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Eye and Vision Exams in the Outpatient Clinic Erika Beard-Irvine MD LCDR MC (FS) USN.

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Presentation on theme: "Eye and Vision Exams in the Outpatient Clinic Erika Beard-Irvine MD LCDR MC (FS) USN."— Presentation transcript:

1 Eye and Vision Exams in the Outpatient Clinic Erika Beard-Irvine MD LCDR MC (FS) USN

2 Objective AAP practice parameters for red reflex and vision screening Techniques for red reflex and vision screening Disease processes Referral criteria

3 Terminology Myopia

4 Terminology Myopia Hyperopia

5 Terminology Myopia Hyperopia Astigmatism

6 Terminology Myopia Hyperopia Astigmatism Amblyopia Anisometropia

7 Red Reflex Examination Newborn examination All routine health supervision visits

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9 Technique Ophthalmoscope power to 0 Lights off Simultaneously at 2-3 feet away Separately at inches away

10 Leukocoria

11 Differential of Leukocoria Retinoblastoma Congenital cataract ROP PFV Coloboma Uveitis Toxocariasis Coats disease Vitreous hemorrhage Retinal dysplasia

12 Absent Red Reflex

13 Absent Red Reflex

14 Asymmetric Red Reflex

15 Asymmetric Red Reflex

16 Asymmetric Red Reflex Mills, MD. The eye in childhood, Am Fam Physician Sep 1;60(3):

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18 Eye Evaluation Ocular history Vision assessment External inspection of the eye and lids Ocular motility assessment Pupil examination Red reflex examination Attempt at opthalmoscopy (>3 yo)

19 Ocular History Does you child seem to see well? Does your child hold objects close to his/her face when trying to focus? Do your childs eyes seem to cross or drift? Do your childs eyes appear unusual? Do your childs eyelids droop or does 1 eyelid tend to close? Have your childs eyes ever been injured? Family history of eye disorders or early eyeglass wear.

20 Vision Assessment Fix and follow Visual acuity measurement (>3 yo) Photoscreening

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22 Screening for amblyogenic factors: Strabismus Media opacities Significant refractive errors Evaluate photo of red reflex and pupillary light reflex AAP says it could be helpful but recommends more study

23 External Examination Tearing or discharge Corneal clouding

24 External Examination Tearing or discharge Corneal clouding Ptosis

25 External Examination Tearing or discharge Corneal clouding Ptosis Iris abnormalities

26 Ocular Motility Corneal reflex test Extra-ocular movements Cover-uncover test Random dot E stereo test

27 Corneal Light Reflex Mills, MD. The eye in childhood, Am Fam Physician Sep 1;60(3):

28 Ocular Motility Corneal reflex test Extra-ocular movements Cover-uncover test Random dot E stereo test

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30 Ocular Motility Corneal reflex test Extra-ocular movements Cover-uncover test Random dot E stereo test

31 Random Dot E

32 Pseudostrabismus

33 Pupil Exam

34 Referral Criteria Leukocoria or absent red reflex Any abnormality on exam Persistent torticollis or head tilt FHx of retinoblastoma FHx corrective lenses in preschool or lazy eye Parent concern


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