eye got it! john davis rn, msn, fnp-bc. all people by nature desire to know. an indication of this...
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Eye Got It!John Davis RN, MSN, FNP-BC
ALL people by nature desire to know. An indication of this is the delight we take in our senses; for even apart from their usefulness they are loved for themselves; and above all others the sense of sight.
Aristotle, first line of “Metaphysics”
Fundoscopy
Vocabulary Strabismus- (cross eye) when both eyes don’t look at the
same place at the same time.
Amblyopia- (lazy eye) is the loss or lack of development of central vision in one eye
Esotropia- Form of strabismus in which the eye turns inward.
Exotropia-Form of strabismus in which the eye turns outward.
Anisocoria- unequal pupil size
Dyscoria- irregular pupil shape
Leukocoria- white pupil
Proptosis- Bulging of the eye anteriorly out of the orbit
Diplopia- double vision
Ptosis- Drooping of the upper eyelid
Myopia- near-sightedness (objects that are near are clear, objects far away appear blurred)
Hyperopia- far-sightedness (objects that are far are clear, objects that are close are blurry)
Normal Developmental Timeline of Vision
Visual Acuity at birth is 20/800 to 20/1000
Visual Acuity at age 6 months is 20/40 to 20/80 Age 6 months to 3 years the child should be able to fixate and
follow a face, a toy or a light.
Visual Acuity at age 3 to 5 years is 20/40 or better No more than 1 line acuity difference between eyes
Visual Acuity at age 6 and older should be better than 20/40 Refer for visual acuity 20/40 and above
Should not have any acuity difference between eyes.
Visual acuity less than 20/40 is needed for admission to military, law enforcement, aviation industry, and commercial truck driving.
Myopia affects about 30% of the U.S. population
How to Assess the Eye
Check Visual Acuity Use a pinhole if student forgot glasses/contact lenses
Check Pupil Size- are they equal, anisocoria?
Check Tracking and Convergence
Inspect the lids
Inspect the conjunctivae- bulbar vs. palpebral
Cover Test- To assess for Strabismus / Amblyopia
With Lights Turned Down Check Pupil Response- Reactive to light? Afferent Pupillary
Defect- Optic Nerve or Retinal disorder
Hirschberg Test
Red Reflex
Tracking Ocular Tracking is the name given to the ability of
the eyes to move smoothly, together, to follow an object moving horizontally and vertically. Important to assess after an eye injury for signs of
extraocular movement entrapment.
In education, tracking refers to eye movement along a fixed target, as in reading.
In the past, some children with central processing dysfunctions (learning disabilities) were suspected of difficulty with tracking as a result of, or associated with, a learning disability. There is no scientific evidence to support this notion.
Most educators no longer ascribe to this view.
Convergence
A normal response is a movement of both eyes nasally, with convergence of the two axes of the eyes.
An inability of the eyes to converge may be related to: Problem with extraocular
muscles
Neurological disorder
If abnormal- refer immediately to ophthalmology
Strabismus
Perform the cover-uncover test with children age three years and older.
Can be treated and corrected if detected within the first 10 years of life.
Treatment is attempted for older children as well but not always correctible.
Occurs in 5-7% of children.
May have persistent squinting, head tilting, face turning, awkwardness, or decreased visual acuity in one eye.
Treatment:
Correct refractive error if present.
Eye patching- good eye
Atropine drops
Surgical correction
Strabismus
Strabismus
Refer immediately if new onset strabismus develops in a school age child.
Need to rule out tumor: Glioma
Astrocytoma
Neuroblastoma
Medulloblastoma
Viral Conjunctivitis
Most commonly adenovirus.
Adenovirus does not have a lipid coat.
Usually watery discharge, occasionally purulent.
Tender swollen preauricular lymph node.
Contagious for 7-10 days.
Treat with artificial tears, frequent hand washing.
Bacterial Conjunctivitis
Usually caused by Staph aureus, Strep pneumo, or H. influenzae.
70% of staph resistant to erythromycin
Can treat with bacitracin, avoid neomycin (neosporin)
Purulent discharge
Eyes crusted shut
Can return to school after 24 hours of antibiotic treatment.
Allergic Conjunctivitis Almost always involves both
eyes.
Eyes are red and itchy
No preauricular lymph node swelling or tenderness
Allergic Shiners
Clear drainage or stringy mozzarella cheese looking drainage
Not contagious but uncomfortable
Ophthalmic anti-histamines and opthalmic mast cell stabilizers to treat
Subconjunctival Hemorrhage
Does it affect vision?
Is it painful? If no- you have your
diagnosis.
Broken blood vessel under the surface of the eye.
Can be caused by a strong sneeze or cough.
Harmless
Resolves in 10-14 days.
Orbital Cellulitis
Orbital Cellulitis
Ocular emergency
No history of injury
Eye is red, warm to touch, swollen, painful
Orbit has a direct line to the central nervous system via the optic nerve- child needs to be hospitalized for IV antibiotics.
Orbital Wall Fracture Ocular emergency
Check the extraocular movments of the eye.
If eye is trapped, consider orbital wall fracture and seek emergency care.
Assess vision- if decreased or vision loss seek emergency care.
If proptosis present or open/perforated globe suspected- shield the eye and seek immediate emergency care.
Retinoblastoma
Cancer of the retina
Typically develops before age 5
Leukocoria- white pupil
Absent red reflex
Particularly noticeable in photographs taken with a flash
Autosomal dominant- often family history of retinoblastoma
Curable when diagnosed early
Which part of the body has the thinnest layer of skin?
Hordeolum (Stye)
Hordeolum (Stye) Localized inflammatory swelling of one or more of
the glands of the eyelid
Mildly tender
May discharge purulent fluid
Exclude from school if draining until on antibiotics.
Treatment:Warm compresses
Massage
Topical antibiotics if pointing outward
Occasionally incision and drainage
Chalazion
Chalazion Chronic version of stye.
Meibomian gland is the main sebaceous gland of the eye.
If the meibomian gland becomes plugged or constipated- chalazion forms.
Treatment:
Warm Compresses
Massage
Oral antibiotics if infection is present as topical will not infiltrate the area.
If above treatment is not effective, surgical excision is necessary.
Cornea The cornea is a smooth, transparent, avascular structure that
covers the iris and joins with the sclera and conjunctival reflection at the limbus.
The cornea functions as a protective window, allowing light to pass in to the eye.
The cornea is richly innervated by the trigeminal, or fifth cranial, nerve and is therefore exquisitely sensitive to touch.
Corneal Ulcer
White or gray spot on the cornea
Very painful
Refer immediately
Causes: Contact Lense Wearers
Bacterial infection
Herpes simplex or zoster infection
Corneal abrasion (scratch on the eye) if it becomes infected
Chemical burn
Thank you!