MORNING REPORT

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					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.
   Retinal abnormalities
   Cataracts
   Glaucoma
   Retinoblastoma
   Strabismus
   Neurologic disorders
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
         PROCEDURES FOR
           EVALUATION
BIRTH TO 3Y/O    -Ocular hx
                 -Vision assessment
                 -External inspection of the eyes
                 and lids
                 -Pupil examination
                 -Ocular motility assessment
                 -Red reflex examination
3y/o AND OLDER   -Same
                 PLUS:
                 -age-appropriate visual acuity
                 measurement
                 -attempt at opthalmoscopy
                 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
           Vision Assesment
 Age 0-3y/o
   Evaluating the child’s ability to fix and follow objects.
     Binocularly and then monocularly
     Awake and alert
Older children
 Visual acuity:
   2-4y/o
     LH symbols or Allen
      cards
   >4y/o:
     Snellen letters,
      Tumbling E test and
      the HOTV test
                   How to do it?
 Child should be comfortable      Non-literate: matching
  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
                                                           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
Vision acuity
       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
                       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
                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
Corneal Light Reflex test




      Penlight
        2 feet in front of the face
                   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
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
                  References
 http://aappolicy.aappublications.org/cgi/content/full/pedi
  atrics;111/4/902

 http://www.health.state.mn.us/divs/fh/mch/webcourse/vi
  sion/mod6c.cfm

 http://www.allaboutvision.com/parents/infants.htm
 http://www.ophthobook.com/chapters/pediatrics

				
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posted:9/16/2011
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