Persistent Hyperplastic Primary Vitreous(PHPV)

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Persistent Hyperplastic Primary Vitreous(PHPV)

Cleared Controversies Commonest complication after surgery for lens extraction in PHPV is Vitreous Hemorrhage. Mittendorf dot and Bergmeister papillae are separate entities from PHPV

Remnants of hyaloid vessels Bergmeister papillae	Bergmeister papillae (Common in healthy adults) tuft of tissue at the optic disc Mittendorf dot (Common in healthy adults) tag of tissue on the posterior capsule of the lens PHPV (extensive remnants)
PHPV is	Almost always unilateral Bilaterality(rare) seen with Trisomy 13(Patau syndrome) Trisomy 22 Norrie's disease Walker Warburg syndrome
MC presenting symptom	White pupillary reflex in newborn(congenital leukocoria)
Differentiating features from retinoblastoma	PHPV Microphthalmos No calcification on CT Cataract Unilaterality No family history	Retinoblastoma Normal(usually)/buphthalmos Calcification present Cataract is rare Bilateral in one fourth cases 10% cases shows family history
Visual prognosis is	Poor despite of early intervention
Musca volitans	Residues of primitive hyaloid vasculature
Commonest complication after surgery for lens extraction in PHPV is	Vitreous Hemorrhage

Trachoma/Rough Eye/Egyptian Ophthalmia - Management

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Trachoma/Rough Eye/Egyptian Ophthalmia - Management

Diagnosis	Field diagnosis - at least 2 in 0-10yrs of age. Follicles on upper tarsal conjunctiva Limbal follicles or herbert pits Conjunctival scarring(trichiasis,Entropion) pannus
Management	Treatment of choice - Azithromycin 20mg/kg oral stat. Current WHO Recommendations for treatment District level prevalence >10% in 1-9yrs old - Mass treatment with azithromycin. District level prevalence >5-10% in 1-9yrs old - targeted treatment with azithromycin(identification & treatment of all members of any family in whom one or more members have follicular trachoma). District level prevalence >5% in 1-9yrs old - azithromycin not necessary. Mass treatment(WHO new guidelines)(Blanket Therapy) Indication - >10% prevalence of severe and moderate trachoma in <10yrs. Treatment - Azithromycin.
SAFE Strategy	Surgery - for trichiasis Antibiotics Facial cleanliness Environmental improvement

Trachoma/Rough Eye/Egyptian Ophthalmia - Classifications

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Trachoma/Rough Eye/Egyptian Ophthalmia - Classifications

MaCallan's Classification(outdated)	Stage I - Incipient Trachoma Stage II - Established Trachoma Stage III - Cicatrising Trachoma Stage IV - Healed Trachoma Stage IIa - matured follicles. Stage IIb - marked papillary hyperplasia.
WHO classification(FISTO)	Trachomatous inflammation, follicular: five or more follicles of at least 0.5 mm diameter on the upper tarsal plate should be present. Trachomatous inflammation, intense: the follicles and papillae are so numerous and inflamed that more than 50% of the palpebral conjunctival blood vessels cannot be seen clearly. Trachomatous scarring: tarsal conjunctival cicatrization with white fibrous bands Trachomatous Trichiasis : Presence of at least one trichiatic eyelash Trachomatous opacities : Presence of a corneal opacity covering part of the pupillary region
Jone’s Classification(outdated)

Trachoma/Rough Eye/Egyptian Ophthalmia - Clinical Features

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Trachoma/Rough Eye/Egyptian Ophthalmia  - Clinical Features

Conjunctival signs A. large fornicial follicles                               B. Superior tarsal follicles	Congestion of upper tarsal and forniceal conjunctiva. Conjunctival follicles - boiled sago grain like follicles. characteristic feature is necrosis n leber cells(large multinucleated cells)(d/f follicular conjunctivitis). Conjunctival follicle in trachoma in children shows Lymphocyte. Commonly present on upper tarsal and forniceal conjunctiva. Follicles on bulbar conjunctiva is pathognomonic. Papillary hyperplasia(velvety appearance to tarsal conjunctiva). Conjunctival scarring/Arlt’s line - linear scar in the sulcus subtarsalis. Concretion - d/t dead epithelial cells,mucus in Glands of Henle.
Corneal Signs C.peripheral corneal infiltrates                         D.superior pannus	Superficial keratitis. Herbert follicles in limbal area. Herbert pits - healed herbert follicles. Pannus - infiltration with vascularization. Cicatricial pannus in trachoma known as Pannus ciccus. Corneal ulcer Corneal opacity
Complications	Lids - entropion,tylosis,ptosis,madarosis,ankyloblepharon. Conjunctival - pseudocyst,xerosis,symblepharon. Corneal - ectasia,xerosis. Blindness Chronic dacryocystitis,chronic dacryoadenitis.
Actual cause of blindness is	corneal opacity and scarring,secondary to eyelid scarring.

Acute Mucopurulent Conjunctivitis

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Acute Mucopurulent Conjunctivitis

MC type of bacterial conjunctivitis	Acute Mucopurulent Conjunctivitis
MC causative organism	Staphylococcus aureus
CF	Discomfort or foreign body sensation, Mucopurulent discharge, Sticky eyes, Matted lashes, Slight blurring of vision, Colored halos(sometimes)
o/e	Conjunctival congestion, Chemosis, Petechial hemorrhage(pneumococcal conjunctivitis
Complications	Marginal corneal ulcers, Superficial keratitis, Blepharitis, dacryocystitis
Management	Topical antibiotics No bandage,No steroids

Ophthalmia Neonatorum/Neonatal Conjunctivitis

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Ophthalmia Neonatorum/Neonatal Conjunctivitis

Age of onset	First month of life.
Acquired during	Birth from infected birth canal(MC), After birth
Bacterial (Staph,Pneumococcus,Hemophilus)	Time of onset- 2-5 days. Pain,tenderness,Mucopurulent discharge,Swollen lids,Chemosis,Conjunctival hyperemia. Management-topical erythromycin,tobramycin,fluoroquinolone.
Neisseria gonorrhoeae	Time of onset - 24-48 hrs. B/L,copious purulent discharge,chemosis,lid edema,corneal ulceration & perforation. Treatment - IV Ceftriaxone,penicillin + Saline lavage.
Chlamydia trachomatis D-K	Time of onset - 5-14days. uni/bilateral,mucopurulent discharge,conjunctival hyperemia. Unlike adults,no follicles in newborn till 8 weeks(lack lymphoid tissue). Treated with oral & topical erythromycin.
Herpes simplex virus	Time of onset - 6-14days. Watery blepharoconjunctivitis,cornea involved. Systemic manifestations present.
Chemical	Time of onset - first 36hrs. Secondary to the use of silver nitrate(crede's method),povidone iodine,erythromycin. B/L,minimal/no edema,serous/mucoid/watery discharge,Conjunctival Hyperemia. Self limited(1 to 2days postpartum).
Prophylaxis	0.5% Erythromycin & 1% Tetracycline Ointment. Crede’s method(outdated) - 1% silver nitrate. im/iv single Ceftriaxone to infants of mothers with untreated gonococcal infection.
Chlamydia trachomatis D-K cause	Inclusion conjunctivitis
Ophthalmia neonatorum can cause	blindness