DOCSLIB.ORG

The Paediatric Ophthalmic Examination Examination of a Child’S Eye Can Be Challenging and Traumatic but Could Save the Child’S Sight Or Even His Life

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Paediatric Ophthalmic Examination Examination of a Child’S Eye Can Be Challenging and Traumatic but Could Save the Child’S Sight Or Even His Life The paediatric ophthalmic examination Examination of a child’s eye can be challenging and traumatic but could save the child’s sight or even his life. A du Bruyn,1 MB ChB, Dip (Ophth), FC (Ophth); D Parbhoo,2 MB ChB, FC (Ophth) 1Consultant Ophthalmologist, St Aidan’s Hospital, University of KwaZulu-Natal, Durban, South Africa 2Consultant Ophthalmologist, Parklands Hospital and Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa Correspondence to: A du Bruyn ([email protected]) Twenty-ve thousand children in South • proptosis • 1 - 2 years: A child should be able to Africa are blind, mainly because of • ptosis pick up hundreds and thousands with congenital cataracts, congenital glaucoma, • epiphora ease (dierent size sweets can be used). malignant tumours (retinoblastoma), • buphthalmos or microphthalmos Teller’s and Cardi acuity cards can be retinopathy of prematurity, inammation • red eyes used. and injuries. Strabismus, amblyopia and • cloudy cornea • 2 - 3 years: At this age they can name refractive errors cause many more children • pupil abnormalities pictures and any of the picture charts to have reduced vision. Unfortunately, half • leucocoria. can be used (Kay pictures, Allen’s picture of these children who go blind will die cards, Bailey-Hall). Hundreds and within 2 years, mainly due to accidents. Visual assessment thousands may still be useful. Visual milestones • 3 - 5 years: Matching optotypes (use Fiy per cent of childhood blindness can be A child’s vision is developing and to establish the illiterate E chart, Landolt’s C test, prevented by early detection and treatment, visual acuity in a child is challenging for Sheridan- Gardener’s test, Lea charts). which can easily be achieved without any most. However, the principles to follow are • 6 years and older: Use the normal adult special equipment by screening children the visual milestones. charts for distance (Snellen’s letter and identifying the causes of blindness. charts, ETDRS charts) and near (reduced However, the examination of a child’s • Birth to 1 month: a baby would briey Snellen letter charts and Jaeger’s test eye can be challenging and traumatic. xate on bright light and faces. types). is article hopes to provide some basics • 1 - 3 months: babies start watching and helpful tricks to perform an accurate parents’ faces when being talked to and If none of this is available, watching a child examination of a child’s eye. is could be a start to follow objects horizontally. reading a page with each eye and with both sight- or a life-saving examination. • 3 months: babies should be able to xate eyes can give valuable clues to a possible well on near objects and follow targets. problem. e eyes should also be aligned in all All squints should directions of gaze by now. If the child cannot read to 6/6, then a • 3 - 5 months: a baby recognises a pinhole occluder can be used if available. If be referred as soon mother’s face. ey start focusing on vision improves with the pinhole, then it is as possible for objects, develop convergence, stereopsis most probably a refractive error and can be management. and colour vision. corrected with glasses. If the vision does not • 6 months: they are able to xate on improve the child should be investigated for distance targets. a cause. • 7 - 12 months: most visual skills would ere are many conditions to be aware of. be fully developed by now. However, it is important to note prematurity of less than 32 weeks and birth weight of Visual acuity testing Watching a child less than 1 500 g. Family history, systemic Visual acuity charts and basic tests reading a page with history, drug exposure and perinatal history ere are multiple dierent visual acuity each eye and with both are vital and so is the schooling history and charts available that are oen used by the diculties at school. ophthalmologist and optometrist, but with eyes can give valuable a few basic tests abnormal visual acuity can clues to a possible Observation could allow you to pick up on easily be identied. Assessment of the visual problem. the conditions listed below: acuity will depend on the age of the child.[1] • lack of xation • nystagmus • Under 1 year: Fix and follow. Objection • strabismus to occlusion of either eye can alert you of Pupil examination in bright light and dim • any swelling or lumps on the lids or possible poor vision in the non-occluded light, looking for anisocoria or a poorly around the eyes eye. reactive pupil is vital. 