Week 5 Chapter 39 Flashcards by Steven Singh

Ability to focus with both eyes simultaneously

Binocular Vision

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Binocular vision by the age of ____ and ___

3-7 months

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Visual acuity is completed by what age?

5 years of age

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Newborn eye vision is

20/400

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Eyeball occupies larger space in orbit and makes it more…

Susceptible to injury

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Hearing is intact in birth

True

Short, wide, and horizontally placed eustachian tubes in young children and increase risk of middle ear infections

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Factors associated with disorders of the eyes and ears of children

Congenital Disorders
- Cataracts and infantile glaucoma
- Prematurity

Genetic Disorders

Family History

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Common Labs and Diagnostics Tests for Eye/ Ear disorders

Inspection and observation

Visual Acuity Test

Audiometry

Tympanometry

Inspection of tympanic membrane with otoscope

Tympanic FLuid Culture

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Inspections in eyes looking for?

Eyes, eyeglasses, strabismus, nystagmus, squinting, edema, discharge and size/ shape of pupils

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Inspection of ears looking for…

Hearing aids, size and shape of ears, position, skin tags, dimples, palpate for pain, enlarged cervical nodes.

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Testing Eyes performed During Physical Examination

Extraocular movements
Pupillary light response and accommodation
Symmetry of corneal light reflex
Presence of red reflex with an ophthalmoscope
Age approximate visual acuity test

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Tumbling E and picture chart appropriate for preschool age children who do not know the alphabet

True

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May be transient or permanent

unilateral or bilateral

Hearing acuity or loss

Language development is dependent on ability to hear

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Transmission of sound through middle of ear is disrupted

Conductive

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Damage to the hair cells in the cochlea or long the auditory pathway

Sensorineural

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Attributed to both the conductive and sensorineural problem

Mixed

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Tests of ears performed during physical examination

Audiometry
Tympanometry
Whisper Test
Weber and Rinne Tests Culture of tympanic discharge

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Hearing test

Audiometry

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Measures tympanic membrane mobility and determines middle of ear pressure

Tympanometry

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4 years or older

One ear occluded stand behind child and whisper

Whisper Test

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6 years or older and uses tuning fork

Weber and Rinne tests

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Vibrating tuning to the middle of top of head. Should be equally heard

Weber

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Vibrating tuning fork on mastoid process, child signals when sound is gone

Rinne

Then vibrating tuning fork outside of ear to test air conduction, child signals when gone

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Air conduction time should be twice as long as bone conduction time

Passing Test

Common Medical Treatments for Eyes

Warm Compress Corrective Lens Patching Eye Muscle Surgery

Common Medical Treatments for Ears

Pressure Equalizing Tubes Hearing Aids Cochlear Implants

Adhesive Patch applied to healthier eye to strengthen the weaker eye (strabismus, ambylopia)

Patching

Surgical alignment of the eye (stabismus)

Eye Muscle Surgery

Inserted into the TM ( chronic otitis media with effusion)

PE Tubes

Surgically inserted electronic prosthetic device (sensoriurneal loss)

Cochlear Implants Must be at least 12 months of age

Treatment of bacterial infections of the eyes and ears

Antibiotics

Block histamine reactions

Antihistamines

Pain relief

Analgesics

Inflamed conjunctiva, purulent discharge, mild pain, occasional eye lid edema

Bacterial Conjunctivitis

Inflamed conjunctiva, watery discharge, usually eyelid edema

Viral Conjunctiva

Inflamed conjunctivae, watery or stringy discharge, itching, eyelid edema usually present

Allergic conjunctivae

Stye infected eyelash follicle

Hordeolum

Chronic scaling and discharges along the eyelids

Blepharitis

Enlargement of oil gland

Chalazion

Common 90% resolve spontaneously

Nasolacrimal Duct Stenosis

Management of Disorders of the Eyelid and Management

Topical antibiotic Tx- Hordeolum, blepharitis Resolve Spontaneously- Chalazion Massage- Nasolacrimal Duct Stenosis

May resolve spontaneously, but if not requires surgery Parent education- hot, moist compresses

Chalazion

Light that enters the lens does not bend to allow it fall directly on the retina

Refractive Errors Farsighted- Hyperopia Nearsighted- Myopia Eyeglasses or contact lens

Misalignment of eyes

Strabismus Patching, corrective lens

Poor visual development in normal eye, "lazy eye"

Amblyopia Patching

Rapid and irregular eye movement

Nystagmus Common cause is neurologic problem

Autosomal Recessive, obstruction of aqueous humor flow and increased intraocular pressure

Glaucoma Surgical Intervention - goniotomy, laser

Opacity of the lens of eye

Cataract

Rapid growth of retinal blood vessels in the premature infant

ROP Retinopathy of Prematurity - Serial Eye Exams

ROP Risk Factors

Low Birth Weight Early Gestational Age Sepsis High Light Intensity Hypothermia Hypoxia Duration and concentration supplemental oxygen

Acuity between 20/60 and 20/200 Legal blindness < 20/200 or peripheral vision less than 20 degrees

Visual Impairment

Factors that increase visual impairment

Prematurity Development Delay Genetic Syndrome Family Hx of Eye Disease African American Diabetes, HIV Previous Serious Eye Injury Chronic Corticosteroid Use

Signs and Symptoms of Visual Impairment

Dull Vacant Stare Infants Does not fix and follow or make eye contact Unaffected by bright light Does not imitate facial expression

Signs and Symptoms Visual Impairment in Toddlers and Older Children

Rubs, shunts and covers eyes Squints and blinks frequently Holds object close or sits close to television Bumps into objects Displays head tilt or forward thrust

AOM

Acute Infectious Process

Otitis Media with Effusion

Collection of fluid in the middle ear without s/s of infection

Otitis Externa

Infection and inflammation of the skin of the external ear canal

Risk factors of Otitis Media

Eustachian Tubes Recurrent Upper Respiratory Infection Daycare Attendance Previous Episode Smoking in Household

HPI Acute Otitis Media

Onset and progression Fever Nasal Congestion Eye or ear pain Eye rubbing Ear pulling Headache Lethargy Behavioral Changes