NURSING CARE OF A

FAMILY WHEN A
CHILD HAS SENSORY
ALTERATIONS
SAS 37
 A. DISORDERS THAT INTERFERE
WITH VISION
I. REFRACTIVE ERRORS
HYPEROPIA/FARSIGHTEDNESS
• vision is blurry at a close range and
clear at a far range.
• normal hyperopia of preschoolers
needs no correction when
performing vision screening with
children of this age because at
about 5 years of age, as a result of
developmental changes, hyperopia
will begin to diminish.
ASSESSMENT
• Focusing on close objects requires
such strong accommodation that
these children often develop
headaches or dizziness while doing
schoolwork.
MANAGEMENT
• A finding of hyperopia in a school-
age child is cause for referral so that
the child can get a prescription for
glasses with a convex lens.
II.
MYOPIA/NEARSIGHTEDNESS
• occurs when light rays focus
anterior to the retina, causing
objects that are far away to be
unfocused.
• Typically, this develops around
age 8 years and then progresses
ASSESSMENT
• These children can read a book or a
computer screen immediately in front of
them but are unable to read the
blackboard clearly from a distance.
• They have difficulty reading signs across
the street or playing baseball.
MANAGEMENT
• Myopia tends to plateau as the child
reaches adolescence.
• Children with myopia need corrective
(concave) lenses to enable them to see
at a distance
III. LASER IN SITU KERATOMILEUSIS (LASIK) and
PHOTOREFRACTIVE KERATECTOMY (PRK)
• permanently change the contour of the cornea and correct refractive
vision errors
• both laser surgery correction procedures for either myopia or hyperopia
• involve an incision under the cornea to change the contour of the eye
globe so that light rays fall more accurately on the retina

MANAGEMENT AFTER SURGERY

• Postoperatively, children may have disturbed tear functioning for 1 or
more months and so need to instill artificial tears or ointments to
prevent surface damage.
• having the procedure carried out before the child’s eye globe has
reached its adult size would require the surgery to be repeated with
maturity, the youngest age at which LASIK therapy is appropriate is
controversial;
• most authorities recommend this not be done before 21 years of age
to allow for natural eye contour changes to occur.
• The exception to this is children who have amblyopia (LAZY EYE)
or strabismus(CROSSED EYE)
IV. ASTIGMATISM
• an irregular curvature of the cornea, causing light to focus incorrectly
on the retina, resulting in an uneven quality of vision.

ASSESSMENT
• When children with astigmatism look at the letter T, for example, they
may see the crossbar but not the letter stem.
• If they focus on the stem, they cannot see the crossbar.
• On any given page of print, therefore, they may see only half the letters
or can have great difficulty reading or following written instructions.
• They may report headache and vertigo after doing close work.
• Even though their vision appears deceptively normal on vision
screening tests (they are able to see all of the numbers on a chart by
tilting their head), these children need to be referred to an
ophthalmologist on the basis of their other problems such as vertigo,
headaches, and difficulty with reading.

MANAGEMENT
• Corrective lenses for close work relieve the symptoms and restore
functional vision.
• Contact lenses may be even more helpful because they actually
smooth out the curvature of the cornea.
• A form of LASIK surgery may be appropriate to correct astigmatism.
V. NYSTAGMUS
• rapid, irregular eye movement, either vertically or horizontally.
• It is not a disease in itself but rather a symptom of an underlying disease
condition.
• It is seen in children with vision-impairing lesions such as congenital cataracts.
• It also occurs as a neurologic sign if there is a lesion of the cerebellum or brain
stem.

MANAGEMENT
• Children with nystagmus should be referred to their primary care provider
initially so the underlying cause of the symptom can be determined.
• A referral to an ophthalmologist may be indicated.
VI. AMBLYOPIA
“lazy eye” or subnormal vision in one eye that causes a child to use
only one eye for vision while “resting” the other eye
• can also develop from strabismus (crossed eyes).
• With strabismus, one eye looks straight ahead while the other eye
“wanders,” causing suppression of one visual image or a loss of
central vision in that eye (amblyopia).
• The same phenomenon can occur if the vision in one eye is obscured
by a lid that does not open fully (ptosis).
ASSESSMENT
• It is recommended that all children between the ages of 3 and 5 years
have at least one vision screening to detect amblyopia
• If a child has amblyopia, a screening exam such as a preschool E chart
typically demonstrates 20/50 vision (which is normal for preschool
age) in one eye, but the other eye shows lessened vision (perhaps as
different as 20/100).
MANAGEMENT
• Treatment for amblyopia is most successful among children younger
than the age of 7 years, but there is evidence to show a response to
treatment for children between 7 and 13 years of age
• Treatment can consist of wearing correcting lenses (glasses), covering
the good eye with a patch, or a combination of the two
• Wearing a patch over the good eye forces the child to use the poor
eye, thus developing vision in that eye.
• Usually, children have some difficulty initially adjusting to a patch
because they are unable to see well from the unpatched eye.
• They may report headaches or dizziness and notice poor depth
perception.
• Only constant attempts to see with the weaker eye, however, will
improve binocular vision, so parents have to enforce patching if
prescribed
• The patch should be removed for 1 hour each day to prevent
amblyopia from developing in the nonamblyopic eye.
• If patching does not produce the anticipated result, LASIK surgery to
improve the refractive error may be indicated.
• administration of levodopa in addition to occlusion therapy because
this almost immediately improves vision in both eyes
VII. COLOR VISION DEFICIT (COLOR BLINDNESS)

• the name implies, the inability to perceive color correctly.

