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Eye and Vision Exams in the Outpatient Clinic

Eye and Vision Exams in the Outpatient Clinic. Erika Beard-Irvine MD LCDR MC (FS) USN. Objective. AAP practice parameters for red reflex and vision screening Techniques for red reflex and vision screening Disease processes Referral criteria. Terminology. Myopia.

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Eye and Vision Exams in the Outpatient Clinic

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  1. Eye and Vision Exams in the Outpatient Clinic Erika Beard-Irvine MD LCDR MC (FS) USN

  2. Objective • AAP practice parameters for red reflex and vision screening • Techniques for red reflex and vision screening • Disease processes • Referral criteria

  3. Terminology • Myopia http://www.ophthobook.com/chapters/pediatrics http://www.childrenshospital.org/az/Site1517/mainpageS1517P0.html

  4. Terminology • Myopia • Hyperopia http://www.childrenshospital.org/az/Site1517/mainpageS1517P0.html

  5. Terminology • Myopia • Hyperopia • Astigmatism http://www.childrenshospital.org/az/Site1517/mainpageS1517P0.html

  6. Terminology • Myopia • Hyperopia • Astigmatism • Amblyopia • Anisometropia http://www.ohioamblyoperegistry.com/

  7. Red Reflex Examination • Newborn examination • All routine health supervision visits http://www.bartsandthelondon.nhs.uk/forgps/checking_for_the_red_reflex_in_children.asp

  8. http://seeweimer.com/eye-anatomy/

  9. Technique • Ophthalmoscope power to 0 • Lights off • Simultaneously at 2-3 feet away • Separately at 12-18 inches away http://www.ophthobook.com/chapters/pediatrics

  10. Leukocoria http://www.daisyseyecancerfund.org/rb/eye/index.html http://www.orphancancer.org/ORbIT/leukocoria.html http://www.nature.com/onc/journal/v25/n38/fig_tab/1209622f1.html

  11. Differential of Leukocoria • Retinoblastoma • Congenital cataract • ROP • PFV • Coloboma • Uveitis • Toxocariasis • Coats’ disease • Vitreous hemorrhage • Retinal dysplasia

  12. Absent Red Reflex http://www.peds.ufl.edu/peds2/research/debusk/pages/page7_61.html

  13. Absent Red Reflex http://www.bartsandthelondon.nhs.uk/forgps/checking_for_the_red_reflex_in_children.asp

  14. Asymmetric Red Reflex http://www.abcd-vision.org/vision-screening/red-reflex.html

  15. Asymmetric Red Reflex http://www.abcd-vision.org/vision-screening/bruckner.html

  16. Asymmetric Red Reflex Mills, MD. “The eye in childhood,” Am Fam Physician. 1999 Sep 1;60(3):907-916.

  17. Eye Evaluation Ocular history Vision assessment External inspection of the eye and lids Ocular motility assessment Pupil examination Red reflex examination Attempt at opthalmoscopy (>3 yo)

  18. Ocular History • Does you child seem to see well? • Does your child hold objects close to his/her face when trying to focus? • Do your child’s eyes seem to cross or drift? • Do your child’s eyes appear unusual? • Do your child’s eyelids droop or does 1 eyelid tend to close? • Have your child’s eyes ever been injured? • Family history of eye disorders or early eyeglass wear.

  19. Vision Assessment • Fix and follow • Visual acuity measurement (>3 yo) • Photoscreening

  20. Photoscreening • Screening for amblyogenic factors: • Strabismus • Media opacities • Significant refractive errors • Evaluate photo of red reflex and pupillary light reflex • AAP says it could be helpful but recommends more study

  21. External Examination • Tearing or discharge • Corneal clouding http://www.mps1disease.com/en/patients/about/signs-and-symptoms/corneal-clouding.aspx

  22. External Examination • Tearing or discharge • Corneal clouding • Ptosis http://www.cosmeticeyesandface.com/Pediatrics.html

  23. External Examination • Tearing or discharge • Corneal clouding • Ptosis • Iris abnormalities http://www.glaucomaconsultantsnorthwest.com/glaucoma%20in%20children.html http://www.med.umn.edu/ophthalmology/faculty/schimmenti/home.html

  24. Corneal reflex test Extra-ocular movements Cover-uncover test Random dot E stereo test Ocular Motility

  25. Corneal Light Reflex http://www.wahajr.com/hajrvb/showthread.php?t=402925749&page=4 Mills, MD. “The eye in childhood,” Am Fam Physician. 1999 Sep 1;60(3):907-916. http://health.utah.gov/cshcn/HSVS/photo.html Mills, MD. “The eye in childhood,” Am Fam Physician. 1999 Sep 1;60(3):907-916.

  26. Corneal reflex test Extra-ocular movements Cover-uncover test Random dot E stereo test Ocular Motility

  27. Corneal reflex test Extra-ocular movements Cover-uncover test Random dot E stereo test Ocular Motility

  28. Random Dot E http://health.minnesota.gov/divs/fh/mch/webcourse/vision/mod7a.cfm

  29. Pseudostrabismus http://www.sarawakeyecare.com/Atlasofophthalmology/paediatric/paediatricophthalmologytpicture4.htm

  30. Pupil Exam http://www.atlasophthalmology.com/atlas/photo.jsf?node=5832&locale=en

  31. Referral Criteria • Leukocoria or absent red reflex • Any abnormality on exam • Persistent torticollis or head tilt • FHx of retinoblastoma • FHx corrective lenses in preschool or “lazy eye” • Parent concern

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