0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50
1380 Strabismus Streptococcal Infections■Compliance with patching and glasses may be difficult in young
children.
follow-up
■After surgery, children still may develop amblyopia or need glasses.
Follow at least to age 5, longer for some conditions. Routine follow-
up 3–4 times per year.complications and prognosis
■Cycloplegic agents used to measure refraction have systemic absorp-
tion. Cyclopentolate most likely to cause problems, esp. in develop-
mentally delayed children.
■Patching for amblyopia may cause amblyopia of patched eye. Follow
the rule of 1 week occlusion per year of life with careful follow-up.
■Prognosis for alignment good. May take several operations plus
glasses.
■Prognosis for good depth perception (stereopsis) is mixed. Early
surgery may improve depth perception prognosis.STREPTOCOCCAL INFECTIONS
RICHARD A. JACOBS, MD, PhDhistory & physical
History
■Clinically relevant species: Streptococcus pyogenes (group A strep-
tococcus), Streptococcus pneumoniae, Streptococcus agalactiae
(group B streptococcus), Streptococcus bovis, viridans streptococci
and groups C and G streptococci
■Streptococci not universally part of normal skin flora
■Colonization by contact with infected persons, usually in extreme
crowding
➣Streptococcal pharyngitis transmitted by saliva droplet or nasal
transmission; crowding facilitates infection
➣Acute rheumatic fever can occur 2–4 weeks afterwards, usually
in school-age children; uncommon in the US
➣Group B streptococcus can be colonized in about 20% female
genital and gastrointestinal tracts; vertical transmission respon-
sible for neonatal sepsis, especially if early rupture of mem-
branes, early gestational age