9/4/2012 Vision Screening Minimalism The Eagles Eye Mobile, and what we offer An eye health first-aid kit: What An eye health first aid kit: What Carter Liotta, OD every nurse should have and why St. Christopher’s Hospital for Children Staff Optometrist, Eagles Eye Mobile Pinkeye, lumps and bumps Optic nerve largeness PA Code mandates snellen In other words… vision screening yearly. Your vision screenings must DOH Procedures Manual guides include eye chart testing. nurses toward plus lens testing Your vision screenings should Y i i i h ld and depth perception testing ideally include plus-lens and once, preferably in 1 st grade. stereopsis testing if never if never done done Color vision testing is be befo fore. recommended, but not Prioritize color vision screenings required. last. Distance and Near Acuities Beginning in October, for Eye Alignment Elementary and Middle Schools Depth Perception One-day as-many-as-we-can- Autorefraction (plus lens) see vision screenings see vision screenings Students will pass, be referred to Students will pass, be referred to EEM, or be referred to Eye Mobile staff ophthalmology through the Team of volunteers nurse. Dawn keeps paperwork at the end Overseen by the nurse of the day; nurse gets it back in …and by Dr. Liotta. one week. Schools with least nurse Results are entered into the e- record system by the nurse. coverage prioritized first 1
9/4/2012 A central, localized room to The Eagles Eye Mobile serves Elementary and Middle Schools in which students can be called the SDP, subject to the economics down en masse . of the surrounding area. Administrative support Children who fail your vision screening and have not been seen i d h b Support from teachers for about on the Eye Mobile in the past school 20 minutes. year may use the service. Lots of help identifying kids, Consent is needed from the parents. calling down classrooms, and Glasses and initial follow-up, if moving them through. needed, are at no cost to the kids and their families. All of the kids in the school Most kids needing glasses will are screened. Some do not receive them within 3 weeks. pass. The optician will call you to schedule the fittings. Consents go home for kids Some kids will need more Some kids will need more who do not pass. h d t advanced care. When 20+ consents have They may or may not get been returned, nurse glasses first. confirms Eye Mobile visit Referral consents will be given with outreach worker. to you. Send them home, and Eye Mobile visits the school. when they come back we will schedule the referral bus. Know your secondary contact. Treatment of common eye conditions in your office is Be mindful of how long g l limited, but it’s surprising d b ’ screenings take before what you can diagnose and scheduling with Dawn. treat with little equipment. 2
9/4/2012 Can be used to “shed light on the A penlight situation,” and in combination A small magnifying glass with a magnifying glass. An ice pack Can be used as a fixation target Saline solution as a child looks up, down, left right, etc. right etc Bland ophthalmic Bland ophthalmic ointment Can be used to check pupils for dilation. Should constrict. Q-Tips Check each eye individually, Baby Shampoo looking for the same response in Cup and Tape either eye. Your hand Shine light into one eye and look at the other. The eye wi with thout the A Pen A Pen an and Pad d Pad light should constrict as much as the one wi with th the light in it. Bumps, bruises and the Bland, Bland, Bland! occasional periorbital hematoma. Saline, especially in “Sensitive Use your penlight. Eyes” formulation, is great for flushing & rinsing contacts. Subconjunctival hemmorage is common, and will resolve. Large bottles should be replaced yearly. yearly Hyphema is NOT a good sign, H h i NOT d i and should be sent to the ER. Smaller bottles can be squeezed onto the back of school Ice packs can also be used to administrators pants, unnoticed. help relieve seasonal allergy and conjunctivitis (pinkeye) – just Eye lubricant is often marketed dispose of it when finished. as “night time” lubricant. Ice packs can be effective The thickness, dotted on a Q-tip, placebo treatments can help remove foreign bodies. Cup and Cup and tape tape foreign objects. Use on a washcloth Remember: For an acid or base to gently clean burn to the eye (cleaning agents, bleach, etc)… oozing, crusty eyes. Run under lukewarm tap water for 15 minutes. Use with a Q-Tip to Q p Find out EXACTLY what got into Find out EXACTLY what got into help control the eye, if you can. Call the nearest eye hospital ER blepharitis for further instruction. “No Tears” formula No Conditioner! 3
