EYES Flashcards
Testing vision in a pre verbal child (<2)
Observe the response to eyes being occulted subjective
Observe response to small toy or 100/1000s
Testing vision in a verbal child. 2-5 years
Leah. Sympobls
Sheridan Gardner single letter
HOTV
Snellens chart from 5years
Strabismus definition and describe pseudo/ real S
Is the misalignment of the 2 eyes
Only one eye can be directed at the object of regard
Psuedostrabismis child broad face / prominent folds check the reflections int he eye they should be parallel
True S Is the misaligned eyes not getting the images Intermittent Persistent/constant always refer Non paralytic Paralytic refer Infantile
Infantile esotropia
Normal up to 4/12 of age x their eyes after that refer if continues
Accommodative esotropia
Long sighted
2-2.5yrs at time of presentation
S is fully or partially controlled with glasses
Need to test the VA of both eyes
Intermittent exotropia
Tend to close one eye in the sunlight
More obvious when they are tired /daydreaming
Constant Exotropia
infants and babies WARNING sign
Often assoc with neurological problem
May have poor vision in one eye catarract intraoccular lesion
Etc
Paralytic Strabismus
History is of sudden onset of S and the child reports double vision if old enough
Causes can be
1 congentital
2 acquired viral/ trauma/ raised ICP
Always consider intracranial pathology
V1 N palsy eye movements show the S lateral rectus muscle when they look to the side
1V n palsy head tilt ( other cause is a sternomastoid tumor)
3 N palsy shows ptosis / pupil dilated ? Exotropic
Intracranial pathology
Examination of Strabismus 6 things
1 VA
2 observe for things like head tilt 1V n palsy
3 corneal light reflex
4 cover/uncover test. GOLD STANDARD fixate near and far uncovered eye may move in/out
5 ocular movements
6 ophthalmoscope Red reflex / optic disc
Risk factors for Strabismus 7
1Family history 2Prematurity /low birthweight 3 Drug/alcohol 4Refractive error 5 I ntraoccular pathology eg cataract retinoblastoma 6Craniofacial disorder 7Neurological
Refer Strabismus
1 concerns about VA 2 concerns intraoccular pathology 3 unequal red reflex 4 sudden onset of S 5 constant S 6 child risk factors for S
Amblyopia
Early diagnosis and treatment is essention
Definition is reduced vision that occurs as a result to interruption of a normal VA development
Amblyopia has to picked up in the sensitive critical period
And it is potentially reversible
Birth to 8 years but esp in the 0-4years
Unilateral A causes
1 Strabismus
2 refractive Errors
3 form deprivation eg ptosis cataract/ large hemangioma
Bilateral A
Uncorrected refractory errors bilateral
Management of Amblyopia
Early treatment is essential 0-4years good 0-8 years possible Treat 1 refractive errors Treat cataracts /ptosis Occlude the good eye = patching Mild-mod 2hours of patching per day Mod -severe 4 hours per day
Leuchocoria = white pupil
Causes
1 retinoblastoma
2 cataract
3 others
Retinoblastoma
1/20,000 75% occur in the first 3 years Bilateral in 25% of cases Germinal mutation 25% hereditary 75% non genetic
