Transcript The Identification and Management of Eye Condtions at

VISUAL IMPAIRMENT
 Most common eye conditions
 How to run an eye clinic at a school
 Signs of vision problems
By Madel Viljoen
Professional Nursing Sister
Prinshof School
40 + DIFFERENT EYE CONDITIONS
Most commonly found in Prinshof School:
• Retinopathy of prematurity
• Oculocutaneous albinism
• Different types of macular degenerations
• Congenital cataracts (aphakia; pseudophakia)
• Optic atrophy
• Glaucoma
RETINOPATHY OF PREMATURITY
Retinopathy of prematurity (ROP) is a condition
that only 6 learners suffered from in 1986, but
today it is one of the most common eye
conditions found at Prinshof School.
Characteristics are:
• Born Prematurely
• Weighs less than 1 kg at birth.
• Incubated
• High % of oxygen
• Causes abnormal growth of the retina
• Results in visual impairment.
ROP – note microcornea of left eye
OCULOCUTANEOUS ALBINISM
• Characterised by defective formation of melanin
(pigment that gives colour to eyes, hair and skin)
• Sensitive to solar radiation.
• Nystagmus
• Photophobia
• High refractive errors are common
• Other abnormalities: aniridia and coloboma
• Treatment: palliative by means of dark glasses,
prescription glasses or contact lenses.
Albinism is found in
all races
DIFFERENT TYPES OF MACULAR
DEGENERATIONS
Stargardt’s macular degeneration
Best’s macular degeneration
Rod-cone degeneration
Cone degeneration
Etc.
CONGENITAL CATARACTS
Congenital infections
• Rubella syndrome
• Toxoplasmosis
Genetic (familial)
Chromosomal abnormalities
• Down’s syndrome
Cataract secondary to other ocular disease
• Marinesco–Sjogren syndrome
Cataract extraction at a young age
• Aphakia
• Pseudophakia
Treatment – yearly eye examinations
Cataract extraction
with cryopencil
CATARACTS
Congenital cataract
affecting nucleus of lens
Mature cataract where
entire lens becomes
opaque. Maturity can
lead to complications
OPTIC ATROPHY
Confirmed - where a pale optic disc is associated
with defective visual acuity or visual field
Numerous causes (frequently undetermined)
• Meningitis
• Trauma
• Chronic glaucoma
• Retinitis pigmentosa
• Intellectually disabled (in some cases)
Treatment – eye examination on at least a yearly
basis
Optic atrophy
(meningitis)
Optic atrophy
following central
retinal artery
occlusion (trauma)
GLAUCOMA
Associated with a raised intro-ocular pressure and
loss of visual field. This is important because learners
with this eye condition cannot be allowed to partake
in contact sports such as soccer, rugby, netball,
diving, etc. This may cause retinal tears or
detachment resulting in permanent loss of vision.
Treatment with eye drops and/or systemic
medication (tablets) to regulate intra-ocular
pressure. Regular eye examinations are necessary.
Other eye conditions where glaucoma can be
prevalent (progressive myopia , ROP and some
syndromes).
Normal optic disk with
cup/disc ratio 0.4
Glaucomatous cup with
cup/disc ratio 0.7 and early
visual field defect
Large terminal glaucomatous cup
with cup/disc ratio of 1.0 and
optic atrophy – Note eye is blind
Operating microscope used by
most ophthalmic for all interior
segment operations
Trabeculectomy, a commonly
used filtrating operation for
glaucoma
Congenital glaucoma with enlarged corneal
diameter (buphthalmos or ox-eye) especially left
OTHER OCULAR MANIFESTATIONS
Diabetic retinopathy (exudates,
haemorrhages)
Hypertension (oedema; haemorrhages)
Rheumatoid disease (dry eyes, scleritis)
Keratomalacia (vitamin A deficiency)
Enucleation – the removal of the eye (due to
eye injury; tumours; cancer)
Diabetic retina with
exudates
Retinal bleeding
due to hypertension
OTHER CONDITIONS CAUSING VISUAL
IMPAIRMENT
Epilepsy
Brain tumours
Injuries
Hydrocephalus
Diabetes
Toxoplasmosis
Cancer of the eye
Macular pigmented
chorioretinal scar from
toxoplasmosis
Maculopathy of
diabetic retinopathy
with exudates and
oedema of macula
Right convergent squint resulting from retinoblastoma
(note white pupil)
Opaque vascularised
cornea after severe
chemical burn
A intraocular foreign
body causing cataract
and infection with
hypopyon (pus in the
anterior chamber)
SYNDROMES AFFECTING VISION
 Coats disease (usually boys; bleeding retinal arteries)
 Hallerman-Streiff syndrome (discrania, bird-like face,
dwarfism, dental anomalies, micropthalmos and
cataracts).
