hg OD and 14 mm Hg OS. Slit lamp examination of the right eye found: Corneal edema, iris atrophy with a deformation of the iris architecture and pupillary anomalies, with polycoria (Figure 1). The evaluation of the angle by gonioscopy found areas of broad synechiae anterior to Schwalbe’s line (Figure 2). While the examination of the left eye was normal (Figure 1B). The posterior segment examination was normal in both eyes. Specular microscopy confirmed the presence of unilateral endothelial pleomorphism and polymegathism. In our case of the retained diagnosis was iridocorneal endothelial syndrome

Case report: an unusual unilateral pterygium — a secondary pterygium caused by parasitosis in the scleral fistula

Background Ocular parasitosis can cause eye damage, which contribute to eye symptoms such as burning, itching and even blindness. It is uncommon to see the parasitosis lying in the sclera layer, neither it causing pterygium. Here, we present an unusual case of a secondary pterygium caused by intrascleral worm. Case presentation A 52-year-old women complained about discomfort in right eye for 6 years. Slit-lamp examination indicated a thickened triangular layers of conjunctiva extending from the nasal edge to the cornea. The diagnosis was pterygium in the right eye. To our surprise, after scleral of nasal side exposed, we could see a tiny fistula right in the sclera which lied right under the pterygium, with an alive and motile worm inside. An intrascleral fistula was noted. Then the worm was removed by forceps from the fistula, which was creamy white, thread-like and 1 cm long. Discussion and conclusions As far as we known, it is the first case of an intrascleral worm hidden beneath the conjunctiva which caused the secondary pterygium. It is hard to know the etiology of the secondary pterygium which caused by parasitosis in the scleral fistula untill excision surgery. It is hard to imagine the worm was living in the sclera of the patient for a long-time.

When the Trauma Draws a Rose: Rosette Cataract

A 40-year-old male patient referred to the ophthalmologic emergency room for complaints of diminution of vision in the left eye since three months after a trauma. Examination of the left eye showed a corrected visual acuity of 20/70. Slit-lamp examination revealed a rosette cataract (Figure 1). The patient underwent phacoemulsification with implantation of an IOL in the bag. The rosette cataract is a posterior subcapsular cataract due to a violent contusion with a closed globe. It can develop in the hours that follow, or on the contrary several years later.

A CLINICAL STUDY ON LENS INDUCED GLAUCOMA IN PATIENTS ATTENDING GOVERNMENT GENERAL HOSPITAL,SRIKAKULAM.

AIM: To determine the prevalence and visual outcomes after cataract surgery in different LIG patients METHODS:In this prospective study 50 patients were taken into study. Detailed history was taken and slit lamp examination was done & IOP was recorded by AT. All the patients were treated preoperatively appropriately. Patients were operated with SICS with PC IOL implantation and Peripheral Iridectomy.During follow up a detailed Ocular examination was done including Refraction using snellens chart and IOP measurement with AT. RESULTS: Among 50 patients 21(42%)were male patients and 29(58%)were female. Maximum patients had Phacomorphic Glaucoma accounting 72% (36patients) and Phacolytic Glaucoma 24%. Highest percentage was among 40-49mmHg (52%) followed by 30-39mmHg (36%) and >50mmHg (10%). Highest patients were between 10-19mmHg (76%). Visual acuity on admission, highest patients were seen in HM positive (64%) followed by PL+(32%). Even No PL were also seen (4%). On follow up after 6weeks ,majority were seen between 6/12- 6/18(52%) CONCLUSION: LIG is an important vision-threatening disease presenting as a painful red eye. It is remaining as one of the important cause of Blindness not only because of Senile cataract but even after cataract surgery due to Glaucoma caused by neglected cataractous lens.Hence, importance should be given for timely surgery for better visual outcome .

Detailed corneal and genetic characteristics of a pediatric patient with macular corneal dystrophy - case report

Background Corneal dystrophies are a group of rare, inherited disorders that are usually bilateral, symmetric, slowly progressive, and not related to environmental or systemic factors. The majority of publications present the advanced form of the disease with a typical clinical demonstration. The initial signs and symptoms of different epithelial and stromal corneal dystrophies are not specific; therefore, it is very important to establish the early characteristic corneal features of these disorders that could guide the diagnostic process. Case presentation The main purpose of this study was to report the differential diagnosis of a pediatric patient with bilateral anterior corneal involvement suspected of corneal dystrophy. An 8-year-old male patient presented with asymptomatic, persistent, superficial, bilateral, diffuse, anterior corneal opacities. Slit lamp examination results were not specific. Despite the lack of visible stromal involvement on the slit lamp examination, corneal analysis based on confocal microscopy and optical coherence tomography revealed characteristic features of macular corneal dystrophy (MCD). The diagnosis of MCD was confirmed by CHST6 gene sequencing. The early corneal characteristic features of MCD, established based on the findings of this case report, include corneal astigmatism (not specific), diffuse corneal thinning without a pattern of corneal ectasia (specific), and characteristic features on confocal microscopy (specific), including multiple, dark, oriented striae at different corneal depths. Conclusions The clinical examination should be complemented with corneal imaging techniques, such as confocal microscopy and optical coherence tomography. In patients suspected of corneal dystrophy, genetic testing plays an important role in establishing the final diagnosis.

Synthetic Fiber Granuloma Misdiagnosed as Chalazion in an 8-year-old Child

Purpose: We report a case of conjunctival synthetic fiber granuloma, which was misdiagnosed as chalazion. Case summary: An 8-year-old female patient, without any previous medical illness or ocular trauma history, visited our hospital with a prolonged mass-like lesion in the left lower palpebral conjunctiva. In her detailed medical history, she said that she often played with her doll's hair. The conjunctival mass first occurred 1 week before her visit to the private clinic. At that time, eye drop treatment was initiated under the diagnosis of chalazion. The child showed no improvement; thus, incision and curettage were performed. The mass in the conjunctiva continued to persist, so she was transferred to the hospital for a biopsy. Slit-lamp examination revealed a patterned agglomeration of fiber strands inside the mass. Complete excisional biopsy was performed under general anesthesia. Histopathological examination revealed a fibrous foreign body in the birefringence, with granulomatous inflammation surrounding it. The patient was diagnosed with synthetic fiber granuloma. Conclusions: Conjunctival synthetic fiber granulomas are easily mistaken as chalazion. If specific fibrous strands are entangled inside the mass on slit-lamp examination, diagnosis and treatment through therapeutic excisional biopsy are required under clinical suspicion.

Diagnosis of Subclinical Keratoconus with a Combined Model of Biomechanical and Topographic Parameters

This study sought to develop a diagnostic model with aberrometry and biomechanical variables for subclinical keratoconus. The design was a cross-sectional study. The topographic data were obtained with a rotating Scheimpflug camera (Pentacam HR), and biomechanical data were obtained with Corvis ST. The study included 81 eyes distributed in 61 healthy corneas and 20 subclinical keratoconus (SCKC), defined as eyes with suspicious topographic findings, normal slit-lamp examination, and a manifestation of keratoconus. Analyses of the topographic and biomechanical data were performed, and a classifying model of SCKC was elaborated. The model for the diagnosis of SCKC includes posterior coma to 90°, Ambrósio’s Relational Thickness in the horizontal profile (ARTh), and velocity when the air pulse is off (A2 velocity). The sensitivity was 89.5%, specificity 96.7%, accuracy 94.9%, and precision 89.5%. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve for the model was 0.951. Diagnosis of subclinical keratoconus depends on the aberrometry variable posterior coma to 90° and the biomechanical variables A2 velocity and ARTh.