9/4/2012. Carter Liotta, OD St. Christopher s Hospital for Children Staff Optometrist, Eagles Eye Mobile. In other words

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1 Carter Liotta, OD St. Christopher s Hospital for Children Staff Optometrist, Eagles Eye Mobile Vision Screening Minimalism The Eagles Eye Mobile, and what we offer An eye health first-aid kit: What every nurse should have and why Pinkeye, lumps and bumps Optic nerve largeness PA Code mandates snellen vision screening yearly. DOH Procedures Manual guides nurses toward plus lens testing and depth perception testing once, preferably in 1 st grade. Color vision testing is recommended, but not required. In other words Your vision screenings must include eye chart testing. Your vision i screenings should ideally include plus-lens and stereopsis testing if never done before. Prioritize color vision screenings last. Beginning in October, for Elementary and Middle Schools One-day as-many-as-we-can- see vision screenings Eye Mobile staff Team of volunteers Overseen by the nurse and by Dr. Liotta. Schools with least nurse coverage prioritized first Distance and Near Acuities Eye Alignment Depth Perception Autorefraction (plus lens) Students will pass, be referred to EEM, or be referred to ophthalmology through the nurse. Dawn keeps paperwork at the end of the day; nurse gets it back in one week. Results are entered into the e- record system by the nurse. 1

2 A central, localized room to which students can be called down en masse. Administrative support Support from teachers for about 20 minutes. Lots of help identifying kids, calling down classrooms, and moving them through. The Eagles Eye Mobile serves Elementary and Middle Schools in the SDP, subject to the economics of the surrounding area. Children who fail your vision screening and have not been seen on the Eye Mobile in the past school year may use the service. Consent is needed from the parents. Glasses and initial follow-up, if needed, are at no cost to the kids and their families. All of the kids in the school are screened. Some do not pass. Consents go home for kids who do not pass. When 20+ consents have been returned, nurse confirms Eye Mobile visit with outreach worker. Eye Mobile visits the school. Most kids needing glasses will receive them within 3 weeks. The optician will call you to schedule the fittings. Some kids will need more advanced care. They may or may not get glasses first. Referral consents will be given to you. Send them home, and when they come back we will schedule the referral bus. Know your secondary contact. Be mindful of how long screenings take before scheduling with Dawn. Treatment of common eye conditions in your office is limited, but it s surprising what you can diagnose and treat with little equipment. 2

3 A penlight A small magnifying glass An ice pack Saline solution Bland ophthalmic ointment Q-Tips Baby Shampoo Cup and Tape Your hand A Pen and Pad Can be used to shed light on the situation, and in combination with a magnifying glass. Can be used as a fixation target as a child looks up, down, left right, etc. Can be used to check pupils for dilation. Should constrict. Check each eye individually, looking for the same response in either eye. Shine light into one eye and look at the other. The eye without the light should constrict as much as the one with the light in it. Bumps, bruises and the occasional periorbital hematoma. Use your penlight. Subconjunctival hemmorage is common, and will resolve. Hyphema is NOT a good sign, and should be sent to the ER. Ice packs can also be used to help relieve seasonal allergy and conjunctivitis (pinkeye) just dispose of it when finished. Ice packs can be effective placebo treatments Cup and tape foreign objects. Bland, Bland, Bland! Saline, especially in Sensitive Eyes formulation, is great for flushing & rinsing contacts. Large bottles should be replaced yearly. Smaller bottles can be squeezed onto the back of school administrators pants, unnoticed. Eye lubricant is often marketed as night time lubricant. The thickness, dotted on a Q-tip, can help remove foreign bodies. Remember: For an acid or base burn to the eye (cleaning agents, bleach, etc) Run under lukewarm tap water for 15 minutes. Find out EXACTLY what got into the eye, if you can. Call the nearest eye hospital ER for further instruction. Use on a washcloth to gently clean oozing, crusty eyes. Use with a Q-Tip to help control blepharitis No Tears formula No Conditioner! 3

4 Your hand is a powerful tool in determining the severity of an eye turn. Please wash it first. Have the student look at your nose. Cover the eye staring at you. Does the turned eye take up fixation? When you uncover the eye, what happens? Constant vs. Intermittant Alternating vs. R or L Eso vs. Exo Pair this information w/ Depth Perception. A pen and pad are crucial in the nurse s office, for two reasons. Patient History (Dr. Flops) Duration How long does it last? Relief? What brings relief? Frequency How often does it happen? Laterality/Location Onset When did it start? Pain Scale of 1-10 Symptoms? Document, Document, Document!! The public at large is horrified of pinkeye, or conjunctivitis More likely to get questions, comments and calls from parents about a pinkeye epidemic than a contagious stomach flu. Conjunctivitis comes in three flavors Allergic Bacterial Viral Allergic conjunctivitis follows most major seasonal allergy symptoms. It is not contagious Treatment includes systemic medication that may already be taken (Claritin, Benadryl) Cool compresses Artificial Tears OTC Drops Zaditor or Alaway recommended. Visine advised against for more than very occasional use. Hallmark of Bacterial conjunctivitis is slimy discharge. Lids stick together, and heavy crusting especially in morning. Gritty, itchy and sometimes painful. Can affect one or both eyes. Treatment with antibiotics is indicated, but overused. Inform the parent that a doctor visit is necessary and an antibiotic needed, just to cover your bases. When parents ignore your advice, remember that even without treatment, bacterial conjunctivitis will generally self-resolve unless the bacterial strain is stubborn. Studies show that antibiotics reduce duration from 4.8 to 3.3 days. Viral conjunctivitis is the most common form of pinkeye. The stereotype of pinkeye spreading like wildfire is based on viral conjunctivitis, which spreads like any virus or common cold. Lidsmaybecrustywithsome some discharge, but not thick and yellow. Eyes appear pink (not red) watery, and glazed. Follicles (bumps) under the lid are a hallmark. Don t share towels and washcloths Use artificial tears and warm compresses Should self-resolve in 3 weeks. 4

5 All of that being said, the $64,000 question about pinkeye is Should I keep my child home from school? For how long? There is no clear-cutcut answer. If a child is school-age and can be good about washing his/her hands, there s no reason to keep them out of school. Toddlers, preschoolers, and younger kids may more easily transfer germs. If keeping them at home, they may return when the visible symptoms subside, usually in a few days. Excessive pain, chronic blur and prominent light sensitivity are generally not symptoms of basic conjunctivitis, and may be signs of a more serious eye condition. An antibiotic/steroid combination such as Tobradex, Zylet or Maxitrol ($4) can ease redness in more mild cases of conjunctivitis. An eye exam is needed first. Parent education that most cases of pinkeye are a cold in the eye can ease tensions, but where diagnostic abilities are limited, refer! Very common in kids. Two varieties: Chalazion and Hordeolum (stye) Caused by gland blockages in the eye lid. Acute Onset Hordeolum are Hot and they Hurt Why? Because they re a bacterial infection Usually a small bump on the margin of the eye. Avoid makeup, eyeliner, etc. Warm compress Do not try to pop it. Chronic Blocked meibomian gland Painless Some resolve with warm compress Some have to be surgically removed and biopsied. A hordeolum, if not treated, can become a chalazion Optic nerve is the pipe that connects your eyes to your brain. The opening of the pipe ( cup ) should be smaller than the walls of the pipe ( disc ). In glaucoma, a larger cup could indicate disease African-Americans often have larger cups, which can be confused for glaucoma When this happens, it is prudent for more tests to be run. Eye pressure tests, photos, and a visual field 5

6 Please ask any questions you may have at this time Thank you for your time and attention! 6

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