PROBLEM BASED LEARNING

ON EYE DISORDERS

SUBMITTED TO: SUBMITTED BY:

MRS. BABY UMA [Link] BLESSY
PROFFESSOR I YEAR [Link](N)
NNC, VALLIOOR NNC,VALLIOOR
Name of the student teacher : M. Grashia Blessy

Name of the subject : Child Health Nursing

Name of the Unit :

Name of the Topic : Eye Disorders

Class of group / batch : III Year B. Sc

Size of the class :

Date and time :

Venue :

AV aids :

Methods of Teaching :

Previous knowledge of the group : Students have learnt about the anatomy and physiology of eye in their first year.

CENTRAL OBJECTIVES:

Helps the students to gain adequate knowledge regarding the eye disorders and develop their positive attitude and skills while
practicing the learning method.
SPECIFIC OBJECTIVES:

Students will be able to:

 understand the anatomy of eye.

 list the different types of eye disorders.
 define conjuntivities, its etiology.
 understand the pathophysilogy of conjunctivitis.
 will be able to list the clinical features of conjunctivitis.
 describe the diagnostic evaluation, management and prevention of conjunctivitis.
 define ophthalmia neonatrum.
 list the etiology.
 describe the mode of infection, pathology, clinical features of ophthalmia neonatrum.
 elaborate the management, prevention and complications of ophthalmia neoonatrum.
 define retinitis.
 describe the etiology, Pathophysiology and clinical features of retinitis.
 elaborate the diagnostic evaluation and management of retinitis.
 define stye.
 describe the etiology, clinical feature, management and prevention of stye.
 define cataract.\\
 explain the types, etiology, and patho physiology.
 elaborate on the diagnostic evaluation, management and post operative care of cataract.
 define glaucoma.
 list the types of glaucoma.
 explain the Pathophysiology of glaucoma.
 enumerate the clinical features of glaucoma.
 elaborate the diagnostic evaluation, management and post operative care of glaucoma.
 define ptosis.
 explain the etiology, diagnostic evaluation and management of ptosis.
 understand refractive errors and gain knowledge about incidence and etiology.
 list the types of refractive errors.
 define myopia.
 explain the Pathophysiology, clinical features and management of myopia.
 define hyperopia.
 explain the pathophysilogy of hyperopia.
 list the clinical features and management of hyperopia.
 define Astigmatisms
 list the types of astigmatism.
 explain the Pathophysiology and management of astigmatism.
 define strsbismus.
 explain the types of strabismus.
 explain the diagnostic evaluation of strabismus
 explain the medical and surgical management.
 describe nursing management and nursing interventions for strabismus.
 define Amblyopia.
 explain the clinical features, diagnostic evaluation, and management.
 understand what retinopathy is.
 explain about congenital blindness.
 explain retinitis pigmentosa.
 explain about leber’s congenital amaurosis.
 explain congenital glaucoma.
 explain about dermoid cysts.
 list the warning signs of Dermoid cysts.
 Teacher’s Learner’s Av
Time Objectives Content Evaluation
activity activity aids
Students will ANATOMY OF THE EYE: Lecturing Listening Black What is the
board anatomy of
understand the The human eye is a complex anatomical device that
eye?
anatomy of eye. remarkably demonstrates the architectural wonders of the human
body. Like a camera, the eye is able to refract light and produce a
focused image that can stimulate neural responses and enable the
ability to see.
The eye is essentially an opaque ball filled with a water-like
fluid. In the front of eyeball is a transparent opening known as the
cornea. The cornea is a thin membrane that has a refraction index of
approximately 1.38. The cornea serves dual purpose of protecting the
eye and refracting light as it enters the eye. After light passes through
the cornea, a portion of it passes through an opening known as the
pupil. Rather than being an actual part of the eye’s anatomy, the pupil
is merely an opening. The pupil is the black portion in the middle of
the eyeball. Its black appearance is attributed to the fact that, the light
that pupil allows to enter the eye is absorbed on the retina (and
elsewhere) and does not exit the eye.
Like the aperture of a camera, the size of pupil can be
adjusted by dilation of the iris. The iris is the coloured part of the eye
– being blue for some people and brown for others (and so forth). It is
a diaphragm that is capable of stretching and reducing the size of the
pupil opening. In bright-light, the iris adjusts its size to reduce the
pupil opening and limit the amount of light that enters the eye. In
dim-light situations, the iris adjusts so as to maximize the size of the
pupil and increase the amount of light that enters the eye. Light that
passes through the pupil opening will enter the crystalline lens. The
crystalline lens is made up of layers of a fibrous material that has an
index of refraction of roughly 1.40. Unlike the lens on a camera, the
lens of the eye ia able to change its shape and thus serves to fine-tune
the vision process. The lens is attached to the ciliary muscles. These
muscles relax and contract in order to change the shape of the lens.
By carefully adjusting the lens shape, the ciliary muscles assist eye in
the critical task of producing an image on the back of the eyeball.
The inner surface of the eye is known as the retina. The retina
contains the rods and cones that serve the task of detecting the
intensity and frequency of the incoming light. An adult eye is
typically equipped with up to 120 million rods that detect the
intensity of light and about 6 million cones that detect the frequency
of light. These rods and cones send nerve impulses to brain. The
nerve impulses travel through a network of nerve cells. There are as
many as one million neural pathways from the rods and cones to the
brain. This network of nerve cells is bundled together to form the
optic nerve on the back of the eyeball. Each part of the eye plays a
distinct part in enabling humans to see.