130 CME April 2013 Vol. 31 No. 4 Paediatric examination Eye movements and strabismus Cover test movement indicates exotropia and Eye movements can be assessed with toys e other more accurate way of assessing outward movement esotropia. and objects that will get a child’s attention for a squint or a deviation of an eye is to • Remove the cover so both eyes xate, but – le gaze, right gaze, up and down and also perform a cover test, which is described as you continue looking at the uncovered right up and down and le up and down. By follows (Fig. 3):[2] eye; if it moves back out, you can conrm looking at the eye movements nystagmus, • Ask the child to focus on an object exotropia (if it moves back in, you can limited movements or overaction of straight ahead (it must be something conrm esotropia). movements may be revealed. that will hold his attention) with both • If there is NO movement of the uncovered eyes and cover 1 eye with your hand or eye when you remove the cover and the Nystagmus can be sensory (caused by an occluder. uncovered eye remains xated then an defective vision) or motor imbalance (as a • Watch the uncovered eye for any alternating exotropia or esotropia is present result of defective eerent mechanisms). movement as it takes up xation: inward (the child is able to xate with both eyes). Children with bilateral central vision loss (as caused by cataracts) will develop sensory nystagmus which is horizontal and pendular. Motor nystagmus have many dierent forms and is caused by cortical and brainstem problems.[2] Strabismus is a misalignment of the eyes due to a muscle imbalance and can be present constantly or may be intermittent. It may cause amblyopia, lack of stereopsis and cosmetic problems that may lead to a poor self-image in children. It could also be the initial manifestation of a life-threatening condition such as a retinoblastoma and must never just be observed. All squints should be referred as soon as possible for management. e squint examination involves observation and a light torch test looking at the light reexes of both corneas (Hirschberg test) Fig. 2. Hirschberg test showing an exotropia in the right eye. which can give you clues to a deviated eye. Hirschberg test Use a penlight or ophthalmoscope to shine a light into both eyes. If normal, the points of light will fall in the same place in both eyes. If abnormal, the reection of the light will appear in dierent places in the two eyes (Figs 1 and 2). Fig. 1. Hirschberg test showing an esotropia in the right eye. Fig. 3. Occlusion of the eye when performing the cover test. 131 CME April 2013 Vol. 31 No. 4 Paediatric examination Lid swelling and proptosis retarded in the long term and surgery is Lid swelling is oen caused by infective indicated as soon as possible. or inammatory conditions or following trauma, but be careful not to miss orbital Epiphora cellulitis or tumours (embryonal sarcoma, Epiphora is a sign of lacrimal drainage advanced retinoblastoma or metastases obstruction or congenital glaucoma (which from other tumours). Look at the colour, is much more serious and can lead to size, consistency and tenderness of the blindness if not treated urgently). Additional lesion and watch out for any associated signs signs such as buphthalmos and a cloudy such as proptosis (Figs 4 and 5), decreased cornea are present in congenital glaucoma. eye movements, decreased visual acuity Fig. 6. Normal red reex. and any involvement of the globe. Proptosis Microphthalmos could suggest a tumour or a life-threatening Microphthalmos (small and abnormal eye) orbital cellulitis and always needs urgent and microcornea (corneal diameter less referral. than 10 mm) are oen associated with other anterior segment abnormalities like glaucoma or cataracts. Red eyes ere are multiple causes for red eyes in children and these can be acute or chronic. Watch out for associated signs like lid Fig. 7. Abnormal red reex in the right eye. swelling, proptosis, conjunctival papillae, corneal ulcers and corneal oedema to assist in the diagnosis. Fig. 4. Proptosis of the le eye due to traumatic Cloudy cornea retrobulbar haemorrhage. e most important cause of a cloudy cornea in small children is congenital glaucoma and this always has to be excluded. Other causes include birth trauma, prenatal infections, congenital corneal dystrophies, sclerocornea, metabolic storage diseases, interstitial keratitis, infective keratitis, Fig. 8. Abnormal red reex due to a congenital Peter’s anomaly and corneal scarring.[3] cataract in the le eye. Leucocoria Always assess for leucocoria. Leucocoria can be identied with the direct ophthalmoscope and in advanced cases may be visible with the naked eye. Testing for a red reex with the direct ophthalmoscope entails looking through the ophthalmoscope at a distance from the child and observing the red light reex Fig. 9. Leucocoria due to a retinoblastoma in Fig. 5. Right proptosis and ptosis due to emitted from the pupil (Figs 6 - 9). the le eye. metastases from a neuroblastoma. e most important causes for leucocoria or primary healthcare clinic.
