Presentation on theme: "John Davis RN, MSN, FNP-BC"— Presentation transcript:
1John Davis RN, MSN, FNP-BC Eye Got It!John Davis RN, MSN, FNP-BC
2ALL people by nature desire to know 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”
5VocabularyStrabismus- (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 eyeEsotropia- Form of strabismus in which the eye turns inward.Exotropia-Form of strabismus in which the eye turns outward.Anisocoria- unequal pupil sizeDyscoria- irregular pupil shapeLeukocoria- white pupilProptosis- Bulging of the eye anteriorly out of the orbitDiplopia- double visionPtosis- Drooping of the upper eyelidMyopia- 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)
6Normal Developmental Timeline of Vision Visual Acuity at birth is 20/800 to 20/1000Visual Acuity at age 6 months is 20/40 to 20/80Age 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 betterNo more than 1 line acuity difference between eyesVisual Acuity at age 6 and older should be better than 20/40Refer for visual acuity 20/40 and aboveShould 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
7How to Assess the Eye Check Visual Acuity Use a pinhole if student forgot glasses/contact lensesCheck Pupil Size- are they equal, anisocoria?Check Tracking and ConvergenceInspect the lidsInspect the conjunctivae- bulbar vs. palpebralCover Test- To assess for Strabismus / AmblyopiaWith Lights Turned DownCheck Pupil Response- Reactive to light? Afferent Pupillary Defect- Optic Nerve or Retinal disorderHirschberg TestRed Reflex
9Ocular 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.Tracking
10ConvergenceA 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 musclesNeurological disorderIf abnormal- refer immediately to ophthalmology
11StrabismusPerform 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 eyeAtropine dropsSurgical correction
13Refer immediately if new onset strabismus develops in a school age child. Need to rule out tumor:GliomaAstrocytomaNeuroblastomaMedulloblastomaStrabismus
14Viral Conjunctivitis Most commonly adenovirus. Adenovirus does not have a lipid coat.Usually watery discharge, occasionally purulent.Tender swollen preauricular lymph node.Contagious for days.Treat with artificial tears, frequent hand washing.
15Bacterial Conjunctivitis Usually caused by Staph aureus, Strep pneumo, or H. influenzae.70% of staph resistant to erythromycinCan treat with bacitracin, avoid neomycin (neosporin)Purulent dischargeEyes crusted shutCan return to school after 24 hours of antibiotic treatment.
16Allergic Conjunctivitis Almost always involves both eyes.Eyes are red and itchyNo preauricular lymph node swelling or tendernessAllergic ShinersClear drainage or stringy mozzarella cheese looking drainageNot contagious but uncomfortableOphthalmic anti-histamines and opthalmic mast cell stabilizers to treat
17Subconjunctival 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.HarmlessResolves in days.
19Orbital Cellulitis Ocular emergency No history of injury Eye is red, warm to touch, swollen, painfulOrbit has a direct line to the central nervous system via the optic nerve- child needs to be hospitalized for IV antibiotics.
20Orbital 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.
21Retinoblastoma Cancer of the retina Typically develops before age 5 Leukocoria- white pupilAbsent red reflexParticularly noticeable in photographs taken with a flashAutosomal dominant- often family history of retinoblastomaCurable when diagnosed early
22Which part of the body has the thinnest layer of skin?
24Hordeolum (Stye)Localized inflammatory swelling of one or more of the glands of the eyelidMildly tenderMay discharge purulent fluidExclude from school if draining until on antibiotics.Treatment:Warm compressesMassageTopical antibiotics if pointing outwardOccasionally incision and drainage
26Chalazion Chronic version of stye. Treatment: Meibomian gland is the main sebaceous gland of the eye.If the meibomian gland becomes plugged or constipated- chalazion forms.Treatment:Warm CompressesMassageOral antibiotics if infection is present as topical will not infiltrate the area.If above treatment is not effective, surgical excision is necessary.
27CorneaThe 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.
28Corneal Ulcer White or gray spot on the cornea Very painful Refer immediatelyCauses:Contact Lense WearersBacterial infectionHerpes simplex or zoster infectionCorneal abrasion (scratch on the eye) if it becomes infectedChemical burn