NORMAL DEVELOPMENT OF EYE:

The eye starts developing at about 22 days of gestation. This
development is not complete at birth. However, the newborn is able
to focus on an object at a distance of 3feet. Sensitivity to brightness
develops rapidly in the first 2 months of life and infant displays
blinking reflex. By 4-6 months of age the infant has visual
accommodation (ability of the eye to focus clearly on objects at all
distances) equal to an adult. ‘Binocularity’ (fixing of two ocular
images into one picture) is also established by 6 months of age.
 ‘visual acuity’ (clearness or sharpness of image) changes win age,
from 20/50 at 18 months to 20/20 at 4 year of age. At birth, the
colour of iris is blue or light grey in fair newborns and brown in dark
newborns. Permanent eye colour may not appear until 1 year of age.
DISORDERS OF EYES:
A. INFECTIOUS AND INFLAMMATORY CONDITIONS OF
Students will be EYES Lecturing Listening Tree What are
chart the different
able to list the 1. Conjunctivitis
types of eye
different types of 2. Ophthalmia neonatrum disorders?
eye disorders. 3. Retinitis
4. Stye (Hordeolum)
B. NON INFLAMMATORY CONDITIONS OF EYE
1. Cataract
2. Glaucoma
3. Ptosis
4. Refractory errors
a. Myopia (near sightedness)
b. Hyperopia (far sightedness)
c. Astigmatism ( blurted vision)
C. DISORDERS OF IMPAIRMENT OF EYE MUSCLES
1. Strabismus (squint)
2. Ambyopia
 D. LESS COMMON EYE DISEASE IN CHILDREN
1. Retinopathy of prematurity
2. Familial (congenital) blindness
3. Retinitis pigmentosa
4. Leber’s congenital amaurosis
5. Congenital glaucoma
6. Dermoid cysts
E. BLINDNESS
Now we can see in detail about the disorders of eyes.
A. INFECTIOUS AND INFLAMMATORY CONDITIONS
OF EYES:
1. CONJUNCTIVITIS
Students will be Definition: Lecturing Listening Roller What is
board conjunctivit
able to define Conjunctivitis (“pink eyes”) is an inflammation of the
is, and list
conjuntivities, its conjunctiva of eye. down the
aetiology of
etiology. Etiology:
conjunctivit
Conjunctivitis during childhood is caused due to allergy or is?
infection by bacteria or virus. The most common bacterial causes
are hemophilus influenza, streptococcus pneumoniea and
Chlamydia. Viruses that cause conjunctivitis are Adenovirus and
Herpes virus.
 Pathophysiology:
Students will be Microbes enter the eye on contact with infected object
Lecturing Listening chart Explain the
able to understand Pathophysio
logy of
the Inflammation of eye
conjunctivit
pathophysilogy of is.
conjunctivitis. Dilation of blood vessels of eye

Swelling, redness, exudates and discharge

Clinical features:
The clinical features of conjunctivitis include –
Students will be  Redness of eye (Hyperemia) Lecturing Listening chart Enumerate
the clinical
able to list the  Tearing and itching in eyes
features of
clinical features  Exudation (flaky and sticky substance on eye lid conjunctivit
is.
of conjunctivitis. margins)
Other symptoms may include –
 Photpphobia
 Pseudoptosis (droping of upper eye lid)
 Periorbital cellulitis
 Pain in eye
 Fever
When a viral infection is the cause, the child may also have
fever, sore throat and runny nose.
 Diagnostic evaluation:
Students will be The diagnosis is made mainly on the basis of clinical
Lecturing Listening OHP Explain the
able to describe features. A culture of the drainage may be obtained to confirm the diagnostic
evaluation,
the diagnostic diagnosis.
managemen
evaluation, Management: t and
prevention
management and Treatment depends upon the type of conjunctivitis –
of
prevention of Causes Associated symptoms Management conjunctivit
is
conjunctivitis. 1. Viral Often associated with  Hygiene
other symptoms of  Rest
generalized viral illness.
2. Bacteri Yellow, green or white  Antibiotic eye
al pus with photophobia. drops or
ointment with
hygiene.
3. Chlam Cough, history of  Systemic
ydial maternal infection. Pain, antibiotics
photophobia and skin  Evaluation by
lesions. specialist.
 Antiviral
agents
4. Allergi Itching, seasonal onset  Antihistamine
c of symptoms, other eye drops
 allergic features, watery  Avoidance of
discharge. allergens.
5. Chemi Watery discharge, onset  Avoidance of
cal of symptoms when irritating
exposed to cigarettes or substances.
other irritants.
6. Traum Pain, photophobia and  Eye patch
a increased tear production  Referral to
specialist