Load more

Recommended publications
  • Vision Screening Training
    Vision Screening Training Child Health and Disability Prevention (CHDP) Program State of California CMS/CHDP Department of Health Care Services Revised 7/8/2013 Acknowledgements Vision Screening Training Workgroup – comprising Health Educators, Public Health Nurses, and CHDP Medical Consultants Dr. Selim Koseoglu, Pediatric Ophthalmologist Local CHDP Staff 2 Objectives By the end of the training, participants will be able to: Understand the basic anatomy of the eye and the pathway of vision Understand the importance of vision screening Recognize common vision disorders in children Identify the steps of vision screening Describe and implement the CHDP guidelines for referral and follow-up Properly document on the PM 160 vision screening results, referrals and follow-up 3 IMPORTANCE OF VISION SCREENING 4 Why Screen for Vision? Early diagnosis of: ◦ Refractive Errors (Nearsightedness, Farsightedness) ◦ Amblyopia (“lazy eye”) ◦ Strabismus (“crossed eyes”) Early intervention is the key to successful treatment 5 Why Screen for Vision? Vision problems often go undetected because: Young children may not realize they cannot see properly Many eye problems do not cause pain, therefore a child may not complain of discomfort Many eye problems may not be obvious, especially among young children The screening procedure may have been improperly performed 6 Screening vs. Diagnosis Screening Diagnosis 1. Identifies children at 1. Identifies the child’s risk for certain eye eye condition conditions or in need 2. Allows the eye of a professional
    [Show full text]
  • Strabismus, Amblyopia & Leukocoria
    Strabismus, Amblyopia & Leukocoria [ Color index: Important | Notes: F1, F2 | Extra ] EDITING FILE ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Objectives: ➢ Not given. Done by: Jwaher Alharbi, Farrah Mendoza. ​ ​ Revised by: Rawan Aldhuwayhi ​ Resources: Slides + Notes + 434 team. ​ ​ NOTE: F1& F2 doctors are different, the doctor who gave F2 said she is in the exam committee so focus on her notes Amblyopia ● Definition Decrease in visual acuity of one eye without the presence of an organic cause that explains that decrease ​ ​ in visual acuity. He never complaints of anything and his family never noticed any abnormalities ​ ● Incidence The most common cause of visual loss under 20 years of life (2-4% of the general population) ● How? Cortical ignorance of one eye. This will end up having a lazy eye ​ ● binocular vision It is achieved by the use of the two eyes together so that separate and slightly dissimilar images arising in each eye are appreciated as a single image by the process of fusion. It’s importance 1. Stereopsis 2. Larger field If there is no coordination between the two eyes the person will have double vision and confusion so as a compensatory mechanism for double vision the brain will cause suppression. The visual pathway is a plastic system that continues to develop during childhood until around 6-9 years of age. During this time, the wiring between the retina and visual cortex is still developing. Any visual problem during this critical period, such as a refractive error or strabismus can mess up this developmental wiring, resulting in permanent visual loss that can't be fixed by any corrective means when they are older Why fusion may fail ? 1.
