Reading the Eye in Children

What this deck covers

Reading the Eye in Children in twelve illustrated clinical cases with worked explanations – case presentations built around clinical images, radiology, teaching illustrations and real laboratory data, with the reference range beside every value a case quotes. This visual, data-interpretation style of practice suits candidates preparing for MRCPCH AKP in particular, alongside Saudi and Gulf licensing examinations such as the Arab Board, DHA and OMSB. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong.

The twelve cases, in order

1. Two swollen discs, and only one of them is an emergency
2. Vision that has faded over a year, and a white disc
3. The light that makes both pupils grow
4. A drooping lid, and the eye rests down and out
5. One small pupil since birth, and two colours of iris
6. A white glow in the family photographs
7. A baby who startles at every sound, and a red spot at the macula
8. An encephalopathic infant, and a retina full of blood
9. Looking left, one eye does not come across
10. Three babies with wobbling eyes, and one needs a scan
11. A baby whose eyes are always looking down
12. Walking into doorframes on both sides

What this deck teaches

• The fundus is the only place the brain is visible. The optic nerve is brain tissue grown forward, so pressure, myelin, vessels and dying cells all show at the disc and the macula before any scanner is booked.
• Read the margin, not the elevation. Buried drusen elevate a disc as convincingly as papilloedema. What separates them is loss of the margin with obscured vessels, and haemorrhage.
• Swelling is a warning, pallor is a receipt. A swollen disc means pressure now and sight that can still be saved. A pale disc means axons already dead and vision that will not return.
• Both pupils always move together. So unequal pupils are an efferent problem, and a swinging torch that dilates both is an afferent one. The lighting says which pupil is the abnormal one.
• A third nerve palsy with the pupil is compression. The pupillomotor fibres run on the outside of the nerve, so anything pressing from without takes the pupil early.
• A white pupil is a same-day referral. Leukocoria is retinoblastoma until an ophthalmologist excludes it, and every other cause of an absent red reflex also loses sight with delay.

Exam pearls from this deck

• Do not read elevation. Read the margin and the vessels crossing it.
• Swelling is a warning. Pallor is a receipt for axons already spent.

The twelve worked cases in this deck, with the images and the full explanation of every option, are part of Pediatric Case Review membership. See what is included, or start with the free Pediatric Exam Review Sets.

More from this system: all neurology illustrated case decks · neurology board questions for bank-style drilling · the free Pediatric Exam Review Sets · pediatric reference values.