Prevention:
If conjunctivitis is allergic or viral in origin, nursing
management focuses primarily on comfort measures. Following
nursing care needs to be given –
 Apply cold compress on the eye.
 Reduce exposure to light.
 Prevent rubbing of the eye.
 Acetaminophen may be administered to relieve
discomfort.
If conjunctivitis is caused by bacterial agents, nursing care
includes:
 Clean the eye using sterile water and cotton swabs,
 from inner canthus to outer canthus.
 Apply the prescribed antibiotic ointment or eye drops.
 Use of dark glasses is advised, in presence of
photophobia.
Family Teaching:
Advise the following ways to prevent transmission of
infection to others:-
 Use good hand washing after touching the eye.
 Use separate towel, sheet and pillow case for infected child.
 Do not allow the medicine dropper to touch child’s eyes
during medication instillation.
 Discard old contact lenses (if child is using) and use new ones
after infection has resolved.
2. OPHTHALMIA NEONATRUM:
Definition:
Students will be Purulent discharge from eye of a newborn, within 21 days
Lecturing Listening Roller What is
able to define of birth is known as ophthalmia neonatrum. Most cases develop board ophthalmia
neonatrum.
ophthalmia this condition within 48-72 hours of life. It is mostly bilateral.
neonatrum. Etiology:
The organisms that may cause ophthalmia neonatrum are –
Students will be Neisseria gonorrhoea, Staphylococcus aureus, [Link], Lecturing Listening chart Enumerate
the etiology
able to list the pseudomonas aeruginosa, certain viruses and Chlamydia
of
etiology. trachomatis. ophthalmia
neonatrum.
Mode of infection:
The mode of infection include:-
1. Intrauterine infection
Students will be 2. Infection during the process of delivery (most common) Lecturing Listening Flann Explain the
el mode of
able to describe 3. Infection after birth
board infection,
the mode of Pathology: pathophysio
logy,
infection, Due to infection, the blood vessels dilate and there is
clinical
pathology, formation of new blood vessels around the papillae. Numerous features of
ophthalmia
clinical features polymorphs are present in the epithelium which leads to purulent
neonatrum
of ophthalmia discharge and exudates formation in the eye.
neonatrum. Clinical features:
It is a bilateral infection which has the following clinical
manifestations:-
 Eyelids are tense and swollen.
 Conjunctiva is congested and swollen.
 Excessive tearing or turbid and thick discharge from eyes.
Management:
i. A swab must be taken from purulent eye discharge and
sent for culture and sensitivity. Depending upon the result,
Students will be the physician prescribes appropriate antibiotic ointment or
Lecturing Listening OHP Describe
able to elaborate eye drops. Crystalline Penicilline, Chloramphenicol,
about the
the management, Erythromycin or Gentamycin eye drops may be prescribed managemen
tDescribe
prevention and by the physician. Polymixin is used for pseudomonas
about the
complications of infection. managemen
t,
ophthalmia ii. Eye care:
Lecturing Listening OHP prevention
neonatrum. The infected eye or eyes are cleaned with strile and
complicatio
swabs moistened with normal saline. Each swab will be
ns of
used once only for wiping the eye from inner canthus to ophthalmia
neonatrum.
outer canthus. Wash eyes as frequently as possible with
warm sterile normal saline.
iii. After cleaning of eyes, instill crystalline penicillin eye
drops.
 Every 5 minute for ½ hour
 Every 1 hour for 12 hours
 Every 2 hourly for 3 days.
In case of Gonococcal or Chlamydia infection, systemic antibiotic
therapy is required.
Prevention:
Ophthalmia neonatrum can be prevent by following simple
measures:-
 Proper antenatal care of pregnant women.
 Treatment of infected vaginal discharge during pregnancy.
 Use of aseptic techniques while delivery and in care of
 newborn.
 Cleaning of each eye with sterile swabs dipped in sterile
water, as soon as the head is delivered and instillation of
chloramphenicol eye drops in each eye as a prophylactic
measure.
Complications:
If the condition is not treated, there can be generalized haziness
of cornea or corneal ulcers, which may lead to blindness.
3. RETINITIS:
Definition:
Inflammation of retina is known as retinitis. It usually
Students will be occurs in association with inflammation of choroid (chorio-
Lecturing Listening Pamp What is
able to define retinitis) or optic nerve (neuroretinitis). Primary retinitis is rare. hlet retinitis?
retinitis. Etiology:
Primary retinitis may be an allergic reaction to some
endogenous toxin. In few cases, the toxin is produced from some
Students will be active or latent septic focus (like dental sepsis, septic tonsils) but
Lecturing Listening Pamp What are
able to describe in most of the cases it is tuberculoprotin from a latent focus in
hlet the
the etiology, lung or any lymph node. aetiology,
pathophysio
Pathophysiology
logy and
and clinical clinical
features of
features of
retinitis?
retinitis. Pathophysiology:
Due to infection, inflammation occurs

Exudates formation

Exudates pass through the brunch’s membrane and reach retina

Exudates from the retina reach the vitreous

Lecturing Listening Pamp
hlet
Floating of black spots in front of eye and retina becomes
oedematous

Distortion of image and blurring of vision

Clinical features:
The child presents with the following clinical features:-
 Floating black spots in front of eye.
 Metamorphopsia (distortion of image)
 Micropsia (objects appear smaller)
 Photopsia or subjective flashes of light due to retinal
irritation.
Diagnostic Evaluation:
The diagnosis of retinitis is established with the help of
 fundoscopy, which show:-
Students will be  Localized grey patch with blurred margins in retina.
able to elaborate  Few hemorrhagic spots or exudates on retina.
the diagnostic  If the gray patch is close to optic disc the margin becomes
evaluation and oedematous. Lecturing Listening Pamp What are
hlet the
management of  Vitreous humour is slightly hazy. diagnostic
retinitis.  If central area is affected, there is permanent defect of evaluation
and
visual acuity with central scotoma. managemen
Management: t of retinitis.

Management of retinitis is as follows:-

 Protect the eye from light by wearing dark goggles.
 Atropine eye drops are instilled thrice daily.
 Eye care should be done using warm sterile water.
 Sub conjunctival or retro-bulbar injection of corticosteroid
may be helpful in arresting the inflammatory process.
 Sodium salicylate may be given for pain relief.
 Systemic antibiotics are prescribed to treat focal sepsis, if
present anywhere in the body.
 Antihistamines are helpful in allergic type.
 Systemic corticosteroids are effective in controlling
inflammation.
 4. STYE:
Definition:
Students will be Stye or hordeolum is an infection of the sebaceous glands Lecturing Listening Leafle What is
t stye?
able to define near the eye lashes. A pustule in the eyelash follicle is known as stye.
stye.