    [Show full text]
  • Ocular Rotations and the Hirschberg Test
    Pacific University CommonKnowledge College of Optometry Theses, Dissertations and Capstone Projects 3-1-1977 Ocular rotations and the Hirschberg test A John Carter Pacific University Recommended Citation Carter, A John, "Ocular rotations and the Hirschberg test" (1977). College of Optometry. 448. https://commons.pacificu.edu/opt/448 This Thesis is brought to you for free and open access by the Theses, Dissertations and Capstone Projects at CommonKnowledge. It has been accepted for inclusion in College of Optometry by an authorized administrator of CommonKnowledge. For more information, please contact [email protected]. Ocular rotations and the Hirschberg test Abstract The Hirschberg test is an objective means of determining the angle of strabismus by noting the distance the corneal reflex of a light source is from the center of the entrance pupil. A scale factor is used in converting the amount the reflex distance is in millimeters ot prism diopters. Recent studies have demonstrated this factor to be 22 prism diopters for each millimeter. This study notes how axial length would effect this scale factor. Using ultrasound axial lengths of thirty eyes were measured and compared to the results of a Hirschberg simulation. A small effect results from this comparison. The mean values of scale factor determination noted twenty-three prism diopters per millimeter. Degree Type Thesis Degree Name Master of Science in Vision Science Committee Chair Niles Roth Subject Categories Optometry This thesis is available at CommonKnowledge: https://commons.pacificu.edu/opt/448 Copyright and terms of use If you have downloaded this document directly from the web or from CommonKnowledge, see the “Rights” section on the previous page for the terms of use.
    [Show full text]
  • 20-OPHTHALMOLOGY Cataract-Ds Brushfield-Down Synd Christmas
    20-OPHTHALMOLOGY cataract-ds BrushfielD-Down synd christmas tree-myotonic dystrophy coronaRY-pubeRtY cuneiform-cortical(polyopia) cupuliform-post subcapsular(max vision loss) Elschnig pearl, ring of Soemmering-after(post capsule) experimenTal-Tyr def glassworker-infrared radiation grey(soft), yellow, amber, red(cataracta rubra), brown(cataracta brunescence), black(cat nigrans)(GYARBB)-nuclear(hard) heat-ionising radiation Membranous-HallerMan Streiff synd morgagnian-hypermature senile oildrop(revers)-galactossemia(G1PUT def) post cortical/bread crumb/polychromatic lustre/rainbow-complicated post polar-PHPV(persistent hyperplastic prim vitreous) radiational-post subcapsular riders-zonular/lamellar(vitD def, hypoparathy) roseTTe(ant cortex)-Trauma, concussion shield-atopic dermatitis snowstorm/flake-juvenile DM(aldose reductase def, T1>T2, sorbitol accumulat) star-electrocution sunflower/flower of petal-Wilson ds, chalcosis, penetrating trauma syndermatotic-atopic ds total-cong rubella zonular-galactossemia(galactokinase def) stage of cataract lamellar separation incipient/intumescence(freq change of glass) immature mature hypermature Aim4aiims.inmorgagnian sclerotic lens layer ant capsule ant epithelium lens fibre[66%H2O, 34%prot-aLp(Largest), Bet(most aBundant), γ(crystalline, soluble)] nucleus embryonic(0-3mthIUL) fetal(3-8mthIUL)-Y shape(suture) infantile(8mthIUL-puberty) adult(>puberty) cortex post capsule thinnest-post pole>ant pole thickest, most active cell-equator vitA absent in lens vitC tpt in lens by myoinositol H2O tpt in lens
    [Show full text]
  • Change of Eye Position in Patients with Orthophoria and Horizontal Strabismus Under General Anesthesia
    Korean J Ophthalmol Vol. 19:55-61, 2005 Change of Eye Position in Patients with Orthophoria and Horizontal Strabismus under General Anesthesia Hee Chan Ku, MD1, Se-Youp Lee, MD2, Young Chun Lee, MD1 Department of Ophthalmology, Uijongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea1, Seoul, Korea Department of Ophthalmology, Dongsan Medical Center College of Medicine, Keimyung University of Korea2, Deagu, Korea We studied the relationship between eye position in the awakened state and in the surgical plane of anesthesia in orthophoric and horizontal strabismus patients. We classified 105 orthophoric and horizontal strabismus patients into 5 groups, measured the eye position at the primary position by photographic measurement of the corneal reflex positions and undertook a quantitative study of eye po sitio n. U nder general anesthesia, the mean diverg ence w as 3 9.7± 8 PD fo r the eso tro pia gro up, 36 .6 ±11.7 PD for exophoria, 27.4±8.1 PD for orthophoria, and 11.1±10.2 PD for exotropia I (≤30 PD). Therefore, the esotropia group had the largest amount of divergence among the groups, but the eye position of the exotropia II (>30 PD) group was rather convergent at 11.0±6.5 PD. According to the eye position of the fixating and nonfixating eyes in the esotropia group, both eyes converged with an angle deviation of 14.4±4.8 PD divergent and 14.1±4.8 PD divergent, respectively (P=.71). In the exotropia groups (I, II), the fixating eye diverged but the nonfixating eye rather converged.
