Common Eye Diseases Case Study

Common eye diseases in children can be classified as follows:
1.Disorders of lids and lacrimal drainage apparatus Common diseases include congenital nasolacrimal duct obstruction, periorbital cellulitis, and orbital cellulitis
1.1 Congenital nasolacrimal duct obstruction Congenital nasolacrimal duct obstruction (NLDO) is the most common disorder of lids and lacrimal drainage apparatus, occur about 5 % of normal term infants. The anatomy of the lacrimal system consists of two parts; the secretory part which secretes the tears and the excretory part which convey the tears to the ocular surface.
(1) Lacrimal secretion part consists of the main lacrimal gland which located in the lacrimal fossa of the frontal bone at the superotemporal

(2) Infectious conjunctivitis or skin infection, the causative organism including adenovirus and herpes zoster virus.
(3) Localized infections adjacent to the orbit such as upper respiratory tract infection, sinusitis, otitis media, dental caries, which spread into the surrounding orbital tissues, the causative organisms are bacteria including Streptococcus pneumoniae and Staphylococcal aureus.
Signs and symptoms: The infection often unilateral. A child will have erythematous swollen eyelids and may have a fever.
Diagnosis: Notice that the child has swollen eyelids, tenderness and severe swollen eyelid may make a child cannot open up the eye. In older children who can open the eye and cooperate well, eye examinations revealed normal visual acuity, no proptosis, full ocular motility, and no relative afferent pupillary defect (RAPD), which differs from orbital cellulitis.
Initial management: Measure vital sign, give broad-spectrum systemic antibiotics such as cephalosporins, ampicillin-clavulanic acid and clindamycin, and closely clinical monitoring after drug

A child will have erythematous swollen eyelids associated with fever, headache or alteration of consciousness.
Diagnosis: Notice that the child has signs and symptoms similar to periorbital cellulitis, but eye examinations revealed decreased visual acuity, proptosis, limitation of ocular movement, or RAPD positive sign associated with obvious systemic symptoms.
Initial management: All patients were given broad-spectrum intravenous antibiotic injection in hospital admission. Blood sample test, hemoculture, and computerized tomography (CT) brain and orbit should be performed to evaluate the extent of the infection. Thus, a child should be immediately referred to an ophthalmologist.
Indications to refer an ophthalmologist:
In a child with suspicion of orbital cellulitis, immediately refer to an ophthalmologist because orbital cellulitis is emergency condition need immediate appropriate management.

2. Disorders of external eye Common diseases include neonatal conjunctivitis and allergic conjunctivitis
2.1 Neonatal