Visual Impairment

Question 1

Risk Factors for Visual Impairment

Answer 1

1. Prematurity
2. Developmental Delays
3. Genetic Syndrome
4. Family History
5. African-American heritage
6. Previous eye injury
7. Diabetes
8. HIV
9. Chronic corticosteroid use
10. Trauma

Question 2

Assessment Finding for Visual Impairment

Answer 2

(1) Neonate should be able to fixate on an object approximately 25-30 cm from the face. After fixation, the infant should be able to follow the object to the midline.

(2) By 2 months of age, the infant should follow the object 180 degrees

(3) By age 3, a variety of standardized age appropriate vision screening charts are available:
(1) Tumbling E
(2) Allen Figures
(3) Snellen Letters or Numbers
(4) Ishihara
(5) Color Vision Testing Made Easy

Should also be screened for color discrimination

Question 3

Visual Screening Steps

Answer 3

(1) Place the chart at the child’s eye level
(2) Make sure there is sufficient lighting
(3) Place a mark on the floor approximately 300-600 cm from the chart
(4) Align the child’s heels on the mark
(5) Have the child read each line with on eye covered and then with the other eye covered. Explain to the child to keep the eye covered by open
(6) Have the child reach each line with both eyes

Question 4

Nursing Assessment for Visual Impairment

Answer 4

Health History:
> Past Medial History
1. Significant for prematurity, genetic defect, ear deformities, hearing impairment (deafness), recurrent ear infections or ear surgeries
> Family History
1. Significant for ear deformities
> History of Present Illness
1. Inquire about the onset, progression and presence of fever, nasal congestion, ear pain, ear pulling, headache, lethargy or behavioral changes
> Treatments used at home
> Assess sign of potential visual impairment

Physical Assessment:
> Observe the eyes: note their positioning and symmetry and the presence of stabismus, nystagmus and squinting
> The eyelids should open equally
> Note variations in eye slant and the presence of epicenthal folds
> Assess the eyes for the presences of eyelid edema, sclera, color, discharge, tearing, and pupillary equality and size/shape of pupils
> Evert the eyelid to inspect the palpebral conjunctivae for redness
> Test for extraocular movements and pupillary light response and accommodation
> Perform appropriate-age visual acuity test (“cover test”)