Eyes and Ears👁️👂

Alterations in Sensory Perception: Disorders of the Eyes and Ears

Differences between Child's Eye and Adult's Eye
  • Eye Color Determination: Occurs between 6 to 12 months of age.
  • Eye Size: The eyeball occupies significant space in the orbital cavity.
  • Lens Shape at Birth: Initially spherical, making distant vision limited.
  • Vision Distance at Birth: Infants can see 20 to 25 centimeters away.
  • Cones and Color Perception: Infants have fewer cones leading to blurry vision; optic nerve is not myelinated.
  • Visual Acuity: At birth about 20/100, improving to 100% by age 6-7.
  • Binocular Vision Development: Typically develops around age 4.
  • Tear Production: Infants do not produce tears in the first 2-4 weeks; absence suggests dehydration.
Assessment in Children’s Eye Health
  • Medical History: Look for prematurity, genetics, and any existing eye problems.
  • Current Symptoms: Note onset, progression, fever, nasal congestion, eye rubbing, sleep disturbances (risk of apnea).
  • Physical Examination:
    • Use ophthalmoscopy for retina and optic nerve check.
    • Assess eye position, symmetry, and conditions (strabismus, ptosis, edema, discharge).
  • PERRLA Assessment:
    • Pupils
    • Equal
    • Round
    • React to light
    • Light reaction
    • Accommodation
  • Labs and Diagnostics: Conduct cultures on any eye discharge.
Common Eye Disorders: Conjunctivitis
  • Definition: Inflammation of bulbar or palpebral conjunctiva.
  • Causes:
    • Infections: Viral (adenovirus, influenza), bacterial (Staphylococcus aureus).
    • Allergies: Exposure to allergens like pollen.
    • Chemicals: Irritants entering the eye.
  • Newborn Risk: Chlamydia and gonorrhea can cause conjunctivitis at birth.
Treatment by Type:
  • Bacterial: Antibiotic drops or ointments; assessed by purulent discharge and pain.
  • Viral: Symptomatic relief; characterized by watery discharge and photophobia.
  • Allergic: Antihistamines; watery, stringy discharge, and itching.
Education for Patients/Parents:
  • Contagion Risk: Highly contagious; wash hands to prevent spread.
  • Return to School: 24-48 hours after starting bacterial treatment; viral treatment depends on symptom resolution; allergic conjunctivitis requires hygiene measures.
Other Eye Disorders
  • Nasal Duct Obstruction:
    • Prevalence: 6-30% of children; 65% cases unilateral.
    • Resolution Rate: 90% resolve by 1 year.
    • Symptoms: Mucoid drainage from tears due to obstruction.
    • Action Required: Surgery if unresolved after 1 year; recommend eyelid cleansing and massage.
Refractive Errors

  • Myopia (Nearsightedness):

    • Characteristic: Difficulty seeing far away; common development between ages 8-12.
    • Pathophysiology: Light focuses in front of the retina.

  • Hyperopia (Farsightedness):

    • Characteristic: Difficulty seeing close; typical in children until 9 years.
    • Pathophysiology: Light focuses behind the retina; can lead to amblyopia if untreated.

  • Astigmatism:

    • Definition: Irregular curvature of the cornea leading to blurred vision.
    • Symptoms: Headaches, dizziness, eye fatigue, and nearness of paper while reading.

  • Strabismus:

    • Definition: Misalignment of the eyes; can be exotropia (outward) or esotropia (inward).
    • Treatment: Glasses, eye patches, or surgery.

  • Nystagmus:

    • Definition: Rapid, irregular eye movement; indicates issues with brain-eye coordination.
    • Associated Conditions: Often found in children with neurological problems or congenital cataracts.
    • Signs: Lack of eye contact, avoidance of bright lights, head tilt.
Summary Points
  • Recognize assessment signs to avoid misdiagnosis:
    • Eye twitching and lack of eye contact are critical indicators for further evaluation.
  • Evaluate and monitor all eye-related disorders regularly, especially in children due to the potential for rapid changes and progression.