PRESCHOOLERS

The mortality of children during the preschool years is low and becoming lower every year as more infectious diseases are preventable.

 Major Causes of DEATH Automobile Accidents Poisoning Falls

MINOR ILLNESES Colds Ear Infections Flu symptoms Vomiting Diarrhea

Room is quiet with no distractions Do not shine a spotlight on the chart Measure the distance It needs occluder No cheating

BROKEN WHEEL ACUITY TEST

LEA CHART

10 feet 20/100 to 20/15 3 out of 5

HVOT Chart

10 feet 20/200 to 20/20 5 out of 6

TUMBLING E Chart

10 feet 20/100 to 20/30 5 out of 6

SNELLEN Chart

AMBLYOPIA

lazy eye subnormal vision in one eye or children are using only one eye for vision while resting the other eye.

All school children should be screened for amblyopia by vision testing with a preschool E chart. The child with amblyopia will have 20/50 vision (normal for preschool age) in one eye. The other eye will show lessened vision (perhaps 20/100).

Amblyopia is correctible if treated during the preschool period. The good eye is covered with patch held firmly in place. This forces the child to use the poor eye to develop vision in that eye. Generally, the child has some difficulty initially adjusting to the patch and being unable to see well from the unpatched eye, possibly develops headaches and dizziness. The patch is removed for 1 hour/day to prevent amblyopia from developing in the non-amblyopic eye. Administration of levodopa Atropine to produce pupil dilatation

STRABISMUS

unequally aligned eyes (cross-eye) normally, the resting position of the eye is straight in strabismus, the resting position may be divergent (turned out) or convergent (turned in). One pupil may be higher than the other (vertical strabismus). May be monocular, in which the same eye deviates constantly. Or may be alternating strabismus, in which one eye deviates first, then the other.

infants eyes may cross occasionally until 6 weeks of age constant strabismus before 6 weeks of age need referral right away Deviations could be:
Exotropia eye turning out

Esotropia eye turning in

Hypertropia eye turning up

depends on the cause of the problem if the fusion mechanism is weak, eye exercises (orthoptics) may be necessary If eyes are diverging problem with convergence because of the nearsightedness or farsightedness, the child needs glasses to correct the basic visual defect if the misalignment is caused by unequal muscle strength, eye-muscle surgery is necessary antibiotic ointment is applied 2-3 days post operatively

ASSESSMENT occurs from 6 weeks of age through the preschool period located on the retina or in the vitreous fluid or extend backward into the choroids, the optic nerve and the subarachnoid space pupil appears white the child will develop strabismus as the eye becomes non-functional this tumor metastasizes along the course of the optic nerve to the subarachnoid space to the brain; it quickly involves the second eye. metastasis to distant body sites occurs because of the rich blood supply to the brain

RETINOBLASTOMA
malignant tumor of the retina of the eye

Cryosurgery freezing the tumor to destroy the local cells photo coagulation through laser surgery to destroy the blood vessels supplying the tumor radiation chemotherapy nitrogen mustard, vincristine, and cyclophosphamide if the tumor is large, enucleation is necessary. observe for bleeding on the dressing and monitor vital signs frequently. restrain the child to keep him from tugging at the dressing and removing it dressing is removed after 48 hours and small patch is applied irrigation with NSS or application of antibiotic ointment eye prosthesis is fitted 3 weeks after surgery

SIGNS AND SYMPTOMS Bacterial conjunctivitis is characterized by: o purulent discharge that causes the eyelids to stick together in the morning o Injected conjunctiva o minimal pain and short duration (1 to 3 days o Vision may be slightly blurred due to exudate Viral conjunctivitis is characterized by: o longer duration (14 to 21 days) o excessive tearing and minimal discharge

RED EYE (CONJUNCTIVITIS)

Bacterial conjunctivitis is very contagious. Instruct patients to wash their hands frequently, especially after applying eye medication. Instruct patient to keep the hands away from the eyes. Keep the child home from school for 2 to 3 days after starting medication.

STY

Also known as hordeolum staphylococcal infection of the sebaceous glands of the eyelids

SIGNS AND SYMPTOMS area of infection is usually red and tender

TREATMENT Application of hot soaks to the eye at least 4 times a day is indicated. If no relief occurs in 48 to 72 hours, incision and drainage may be necessary.

HEALTH TEACHING Instruct patients to keep their hands away from their eyes. Keep the eye area clean. Hot soaks are a very effective treatment if done 4 times a day.