Strabismus

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Ashley Powell
MSN,RN,PCN
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Outline

Overview

  1. Lack of coordination between extraocular muscles resulting in inability to direct both eyes at the same point.  Often referred to as “cross-eyed”.

Nursing Points

General

  1. Normal finding in infant but should not be present after 4 months of life.
  2. Treatment should occur as early as possible to avoid lifelong visual problems.

Assessment

  1. Eyes crossed
  2. Poor depth perception
  3. Squinting of eyes and tilting of head
  4. Binocular vision is lost without treatment

Therapeutic Management

  1. Eyeglasses
  2. Vision therapy
  3. Surgery
  4. Combination therapy:
    1. Wearing an eye patch on the good eye will help strengthen the weak eye.

Nursing Concepts

  1. Sensory Perception

Patient Education

  1. Eye patch should be worn on the good eye

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Transcript

Hey guys, in this lesson we are going to talk about strabismus or what is often referred to as being “cross eyed” .

When a person or child has strabismus there is a lack of coordination between the muscles around the eyes. This results in the child not being able to focus both eyes on the same object at the same time. This is called lack of binocularity and can result in double vision, blurry vision and poor depth perception. Over time, if untreated the brain will learn to ignore the eye that isn’t focusing. When this happens you end up with amblyopia or what is often called a lazy eye. To prevent this from happening strabismus needs to be treated by the time a child is 4-6 years old.

The first thing noticed during assessment of a child with strabismus is that their eyes may appear crossed or not working in a coordinated way. Because of this lack of focus they will have double or blurred vision and poor depth perception. To compensate for this the child may squint their eyes or tilt their head to try and get a better focus on what they are looking at.

So, first things first, these kids need a full eye exam. This won’t likely fall to you as the RN, but could if you go on to train as a nurse practitioner. Tests use to further investigate for strabismus are the corneal light reflex test, and the cover test.

The first step to help treat the strabismus is to give the weaker eye a chance to get stronger and the way this is done is to put an eye patch over the stronger eye for a certain number of hours per day to let the weak eye learn to focus and take over.

Vision therapy is also used to help strengthen the eye muscles and teach the eyes to work together and it’s basically just like physical therapy for the eyes.

If these things don’t work then the child may need to have surgery to either loosen or tighten the muscles that are causing the problems.

Your priority nursing concepts for a pediatric patient with strabismus are sensory perception and human development.
Okay guys, lets go over the key points for this lesson! When a child has strabismus their eyes aren’t able to focus together on an object. This can lead to the eyes appearing crossed and the patient will experience double vision and have poor depth perception. The first step in treating this is to place an eye patch over the good eye to help the weaker eye get stronger. If this doesn’t work the child may need surgery. It’s super important to get this treated by 4-6 years to prevent amblyopia or lazy eye- where the brain basically permanently learns to ignore the weak, unfocused eye.

That’s it for our lesson on Strabismus in pediatric patients! Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!

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My Study Plan

Concepts Covered:

  • Prenatal Concepts
  • Musculoskeletal Disorders
  • Respiratory Disorders
  • Childhood Growth and Development
  • Prenatal and Neonatal Growth and Development
  • Adulthood Growth and Development
  • Integumentary Disorders
  • Hematologic Disorders
  • Pregnancy Risks
  • Oncologic Disorders
  • Postpartum Complications
  • Fetal Development
  • Endocrine and Metabolic Disorders
  • Labor and Delivery
  • Gastrointestinal Disorders
  • Labor Complications
  • EENT Disorders
  • EENT Disorders
  • Postpartum Care
  • Cardiovascular Disorders
  • Newborn Care
  • Renal and Urinary Disorders
  • Newborn Complications
  • Neurologic and Cognitive Disorders
  • Liver & Gallbladder Disorders
  • Microbiology
  • Infectious Disease Disorders

