Included In This Lesson
Study Tools
Outline
Overview
- Lack of coordination between extraocular muscles
- Lack of binocularity
- Eyes unable to simultaneously look at the same object
- Often referred to as “cross-eyed”.
Nursing Points
General
- Normal finding for infants <4 months
- Treatment before 4-6 years is essential
- To avoid lifelong visual problems
- Amblyopia will occur if untreated
- “Lazy eye”
- Brain learns to ignore unfocused eye
Assessment
- Tests used to detect strabismus
- Corneal light reflex test
- Cover test
- Eyes crossed or deviated
- Poor depth perception
- Squinting of eyes and tilting of head
- Binocular vision is lost without treatment
- Patient may see…
- Single blurred image
- Double image with one blurred
Therapeutic Management
- Need a full eye exam
- Eyeglasses
- Eye patch
- Worn on the good eye to strengthen the weak eye.
- Vision therapy
- Surgery
- If initial treatment was delayed
- Permanent loss of vision (amblyopia) may occur if untreated before 4-6 years
Nursing Concepts
- Sensory Perception
- Human Development
Patient Education
- Eye patch should be worn on the good eye
References:
American Optometric Association. (2019). Strabismus (Crossed Eyes). Retrieved from https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/strabismus
Hockenberry, M., Wilson, D. & Rodgers, C. (2017). Wong’s essentials of pediatric nursing (10th ed.) St. Louis, MO: Elsevier Limited.
Lissauer, T. & Carroll, W. (2018). Illustrated textbook of pediatrics (5th ed.) Europe: Elsevier Limited.
ADPIE Related Lessons
Related Nursing Process (ADPIE) lessons for 07.01 Strabismus
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!
Ashley Powell, MSN, RN, PCN 