Etiology:
A stye may be caused by bacterial or viral infection. It is
Students will be
most often caused by staphylococcus infection. Lecturing Listening Leafle What are
able to describe
Clinical features: t the etiology,
the etiology, Clinical
The clinical features of hordeolum are as follows:- features ,
clinical feature,
 Pustule in eyelash managemen
management and t and
 Pain and tenderness prevention
prevention of
 Localized swelling of eyelid of stye.
stye.
 Redness in eye
As hordeolum forms, it gets filled with purulent material
 and becomes red and painful.
Management:
 Warm compress must be applied on eye, several times in a
day.
 Eye care is done frequently.
 Antibiotic eye drops are instilled.
 If the hordeolum does not resolve spontaneously, incision
and drainage of purulent material is be done.
Prevention:
This type of infection can be prevented by observing hand
washing practice and maintaining personal hygiene.
B. NON IFLAMMATORY CONDITIONS OF EYE:
1. Cataract:
Definition:
Students will be Cataract is the development of opacity in the crystalline
Lecturing Listening OHP What is
able to define lens of eye. As light cannot pass through the opacity, vision
cataract?
cataract. becomes blurred.
Incidence:
Congenital cataract affects 1/in 250 newborns.
Types:
Cataract can be of the following types:-
 Unilateral or bilateral
  Partial or complete
Students will be  Congenital or acquired
Lecturing Listening OHP What are
able to explain the Etiology: the types,
aetiology
types, etiology, The etiology of congenital or acquired cataract is as
and
and patho follows:- pathophysio
logy of
physiology. Cataract
cataract?

Congenital or primary Acquired or secondary

 Intrauterine infections  Trauma
in early months of  Retrolantal fibroplasias
pregnancy like  Uveitis
German measles and  Glaucoma
toxoplasmosis
 Maternal mannutrition
 Galactosemia
 Chromosomal
anomalies like Down’s
syndrome
 Ocular malformation
 Mental retardation
 Pathophysiology:
The lens capsule is formed during the fourth and fifth
week of gestation. It is a clear membrane which allows light to
enter the eye and refract the rays for a clear image on retina. If
there is any reason that interferes with lens development, the lens
becomes milky white and cloudy, obscuring light rays and thus
vision.
Diagnostic evaluation:
Infants with a family history or prenatal history paving
Students will be them at risk for cataract should be assessed soon after birth. The
Lecturing Listening OHP What are
able to elaborate opacity or cloudiness of lens can be seen with naked eye. When the
diagnostic
on the diagnostic the nurse does eye examination using a penlight, it reveals
evaluation,
evaluation, absence of red light reflex and white papillary reflex. managemen
t and post
management and Management:
operative
post operative The definitive treatment for cataract is surgical removal of care of
cataract?
care of cataract. the cataract from affected eye. The affected lens is removed and
artificial intraocular lens is put in the affected eye.
The time at which cataract surgery is performed, is crucial
to prognosis. If cataract is noticeable at birth; surgery must be
done before 8 weeks of age, to prevent irreversible visual
impairment.
 Post operative care:
 After surgery the child needs eye patching or shielding for
several days.
 Instillation of antibiotic and steroidal eye drops several
times a day.
2. GLAUCOMA:
Definition:
Students will be Glaucoma is the condition of increased intra ocular
Lecturing Listening Hand What is
able to define pressure (IOP), causing gradual loss of sight. out Glaucoma?
glaucoma. Types:
Glaucoma has two forms:-
o Congenital or infantile glaucoma:
Students will be It occurs in children under 3years of age. It may be Lecturing Listening Hand What are
out the types of
able to list the present at birth.
glaucoma?
types of o Juvenile glaucoma:
glaucoma. It affects children older than 3 years of age and is
usually secondary to some other disease.
Incidence and Etiology:
Congenital or infantile glaucoma occurs in 1 out of 10,000
live births. It occurs due to defect in the drainage system
of eye. It is usually caused by a developmental anomaly of
the iridocorneal angel of eye known as
 trabeculodysgenesis.
Juvenile glaucoma occurs secondary to some other
disease like retinoblastoma, trauma to the eye etc.
Pathophysiology:
Students will be Due to defective development of the trabecular meshwork, Lecturing Listening Hand What is the
out pathophysio
able to explain the sufficient amount of aqueous humor is not drained out of the intra
logy of
Pathophysiology ocular space. This leads to accumulation of aqueous humour in the glaucoma?
of glaucoma. anterior chamber of eye, resulting in increased intra ocular
pressure. This increased pressure causes damage to the ganglion
cells of retina, leading to necrosis of the optic disc, which results
in blindness.
Clinical features:
The clinical features of glaucoma are:-
Students will be o Excessive tearing.
Lecturing Listening Hand What are
able to enumerate o Involuntary closing of eyelid out the clinical
features of
the clinical o Photophobia
glaucoma?
features of o Enlargement of eyeball (Buphthalmos)
glaucoma. o Haziness or clouding of cornea
o Pain in the eyeball
Diagnostic evaluation:
Intraocular pressure of eye is measured by tonometry. The
normal pressure is 12 to 20 mm Hg. For measurement of
 intraocular pressure in infants and young children, anesthesia may
Students will be be required. Assessment of corneal diameter and examination of
able to elaborate retina is done to assess any damage to optic nerve due to increased Lecturing Listening Hand What are
out the
the diagnostic pressure.
diagnostic
evaluation, Management: evaluation,
managemen
management and The definitive treatment is surgery. Goniotomy or
t and post
post operative Trabeculotomy is done to open the channel of outflow of aqueous operative
care of
care of glaucoma. humour from the anterior chamber of the eye, thereby reducing
glaucoma?
intra ocular pressure.
Post operative care:
The post operative nursing care aims at the following:-
o Management if intraocular pressure
o Management of pain
o Reducing fear and anxiety
o Teaching care givers about home management.
These aims can be achieved by taking the following steps:-
o Prevent increase of intra ocular pressure by
preventing straining, crying and getting startled.
o Eye patch must be applied.
o Administer the prescribed analgesic and antibiotics
o Educate the care givers about recognition of signs
of increased intra ocular pressure, signs of
 infection, instillation of eye drops and need for
follow up.
3. PTOSIS:
Students will be Definition:
able to define Drooping of upper eyelid by weakness of ocular Lecturing Listening OHP What is
pitosis?
ptosis. muscles is known as ptosis. It occurs due to weakness of
levator palpebrae or less frequently, the muller muscles.
Etiology:
Students will be Ptosis occurs on following conditions:
Lecturing Listening OHP What are
able to explain the  Myasthenia gravis
the etiology,
etiology,  Eyelid injuries diagnostic
evaluation
diagnostic  Third nerve palsy
and
evaluation and Diagnostic evaluation: managemen
t of ptosis?
management of Assessment of the child shows drooping of eyelid and
ptosis. impaired vision as the eyelid covers the pupil.
Management:
The problem needs surgical correlation to raise the
eyelid and increase visual field. Patching of the eye is needed
post operatively for few days.

