Free Board Certified Ophthalmologist Pediatric Ophthalmology and Strabismus Questions and Answers

Question 1

A 10-month-old infant presents with persistent tearing and mattering of the right eye since birth, consistent with congenital nasolacrimal duct obstruction (CNLDO). Conservative management with massage and topical antibiotics has failed to resolve the symptoms. According to current evidence, what is the most appropriate next step in management?

Accepted Answer

Perform nasolacrimal duct probing under general anesthesia.

Answer

Spontaneous resolution of CNLDO is high in the first year of life, but the rate plateaus after 9-10 months. Probing is a highly successful first-line surgical intervention, with success rates declining after 12-15 months. Therefore, for a 10-month-old who has failed conservative therapy, probing is the most appropriate next step. DCR is reserved for failed probings or complex cases, and placing a tube without probing is not the standard initial procedure.

Question 2

A 5-month-old infant is diagnosed with infantile esotropia. Which of the following clinical features is most characteristic of this condition?

Accepted Answer

A large-angle, constant esotropia (>30 prism diopters).

Answer

Infantile esotropia is defined by its onset before 6 months of age and is characterized by a large, constant angle of deviation, typically greater than 30 prism diopters. While amblyopia can occur, cross-fixation is common, leading to equal vision in many cases. The refractive error is usually only mildly hyperopic, and glasses do not correct the deviation. Apparent abduction deficits can be seen due to cross-fixation, but true palsies are not characteristic.

Question 3

According to the American Academy of Pediatrics and American Academy of Ophthalmology screening guidelines, which of the following infants requires screening examinations for retinopathy of prematurity (ROP)?

Accepted Answer

An infant born at 29 weeks gestation with a birth weight of 1200 grams.

Answer

Current ROP screening guidelines recommend examinations for all infants with a birth weight of less than 1500 grams or a gestational age of 30 weeks or less. An infant born at 29 weeks with a birth weight of 1200 grams meets both of these criteria and definitively requires screening. The other infants listed fall outside these primary screening parameters.

Question 4

A 4-year-old child is diagnosed with moderate amblyopia (20/60) in the left eye due to strabismus. After prescribing the appropriate spectacle correction, you plan to initiate occlusion therapy. Based on the Pediatric Eye Disease Investigator Group (PEDIG) Amblyopia Treatment Studies, what is the most appropriate initial patching regimen?

Accepted Answer

Patching the right eye for 2 hours per day.

Answer

The PEDIG Amblyopia Treatment Studies demonstrated that for moderate amblyopia (defined as 20/40 to 20/80) in children aged 3 to 7 years, patching the sound eye for 2 hours per day is as effective as patching for 6 hours per day. This less burdensome regimen improves compliance while achieving similar visual outcomes. Full-time or 6-hour patching is typically reserved for severe amblyopia or as a next step if 2-hour patching fails.

Question 5

A patient presents with a new-onset vertical diplopia and a compensatory right head tilt. Examination reveals a left hypertropia that worsens in right gaze and with a right head tilt. Using the Parks-Bielschowsky three-step test, which muscle is paretic?

Accepted Answer

Left superior oblique

Answer

Step 1: A left hypertropia implicates weakness in a left eye depressor (inferior rectus, superior oblique) or a right eye elevator (superior rectus, inferior oblique). Step 2: The hypertropia worsens in right gaze, which isolates muscles with primary vertical action in adduction (left superior oblique) or abduction (right superior rectus). Step 3: The hypertropia worsens with a head tilt to the right (ipsilateral to the hypertropic eye's paretic intorter). During a right head tilt, the right eye intorts (RSR, RSO) and the left eye extorts (LIO, LIR). A weak left superior oblique (an intorter) would cause the left superior rectus to be unopposed, worsening the hypertropia. All three steps point to a left superior oblique palsy.

Board Certified Ophthalmologist Practice Test

Board Certified Ophthalmologist Practice Test

Free Board Certified Ophthalmologist Pediatric Ophthalmology and Strabismus Questions and Answers