• It occurs in 4% to 8% of boys because one of the sets of cones of the
retina that perceive red, green, or blue is absent.
• It is inherited as a sex-linked disorder, although there is also a high
incidence in children with hemophilia (which is also sex linked),
congenital nystagmus, or glucose-6-phosphate dehydrogenase
deficiency.
ASSESSMENT
• The vision problem may involve the inability to distinguish red from
green or blue from yellow.

• A small proportion of children are unable to see any colors.

MANAGEMENT
• There is currently no therapy for color vision deficit because the
condition is caused by a genetic mutation.
• The deficit is categorized based on severity.
• It’s important that the loss of color perception is detected early so the
child is not asked to complete color identification assignments in
preschool and can learn to appreciate color changes in traffic signals
or other color-dependent signs necessary for safety.
• Some children associate color blindness with total “blindness” and
fear they will eventually lose their eyesight.
B. STRUCTURAL I. PTOSIS
PROBLEMS OF THE EYE
•  the inability to raise the
•  Structural problems of the upper eyelid the usual
eye tend to be congenital or distance, so the eyelid always
already present at birth. remains slightly closed.
ASSESSMENT
• children tend to wrinkle their forehead and raise their eyebrows more than usual
in an attempt to lift the eyelid further or cock their heads back to see under the
lowered lid.
• The condition may be congenital (frequently hereditary and bilateral) or acquired
(usually unilateral.
• It may be a result of injury to the lid or levator muscle, injury to the third cranial
nerve, or from the development of myasthenia gravis
• If the third cranial nerve has been injured, paralysis of one or more of the other
muscles supplied by that nerve will also be affected and a child will exhibit:
• A dilated pupil
• An inability to rotate the eye globe upward, medially, or downward
• Weakness of accommodation (looking at near objects)
MANAGEMENT
• After a careful investigation of the cause has been completed, ptosis
is corrected surgically.
• The correction is usually important to the child from a cosmetic
standpoint, but if the ptosis is unilateral, and more importantly, if the
lid obstructs vision, early surgery is necessary to prevent the
development of amblyopia (from a lack of use of the closed eye.
• Be certain that parents understand it’s important that ptosis be
corrected during the preschool period because although the ptosis
can be corrected when the child is older, the amblyopia cannot.
II. STRABISMUS
• is unequally aligned eyes (cross-eyes) caused by an imbalance of
the extraocular muscles that control the movement of the eye globes,
similar to the handling of reins of a horse.
• Approximately 1% to 2% of children demonstrate some degree of
strabismus.
• The condition does not favor either gender, social status, or
geographic area; about 30% of children have a history of a similar
strabismus in the family.
ASSESSMENT
• Infants’ eyes may cross occasionally until 6 weeks of age.
Definite deviations are obvious at a physical exam Note if the
deviation is:
• exotropia (an eye turns out)
• esotropia (an eye turns in)
• or hypertropia (an eye turns up).
• may be detected best when children are asked to examine a
nearby object because to do this, they must turn both eyes
medially, or converge, to focus at the short distance.
• If farsighted in one eye, they will have to turn the affected
eye in more than the other, causing esotropia.
• If one eye is nearsighted, they will not need to turn that eye in as far as
the other one; this results in divergence or exotropia.

Paralytic strabismus is caused by paralysis of a muscle or nerve, perhaps

from an injury (such as a birth injury), or an invading lesion.
• The eyes appear straight except when they are moved in the direction of
the paralyzed muscle. Then, double vision occurs, and the crossed eye is
evident.
• Such children often close one eye or tilt their head to decrease the double
vision.
• They may tilt their head so much that they appear to have a torticollis or
“wry neck”—an orthopedic rather than an eye problem.
• They may appear clumsy because of the diplopia.
MANAGEMENT
• The therapy for strabismus depends on the cause of the problem.
• If the fusion mechanism is weak, eye exercises (orthoptics) can strengthen
the weak muscle
• If eyes are diverging because of farsightedness or nearsightedness, the child
needs glasses or contact lenses to correct the basic visual defect.
• Surgical treatment can be used to permanently align the extraocular
muscles if the cause is due to muscle strength.
• A side effect of strabismus can be amblyopia because, to avoid double
vision, the child suppresses the vision in one eye.
• For this reason, eye correction for strabismus must be done early in life,
before 7 years of age..
• After strabismus surgery, eye patches are not usually required.
• Postoperatively, antibiotic ointment is applied to the eye for 2 or 3
days.
• The child may experience some pain on eye movement for the first
day as well as nausea and vomiting.
• Follow-up visits after surgery are necessary to determine the success
of the surgery.
• Retest children who have had this surgery periodically at health
maintenance visits to be certain their vision remains equal and eye
alignment remains straight.