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Eye Got It! John Davis RN, MSN, FNP-BC.  ALL people by nature desire to know. An indication of this is the delight we take in our senses; for even apart.

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Presentation on theme: "Eye Got It! John Davis RN, MSN, FNP-BC.  ALL people by nature desire to know. An indication of this is the delight we take in our senses; for even apart."— Presentation transcript:

1 Eye Got It! John Davis RN, MSN, FNP-BC

2  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”

3 Anatomy

4 Fundoscopy

5 Vocabulary  Strabismus- (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 eye  Esotropia- Form of strabismus in which the eye turns inward.  Exotropia-Form of strabismus in which the eye turns outward.  Anisocoria- unequal pupil size  Dyscoria- irregular pupil shape  Leukocoria- white pupil  Proptosis- Bulging of the eye anteriorly out of the orbit  Diplopia- double vision  Ptosis- Drooping of the upper eyelid  Myopia- 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)

6 Normal Developmental Timeline of Vision  Visual Acuity at birth is 20/800 to 20/1000  Visual Acuity at age 6 months is 20/40 to 20/80  Age 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 better  No more than 1 line acuity difference between eyes  Visual Acuity at age 6 and older should be better than 20/40  Refer for visual acuity 20/40 and above  Should 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

7 How to Assess the Eye  Check Visual Acuity  Use a pinhole if student forgot glasses/contact lenses  Check Pupil Size- are they equal, anisocoria?  Check Tracking and Convergence  Inspect the lids  Inspect the conjunctivae- bulbar vs. palpebral  Cover Test- To assess for Strabismus / Amblyopia  With Lights Turned Down  Check Pupil Response- Reactive to light? Afferent Pupillary Defect- Optic Nerve or Retinal disorder  Hirschberg Test  Red Reflex


9 Tracking  Ocular 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.

10 Convergence  A 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 muscles  Neurological disorder  If abnormal- refer immediately to ophthalmology

11 Strabismus  Perform 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 eye  Atropine drops  Surgical correction

12 Strabismus

13  Refer immediately if new onset strabismus develops in a school age child.  Need to rule out tumor:  Glioma  Astrocytoma  Neuroblastoma  Medulloblastoma

14 Viral Conjunctivitis  Most commonly adenovirus.  Adenovirus does not have a lipid coat.  Usually watery discharge, occasionally purulent.  Tender swollen preauricular lymph node.  Contagious for 7-10 days.  Treat with artificial tears, frequent hand washing.

15 Bacterial Conjunctivitis  Usually caused by Staph aureus, Strep pneumo, or H. influenzae.  70% of staph resistant to erythromycin  Can treat with bacitracin, avoid neomycin (neosporin)  Purulent discharge  Eyes crusted shut  Can return to school after 24 hours of antibiotic treatment.

16 Allergic Conjunctivitis  Almost always involves both eyes.  Eyes are red and itchy  No preauricular lymph node swelling or tenderness  Allergic Shiners  Clear drainage or stringy mozzarella cheese looking drainage  Not contagious but uncomfortable  Ophthalmic anti-histamines and opthalmic mast cell stabilizers to treat

17 Subconjunctival 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.  Harmless  Resolves in days.

18 Orbital Cellulitis

19  Ocular emergency  No history of injury  Eye is red, warm to touch, swollen, painful  Orbit has a direct line to the central nervous system via the optic nerve- child needs to be hospitalized for IV antibiotics.

20 Orbital 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.

21 Retinoblastoma  Cancer of the retina  Typically develops before age 5  Leukocoria- white pupil  Absent red reflex  Particularly noticeable in photographs taken with a flash  Autosomal dominant- often family history of retinoblastoma  Curable when diagnosed early

22 Which part of the body has the thinnest layer of skin?

23 Hordeolum (Stye)

24  Localized inflammatory swelling of one or more of the glands of the eyelid  Mildly tender  May discharge purulent fluid  Exclude from school if draining until on antibiotics.  Treatment:  Warm compresses  Massage  Topical antibiotics if pointing outward  Occasionally incision and drainage

25 Chalazion

26  Chronic version of stye.  Meibomian gland is the main sebaceous gland of the eye.  If the meibomian gland becomes plugged or constipated- chalazion forms.  Treatment:  Warm Compresses  Massage  Oral antibiotics if infection is present as topical will not infiltrate the area.  If above treatment is not effective, surgical excision is necessary.

27 Cornea  The 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.

28 Corneal Ulcer  White or gray spot on the cornea  Very painful  Refer immediately  Causes:  Contact Lense Wearers  Bacterial infection  Herpes simplex or zoster infection  Corneal abrasion (scratch on the eye) if it becomes infected  Chemical burn

29 Mydriasis

30 Thank you!

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