NR-602 Primary Care of the Childbearing &

Childrearing Family Practicum

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NR 602: PEDIATRIC STUDY TOPICS FINAL STUDY GUIDE

Eye Disorders- 616- 646

Strabismus- a defect in In ocular alignment, or the position of the eyes in relation to each other; It is

commonly called lazy eye. And strabismus, the visual axes are not parallel because the muscles of the eyes are

not coordinated; When one eye is directed straight ahead, the other deviates.

Retinoblastoma is an intraocular tumor that develops in the retina. Although it is rare, this malignant retinal

tumor is the most common tumor in childhood (some 4% of cancers in children younger than 15 years of age)

Clinical findings

• strabismus is the most common finding

• there is a decreased visual acuity uni- or bilateral white pupil (leukocoria), described often as an

intermittent “glow, glint, gleam, or glare” by parents, is usually seen in low light settings or

noted in photographs taken with a flash i.e. (cat's eye reflex)

• other symptoms include an abnormal red reflex, nystagmus, glaucoma, orbital Cellulitis and

photophobia, hyphema, hypopyon (plus an anterior Chamber of eye); Signs of global rupture or

also possible

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Bulbar or palpebral conjunctival injection is a common presentation, which can be unilateral or bilateral.

differential diagnosis should include allergy, conjunctivitis, infection, foreign body, chemical exposure, or

systemic inflammatory disease, irritation of the conjunctiva or cornea, and congenital glaucoma.

Watery discharge can occur with allergies, nasolacrimal obstruction, foreign bodies, viral infection, and iritis.

Purulent or mucoid discharge can be noted with chronic dacrocystitis or nasolacrimal obstruction.

Advanced allergic conjunctivitis can have some mucoid production.

To differentiate, microscopic investigation of discharge may lead to other clues.

Photophobia is a symptom common of trauma and in infants with glaucoma or retinal disease. Other non-eye

related causes of photophobia include migraines and meningitis.

A white pupil, or leukocoria is a serious finding and demands immediate referral to the pediatric

ophthalmologist.

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Causes of leukocoria include retinal detachment, cataract, retinal dysplasia, retinopathy of prematurity, and in

newborns retinoblastoma.

All newborns should have a fundoscopic examination within 24 hours of birth and yearly on physical

examinations.

Conjunctivitis chart

Chalazion vs Stye

CHALAZIONS – Benign, chronic lipogranulomatous inflammation of the eyelid

Causes – blockage of the meibomian cyst

Risk – hordeolum or any condition which may impede flow through the meibomian gland. Also mite species that reside in

lash follicles

Assessment – PAINLESS, NOT INVOLVING LASHES

 Lid edema, or palpable mass

 Red or grey mass on the inner aspect of lid margin

Prevention – good eye hygiene

Treatment – warm, moist compresses 3x per day

 Antibiotics not indicated because chalazion is granulomatous condition, if secondarily infected consider

SULFACETAMIDE, ERYTHROMYCIN

Follow up – 2-4 weeks, if still present after 6 weeks follow up with ophthalmologist

BlepharitisBLEPHARITIS – Inflamation/infection of the lid margins (chronic problem)

2 Types:

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seborrheic (non ulcerative) : irritants (smoke, make up, chemicals)

• s&s – chronic inflammation of the eyelid, erythema, greasy scaling of anterior eyelid, loss of eyelashes, seborrhea

dermatitis of eyebrows and scalp

Ulcerative- infection with staphylococcus or streptococcus

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