 Alport syndrome (nephropathy, perceptive deafness,
anterior lenticonus and cataracts)
 Marfan syndrome (very tall persons, lax joints,
arachnodactyly, kyphoscoliosis, heart defects,
dislocated lenses, myopia and retinal detachment)
 Usher syndrome (RP & deafness).
 I have only named a few - there are many other
syndromes associated with visual defects, which may
be life-threatening. (Xeroderma pigmentosa;
Spiegelmeyer - Vogt syndrome)
Hallerman-Streiff
syndrome: Facial
deformities
Alport syndrome:
Severe nephritis
Dislocated lens
(Marfan syndrome)
Hyphaema filling
more than half the
interior chamber
(Coats disease)
Xeroderma
pigmentosum:
Severe ultra-violet
damage of the skin
Spielmeyer –Vogt Syndrome: Notice the
difference due to degeneration of body,
mind and soul
SCHOOL CLINIC NECESSITIES
Basic needs:
1. Professional nursing sister
Preferably with qualifications in general nursing,
psychiatric nursing, maternity nursing and
community health nursing.
Many schools does not have professional nursing
sisters. As you well know, one cannot run a
school without teachers, and it is impossible to
run a clinic without a professional nurse.
2. Medical file with the following
documentation:
Ophthalmologists report
Optometric report
Medical questionnaire
All other relevant medical reports
Copy of the prescription for all chronic medication
needed
Recording chart for all medical inputs.
3. Medical clinic:
Lockable room
Lockable medicine cabinets
Medication – Schedule 1
Software (gloves, bandages, etc)
Hardware (canisters, tweezers, specimen jars)
Diagnostic test equipment: urine abnormalities,
pregnancy, drug use
Ear, nose and throat set
Stethoscope
Equipment to take the blood pressure and
temperature
Basin with running water (washing hands,
drinking water)
Basin with running water (cleaning wounds,
washing equipment)
Toilets
Examination table
Bed with linen
Cleaning materials
4. Eye clinic:
Room must be 4-6m long for correct Snellen
reading (distance vision)
Slit lamp and refractor
Projector
Testing material: Distance vision charts, Near
vision charts, Colour vision charts, etc.
Charts - literate and illiterate
Recording forms
Test lenses, pinhole glasses, etc.
5. Evaluation and assessment sessions:
Establish assessment dates
Documentation provided by parents:
• A report from an eye specialist containing a
diagnosis of the eye condition
• Identity documents of parents
• All other relevant medical reports
• Optometrist’s report
• Birth certificate
• ‘Road to health’ card
• Latest school report
Documentation to be completed for enrolment:
• Application for admission form
• Medical questionnaire
• Code of conduct
• Hostel application form
• Information on school wear
Optometrist - tests visual acuity
Eye specialist - to confirm diagnosis
Procedure for evaluation:
• An appointment for the evaluation of a learner
for admission is made in advance.
• The prospective learner must preferably be
accompanied by at least one biological parent
or legal guardian on the day of evaluation.
• During the evaluation the learner undergoes an
optometric test and additional relevant testing
procedures.
• The appropriate placement of the learner is
discussed by a trans-professional team
(principal, professional nurse, psychologist,
occupational therapist, speech therapist, etc.).
SIGNS OF VISION PROBLEMS
Eliminating the visual problems that are helping
to produce the following signs can quickly pay
off in the child's improved school performance:
1. Holding a book very close (only 10-20 cm away).
2. Child holds head at an extreme angle to the
book when reading.
3. Child covers one eye when reading.
4. Child squints when doing near vision work.
5. Constant poor posture when working close.
6. The child removes his or hear head back and
forth while reading instead of moving only the
eyes.
7. Poor attention span, drowsiness after prolonged
work less then an arm's length away.
8. Homework requiring reading takes longer than it
should.
9. Child occasionally or persistent reports seeing
double while reading or writing.
10. Loses place when moving gaze from desk work
to chalkboard, or when copying from text to
workbook.
11. Child reports blurring or doubling only when
work is hard.
12. Child must use a marker to keep their place
when reading.
13. Writing up or down hill, irregular letter or word
spacing.
14. Child reverses letters (b for d) or words (saw for
was).
15. Repeatedly omits "small" words.
16. Rereads or skips words or lines unknowingly.
17. Fails to recognize the same word in the next
sentence.
18. Misaligns digits in columns of numbers.
19. Headaches after reading or near work.
20. Burning or itching eyes after doing near vision
work.
21. Child blinks excessively when doing near work,
but not otherwise.
22. Rubs eyes during or after short periods of
reading.
23. Child fails to visualize (can’t describe what he
was reading about).
The End