4. REFRACTORY ERRORS:
Refraction is the process by which the cornea and lens
Students will be of the eye bend light rays, to focus on the retina. When the Lecturing Listening PPT What did
you
able to understand bending of rays and length of eyeball are uncoordinated, the
understand
refractive errors image does not fall on a single point on retina. This results in about
refractive
and gain refractory errors. When refraction is normal it is known as
errors?
knowledge about ‘emmetropia’.
incidence and Incidence and etiology:
etiology. Refractory disorders are the most common type of
visual disorders in children that occur due to the following
reasons:-
1. Abnormal curvature of refractive surface
2. Abnormal position of refractive surfaces
3. Abnormal anterio-postetior length of eye ball
4. Abnormal refractive index of refractive media of eyeball i.e.
lens (as in cataract) and vitreous humor (after vitrectomy)
Types :
He following Refractive disorders may be present in
Students will be children:-
Lecturing Listening PPT What are
able to list the 1. Myopia (Near sight)
the types of
types of refractive 2. Hyperopia (Far sightedness) refractive
errors?
errors. 3. Astigmatism (Blurred vision)
Students will be A. MYOPIA (NEAR SIGHTEDNESS)
able to define Definition Lecturing Listening PPT What is
myopia?
myopia. Myopia is the condition in which the parallel rays from distant object
focus in front of retina.

Students will be Types

Lecturing Listening PPT What are
able to list the i. Congenital myopia: It is present at birth and may be unilateral or
the types of
types of myopia. bilateral. It is usually associated with convergent squint. myopia?
ii. Simple myopia: This is the commonest type and is not associated
with any degenerative changes in retina and choroid. It starts in early
adolescence, increases during school years and becomes stationary
after the age of 25 years.
iii. Progressive myopia: This type progresses rapidly and is
 accompanied by degenerative changes in vitreous, choroids and
retina.

Students will be Pathophysiology

Lecturing Listening PPT What is the
able to explain the When the length of eyeball in anterio-posterior axis is more due to pathophysio
logy,
Pathophysiology, over development of the eye, or if the refractive index of lens is
clinical
clinical features greater than normal or if the curvature of cornea is greater than features and
managemen
and management normal, it causes the light rays to focus in front of retina.
t of
of myopia. myopia?
Clinical Features
The clinical features of myopia are as follows:
 Dimness of vision for distant objects – The child usually
complains that he/she cannot see the writing on blackboard in
school.
 If the defect is severe, apart from dimness of vision for distant
objects, the child complains of headache on reading.
 The child is seen holding books closely to eyes, while
reading.

Management
The defect should be corrected by prescribing a concave lens; of
appropriate strength for the child. Photorefractive keratectomy laser
 surgery may be used to correct myopia.

B. HYPEROPIA (FAR SIGHTEDNESS)

Students will be Definition
Lecturing Listening PPT What is
able to define Hyperopia is the condition in which parallel rays from a distant object hyperopia?
hyperopia. focus behind the retina. This is the most common refractory error.

Students will be Pathophysiology

Lecturing Listening PPT What is the
able to explain the When the length of eyeball in anterio-posterior axis is shorter than pathophysio
logy of
pathophysilogy of normal or if the refractive index of lens is low or if the curvature of
hyperopia.
hyperopia. cornea is less than normal, the light rays focus behind the retina
resulting in difficulty with near vision.
 Clinical Features
Students will be The Clinical features of hyperopia are as follows-
able to list the  Diminished vision, both for near and distant objects. Lecturing Listening PPT What are
clinical features  In less severe hyperopia, the child complains of reading the clinical
features and
and management problem. managemen
of hyperopia.  There may be headache, transient blurring of vision t of
hyperopia.
(particularly while reading), pain in eyes, heaviness of eyelids
and redness of eyes.

Management
This refractory error can be corrected by using convex lens of proper
strength.

