11 Anat Congen Anom 18 00 2 9m 25s end

It's usually quite successful, and if there are

no other congenital anomalies,

then the child should have decent vision.

Retinoblastoma.

This is the most common

infantile tumor of the eye.

It's rapidly growing,

fortunately, has a very high survival rate now,

almost 98%,

very treatable, occasionally bilateral.

Sometimes, it appears as a white reflex.

When mothers are taking pictures with cameras,

they may get a red reflex here, or none,

or the white reflex here, or they just may happen to see it.

And sometimes, these children develop a little strabismus.

Hopefully, something develops very quickly,

so the mother recognizes it, brings the child in.

This was a story in December of 12/17,

where a mother noted that the child had a white reflex.

She brought the patient in,

and the tumor was treated by threading a very--

this is interesting.

They threaded a very small catheter

from the thigh, directly--

think of this, into that tiny retinal artery--

to directly treat this tumor

with chemotherapy

and intravitreal chemotherapy,

and they cured it.

That, to me, is absolutely amazing.

When I was a resident

and I had one or two of these children,

we, unfortunately, had to remove the eye back in the 60s,

because we didn't have a way to treat this adequately.

In rare cases, unfortunately,

both eyes in a child had to be removed.

Now, no eye has to be removed from what I understand.

What a development. Wow!

Look at all the young children now

that don't have to lose their eyes because of this tumor,

if it's recognized reasonably early.

Congenital staphyloma.

This is the normal retina,

and it's not that normal looking, as you can see,

some optic disc atrophy from this.

But what's happened here, this is called a "staphyloma,"

and this is a big posterior bulge.

You can see how it just bulges back here.

This is the normal emmetropic eye,

and so this is further back.

So this area is highly, highly myopic,

maybe 10, 12, 15, 20, diopters of myopia.

And if it involved in the fovea,

the patient is going to develop

amblyopia, because he's probably--

he's definitely going to be looking with the other eye.

This is pathological myopia in a posterior staphyloma.

Anterior staphylomas,

I have never seen one, they're quite rare,

but this is an anterior bulging of the cornea

and anterior chamber.

That's pretty horrible looking.

These, I've seen multiple cases of this,

not uncommon at that time

for a young teenager to come in, that

"I have poor vision, but I don't know why."

And you look in and you find this posterior staphyloma

Nasolacrimal system.

It's not the gland, superior temporal,

it's not fully developed till the age three or four,

but it begins to function earlier,

at about three months of age.

And it's not uncommon for this nasolacrimal duct--

this is the sac, this is the duct--

to not completely hollow out.

Normally, it's filled with, I don't know what,

developmental tissue,

and it hollows out just or after birth;

but in some infants, it remains closed,

so we're going to have to

insert a device in here to unblock this.

This is a punctum dilator.

Has a pointed end here,

and you insert it in here,

and it dilates the punctum so that you can then insert

these punctum probes.

And they vary with thickness in their numbers on there.

And the doctor will ask you to give them

the the punctum dilator, initially,

and then the punctum probe,

and he'll tell you what number he want.

And the way the blockage is treated,

is initially,

the probe is inserted into this direction

and goes down two millimeters,

and then it's turned horizontally

to go through the horizontal canaliculus

into the nasolacrimal sac,

at which point it is then, again,

turned back vertically,

and the doctor pushes until he reaches the block.

And at that point, he'll push very hard,

and you'll hear this

[claps hand] pop,

and then the baby will start to cry.

At that point, probably some blood,

a tiny drop or two of blood will come out of the nose.

So then the doctor will take an irrigator

and put an irrigating cannula in here

and irrigate with balanced salt solution,

and it'll come out the nose,

and he knows that the block is unblocked at that point.

This is a dacryoscystitis,

which occurs when a block remains,

or in an adult, is formed,

and doesn't clear itself,

And this area becomes very red and hot and tender,

and this requires systemic antibiotics

and then frequently, an incision drain it.

And if the block causes permanent damage,

then you have to go in and create a hole, right here

into the nose to bypass the block.

A dacryoadenitis is an inflammation

of the lacrimal gland up in the superior temporal quadrant.

Additional congenital anomaly terms

that you need to know are the following.

Anophthalmia, "Ano-," is "without,"

means no globe.

Buphophthalmos is a large globe.

Look at this eye compared to this one,

it's huge here, you can see this huge cornea.

Buphophthalmos, a large globe,

and this is in congenital glaucoma,

where they developed the glaucoma before they were born.

So the globe just gets larger,

and all the elements of the eye are larger,

and the cornea may be cloudy due to high pressure.

This actually is a bilateral,

but you can see how much larger this one is.

This is a hemangioma,

probably a Sturge-Weber syndrome,

and glaucoma is occured with this.

Microphthalmas is a small globe.

So if this is a normal size globe,

you can see this is really small,

is "MAI-cro" or "MI-cro-" ophthalmic globe.

These are the terms that you should be sure, you know.

And I'll point out one thing right now is

Bergmeisters's papillae can be spelled "-AE" or "-A,"

and for test purposes,

we're going to spell it "papillae," "-AE."

So if you spell it with just an "-A,"

you'll probably miss the question.

So be sure you know all of these terms.

Well, people, that's about it for this semester.

All you've got left are your finals,

and if you've studied well during the semester,

and you study well this next week,

you shouldn't have any trouble passing this course.

This course has given you just the baseline

for what you need to know when we discuss

diseases and disorders of the eye.

It will be a lot more interesting to you, I guarantee you,

and I think you'll enjoy that course in your pharmacology,

although they're both hard, a lot.

So good luck on the final,

and I hope to "see" all of you in a couple weeks.