eye examination in infants children and young adults by pediatricians
Download
Skip this Video
Download Presentation
Eye examination in infants, children and young adults by pediatricians

Loading in 2 Seconds...

play fullscreen
1 / 32

Eye examination in infants, children and young adults by pediatricians - PowerPoint PPT Presentation


  • 130 Views
  • Uploaded on

Eye examination in infants, children and young adults by pediatricians. Ronit Friling Pediatric Ophthalmology Unit, Schneiders Childrens Medical Center of Israel, Petah Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Eye evaluation in the physician’s office.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Eye examination in infants, children and young adults by pediatricians' - eros


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
eye examination in infants children and young adults by pediatricians

Eye examination in infants, children and young adults by pediatricians

Ronit Friling

Pediatric Ophthalmology Unit,

Schneiders Childrens Medical Center of Israel, Petah Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

eye evaluation in the physician s office
Eye evaluation in the physician’s office

Birth to three years

  • Ocular history
  • Vision Assessment
  • External inspection of the eyes and lids
  • Ocular motility assessment
  • Pupil examination
  • Red reflex examination
ocular history
Ocular history
  • Does your child hold objects close to his or her face?
  • Does your child’s eyes appear straight or crossed?
  • Relevant family history regarding eye disorders
vision assessment
Vision Assessment

Age 0-3 years

To determine whether each eye can fixate on an object, maintain fixation and follow the object into various gaze positions.

The assessment should be performed binocularly and then monocularly.

visual acuity measurement
Visual Acuity Measurement

Older than 3 years

Picture tests such as (LEA symbols) and Allen cards can be used for children 2-4 years of age

external examination
External Examination

Consists of penlight evaluation of the lids, conjunctiva, sclera, cornea and iris.

Persistent discharge or tearing may be attributed to ocular infection, allergy or glaucoma but the most common cause is lacrimal duct obstruction.

ocular motility
Ocular Motility

The most common cause of pseudostrabismus is prominent epicentral lid folds that cover the medial portion of the sclera on both eyes

pupils
Pupils

The pupils should be equal, round, and reactive to light in both eyes

red reflex test
Red Reflex Test

The red reflex can be used to detect opacities in the visual axis such as cataract or corneal abnormality and abnormalities of the back of the eye such as retinoblastoma or retinal detachment

visual acuity test
Visual Acuity Test

Snellen Acuity Cards

HOTV Test

The test consists of a wall chart composed of H,O,T,V

The child is provided a board containing a large H,O,T,V

Allen Cards

Consists of 4 cards containing 7 schematic figures

LEA Symbols

The LH Symbol test is made of

house, apple, circle, square

amblyopia1
Amblyopia

The most common cause of monocular visual impairment in children

A substandard correct visual acuity without evidence of organic eye disease Prevalence 2-2.5% in general population

causes
Causes
  • Strabismus
  • Anisometropia
  • Visual deprivation
compliance
Compliance
  • 49% - 87%
  • Skin imitation
  • Social reasons
pharmocologic penalization
Pharmocologic Penalization
  • Instillation of a long acting topic cycloplegic agent (atropine) into the sound eye
  • Prevents accommodation
  • Blurring the sound eye at near fixation
slide17
Penalization has been advocated only for mild and moderate amblyopia 6/18 or better
  • Because the blurring effect on the sound eye may be insufficient when visual acuity in the amblyopic eye is worse that 6/18
patching group atropine group
6 hours 43% of patients 8 hours 30% of patients

10 hours 7% of patients

12 hours 20% of patients

A drop of atropine per day

Patching GroupAtropine Group
results on va in the amblyopic eye
Results on VA in the amblyopic eye
  • Improvement in VA from base line in both patching and atropine groups
results cont
Results (cont)
  • Mean change in V.a. from baseline
  • 3.16 lines - patching group
  • 2.84 lines - atropine group
va in the sound eye
VA in the sound eye
  • At six-month examination
  • VA in the sound eye was decreased from baseline by 1 line
  • 7% - patching group
  • 15% atropine group
side effects
Side effects
  • Patch - skin irritation
  • Atropine - light sensitivity 18%
  • Lid - irritation 4%
treatment
Treatment
  • Encouragement of visual development making the patient use the amblyopic eye by reducing the visual stimulation of the fellow eye
criteria for combined optical atropine penalization treatment coat
Criteria for combined optical atropine penalization treatment (COAT)
  • Lack of compliance with conventional full-time total occlusion
  • Failed to show an expected improvement (doubling in VA) after apparent compliance
criteria for coat
Criteria for COAT
  • A hypermetropic refractive error of at least 1,75D in the fellow eye (the eye to be penalized)
  • The prescription for the fellow eye was replaced with a plano lens
follow up
Follow-up
  • Treatment was continued until the VA in the amblyopic

eye was either equal to that of the fellow eye or had not improved

pharmacologic penalization
Pharmacologic penalization
  • Ease of administration
  • Reliable assessment of compliance
  • Relative cheapness
disadvantage
Disadvantage
  • Potential toxicity
  • Duration of effect if reverse amblyopia is detected
results
Results
  • The mean VA in the fellow eye at the end of treatment was not significantly different from that of the commencement of treatment
  • The change in VA after COAT was much higher than after occlusion
results cont1
Results (cont)
  • COAT for previously foiled FTO produced a success rate of 76% success is defined as doubling of VA of the amblyopic eye
ad