1 of 39

Course: Pediatric Nursing

Topic: Nursing Care of Child With Eye Disorders III

The Nurses International Community

Contact info: info@nursesinternational.org

2 of 39

COPYRIGHT

NI Privacy Policy and Terms of Use.

Contact info: info@nursesinternational.org

3 of 39

Module Goals

Learners will be able to:

Define refractive errors, amblyopia, nystagmus, and glaucoma.
List signs/symptoms of the above eye disorders in children.
Identify related diagnostic procedures.
Describe evidence-based management of the above eye disorders.
Discuss the nursing management of a child with the above eye disorders.

Contact info: info@nursesinternational.org

4 of 39

Visual Disorders

Refractive errors

Astigmatism
Myopia

Amblyopia
Nystagmus
Glaucoma

Contact info: info@nursesinternational.org

5 of 39

Refractive Error in Children

The eye is not able to properly focus images on the retina, causing blurred vision.

Common refractive errors in children

Myopia
Hyperopia
Astigmatism

Found to cluster in families

American Academy of Ophthalmology, 2014

Khazaine,2022

The Stanford Children's Health, n.d

Contact info: info@nursesinternational.org

6 of 39

Common Refractive Error

Myopia: (nearsightedness)

Close objects look clear, but distant objects appear blurred

Hyperopia: (farsightedness)

Distant objects look clear, but close objects appear unclear
Light from close objects cannot focus clearly on the retina

Astigmatism: (distorted vision)

An irregular curvature of the focusing surfaces of the eye
Distorts or blurs vision for both near and far objects

American Academy of Ophthalmology, 2014

Khazaine,2022

Contact info: info@nursesinternational.org

7 of 39

Refractive Error: Symptoms

Children are often not able to make their vision problems known or do not have symptoms
Signs to look for are:

Squint and frown when reading
Excessively blink or rub their eyes
Squinting and frowning
Headache
Poor school performance

Khazaine, 2022

Contact info: info@nursesinternational.org

8 of 39

Refractive Error: Diagnosis/ Treatment

Diagnosis:

Screening
Eye examination

Treatment:

Eye glasses
Contact lenses

Khazaine,2022

Contact info: info@nursesinternational.org

9 of 39

Critical Thinking Question

Which of the following statements are true regarding refractive error? (Select all that apply)

In myopia closer objects look clear, but distant objects appear blurred
In hyperopia, vision for both near and far objects are blurry
Vision should be assess in children with poor school performance
Children can usually identify problems with their vision

Contact info: info@nursesinternational.org

10 of 39

Amblyopia (Lazy Eye)

A type of poor vision that occurs in one eye
Starts in childhood
The most common cause of vision loss in children
Develops when there’s a breakdown in how the brain and the eye work together, and the brain is unable to recognize the sight from one eye

National Eye Institute, 2019

Contact info: info@nursesinternational.org

11 of 39

Amblyopia (Lazy Eye): Symptoms

Symptoms of amblyopia may be difficult to notice
A child with amblyopia may have poor depth perception (difficulty determining how near or far an object is)
May struggling to seeing and use compensation techniques:

Squinting
Shutting 1 eye
Tilting their head

National Eye Institute, 2019

Contact info: info@nursesinternational.org

12 of 39

Amblyopia (Lazy Eye): Risk Factors

Children at higher risk:

Prematurity
Small for gestational age
Family history of amblyopia, childhood cataracts, or other eye conditions
Developmental disabilities

National Eye Institute, 2019

Contact info: info@nursesinternational.org

13 of 39

Amblyopia (Lazy Eye): Causes

Unknown cause in most cases
Some eye conditions:

Refractive errors: (nearsightedness,farsightedness and astigmatism
Strabismus
Cataract

National Eye Institute, 2019

Contact info: info@nursesinternational.org

14 of 39

Amblyopia (Lazy Eye):Treatment

Treatment for its causes:

Glasses or contacts (for nearsighted or farsighted)
Surgery (for cataract)

The next step is to retrain the brain and force it to use the weaker eye and include:

Wearing an eye patch on the stronger eye
Putting special eye drops in the stronger eye (atropine)

**Important to start treatment early

National Eye Institute, 2019

Contact info: info@nursesinternational.org

15 of 39

Critical Thinking Question

Which of the following are the causes of amblyopia? (Select all that apply)

Strabismus
Cataract
Refractive errors
Premature birth
Normal vaginal birth

Contact info: info@nursesinternational.org

16 of 39

Nystagmus

A condition where the eyes move rapidly and uncontrollably

Usually affects both eyes
Movement occurs:

