Date post: | 02-Jan-2016 |
Category: |
Documents |
Upload: | sherilyn-laurel-poole |
View: | 215 times |
Download: | 0 times |
CHILD HEALTH SURVEILLANCE Vision Screening & Eye Problems
Gordon N Dutton
Emeritus Professor of Visual Science
Paediatric Ophthalmologist
Importance of surveillance
Detects life threatening conditions - very rare
Detects sight threatening conditions- common
Detects genetic conditions- occasionally
Detects cosmetic conditions- fairly common
6 Week Check
Vision: fixing & following External examination
lids cornea pupil
Red reflex direct ophthalmoscope
Visual Assessment in Children
Visual acuity Corneal light reflection Cover test Eye movements Tests of stereopsis Refraction Red reflex Dilated fundoscopy
Visual Acuity in Kids
Fixing and following light or toy
“Objection to occlusion”
Preferential looking tests
Identifying or matching pictures or letters
Vision reduced in both eyes
Wrong test for age or ability Poor attention Refractive error Structural problem with eye Central visual problem Want glasses !
Vision reduced in one eye
Loss of attention Refractive error Amblyopia Structural problem with eye Central problem
Amblyopia
Unilateral poor vision in childhood in a normal eye
Treat by patching the “good eye”
Glasses are often required
Easier to reverse the younger the child
If not reversed by age 7 or 8 then permanent
Amblyopia Treatment
SeverityAgeFull or part-time patchingAlways with glassesPreferably with close work
What Is an Orthoptist?
Responsible for the diagnosis and management of patients presenting with defects of binocular vision and disorders of eye movement, e.g. squint, amblyopia, diplopia and ocular muscle palsy.
Screening Role
Visual field assessment
Esotropia
Convergent squint Associated with hypermetropia
(longsightedness)
Pseudoesotropia - frequently seen if prominent epicanthic folds (broad nasal bridge).
Refraction
Test focus of eye by refraction with a retinoscope and lenses.
Most glasses prescribed in childhood for hypermetropia (longsightedness).
If difference in focus between the eyes (anisometropia) then risk of amblyopia.
Blocked Nasolacrimal Duct
Most resolve spontaneously Refer if no resolution by 1 year of age No antibiotics unless “white of eye” is red Massaging lacrimal sac may help
Chalazion
Apply local heat with a clean facecloth
Massage towards eye
10 mins twice daily
Surgery not required in child