    [Show full text]
  • Ocular Trauma Occupational Ocular Trauma
    AOCOPM Midyear Educational Meeting March 8-11, 2018 I. Introduction II. Objectives Epidemiology of Ocular Injuries Michael B. Miller, D.O., O.D., M.P.H. Review of Anatomy Wellstar Occupational Medicine Examination of eye Atlanta, GA Examine eye for trauma and foreign bodies Manage chalazia, styes, corneal abrasions, foreign bodies Ocular Trauma Occupational Ocular Trauma “Epidemiological data on eye injuries In US, 280,000 work-related tx in ED are still rare or totally lacking in large 1999 (Am J Ind Med 2005) parts of the world.” J Clin Ophth Res 2002, BLS est 65,000/year 2016 2009, BLS est. 2.9/10,000 full time 90 % are preventable workers requiring 2 or more days off Prevalence rates vary a great deal (5- NIOSH Work-RISQS query shows 15%) 134,000 in 2015 Approx 50% work-related Non-traumatic ocular illnesses (allergic conjunctivitis) grossly underreported Occupational Ocular Trauma Risk Factors- Ocular Trauma Majority are males BLS est. 60% fail to wear proper eye Most are in age 25-44 protection incl. side/top shields Metalworkers at highest risk Use of tools (unskilled use increases risk 48X) Others: agriculture, construction, manufacturing Performing unusual task (< 1 day/week) Types of injuries: Abrasions, FB/splash, Working overtime (3X inc risk) Conjunctivitis, Burns, Contusion, Distraction, fatigue, Rushed Open/Penetrating wound, Assoc with sleep duration not stat signif F - 1 AOCOPM Midyear Educational Meeting March 8-11, 2018 PPE Effect- Ocular Trauma Anatomy 44% reported eye injury despite PPE (Occ Med, Jan 2009) Reported increase use of PPE during work following eye injury (from median 20% to 100%) (Workplace Health Safety, 2012) Role of provider education in prevention….Yuge! Anatomy of the orbital septum Anatomy of the eye and surrounding structures IV.
    [Show full text]
  • Amblyopia Strabismus
    7 Strabismus, Amblyopia & Leukocoria Color index: 432 Team – Important – 433 Notes – Not important [email protected] Objectives (Weren’t provided) Strabismus Amblyopia Leukocoria Esotropia Pseudostrabismus Exotropia Strabismus Definition: Abnormal alignment of the eyes; the condition of having a squint. (Oxford dictionary) Epidemiology: 2%-3% of children and young adults. Prevalence in males=females Causes: Inherited pattern. Most patients fall under this category, so it is important to ask about family history. Idiopathic. Binocular Single Vision can be: Neurological conditions (Cerebral palsy, Hydrocephalus & -Normal – Binocular Single brain tumors). vision can be classified as Down syndrome. normal when it is bifoveal and Congenital cataract, Eyes Tumor. there is no manifest deviation. -Anomalous - Binocular Single Why we are concerned about strabismus? vision is anomalous when the 1. Double vision. Mainly in adults. because images of the fixatedchildren object and infants have a suppression feature which are projected from the fovea is not found in adults of one eye and an extrafoveal 2. Cosmetic. area of the other eye i.e. when 3. Binocular single vision. the visual direction of the retinal elements has changed. Consequences A small manifest strabismus is therefore always present in Amblyopia (lazy eye). In children anomalous Binocular Single Double vision. Usually in adults but you may vision. see it in children. E.g: if they have a tumor and they present with sudden esotropia and diplopia Tests for deviation: 1. Hirschberg test: 1mm from pupil center=15PD (prism diopter) or 7o. also known as corneal light reflex you shine the light at one arm length into both eyes and see the corneal reflex.