C. ASTIGMATISM
Students will be Definition
Lecturing Listening PPT What is
able to define Astigmatism is the refractory error in which refraction differs in astigmatism
?
Astigmatism different meridians of eye. In the horizontal meridian, the eye is
emmetropic while in the vertical meridian, it is hypermetropic or
myopic.
 Types
i. Irregular astigmatism: Here the rays of light are reflected very
Students will be irregularly due to irregular corneal curvature, as in case of corneal
Lecturing Listening PPT What are
able to list the scar. the types of
astigmatism
types of ii. Regular astigmatism: In this type, the meridians of greatest and
?
astigmatism. least curvature are at right angles to each other. They are called
principal meridians. It is of the following types:
  Simple astigmatism: In this type, one meridian is emmetropic
(normal refraction) while other is either myopic or
hypermetropic/hyperopic.
 Compound astigmatism: In this type, both the meridians are
either myopic or hypermetropic/hyperopic.
 Mixed astigmatism: When one meridian is myopic and the
other is hyperopic, it is known as mixed astigmatism.

Pathophysiology
Students will be Astigmatism occurs where there is uneven curvature of the cornea or
Lecturing Listening PPT What is the
able to explain the lens or both, preventing light rays from focusing correctly on retina. pathophysio
logy and
Pathophysiology It also occurs due to dislocation of the lens. managemen
and management t of
astigmatism
of astigmatism. Management ?
For the correction of regular astigmatism, cylindrical lens of proper
strength is prescribed. In case of irregular astigmatism, correction in
eye sight can’t be made with cylindrical lens, but use of contact lens
can be helpful.

C. DISORDERS OF IMPAIRMENT OF EYE MUSCLES

Eye movements are coordinated and controlled by six small muscles,
innervated by cranial nerves III, IV and VI. If these muscles are
 affected, vision becomes impaired. Disorders of eyes, related to
impairment of muscles are – Strabismus and Amblyopia.

1. STRSBISMUS (SQUINT)
Definition
The deviation of visual axis from normal alignment is known as
Students will able strabismus. The visual line of each eye does not simultaneously focus
What is
to define on the same object due to lack of muscle coordination resulting in a
Lecturing Listening PPT strabismus?
strabismus. crossed – eye appearance.

Incidence
Strabismus occurs in 2-3% of all children. Approximately half of
these children have a family history for the defect. Transient
strabismus is normal in first 4-6 months of life and is attributed to
physiologic hypermetropia.
 Types
Strabismus is of two types:
Students will be i. Paralytic or non-concomitant type
Lecturing Listening PPT What are
able to explain the ii. Non paralytic or concomitant type
the types of
types of strabismus?
strabismus. According to another classification, strabismus is of three types-
i. Esotropia
ii. Exotropia
iii. Hypertropia

i. Paralytic or non-concomitant type

This type occurs due to weakness or paralysis of one or more extra
ocular muscles. There is limitation in movement of eye and diplopia
occurs. Congenital paralytic strabismus occurs due to neuromuscular
anomalies or birth trauma. Acquired strabismus results due to
intracranial tumors, myasthenia gravis, CNS infections, polio,
encephalitis, diphtheria toxin, lead toxicity, botulism, thiamine
deficiency and fracture of base of skull.

ii. Non paralytic or concomitant type

This is the commonest type. The movements of individual ocular
muscles are present, but coordination is lacking. Diplopia does not
 occur in this type.
Another Classification of strabismus classifies it into three types-
i. Esotropia (convergent): In this type, the eyes turn towaaards the
midline.
ii. Exotropia (Divergent): In this type, the eyes turn away from the
midline.
iii. Hypertropia: In this type, the eyes are out of vertical alignment.
One pupil appears higher than the other.

Diagnostic Evaluations
Students will be Two tests may be done for screening of strabismus – The Hirschberg Lecturing Listening PPT What are
the
able to explain the test and Cover-Uncover test. The latter is more definitive test.
diagnostic
diagnostic evaluations
of
evaluation of i. Hirschberg test
strabismus?
strabismus. A pen light is held such that the light is facing straight ahead and is
approximately 12 inches from the child’s head. Using one hand the
ophthalmologist turns the child’s head so that the light is in midline
position towards child’s eyes. The ophthalmologist than observes the
light reflection from cornea. The reflected light should be seen
symmetrically in the center of both corneas.
In esotropia, light reflection is displaced to the outer margin of cornea
as the eye deviates inward. In exotropia, light reflection is displaced
to the inner margin of cornea, as the eye deviates outward.

ii. Cover-Uncover/test
This test is performed on infants greater than 6 months of age through
school age. Place the child in a seated position on the examining table
or caregiver’s lap. The physician stands 2 feet away, in front of the
child. The child is asked to focus attention on penlight in the hands of
the physician. A cover card or hand is placed over one eye. Wait until
the uncovered eye focuses, then remove the cover card or hand and
evaluate the eye just uncovered for focusing movement.
The normal finding is that neither eye moves when cover card or
hand is being removed. It is abnormal for one or both eyes to move to
focus on pen light during assessment. Strabismus after 6 months of
age is abnormal and indicates eye muscle weakness.

Management
Early diagnosis and treatment is desirable, as failure to do so results
in permanent Amblyopia. The goal of treatment is to attain the best
possible vision in each eye while also attaining binocular vision.
Treatment can be medical or surgical. To develop best possible and
equal or near equal vision in both eyes, it is essential that all
refractory errors be corrected after accurate assessment of visual
 acuity. Also other associated conditions such as cataract should be
treated.

Medical Management
The medical approach may utilize occlusion therapy and orthoptic
training for correction of strabismus.
Students will be a. Occlusion therapy Lecturing Listening PPT What are
the medical
able to explain the Occlusion therapy is recommended, if the squinting eye is amblyopic.
and surgical
medical and Vision improves in squinting eye by continuous exercise. For this managemen
t of
surgical purpose, the normal eye has to be absolutely occluded for 1-2 weeks
strabismus?
management. or longer (at a time for 6-8 weeks).
b. Orthoptic training
Specially designed visual exercises are taken in order to encourage
the production of simultaneous and binocular vision, elimination of
false projection and production of stereoscopic apparition.
c. Pharmacologic therapy
Use of miotic drugs makes accommodation easier.