Side to side (horizontal nystagmus)
Up and down (vertical nystagmus)
In a circle (rotary nystagmus)

A child may tilt or turn their head to see more clearly

American Academy of Ophthalmology, 2022

Contact info: info@nursesinternational.org

17 of 39

Nystagmus: Forms

Infantile:

Often develops by 2 to 3 months of age
Tend to move in a horizontal swinging fashion
Associated conditions:

Albinism
Congenital absence of the iris
Underdeveloped optic nerves and congenital cataract

American Optometric Association, n.d

Contact info: info@nursesinternational.org

18 of 39

Nystagmus: Forms (Continued)

Spasmus nutans:

Usually occurs between 6 months and 3 years of age
Improves on its own ( by 2 -8 years of age)
Symptoms:

Often nods and tilts head
Eyes may move in any direction

Usually no treatment required

Acquired:

Develops later in childhood or adulthood

American Optometric Association, n.d

Contact info: info@nursesinternational.org

19 of 39

Nystagmus: Symptoms

Involuntary eye movement
Movement in one or both eyes
Objects may appear blurry and shaky
Nighttime vision problems or sensitivity to light
Balance problems and dizziness

American Optometric Association, n.d

Contact info: info@nursesinternational.org

20 of 39

Nystagmus: Diagnosis

Medical history to determine underlying health problems
Comprehensive eye examination:

Vision test
A refraction test to determine the correct lens power

Other tests:

Ear exam, neurological exam, brain MRI

Healthline

Contact info: info@nursesinternational.org

21 of 39

Nystagmus: Treatment

Depends on its cause

Congenital nystagmus lessens over the course of childhood without treatment.
Eyeglasses and contact lenses do not correct the nystagmus itself but help to improve vision.
Using large-print books, magnifying devices and increased lighting aid vision.
Rarely, surgery to alter the position of the muscles responsible for eye movement.

Healthline, American Optometric Association

Contact info: info@nursesinternational.org

22 of 39

Nursing Management

Assess for signs and symptoms
Quick referral of suspected cases to the specialist
Ensure child and family’s concerns are addressed appropriately
Assist child and family with access to support and resources in the community
Emotional support
Child and family education

About the disease process and treatment
Importance of eyeglass and contact lenses

Contact info: info@nursesinternational.org

23 of 39

What Would the Nurse Do?

Which of the following information is appropriate for the nurse to include in parent education session regarding their children with nystagmus? (Select all that apply)

It is a condition where eyes move rapidly and uncontrollably
Eyes may move side to side, up and down, or in circular motion
Both eyes are involved
Child will have night vision, sensitivity to light, and balance problems
Glasses or contact lenses usually correct the nystagmus

Contact info: info@nursesinternational.org

24 of 39

Glaucoma in Children

Eye disease that damages optic nerve causing loss of vision and blindness
Cause:

Eye usually either makes too much aqueous fluid too quickly or the fluid drains away too slowly
Results in high intraocular pressure (IOP)
High IOP causes damage to the optic nerve

Glaucoma UK, n.d.a

National Eye Institute, 2022

Contact info: info@nursesinternational.org

25 of 39

Normal Aqueous Fluid Circulation

Contact info: info@nursesinternational.org

26 of 39

Glaucoma

Contact info: info@nursesinternational.org

27 of 39

Glaucoma in Children: Types

Primary glaucoma:

Developmental abnormality of the anterior chamber (AC) angle
Cause ineffective aqueous fluid drainage and increased IOP
Most common in young children

Developmental anomaly in trabecular meshwork and anterior chamber angle

Secondary glaucoma:

Acquired conditions that lead to glaucoma
Primarily involve eye, or may be part of wider systemic condition

Glaucoma UK, n.d.a

National Eye Institute, 2022

Edmunds et al., 2015

Marchini, Toscani, & Chemello, 2014

Contact info: info@nursesinternational.org

28 of 39

Glaucoma in Children: Signs/Symptoms

In neonate and infants:

Excessive tearing
Hypersensitivity to light
Squeezing of the eyelids
Cloudy enlarged cornea
Enlarged eyeball

Older children:

Progressive nearsightedness
Strabismus, nystagmus
Blurry vision

Marchini, Toscani, & Chemello, 2014

Contact info: info@nursesinternational.org

29 of 39

Glaucoma in Children: Diagnostics

Family history of glaucoma, parental consanguinity, associated congenital defects.
Maternal history of infection (rubella) during pregnancy, and birth history (forceps use).
In older children, a history of trauma, ocular surgery, or corticosteroid.
Assessment child’s overall appearance, visual behavior, signs of nystagmus or strabismus.
Complete ocular assessment of eye structures including optic nerve head and IOP.