    [Show full text]
  • Ocular Motility
    10 Ocular Motility C. Denise Pensyl, William J. Benjamin linicians are faced with the challenge of differenti­ approximately 2 rnm, below which the effects of Cating the etiologies of asthenopia, blur, diplopia, reduced retinal illuminance and diffraction outweigh and headaches associated with the use of the eyes by the beneficial aspects ofan increase in depth offield and their patients. Oculomotor deficiencies can be one of reduction of ocular spherical aberration. The entrance several possible causes of such symptoms and are the pupil also controls blur circle size at the retina for object result of defects in the central nervous system, afferent rays not originating from the far point plane of the eye. or efferent nerve pathways, or local conditions of a The entrance pupil averages 3.5 mm in diameter in nature so as to impede appropriate oculomotor func­ adults under normal illumination but can range from tion. Oculomotor function will be extensively analyzed 1.3 mm to 10 mm. It is usually centered on the optic during phorometry (see Chapter 21) in terms of binoc­ axis of the eye but is displaced temporally away from ularity and muscle balance after the subjective refraction the visual axis or line of sight an average of 5 degrees. has been completed. This chapter focuses on clinical The entrance pupil is decentered approximately procedures that are typically used to analyze oculomo­ 0.15 mm nasally and 0.1 mm inferior to the geometric tor function before the subjective refraction is per­ center ofthe cornea. J This amount ofdecentration is not formed, though in some cases the practitioner may distinguished in casual observation or by the clinician's decide to use a few of these tests after the refraction is normal examination ofthe pupils.
    [Show full text]
  • Online Ophthalmology Curriculum
    Online Ophthalmology Curriculum Video Lectures Zoom Discussion Additional videos Interactive Content Assignment Watch these ahead of the assigned Discussed together on Watch these ahead of or on the assigned Do these ahead of or on the Due as shown (details at day the assigned day day assigned day link above) Basic Eye Exam (5m) Interactive Figures on Eye Exam and Eye exam including slit lamp (13m) Anatomy Optics (24m) Day 1: Eye Exam and Eye Anatomy Eyes Have It Anatomy Quiz Practice physical exam on Orientation Anatomy (25m) (35m) Eyes Have It Eye Exam Quiz a friend Video tutorials on eye exam Iowa Eye Exam Module (from Dr. Glaucomflecken's Guide to Consulting Physical Exam Skills) Ophthalmology (35 m) IU Cases: A B C D Online MedEd: Adult Ophtho (13m) Eyes for Ears Podcast AAO Case Sudden Vision Loss Day 2: Acute Vision Loss (30m) Acute Vision Loss and Eye Guru: Dry Eye Ophthalmoscopy and Red Eye Eye Guru: Abrasions and Ulcers virtual module IU Cases: A B C D E Red Eye (30m) Corneal Transplant (2m) Eyes for Ears Podcast AAO Case Red Eye #1 AAO Case Red Eye #2 EyeGuru: Cataract EyeGuru: Glaucoma Cataract Surgery (11m) EyeGuru: AMD Glaucoma Surgery (6m) IU Cases: A B Day 3: Intravitreal Injection (4m) Eyes for Ears Podcast Independent learning Chronic Vision Loss (34m) Chronic Vision Loss AAO Case Chronic Vision Loss reflection (due Day 3 at 8 and and Systemic Disease pm) Systemic Disease (32m) EyeGuru: Diabetic Retinopathy IU Cases: A B Eyes Have It Systemic Disease Quiz AAO Case Systemic Disease #1 AAO Case Systemic Disease #2 Mid-clerkship
    [Show full text]
  • Pediatric Vision Screening
    Pediatric Vision Screening Allison R. Loh, MD,* Michael F. Chiang, MD*† *Department of Ophthalmology and †Department of Medical Informatics and Clinical Epidemiology, Casey Eye Institute, Oregon Health and Science University, Portland, OR Practice Gap Incorporating vision screening and a basic eye examination in the primary care setting can be challenging. Determining which screening examination to perform and when to refer a patient to a pediatric eye care provider is critical. Objectives After completing this article, readers should be able to: 1. Understand the importance of vision screening and know what conditions can be detected by periodic eye examinations. 2. Describe the components of a vision screening examination at different ages and plan an appropriate evaluation of vision. 3. Recognize the indications for referral to pediatric ophthalmology. INTRODUCTION Vision screening is crucial for early detection and prevention of vision loss in young children. Vision screening can be performed by primary care providers, trained laypersons (eg, school-based screenings), and eye care providers. Vision screening techniques are either provider-based (eg, traditional acuity testing, inspection, red reflex testing) or instrument-based. Instrument-based screening can often be performed at an earlier age than provider-based acuity testing and allows earlier screening for risk factors that are likely to lead to amblyopia and poor vision. The American Academy of Pediatrics (AAP) and the American Association for Pediatric Ophthalmology and Strabismus have developed guide- lines to help practitioners screen for vision problems at different ages (Table 1). AUTHOR DISCLOSURE Dr Loh has disclosed no financial relationships relevant to this THE IMPORTANCE OF VISION SCREENING article.