9/4/2012 Your hand is a powerful tool in A pen and pad are crucial in the determining the severity of an eye nurse’s office, for two reasons. turn. Please wash it first. Patient History (Dr. Flops) Have the student look at your nose. ◦ Duration – How long does it last? Cover the eye staring at you. ◦ Relief? – What brings relief? Does the turned eye take up y p Frequency How often does it happen? ◦ Frequency – How often does it happen? fixation? ◦ Laterality/Location When you uncover the eye, what ◦ Onset – When did it start? happens? ◦ Pain – Scale of 1-10 ◦ Symptoms? Constant vs. Intermittant Document, Document, Document!! Alternating vs. R or L Eso vs. Exo Pair this information w/ Depth Perception. The public at large is horrified of pinkeye, or Allergic conjunctivitis follows most major conjunctivitis seasonal allergy symptoms. It is not contagious More likely to get questions, comments and calls from parents about a pinkeye epidemic Treatment includes systemic medication that than a contagious stomach flu. may already be taken (Claritin, Benadryl) Cool compresses Conjunctivitis comes in three flavors Artificial Tears ◦ Allergic OTC Drops – Zaditor or Alaway ◦ Bacterial recommended. Visine advised against for ◦ Viral more than very occasional use. Hallmark of Bacterial conjunctivitis is slimy discharge. Viral conjunctivitis is the most Lids stick together, and heavy crusting – especially in common form of “pinkeye.” morning. The stereotype of pinkeye spreading Gritty, itchy and sometimes painful. like wildfire is based on viral conjunctivitis, which spreads like any Can affect one or both eyes. virus or common cold. Treatment with antibiotics is indicated, but overused. , Lids may be crusty with some Lids may be crusty with some Inform the parent that a doctor visit is necessary and an discharge, but not thick and yellow. antibiotic needed, just to cover your bases. Eyes appear pink (not red) watery, and glazed. When parents ignore your advice, remember that even Follicles (bumps) under the lid are a without treatment, bacterial conjunctivitis will generally hallmark. self-resolve unless the bacterial strain is stubborn. Don’t share towels and washcloths Studies show that antibiotics reduce duration from 4.8 Use artificial tears and warm to 3.3 days. compresses Should self-resolve in 3 weeks. 4
9/4/2012 Excessive pain, chronic blur and prominent light sensitivity are generally not symptoms All of that being said, the $64,000 of basic conjunctivitis, and may be signs of question about pinkeye is… a more serious eye condition. Should I keep my child home from An antibiotic/steroid combination such as school? For how long? Tobradex Zylet or Maxitrol ($4) can ease Tobradex, Zylet or Maxitrol ($4) can ease There is no clear-cut answer. There is no clear cut answer. If a child is school-age and can be redness in more mild cases of good about washing his/her hands, conjunctivitis. An eye exam is needed first. there’s no reason to keep them out of school. Parent education that most cases of pinkeye Toddlers, preschoolers, and younger are “a cold in the eye” can ease tensions, kids may more easily transfer germs. but where diagnostic abilities are limited, If keeping them at home, they may refer! return when the visible symptoms subside, usually in a few days. Acute Onset Hordeolum are Hot and they Hurt Very common in kids. Why? Because they’re a Two varieties: Chalazion and bacterial infection H Hordeolum (stye) d l ( t ) Usually a small bump on Caused by gland the margin of the eye. blockages in the eye lid. Avoid makeup, eyeliner, etc. Warm compress Do not try to pop it. Chronic Optic nerve is the “pipe” that Blocked meibomian connects your eyes to your brain. gland The opening of the pipe Painless (“cup”) should be smaller than Some resolve with the walls of the pipe (“disc”). In glaucoma, a larger cup In glaucoma a larger cup warm compress could indicate disease Some have to be African-Americans often have surgically removed larger cups, which can be confused for glaucoma and biopsied. When this happens, it is A hordeolum, if not prudent for more tests to be treated, can become a run. Eye pressure tests, photos, chalazion and a visual field 5
9/4/2012 Please ask any questions you may have at this time Thank you for your time and attention! 6
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