Untitled Flashcards Set

STRUCTURAL PROBLEMS OF THE EYE • Structural problems of the eye tend to be congenital or already present at birth. PTOSIS •the inability to raise the upper eyelid, the usual distance, so the eyelid always remains slightly closed. ASSESSMENT • children tend to wrinkle their forehead and raise their eyebrows more than usual in an attempt to lift the eyelid further or cock their heads back to see under the lowered lid. • The condition may be congenital (frequently hereditary and bilateral) or acquired (usually unilateral. • It may be a result of injury to the lid or levator muscle, injury to the third cranial nerve, or from the development of myasthenia gravis • If the third cranial nerve has been injured, paralysis of one or more of the other muscles supplied by that nerve will also be affected and a child will exhibit: •A dilated pupil •An inability to rotate the eye globe upward, medially, or downward •Weakness of accommodation (looking at near objects) MANAGEMENT •After a careful investigation of the cause has been completed, ptosis is corrected surgically. •The correction is usually important to the child from a cosmetic standpoint, but if the ptosis is unilateral, and more importantly, if the lid obstructs vision, early surgery is necessary to prevent the development of amblyopia (from a lack of use of the closed eye. • Be certain that parents understand it's important that ptosis be corrected during the preschool period because although the ptosis can be corrected when the child is older, the amblyopia cannot. STRABISMUS • is unequally aligned eyes (cross-eyes) caused by an imbalance of the extraocular muscles that control the movement of the eye globes, similar to the handling of reins of a horse. • Approximately 1% to 2% of children demonstrate some degree of strabismus. • The condition does not favor either gender, social status, or geographic area; about 30% of children have a history of a similar strabismus in the family. ASSESSMENT • Infants' eyes may cross occasionally until 6 weeks of age. Definite deviations are obvious at a physical exam Note if the deviation is: • exotropia (an eye turns out) • esotropia (an eye turns in) • or hypertropia (an eye turns up). • may be detected best when children are asked to examine a nearby object because to do this, they must turn both eyes medially, or converge, to focus at the short distance. • If farsighted in one eye, they will have to turn the affected eye in more than the other, causing esotropia. • If one eye is nearsighted, they will not need to turn that eye in as far as the other one; this results in divergence or exotropia. Paralytic strabismus is caused by paralysis of a muscle or nerve, perhaps from an injury (such as a birth injury), or an invading lesion. • The eyes appear straight except when they are moved in the direction of the paralyzed muscle. Then, double vision occurs, and the crossed eye is evident. • Such children often close one eye or tilt their head to decrease the double vision. • They may tilt their head so much that they appear to have a torticollis or "wry neck"—an orthopedic rather than an eye problem. • They may appear clumsy because of the diplopia. MANAGEMENT • The therapy for strabismus depends on the cause OF THE PROBLEM • The therapy for strabismus depends on the cause of the problem. •If the fusion mechanism is weak, eye exercises (orthoptics) can strengthen the weak muscle • If eyes are diverging because of farsightedness or nearsightedness, the child needs glasses or contact lenses to correct the basic visual defect. •Surgical treatment can be used to permanently align the extraocular muscles if the cause is due to muscle strength. • A side effect of strabismus can be amblyopia because, to avoid double vision, the child suppresses the vision in one eye. contact lenses to correct the basic visual defect. • Surgical treatment can be used to permanently align the extraocular muscles if the cause is due to muscle strength. • A side effect of strabismus can be amblyopia because, to avoid double vision, the child suppresses the vision in one eye. • For this reason, eye correction for strabismus must be done early in life, before 7 years of age.. • After strabismus surgery, eye patches are not usually required. • Postoperatively, antibiotic ointment is applied to the eye for 2 or 3 days. • The child may experience some pain on eye movement for the first day as well as nausea and vomiting. • Follow-up visits after surgery are necessary to determine the success of the surgery. •Retest children who have had this surgery periodically at health maintenance visits to be certain their vision remains equal and eye alignment remains straight.