Marchini, Toscani, & Chemello, 2014

Contact info: info@nursesinternational.org

30 of 39

Glaucoma in Children: Management

Medical therapy

Topical eye drops or oral medications to lower IOP by either increasing the exit of fluid in the eye or decreasing its production.

Surgery or laser therapy to create drainage canal to drain fluid
Eye patching, glasses may also be prescribed for visual disorders like strabismus, nearsightedness

Marchini, Toscani, & Chemello, 2014

National Eye Institute, n.d.

Contact info: info@nursesinternational.org

31 of 39

Nursing Management of Glaucoma in Children

Assess and identify signs/symptoms for glaucoma
Quick referral of suspected cases to the specialist
Ensure child and family’s concerns are addressed appropriately
Assist child and family access support and resources in the community
Child and family counselling/education:

Administration of prescribed medication
Post-surgical care and education
Disease process

Contact info: info@nursesinternational.org

32 of 39

Critical Thinking Question

Which of the following is true regarding glaucoma? (Select all that apply)

Too much pressure on the optic nerve may cause glaucoma
Forceps delivery may also cause glaucoma
May have nystagmus, strabismus
Surgery or laser therapy may be indicated to reduce intraocular pressure

Contact info: info@nursesinternational.org

33 of 39

Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations.

AHRQ, 2020

Contact info: info@nursesinternational.org

34 of 39

Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may effect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

Contact info: info@nursesinternational.org

35 of 39

References:

American Academy of Ophthalmology. (2014). Refractive Errors in Children. https://www.aao.org/salud-ocular/consejos/children-refractive-errors

American Academy of Ophthalmology. (2022). What Is Nystagmus?. https://www.aao.org/eye-health/diseases/what-is-nystagmus

American Optometric Association. (n.d). Nystagmus. https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/nystagmus?sso=y

Bascom Palmer Eye Institute. (n.d.). Pediatric Glaucoma. The Samuel & Ethel Balkan International Pediatric Glaucoma Center. https://umiamihealth.org/en/bascom-palmer-eye-institute/specialties/glaucoma/pediatric-glaucoma

Contact info: info@nursesinternational.org

36 of 39

References:

Edmunds, B., Loh, A.R., Fenerty , C., & Papadopoulos, M. (2015, November 1). Secondary Glaucoma: Glaucoma Associated with Acquired Conditions. American Academy of Ophthalmology. https://www.aao.org/disease-review/secondary-glaucoma-glaucoma-associated-with-acquir

Erickson, A. (2019). Causes of Uncontrolled Eye Movements and When to Seek Help. [Review of article ‘Causes of Uncontrolled Eye Movements and When to Seek Help’ by B. Alana]. Healthline. https://www.healthline.com/health/nystagmus

Glaucoma UK. (n.d.a). What is glaucoma?. https://glaucoma.uk/about-glaucoma/what-is-glaucoma/

Contact info: info@nursesinternational.org

37 of 39

References:

Glaucoma UK. (n.d.b). Glaucoma in babies and children. https://glaucoma.uk/about-glaucoma/what-is-glaucoma/glaucoma-in-babies-and-children/

Khazaine, L. M. (2022). Refractive Disorders in Children. MSD Manual. https://www.msdmanuals.com/home/children-s-health-issues/eye-disorders-in-children/refractive-disorders-in-children

Marchini, G., Toscani, M., & Chemello, F. (2014). Pediatric glaucoma: current perspectives. Pediatric Health Med Ther, 5:15-27. https://doi.org/10.2147/PHMT.S44709

MedlinePlus. (n.d.). Slit-lamp exam. https://medlineplus.gov/ency/article/003880.htm

Contact info: info@nursesinternational.org

38 of 39

References:

National Eye Institute. (2019). Amblyopia (Lazy Eye). https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/amblyopia-lazy-eye#:~:text=Amblyopia%20

National Eye Institute. (2022, April 21). Glaucoma. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma

NHS. (2020). Astigmatism. https://www.nhs.uk/conditions/astigmatism/

The Stanford Children’s Health. (n.d). Refractive Errors in Children. https://www.stanfordchildrens.org/en/topic/default?id=refractive-errors-in-children-90-P02098

Contact info: info@nursesinternational.org

39 of 39

Please go to

My Learning Experience

to provide feedback on your experience.

Thank you, and come back soon!

Contact info: info@nursesinternational.org