Answer: Retinopathy of prematurity (ROP)
ROP is a condition that can develop in premature infants. In comparison to other eye conditions, which can be initially screened by general practitioners (i.e. red reflex for retinoblastoma, ocular misalignment with strabismus), ROP requires a dilated fundus and peripheral retinal exam and therefore requires screening by an ophthalmologist.
Answer: Assisted ventilation, low birth weight, and respiratory distress
The leading risk factors for ROP are early gestational age and low birth weight. The American Academy of Pediatrics recommends screening all infants for ROP if they meet the following criteria:
- Infants with birth weight ≤1500 or gestational age <30 weeks.
- Infants with birth weight between 1500 and 2000 grams or a gestational age >30 weeks who have risk factors for ROP.
Other risk factors for ROP include infants who have ≥1 week of assisted ventilation, respiratory distress, anemia and blood transfusions.
Past Medical History:
Past Ocular History: None
Family History: Notable for retinal detachment in patient’s uncle in setting of poorly controlled type 2 diabetes.
Social History: Non-contributory
General appearance: Neonate with mechanical ventilation, breathing comfortably. No dysmorphic features.
Vitals: Temp: 37 C, BP: 52/30 HR: 112 bpm, RR 40 on mechanical ventilator with PEEP 6cm, FiO2 92%. Weight: 1420 g (5th percentile);
Visual acuity: Light perception OU
Pupillary reflex: Red pupillary reflex OU
Pupils: PERRL OU
Intraocular pressures (IOP): Soft to palpation OU
External ocular exam:
Eyelids: flat OU, no ptosis OU
Conjunctiva: white and quiet OU
Cornea: Clear OU
Anterior chamber: Formed OU
Iris: Flat without neovascularization OU
Lens: Clear OU
Dilating drops using Cyclomydril (cyclopentolate 0.2%) / phenylephrine 1%) were instilled in both eyes. During instillation, the patient’s heart rate and respiratory status remained stable.
Below are photos of the left eye:
Above Images courtesy of Robin Ginsburg, MD
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Peds ophtho Case 4 Index
Peds Ophtho Case 4: Introduction