Eye Disorders- Abby Hyatt(numerous eye disordersfollowed by specialist discussed in the textbook) Bulbar or palpebral conjunctival injection is a common presentation, which can be unilateral or bilateral. differential diagnosisshould include allergy, conjunctivitis, infection, foreign body, chemical exposure, or systemic inflammatory disease, irritation of the conjunctiva or cornea, and congenital glaucoma. Watery discharge can occur with allergies, nasolacrimal obstruction, foreign bodies, viral infection, and iritis. Purulent or mucoid discharge can be noted with chronic dacrocystitis or nasolacrimal obstruction. Advanced allergic conjunctivitis can have some mucoid production. To differentiate, microscopic investigation of discharge may lead to other clues. Photophobia is a symptom common of trauma and in infants with glaucoma or retinal disease. Other non-eye related causes of photophobia include migraines and meningitis. A white pupil, or leukocoria serious finding and demands immediate referral to the pediatric ophthalmologist. Causes of leukocoria include retinal detachment, cataract, retinal dysplasia, retinopathy of prematurity, and in newborns retinoblastoma. All newbornsshould have a fundoscopic examination within 24 hours of birth and yearly on physical examinations. Common eye traumasthat may present to primary care are asfollows: Scratch or laceration to the cornea Blunt trauma to the orbit; note that an orbital fracture can cause muscle entrapment, compartment syndrome Hyphema Chemical or heat-related burns Musculoskeletal Injuries- assessment & treatment- Abby Hyatt Osgood-Schaltter Disease Aseptic necrosis of the tibial tubercles and apophysis. Signs and symptoms: painfulswelling of tibial tubercle, limp, intermittent pain over months, hip pain may be aggravated by extension of knee against resistance, worsens with squatting, stair walking, forceful contraction of the quadriceps, usually due to overuse injury associated with athletic activity during rapid growth of tibial tuberosity, relived by rest. More common in males. 1 Diagnostics: X-ray, MRI if osteochondral lesion. Treatment 2 Rest, modified activity, ice, NSAIDs,Quadricepsstrengthening and stretch,tibial band during activity. Talipes Equinovarus Congenita (Clubfoot) Adduction of forefoot with plantar flexed at ankle (equines), or curvesin (varus). Clinical Diagnosis: X-ray Treatment Ortho, casting Tibial torsion or femoral inversion Foot turnsin during walking or running. Pigeon-toed appearance. May be congenital or acquired from increased load on femur due to sitting in utero incorrectly, or FHx. Diagnostics: usually clinical or leg and hip X-ray. Treatment Reassurance, braces,specialshoes, and/or cast. Refer to ortho ofsevere deformity. Excellent prognosis. Growth Pains Idiopathic. Signs and symptoms: pain at the lower limbs, bilateral, intermittent, localized to the muscles. Rule out neuro disorders. Treatment Reassurance, massage, heat, NSAIDs ifsevere. Overused injury “Little League” elbow Physical stress producesforces in and around the elbow during throwing motion (baseball or softball), valgus stress is placed on elbow resulting in tension on the medial structures, repetition causes pathological changes. Signs and symptoms: pain in elbow, decreased elbow ROM, mild flexion contracture, point tenderness, swelling, decreased performance. Diagnostics: X-ray. Treatment Ice, resting arm, NSAIDs. Genu Varum Alignment of the knee with the tibia medially (varus) in relation to the femur. Bowlegged appearance asresult of uterine position. Measure distance between knees with feet together, distance should be less than 5 inches. An angular deformity is physiologic and normal up to 3 y.o. Pathologic if more than 15 degrees. Associated with shortstature, rapidly progressing Treatment Brace/splint, NSAIDsfor pain, and strengthening exercise. If rickets-prescribe Vitamin D. If overweight- weight management. Genu Valgum Alignment of the knee with the tibia laterally deviated (valgus) with relation to the femur. Commonly known as knock-kneed. Physiologic (over the first 3 years, 10-15 degrees, more common in girls) or pathologic (before age of 2 y.o, valgus angle >15 degrees, increasing in severity. Associated with shortstature, obesity and asymmetry, due to metaphyseal dysplasia or injury). Treatment Bracesfor angles more than 15 degrees. In some cases, resolvesspontaneously by age 6. Refer to orthopedic for suspected pathology. Toxic Transient Synovitis