Why worry about strabismus?

[1,8]

Vitreous Hemorrhage (dark reflex)Hypopyon (layering of WBCs in anterior chamber)

Initial Presentation

• Most (75%) PARENTS detect abnormality

http://shainazhope.com/

Retinoblastoma

• Autosomal dominant (RB1) with incomplete penetrance• Increased risk other cancers

– Only 5-10% of cases have family history

Retinoblastoma

• Age– 90% younger than 5 years at diagnosis– Average of 18 months– Rare cases in adults [1]

Morbidity/ Mortality

• 5 year survival 93%• If untreated: Metastatic spread within 6

months– 50% 1yr survival

• With early detection, among most curable childhood cancer

• Leukocoria is actually a late finding– Ocular survival 9% at 5 years

Red Reflex

http://www.daisyseyecancerfund.org

[9]

Red Reflex

• Screens all aspects of optical pathway– Tear film, cornea, aqueous and vitreous humor,

iris, lens, retina.– Over 30 Diseases:

• Cataracts, glaucoma, retinoblastoma, systemic disease [3].

White Reflex “White Pupil”

tapetum lucidum"bright tapestry"

White Reflex

• PCP first noted presenting signs in only 5%• Delayed PCP referral 21% (3.75 months)

– PCP reassured parents of normalcy or made wrong diagnosis– False reassurance with normal red reflex

[11]

AAP Policy (Dec 2008)

• Document Red Reflex:– In newborn nursery– ALL routine health supervision visits

• Previous Recs: within 2months; 6 months; 1,3,5,10yrs

• Refer to ophtho:– All high risk patients

• Fam Hx: RB, infantile cataracts, retinal dysplasia, glaucoma– Based on parental observation alone– Abnormal red reflex (urgent)– Contact ophthalmologist directly– Document confirmation of proper followup [3]

What’s your Dx

Retinoblastoma

Pseudostrabismus

Strabismus

www.kidsretina.blogspot.comPediatric retina blog

Persistent Fetal Vasculature

Neuroblastoma with “Raccoon Eyes”

Congenital Cataracts

Congenital Glaucoma

Normal Retina

Take Home Points

• Screen in the nursery and at every checkup!• Take parental concerns seriously and refer!• Do not trust a normal red reflex if concerns

are present.• Call ophthalmologist directly, especially if

abnormal exam.• Close followup of high risk patients.