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Pediatric
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Ophthalmology
Pearls
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PEARLS
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Pearls
Bruchner test: Easy way to pick up on refractive error in the young child (hyperopia, myopia, or anisometropia
if asymmetric)
Send all hyphemas for same day evaluation with ophtho (or ED if ophtho clinic not feasible). Don’t be lured by
an otherwise normal eye exam
Your direct ophthalmoscope is your best friend... NOT. Think about all the information about the visual system
you can get from watching a patient and asking them to do some simple tasks (or asking parents what they do
at home).
Remember your aperture and optic disc orientation before you move in. Large aperture for large pupil, small
aperture for small pupil
Optic disc 15 degrees towards nose when you are oriented temporally and at the correct height
When checking visual acuity you MUST have one eye completely occluded without any light reaching it
OK to use sounds when checking EOMs but soundless for acuity (kids are like bats – they will cheat and try
and triangulate position with sound)
Every parent worried about their cross-eyed kid has photos to prove it (or make you look even smarter when
you show them why it’s pseudostrabismus)
Not every tearing newborn eye is lacrimal duct stenosis – don’t miss a case of congenital glaucoma (if they
have huge pupils/large corneal diameters think twice)
INFERIOR CRESCENTS
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Remember that the painful eye differential is grouped in 3 categories:
Surface pathology (pain dissipates with proparacaine)
Inflammation (slit lamp)
Pressure
https://www.aao.org/interactive-tool/strabismus-simulator is great
(but challenging) in trying to figure out strabismus
Wear glasses!