Retinopathy of Prematurity

Sasha Mansukhani
Retinopathy of Prematurity - Symptoms
Ideally, the disease is picked up at an asymptomatic stage by screening of at risk neonates.
However it is common that the parents directly present at a later stage with the complaints of: -
• Inability of the child to see
• Abnormal pendular or searching movements of the eyes
• White reflex in the pupillary area (when the child has the stage 5 disease which Terry had described as Retrolenticular Fibroplasia).

In modern times, with the various studies done and treatment options available, a neonate at risk developing advanced disease without having had an ophthalmic check up or referral done, can have severe medicolegal repercussions for the primary treating pediatrician or neonatologist.

The pupillary reaction is assessed with the help of torch light or the indirect ophthalmoscope with the aid of the 20 Dioptre lens for magnification. A rigid pupil that does not even respond to dilating drops is a sign of ‘Plus Disease’ (described later) indicating a tendency to progression. The neonate at risk is examined by Indirect Ophthalmoscopy. The pupil is dilated with Tropicamide 0.5-1% with Phenylephrine 2.5%(19). Cyclopentolate 0.5-1% can also be used(19). A single drop is instilled in each eye 5-10 minutes apart and 2-3 instillations is usually adequate(19).

Atropine drops or ointment is not to be used for dilation as tachycardia, hyperthermia or severe dehydration can occur in premature babies. In India Phenylephrine drops are available in 10% concentration and can be diluted (1:4) with distilled water or a lubricant to get a concentration of 2.5%(19).

Retinopathy of Prematurity Retinopathy of Prematurity 11/05/2014
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