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Why worry about strabismus?

Why worry about strabismus?. [1,8]. 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

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Why worry about strabismus?

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  1. Why worry about strabismus?

  2. [1,8]

  3. Initial Presentation • Most (75%) PARENTS detect abnormality http://shainazhope.com/

  4. Retinoblastoma • Autosomal dominant (RB1) with incomplete penetrance • Increased risk other cancers • Only 5-10% of cases have family history

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

  6. 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

  7. Red Reflex http://www.daisyseyecancerfund.org

  8. [9]

  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].

  10. White Reflex “White Pupil” tapetumlucidum "bright tapestry"

  11. White Reflex

  12. 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

  13. [11]

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

  15. What’s your Dx Retinoblastoma

  16. Pseudostrabismus Strabismus

  17. Persistent Fetal Vasculature www.kidsretina.blogspot.com Pediatric retina blog

  18. Neuroblastoma with “Raccoon Eyes”

  19. Congenital Cataracts

  20. Congenital Glaucoma

  21. Normal Retina

  22. 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.

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