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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.

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MORNING REPORT

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  1. MORNING REPORT KAREN ESTRELLA H. PEDS PGY-2 SBH DEC/2010

  2. AAP GUIDELINES EYE EXAMINATION IN INFANS, CHILDREN AND YOUNG ADULTS BY PEDIATRICIANS

  3. 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

  4. 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

  5. PROCEDURES FOR EVALUATION

  6. 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

  7. Vision Assesment • Age 0-3y/o • Evaluating the child’s ability to fix and follow objects. • Binocularly and then monocularly • Awake and alert

  8. Older children • Visual acuity: • 2-4y/o • LH symbols or Allen cards • >4y/o: • Snellen letters, Tumbling E test and the HOTV test

  9. 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

  10. 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

  11. Vision acuity

  12. 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

  13. 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

  14. 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

  15. Corneal Light Reflex test • Penlight • 2 feet in front of the face

  16. 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

  17. 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

  18. References • http://aappolicy.aappublications.org/cgi/content/full/pediatrics;111/4/902 • http://www.health.state.mn.us/divs/fh/mch/webcourse/vision/mod6c.cfm • http://www.allaboutvision.com/parents/infants.htm • http://www.ophthobook.com/chapters/pediatrics

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