Study Plan Lessons

OB Course Introduction
Pediatrics Course Introduction
Care of the Pediatric Patient
Care of the Pediatric Patient
Care of the Pediatric Patient
Vitals (VS) and Assessment
Vitals (VS) and Assessment
Overview of Childhood Growth & Development
Developmental Stages and Milestones
Growth & Development – Infants
Growth & Development – Infants
Growth & Development – Toddlers
Growth & Development – Preschoolers
Growth & Development – Preschoolers
Growth & Development – School Age- Adolescent
Growth & Development – School Age- Adolescent
Eczema
Gestation & Nägele’s Rule: Estimating Due Dates
Impetigo
Pediculosis Capitis
Burn Injuries
Burn Injuries
Fundal Height Assessment for Nurses
Physiological Changes
Sickle Cell Anemia
Sickle Cell Anemia
Discomforts of Pregnancy
Iron Deficiency Anemia
Hemophilia
Nutrition in Pregnancy
Abortion in Nursing: Spontaneous, Induced, and Missed
Pediatric Oncology Basics
Anemia in Pregnancy
Leukemia
Cardiac (Heart) Disease in Pregnancy
Nephroblastoma
Nephroblastoma
Hematomas in OB Nursing: Causes, Symptoms, and Nursing Care
Hydatidiform Mole (Molar pregnancy)
Gestational HTN (Hypertension)
Infections in Pregnancy
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
HELLP Syndrome
Fertilization and Implantation
Fever
Dehydration
Dehydration
Fetal Development
Fetal Environment
Fetal Circulation
Process of Labor
Vomiting
Vomiting
Pediatric Gastrointestinal Dysfunction – Diarrhea
Mechanisms of Labor
Leopold Maneuvers
Celiac Disease
Celiac Disease
Fetal Heart Monitoring (FHM)
Appendicitis
Appendicitis
Obstetrical Procedures
Intussusception
Umbilical Hernia
Constipation and Encopresis (Incontinence)
Constipation and Encopresis (Incontinence)
Strabismus
Conjunctivitis
Prolapsed Umbilical Cord
Acute Otitis Media (AOM)
Placenta Previa
Abruptio Placentae (Placental abruption)
Tonsillitis
Precipitous Labor
Dystocia
Postpartum Physiological Maternal Changes
Acute Bronchitis
Postpartum Interventions
Bronchiolitis and Respiratory Syncytial Virus (RSV)
Postpartum Discomforts
Breastfeeding
Pneumonia
Asthma
Asthma
Cystic Fibrosis (CF)
Sudden Infant Death Syndrome (SIDS)
Congenital Heart Defects (CHD)
Congenital Heart Defects (CHD)
Postpartum Hematoma
Defects of Increased Pulmonary Blood Flow
Defects of Increased Pulmonary Blood Flow
Defects of Decreased Pulmonary Blood Flow
Defects of Decreased Pulmonary Blood Flow
Obstructive Heart (Cardiac) Defects
Obstructive Heart (Cardiac) Defects
Subinvolution
Mixed (Cardiac) Heart Defects
Mixed (Cardiac) Heart Defects
Postpartum Thrombophlebitis
Initial Care of the Newborn (APGAR)
Nephrotic Syndrome
Nephrotic Syndrome
Enuresis
Newborn Physical Exam
Body System Assessments
Epispadias and Hypospadias
Newborn Reflexes
Babies by Term
Cerebral Palsy (CP)
Meningitis
Transient Tachypnea of Newborn
Retinopathy of Prematurity (ROP)
Spina Bifida – Neural Tube Defect (NTD)
Autism Spectrum Disorders
Autism Spectrum Disorders
Erythroblastosis Fetalis
Addicted Newborn
Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Hyperactivity Disorder (ADHD)
Newborn of HIV+ Mother
Tocolytics
Betamethasone and Dexamethasone
Scoliosis
Magnesium Sulfate
Opioid Analgesics
Prostaglandins
Uterine Stimulants (Oxytocin, Pitocin)
Meds for PPH (postpartum hemorrhage)
Rh Immune Globulin (Rhogam)
Lung Surfactant
Eye Prophylaxis for Newborn (Erythromycin)
Phytonadione (Vitamin K)
Hb (Hepatitis) Vaccine
Rubeola – Measles
Rubeola – Measles
Mumps
Mumps
Varicella – Chickenpox
Pertussis – Whooping Cough
Influenza – Flu
Acute Otitis Media (AOM)
Antepartum Testing
Bronchiolitis and Respiratory Syncytial Virus (RSV)
Cerebral Palsy (CP)
Chorioamnionitis
Cleft Lip and Palate
Clubfoot
Conjunctivitis
Cystic Fibrosis (CF)
Pediatric Gastrointestinal Dysfunction – Diarrhea
Disseminated Intravascular Coagulation (DIC)
Ectopic Pregnancy
Eczema
Enuresis
Epiglottitis
Family Planning & Contraception
Fetal Alcohol Syndrome (FAS)
Fever
Gestational Diabetes (GDM)
Gravidity and Parity (G&Ps, GTPAL)
Hemophilia
Hydrocephalus
Hyperbilirubinemia (Jaundice)
Hyperemesis Gravidarum
Imperforate Anus
Impetigo
Incompetent Cervix
Intussusception
Marfan Syndrome
Mastitis
Maternal Risk Factors
Meconium Aspiration
Meningitis
Menstrual Cycle
Omphalocele
Pediculosis Capitis
Pertussis – Whooping Cough
Phenylketonuria
Postpartum Hemorrhage (PPH)
Premature Rupture of the Membranes (PROM)
Preterm Labor
Reye’s Syndrome
Rheumatic Fever
Scoliosis
Signs of Pregnancy (Presumptive, Probable, Positive)
Spina Bifida – Neural Tube Defect (NTD)
Tonsillitis
Varicella – Chickenpox