    [Show full text]
  • 1 Workup 1.1 Ophthalmic History Ref: Lecture Notes – Ophthalmology Ch2, Oxford Handbook of Ophthalmology Ch1, Uptodate
    1 Workup 1.1 Ophthalmic History Ref: Lecture Notes – Ophthalmology Ch2, Oxford Handbook of Ophthalmology Ch1, UpToDate History of present illness (HPI): □ Chief complaint: → Onset: acute (eg. vascular), subacute (eg. optic neuritis), chronic, acute on chronic (eg. acute glaucoma attack → Laterality: Rt (OD), Lt (OS), both (OU) [NOT ‘LE’] → Quality → Severity → Progression: intermittent vs constant, progressive vs stable → Aggravating and relieving factors □ Associating symptoms: ocular and non-ocular symptoms Complaint Considerations D/dx Preceding trauma? Eyelid pathologies Pattern of redness? – diffuse vs focal? Perilimbic involvement/sparing? Conjunctivitis (allergic, bacterial, viral) Any pain/discomfort? Subconjunctival haemorrhage □ FB sensation → corneal ds Episcleritis □ Severe pain → keratitis, scleritis, Scleritis Red eye glaucoma Corneal ulcer, abrasion, FB Any photophobia? (corneal ds, uveitis) Keratitis Any blurred/loss of vision? Uveitis Any discharge? (conjunctivitis) Trauma Any associating systemic inflammatory diseases? – eg. SNRA, Behcet’s Acute angle closure glaucoma *: requires urgent ophthalmic referral Any contact lens wear? (keratitis) Transient vs persistent? – vascular Amaurosis fugax due to migraine, insufficiency vs structural causes ↑ICP, retinal a. insufficiency Unilateral vs bilateral vs VF defects? – Ocular media: acute angle closure ocular vs retrobulbar pathologies glaucoma, keratitis, uveitis, vitreous Central vs periphery? – macular vs haemorrhage Acute other pathologies Retinal:
    [Show full text]
  • Approach to Esotropia Clearer for You!
    This podcast will review an approach to a child presenting with esotropia – the most common type of strabismus. The approach includes history taking, physical examination, specific tests, indication for referral and management of esotropia. This podcast was created by Katia Milovanova, a medical student at the University of Alberta, in collaboration with Dr. Natashka Pollock, a pediatric ophthalmologist at the University of Alberta. 1 Today we will cover the following learning objectives on the topic of esotropia: 1) Define and differentiate the main categories of esotropia. 2) Develop an approach to evaluating a patient with esotropia. 3) Delineate appropriate urgent and non-urgent ophthalmology referrals for esotropia. 4) Discuss general treatment approaches for esotropia. 2 Let’s work through a clinical case as we go, so we can apply the information we are learning. You are a medical student working at an urban family medicine clinic. Tim is a 2.5 year old boy presenting with a new onset esotropia. His mother is worried because she has been noticing his left eye turning in over the last few weeks. Before we begin, we must define ‘strabismus’. Strabismus is simply abnormal alignment of the eyes; one or both eyes may deviate from their primary position. Esotropia is a type of strabismus, in which one or both affected eyes look in towards the nose (colloquially termed ‘cross-eyed’). This is the most common type of strabismus, occurring in 2-4% of the population (which is almost 1 in 20 kids!). 3 It is very important to diagnose and correct esotropia before stereopsis develops around the age of 4.
    [Show full text]