Transcript MORNING REPORT

MORNING REPORT
KAREN ESTRELLA H.
PEDS PGY-2 SBH
DEC/2010
AAP GUIDELINES
EYE EXAMINATION IN INFANS, CHILDREN AND YOUNG
ADULTS BY PEDIATRICIANS
INTRODUCTION
 Early detection and treatment of ocular disorders in
children is important to avoid life-long visual
impairment.
 Retinal abnormalities
 Cataracts
 Glaucoma
 Retinoblastoma
 Strabismus
 Neurologic disorders
TIMING OF EXAMINATION AND
SCREENING
 Newborn
 Every WCC
 1st visual acuity at 3y/o
 WHEN TO REFER?
 Very premature
 Fhx: congenital cataracts, Rb, metabolic or genetic diseases
 Developmental delay
 Neurologic difficulties
 Systemic disease associated with eye abnormalities
 Any child unable to be tested after 2 attempts
 Abnormal eye exam
PROCEDURES FOR
EVALUATION
BIRTH TO 3Y/O
-Ocular hx
-Vision assessment
-External inspection of the eyes
and lids
-Pupil examination
-Ocular motility assessment
-Red reflex examination
3y/o AND OLDER
-Same
PLUS:
-age-appropriate visual acuity
measurement
-attempt at opthalmoscopy
Ocular History
 Does your child seem to see well?
 Does your child hold objects close to his or her face when trying to
focus?
 Do your child’s eyes appear straight or do they seem to cross or
drift or seem lazy?
 Do your child’s eyes appear unusual?
 Do your child’s eyelids droop or does 1 eyelid tend to close?
 Have your child’s eye(s) ever being injured?
 FHX: early childhood use of glasses in parents or siblings
Vision Assesment
 Age 0-3y/o
 Evaluating the child’s ability to fix and follow objects.
 Binocularly and then monocularly
 Awake and alert
Older children
 Visual acuity:
 2-4y/o
 LH symbols or Allen
cards
 >4y/o:
 Snellen letters,
Tumbling E test and
the HOTV test
How to do it?
 Child should be comfortable
and in good health
 On parent’s lap
 Or sitting on a chair
 At 10 feet from wall chart
 Keep eyeglasses exc if only
for reading
 Good occlusion of eye
 Non-literate: matching
Literate
 Tell child to keep both eyes
opened
 Cover the left eye first
 Start with the top line and
continue downward showing one
letter/symbol per line.
 If the child reaches the 10/10 line,
show the remaining (3)
letters/symbols
*Be careful not to cover up any
part of the box surrounding the
letters with your finger as this can
affect the sensitivity of the test.
• If the child misses a letter/symbol, go to the line above and show 4
different letters/symbols
• If the child matches all of them , proceed downward.
• The number recorded for vision acuity is the smallest line the child can
read correctly
Vision acuity
External Examination
(lids/orbit/cornea/iris)
 Penlight evaluation of lids, conjuntiva, sclera, cornea
and iris
 Persistent d/c or tearing
(ocular infection, allergy, Glaucoma)
MOST COMMON:
Lacrimal duct obstruction
 Ptosis
Unilateral: amblyopia
Bilateral: myasthenia
Pupils
 Should be equal, round and reactive to light BL]
 Slow or poorly reactive: retinal or optic nerve
dysfunction
 Asymmetry: Horner sd (sympathetic) or 3rd nerve palsy
Ocular motility
 Evaluate for strabismus
 The eyes are not aligned with each other
 Esotropia (ET): The eyes are turned inwards
 Exotropia (XT): The eyes are turned outwards
 Eso/Exo-phoria: Phorias are eye deviations that are only
present some of the time, usually under conditions of stress,
illness, fatigue, or when binocular vision is interrupted.
 Evaluation;
 Corneal light reflex test
 Cross cover test
Corneal Light Reflex test
 Penlight
 2 feet in front of the face
Red Reflex
 Detect opacities: cornea, lens or retina
 HOW TO DO IT?
 Darkened room
 Direct ophtalmoscope focused on each eye(12-18inches
away) and then both eyes simulataneoulsy at 3feet away
Cross cover test
Child looking ahead 10 feet from
object
•Eye chart
•Toy
•As child looks for the object, cover
the eye and see movement of other
eye
•Any movement in or out when
shifting the cover indicates a
strabismus is present
References
 http://aappolicy.aappublications.org/cgi/content/full/pedi
atrics;111/4/902
 http://www.health.state.mn.us/divs/fh/mch/webcourse/vi
sion/mod6c.cfm
 http://www.allaboutvision.com/parents/infants.htm
 http://www.ophthobook.com/chapters/pediatrics