BABY WATCH EARLY INTERVENTION VISION SCREENING TRAINING

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BABY WATCH EARLY INTERVENTION VISION SCREENING
TRAINING

• Part III .. Misalignment
• Developed by Darla Fowers, R.N., M. Ed.

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• Instructions for completing the Vision Screen
  Training by CD

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III. IS MISALIGNMENT OBSERVED?
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MISALIGNMENT

• Eyes that do not appear to be looking in the same
  direction at the same time, or ..
• Eyes that do not appear to be positioned in the
  eye sockets in the way you would anticipate, or
  ..
• Eyes that do not appear to be lined up quite
  right, in any way
• may be misaligned as seen in the following
  picture

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MISALIGNMENT

• It is not unusual to observe that the eyes of a
  very young infant do not always work together, or
  they drift in and out of position
• Both eyes are usually working together, and no
  longer drifting by the time the baby is about 6
  months of age
• However, parent(s) may report the eyes continue
  to drift beyond 6 months, when the child is
  tired, or when the child is ill (that information
  needs to be noted on the assessment form)

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MISALIGNMENT

• As one observes a child for possible misalignment
  it will be important to not be fooled by
• a child with wide epicanthal folds as seen in
  children of oriental decent or with a diagnosis
  of Down Syndrome, or
• A child with a wide bridge of the nose
• In the conditions noted above, straight eyes
  may actually appear crossed/misaligned

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MISALIGNMENT

• Misalignment of the eyes is of great concern.
  The brain will not tolerate the reception of two
  conflicting images. In such a case the brain
  will shut one of the images down, effectively
  blinding the eye which is shut down.
• This condition is known as amblyopia

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How To Check for Misalignment

• Observe the child to see where the eye(s) usually
  rest
• Complete the assessment form as follows

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MISALIGNMENT Continued .

• DDraw a circle to indicate the where the eye
  usually rests.

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MISALIGNMENT

• If misalignment appears to be a new or isolated
  happening wait 2 weeks, then rescreen.
• In the meantime have family/caregivers watch for
  any signs of the misalignment, especially at
  times when the child may be tired or ill. If the
  behavior is noted during the observation period
  or at the time of rescreening, refer to PIP and
  an ophthalmologist.

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MISALIGNMENT

• The second part of assessing for eye misalignment
  involves determining if light is reflected from
  the same place in each eye

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Is the light reflected from the same place in
both eyes?

• This test helps to determine whether the child is
  using binocular vision, (the ability of the eyes
  to work together) or if the child has eye muscle
  problems.

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Is the light reflected from the same place in
both eyes? Continued

• Shine a penlight into the eyes from about 18.
  The light should be centered on the bridge of the
  nose.

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Is the light reflected from the same place in
both eyes?

• The light should reflect back as seen in the
  following picture

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light reflection

• Note any difference in the light reflection on
  the assessment form

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light reflection

• Indicate, by drawing a dot, whether the light
  reflection is centered in both eyes, centered in
  one eye and off-center in the other, or
  off-centered in both.
• The following demonstrates some examples of this
  

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light reflection

• If any misalignment is noted, refer to PIP and an
  ophthalmologist