Surgical Management
Surgery involves shortening; lengthening or repositioning of extra
ocular muscles should be under taken at earliest if other modalities
fail.
Students will be Nursing management:
Lecturing Listening PPT What are
able to describe Nursing assessment
the nursing
nursing It includes the following:- managemen
t and
management and i. Assess for red light reflex, especially in newborns.
intervention
nursing Absence or asymmetry of red light reflex may indicate s for
strabismus?
interventions for congenital cataract or an intraocular tumor.
strabismus. ii. Inspect eyes for redness of conjunctiva, cloudiness of
cornea, excessive tearing, ptosis or misalignments,
which provide clue to congenital eye problems.
iii. Assess the visual acuity routinely in infants and
children.
Nursing interventions:
i. Minimizing effects of vision loss.
 Encourage and assist parents in obtaining corrective
lenses for child.
 Assist parents in locating and finding resourses such
as financial assistance, special education in braille or
parental support groups.
ii. Minimize body image disturbance.
 Encourage parents to focus on normalization rather
than begin over protective towards the child.
 Allow the child to play with peers and make his life as
 normal as possible.
 Encourage parental acceptance towards appearance of
the child.
iii. Prevent injury:
 Encourage the family to take care of child’s safety at
home, school and in community.
 Advise the family to maintain a consistent and
uncluttered furniture arrangement. Notify the child of
changes done in home setting.
 Instruct the child to use a cane or other walking
assistance device.
iv. Promote normal growth and development:
 Encourage the parents to provide many sensory
opportunities to the child such as manipulating
objects, hearing various sounds, noting the smells in
environment etc.
v. Parental education:
 Parents must be taught about instillation of
medications and use of eye shield to prevent injury to
the eye after surgery.
 Bed rest may be required immediately post
operatively.
  Older children should be advised to avoid engaging in
strenuous activities or contact sports for at least 2
week.
 Avoid over feeding the child to prevent vomiting that
may cause straining.
 Do not let the child cry.
 Encourage and teach parents to do eye care to remove
eye discharge or crusts on lashes by washing the eyes
with warm water. Eye care can also be done by wiping
off the eyes with moist cotton balls.
2. AMBLYOPIA:
Definition:
Amblyopia means poor vision in one eye that has not
Students will be developed normal sight. It is unrelated to an organic cause. The
able to define condition is sometimes called “lazy eye”. It occurs when visual acuity
Lecturing Listening PPT What is
Amblyopia. is better in one eye that the other. amblyopia?

Incidence and Etiology

Amblyopia occurs in approximately 2-3% of the population in
preschool age.
- The most common cause of Amblyopia is strabismus, where
the brain suppresses vision in deviated eye to avoid double
 image that is receiving. Eventually the eye sight of deviated
eye is lost.
- Other causes of Amblyopia are cataract, corneal opacity or
prolonged patching of eye to correct strabismus and refractive
Amblyopia, which occurs when there is asymmetric refractive
error in each eye.

Clinical Features
Students will be Infants and children with Amblyopia often do not display any
Lecturing Listening PPT What are
able to explain the symptoms. They may occasionally over reach for an object.
the clinical
clinical features, features,
diagnostic
diagnostic Diagnostic Evaluation
evaluation,
evaluation, and Amblyopia is usually asymptomatic because the good eye assumes and
managemen
management. the burden of vision and the child is unaware that there is a problem.
t of
It is therefore essential, that child’s eyes are examined periodically strabismus?
before the age of 7 years. If any difference in the visual acuity of two
eyes is detected the child should be referred to an ophthalmologist for
treatment.

Management
If the cause of Amblyopia is strabismus, surgery may be required. If
the cause is a cataract, then cataract removal surgery is done.
 Refractive Amblyopia is treated by correcting refractive error with
corrective lenses.
The main management of Amblyopia is occlusion of the good eye to
force vision in the “lazy eye”.

D. LESS COMMON EYE DISEASES IN CHILDREN

While the above eye disorders are common and easy to correct, if
detected and treated early, eye diseases can be much more serious.
Some of them can be treated cured, others are incurable. Fortunately,
these diseases are rare. Examples of such eye diseases are:

Students will 1. RETINOPATHY OF PREMATURITY (ROP)

understand what Babies born with a very low birth weight have an increased risk of
Lecturing Listening PPT What is
retinopathy is. developing abnormal peripheral retinal blood vessels that can cause
retinopathy?
the retina to become loose (detached retina), which can lead to
blindness. Those babies who do not develop this problem in
childhood still have an increased risk of retinal detachment later in
life, and should be seen regularly by an eye doctor to check for retinal
detachments.

Students will be 2. FAMILIAL (CONGENITAL) BLINDNESS

able to explain If there is a history of blindness in the family of either the father or
Lecturing Listening PPT What is
about congenital mother, parents need to seek genetic counselling to help determine congenital
blindness?
blindness. the risk of blindness in their children.

3. RETINITIS PIGMENTOSA
Students will be In this inherited disease, the retina in eye degenerates more and more
Lecturing Listening PPT What is
able to explain over time (progressively). Children are unable to see at night
retinitis
retinitis (develop night blindness) and then lose their side (peripheral) vision. pigmentosa
?
pigmentosa. Tunnel vision (no side vision at all, as if in a tunnel) develops,
followed by complete blindness.

