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14 Cards in this Set
- Front
- Back
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Age to receive eye examination schedule (4) (American Optometric Association) |
1. 3-6 month - vision system is growing rapidly - most components of vision developed by 1 year - early detection = early treatment
2. 2-3 years - vision problem occur, e.g. accommodative esotropia and meridional amblyopia - children begin to communicate - easy to examine (less fearful to examine)
3. 5/6 years (before entering primary school) - ensure children entering primary school with optimal vision for learning - detect problem before they impact on learning
4. Yearly afterward - vision demand change with academic skill increase - learning to read (check visual perceptual skill if learning difficulty) - reading to learn: small print (accommodation, binocularity and ocular motor problem) - refractive error change |
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General guideline for a productive pediatric examination (5) |
1. Be flexible 2. Be adaptive 3. Work efficiently 4. Appropriate clothing 5. Have fun |
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Objective of a pediatric examination (5) |
1. Complaint - history taking
2. Children vision state - VA taking, contrast sensitivity
3. Significant refractive error - refractive (objective)
4. Children binocular status - cover test, motility, stereopsis, accommodation and vergence
5. Children ocular health - ocular health check
Colour vision, visual field |
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History taking guideline in general (4) |
1. Open ended 2. Take and record negative history 3. Ask questions aimed at excluding condition 4. Good manner |
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History taking (7) |
1. Observation (start at waiting area)
2. Chief complaint
3. Birth history - prenatal (during pregnancy) - perinatal (at birth)
4. Development history since birth
5. Progress at school
6. Present medical history
7. Family history |
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Observation (6) |
1. Posture 2. Head tilt 3. Dace turn 4. Eye turn 5. Hard blinking 6. Eye rubbing |
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Chief concern (4) + Follow up (5) + Possible cause (6) |
1. Failed a vision screening 2. Difficulty seeing blackboard 3. Appear to have an eye turn 4. Hold book close to eye Follow up 1. Onset 2. Frequency, duration 3. Type: stability (changing), severity 4. Associated symptom/ sign 5. Previous treatment Possible cause 1. Rx 2. BV anomalies 3. Eye disease 4. Systemic disease 5. Drug related 6. Trauma |
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Birth history During pregnancy (4) At birth (5) |
During pregnancy 1. Maternal age - older mother (>35 years): strabismus, high Rx, nystagmus, Down's syndrome - young mother: poor vision (low birth weight)
2. Maternal health - Q: did you keep well yourself during your pregnancy - viral infection - diabetes - Rubella (Rubella virus 德國麻疹) - if congenital: cloudy cornea, deafness, developmental delay, excessive sleepiness, irritability, low birth weight, intellectual disability, seizure, small head size, skin rash at birth - mumps 痄腮, measles 麻疹 or other fever producing diseases - smoking (colic 絞痛), alcohol, excessive coffee
3. Toxaemia of pregnancy 妊娠毒血症 - sign and symptom: high blood pressure, protein in urine - cause: blood vessel supply to placenta do not develop well
4. Rhesus (Rh) factor - another blood system (~ABO system) - Rh incompatibility during pregnancy
At Birth 1. Full time/ premature 37-38 weeks 2. Delivery: induced/ forcep - if forcep delivery: - may cause swelling in area of lateral rectus - if distressed, may cause mental/ physical retardation - 10X chance to have squit - delivery straight forward 3. Apgar score >=7 4. Normal birth size and weight 5. Small for dates: increase risk of squit/ amblyopia |
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Apgar test (5) + Apgar score (5) |
Give to baby twice - once at 1 min after birth - again at 5 min after birth Apgar test 1. Appearance (skin color) 2. Pulse (heart rate) 3. Grimace reflex (reflex) 4. Activity (muscle tone) 5. Respiration (breathing rate and effort)
Apgar scoring - score >=7 = good health 1. Appearance (skin color) - 2 scores: normal colour all over (hand and feet are pink) - 1 score: normal colour (but hand and feet are bluish) - 0 score: bluish grey or place all over
2. Pulse (heart rate) - 2 scores: normal (>100 beats/min) - 1 score: < 100 beat/min - 0 score: absent (no pulse)
3. Grimace (reflex irritability) - 2 scores: pulls away, sneeze, cough, cries with stimulation - 1 score: facial movement only with stimulation - 0 score: absent (no response to stimulation)
4. Activity (muscle tone) - 2 scores: active, spontaneous movement - 1 score: arms and legs flexed with little movement - 0 score: no movement, floppy one
5. Respiration (breathing rate and effort) - 2 scores: normal rate and effort, good cry - 1 score: slow/ irregular breathing, weak cry - 0 score: absent (no breathing) |
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Development history (4) Medical history (2) Family history (4) |
Developmental history 1. Cerebral damage/ cerebral palsy 2. Hearing problem 3. Motor development 4. Cognitive development
Medical history 1. Recent infection 2. Recent medication - Tetracycline: tooth staining - Antibiotic taken at young age/ by mum during pregnancy
Family history 1. Squit (strong association) 2. Amblyopia 3. High Rx 4. Inherited condition - ptosis - nystagmus - aniridia - congenital cataract |
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Down syndrome (6) + (4) |
Main visual problem 1. High myopia 2. Astigmatism 3. Poor accommodation 4. Esotropia 5. Nystagmus 6. Cataract - given educational problem that children may face (appropriate spectacule for distance/ near)
Other 1. Oblique orbital fissure: prominent epicanthus 2. Conjunctiva is more prone to infection and chronic inflammation - thickening of membrane 3. Dry and flaskey skin - more to have blepharitis 4. Hypoplasia of iris, Brushfield spot - small, white or grayish/brown spots elevated on the periphery of the iris - aggregation of connective tissue (iris stroma) |
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Cerebral palsy (8) |
1. Loss of movement/ loss of other nerve function 2. Caused by injury to brain during fetal development/ soon after birth 3. Affect 2-4/1000 people (0.2-0.4%) 4. Increase muscle tone (spasticity 痙攣) 5. Paralysis 6. Speech abnormalities 7. Intellect from normal to severe retardation 8. No contagious (infections), do not get better |
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Deafness (2) |
1. Half of congenitally deaf children: ocular problem 2. Can identify hearing problem through eye exam |
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Risk factor for squint/ amblyopia (8) |
1. Family history of squint/ amblyopia 2. Family history of inheritable eye condition 3. Mother age (old/ young) 4. Poor maternal health/ diet 5. Brain damage 6. Prematurity (Small for date) - low birth weight 7. Difficult birth (forcep delivery) 8. Congenitally deaf |