Students will be 4. LEBER’S CONGENITAL AMAUROSIS

able to explain Blindness or near-blindness occurs in children with this disease
about leber’s because of loss of nerve function in the retina of both eyes. A jerky Lecturing Listening PPT What is
Leber’s
congenital movement of the eyes (nystagmus) may occur along with
congenital
amaurosis. hypersensitivity to light and sunken eyes. amaurosis?

Students will be 5. CONGENITAL GLAUCOMA

What is
able to explain In this disease, high pressure of the fluid within the eye, together with
congenital
congenital an enlarged cornea can cause nerve damage in newborns and infants. Lecturing Listening PPT glaucoma?
glaucoma. A common cause is malformation of some parts of the eye. Too much
tearing (excessive watering) can be a warming sign of congenital
glaucoma but may also indicate less serious conditions, such as a
 blocked tear duct.

Students will be 6. DERMOID CYSTS

able to explain These are bumps usually found on the side of the head near the
Lecturing Listening PPT What is a
about dermoid eyebrow. They are not cancer, but are actually capsules containing dermoid
cyst?
cysts. skin tissue, hair, fat, or other body tissue. Dermoid cysts should be
removed before the child begins to walk because they can break open
during a fall and cause painful inflammation.

Warning Signs
Students will be An eye doctor-either an optometrist or an ophthalmologist must be
able to list the consulted, if any of the following signs are present in the child:
Lecturing Listening PPT What are
warning signs of  Eyes flutter quickly from side to side (nystagmus). the warning
signs of
Dermoid cysts.  Eyes are watery all the time. dermoid
 Eyes are always sensitive to light. cysts?

 Eyes change in any way from their usual appearance.

 White or yellow material appears in the pupil.
 Redness in either eye persists for several days.
 Pus or crust appears in either eye.
 Eyes look crossed or “wall-eyed”.
 The child constantly rubs his or her eyes.
 The child often squints.
  The child’s head is always tilted.
 Eyelids tend to droop.
 One or both eyes seem to bulge.
 One pupil is larger or smaller than the other
(asymmetric pupil size).
 Baby does not make eye contact by 3 months of age.
 Baby does not focus on and follow objects by 3
months of age.
 Baby does not reach for objects by 6 months of age.
 Baby covers or closes one eye.
 One eye constantly or sometimes (intermittently) turns
in, out, up or down.
BLINDNESS:
Definition:
Students will be Lecturing Listening PPT What is
According to W.H.O. “The inability to count fingers in day blindness?
able to define
light from a distance of 3 meters is defined as blindness”
blindness.
Prevalence and etiology:
It is estimated that there are 16-18 million blind people in the
world. In India, their number is about 9 million. The main causes of
blindness in children are:
o Vitamin A Deficiency
o Malnutrition
 o Eye infections
o Injuries
o Congenital eye disorders like cataract
o Tumors
Problems of blind child:
Problems faced by a blind child routinely are:
Students will be 1. Problems of attachment:
Lecturing Listening PPT What are
able to elaborate When a mother discovers that her child is blind, the
the
the problems of initial reaction is often of depression and grief followed by problems of
blindness?
blind child. rejection of the child. Due to blindness, the vital interaction
between infant and mother is hampered.
2. Inability to use hands as organ of perception:
In normal sighted infants, hand coordination and
reaching for objects is developed until 9 months to one year.
Those infants who do not receive early intervention, the hand
may not develop as an autonomus organ of perception and
they may develop as an autonomus organ of perception and
they not make sensitive discrimination and are incapable of
Braille reading.
3. Problem in locomotion:
The blind children show marked delay in locomotion.
While a normal sighted child starts walking by one year, blind
 children start waking independently by two years. There are
constant difficulties in travelling from one place to another.
4. Problems in language development:
In many blind children, there is delay in the
development of capacity for abstraction, leading to difficulties
in travelling from one place to another.
5. Dependence:
The most capable blind child even if given an
optimum environment, is more dependent on parents or care
takers than normal child. Routine self care skills such as
dressing, eating, toilet training, personal hygiene etc. Present
practical problem. They require special education (Braille
system) and can be trained in special schools. Integration into
the society is also a special problem.
6. Behavioural problems:
Certain common behavioural problems are seen in
blind children like body swaying, head knocking, eye
rubbing, head rotating or repetitive hand motions. The child
may develop severe ‘blind deviant child syndrome’ in which
the child demonstrates stereotyped hand behaviour, rocking,
swaying and mutism or copying spoken words.
 Management:
Students will be Early intervention can greatly alleviate the problems
Lecturing Listening PPT What is the
able to explain the of blind children. managemen
t of
management of Blind children can be helped in following ways:
blindness?
blindness. o The blind child should be trained to recognize
tactile and auditory stimuli which will be
helpful in locomotion.
o Help the child in speech development by
providing speech therapy.
o Occupational therapy or vocational training
should be provided to these children so that
they can earn their living.
o These children should be trained to recognize
and use common household things.
o They should be trained to travel independently
using various tools and techniques like long
cane, guide dog, GPS system etc.
SUMMARY:

We have discussed about various disorders of eye, its etiology, Pathophysiology, clinical features, management and
prevention for each. Hope you have understood.

CONCLUSION:

Now it’s time for discussion, so if there is any clarification you can ask. Thank you

RECAPITATION:

1. Explain conjunctivitis.
2. Describe blindness
3. Elaborate on refractive errors
4. warning signs of dermoid cyst

ASSIGNMENT:

Draw a nursing care plan for a patient who has undergone cataract surgery.

BIBLIOGRAPHY:

1. RIMPLE SHARMA “ESSENTIALS OF PEDIATRIC NURSING”, first edition, 2013, Jaypee brothers publication, page no:
646-664, 784-786