Eye health in childhood

• Understand and describe normal visual development and milestones; including variations of normal development, for example, intermittent squint prior to six months of age.
• Perform an eye examination/vision assessment on an infant or child including:
  • red reflex (Abnormal)
    • Cataract: A cloudy lens can block light, leading to an abnormal or absent reflex.
    • Retinoblastoma: A white reflex (leukocoria) can indicate a tumor in the retina.
    • Retinopathy of Prematurity: Abnormal blood vessels in the retina can affect the reflex.
    • Corneal Opacities: Scarring or other abnormalities in the cornea can obstruct light.
    • Vitreous Opacities: Bleeding or other issues in the vitreous (gel-like substance in the eye) can block the reflex.
    • Strabismus: Misalignment of the eyes can cause asymmetry in the red reflex.
  • fix and follow
  • accommodation
  • assessment of visual acuity whilst correcting for refractive error.
• Recognise and manage serious eye conditions of childhood:
  • congenital/genetic:
    • congenital/paediatric cataract
    • retinoblastoma, other tumours of the eye
    • retinitis pigmentosa, keratoconus, and other genetic conditions
    • congenital blindness
    • haemangiomas
  • acquired:
    • amblyopia
    • retinopathy of prematurity
    • corneal abrasion
    • chemical burns – acid and alkali
    • periorbital and orbital cellulitis
  • other:
    • nystagmus
    • ptosis
    • coloboma
    • paediatric glaucoma.

Key Features and Management of Serious Eye Conditions in Childhood

Congenital/Genetic Conditions

1. Congenital/Pediatric Cataract
   • Features: Clouding of the lens, poor vision, leukocoria (white pupillary reflex), nystagmus.
   • Management: Surgical removal of the cataract, corrective lenses, amblyopia therapy if needed.
2. Retinoblastoma
   • Features: Leukocoria, strabismus, red and irritated eyes, vision problems.
   • Management: Enucleation, chemotherapy, radiotherapy, cryotherapy, laser therapy.
3. Retinitis Pigmentosa
   • Features: Night blindness, peripheral vision loss, retinal pigmentation changes.
   • Management: No cure; manage with vitamin A supplementation, low vision aids, genetic counseling.
4. Keratoconus
   • Features: Progressive thinning and cone-shaped deformation of the cornea, visual distortion.
   • Management: Contact lenses, corneal cross-linking, corneal transplant in severe cases.
5. Congenital Blindness
   • Features: Total or near-total absence of vision from birth, various causes.
   • Management: Depends on the underlying cause; early intervention programs, support services, and assistive devices.
6. Hemangiomas
   • Features: Red, raised lesions near or on the eyelid, can affect vision if large or in a critical location.
   • Management: Observation, beta-blockers, corticosteroids, laser therapy, surgery if needed.

Acquired Conditions

1. Amblyopia (lazy eye)
   • Features: Reduced vision in one eye, misalignment of the eyes (strabismus), or difference in prescription between eyes.
   • Management: Corrective glasses, patching the stronger eye, atropine drops, vision therapy.
2. Retinopathy of Prematurity
   • Features: Abnormal blood vessel growth in the retina, can lead to retinal detachment.
   • Management: Regular eye exams, laser therapy, cryotherapy, anti-VEGF injections.
3. Corneal Abrasion
   • Features: Pain, redness, tearing, sensitivity to light, blurred vision.
   • Management: Topical antibiotics, pain management, avoid contact lenses until healed.
4. Chemical Burns – Acid and Alkali
   • Features: Redness, pain, tearing, blurred vision, potential corneal damage.
   • Management: Immediate irrigation with water or saline, urgent ophthalmologic evaluation, topical antibiotics, pain management.
5. Periorbital and Orbital Cellulitis
   • Features: Swelling and redness around the eye, pain, fever, possible vision changes.
   • Management: Oral or intravenous antibiotics, hospital admission in severe cases, surgical drainage if abscess is present.

Other Conditions

1. Nystagmus
   • Features: Involuntary, rhythmic eye movements, can affect vision stability.
   • Management: Corrective lenses, vision therapy, surgery in some cases.
2. Ptosis
   • Features: Drooping of the upper eyelid, can obstruct vision if severe.
   • Management: Surgical correction, treatment of underlying condition if applicable.
3. Coloboma
   • Features: Keyhole-shaped defect in the eye structures, can affect iris, retina, choroid, or optic nerve.
   • Management: Visual aids, surgical repair in some cases, regular monitoring.
4. Pediatric Glaucoma
   • Features: Enlarged eye, corneal clouding, tearing, sensitivity to light, vision loss.
   • Management: Medications to lower intraocular pressure, surgical interventions (trabeculotomy, goniotomy), regular monitoring.

Diagnose and manage common eye disorders in childhood

• bacterial and viral conjunctivitis
• chalazion
• hordeolum (stye)
• blepharitis
• allergic conjunctivitis
• blocked tear duct
• strabismus and pseudostrabismus
• refractive error and astigmatism
• colour blindness.

Eye health in adults

• Diagnose and manage common eye conditions including:
  • visual disorders:
    • refractive error
    • strabismus and amblyopia
    • colour blindness
    • flashers and floaters
  • inflammatory:
    • allergic and irritant conjunctivitis
    • blepharitis
    • scleritis and episcleritis
    • iritis/uveitis
    • blocked nasolacrimal duct/dacrocystitis
    • pterygium
    • pinguecula
  • traumatic:
    • subtarsal foreign body
    • subconjunctival haemorrhage
    •  hyphaema
  • complications of chronic disease:
    • hypertensive retinopathy
    • diabetic retinopathy and diabetic macular oedema
  • degenerative:
    • macular degeneration
  • other/multiple causes:
    • glaucoma
    • ptosis
    • dry eye
    • cataract
    • ectropion, entropion.
• Diagnose and manage common eye infections including:
  • conjunctivitis – bacterial or viral
  • chalazion and hordeolum (stye)
  • trachoma and trichiasis.
• Diagnose and manage eye emergencies/serious eye conditions:
  • traumatic:
    • corneal injury – abrasion/foreign body
    • ‘flash’ burns
    • chemical burns – acid and alkali
    • retinal detachment
    • intraocular foreign body
    • other direct trauma to the eye, including blowout fractures
  • inflammatory or infective:
    • temporal arteritis
    • optic neuritis
    • herpes simplex keratitis
    • herpes zoster ophthalmicus
    • orbital and periorbital cellulitis
    • endophthalmitis
  • other:
    • acute glaucoma
    • central retinal artery occlusion
    • central retinal vein occlusion
    • vitreous haemorrhage
    • intraocular tumour
    • papilloedema
    • corneal ulcer.
• Safely and competently perform common examinations:
  • fluorescein staining and examination with a blue light
  • dilatation of the pupil
  • assessment of visual acuity; including in culturally and linguistically diverse patients and illiterate patients
  • correction of refractive error and assessment of visual acuity
  • visual fields
  • eversion of the eye lid
  • assessment of intraocular pressure
  • assessment of colour vision
  • assessment of eye movements
  • direct ophthalmoscopy.
• Safely and competently perform common minor procedures:
  • removal of a conjunctival, corneal or subtarsal foreign body, including the use of a burr
  • incision and drainage of a hordeolum
  • eye irrigation and assessment of pH
  • trimming/removal of eye lashes in trichiasis.
• Recognise when eye symptoms or signs are related to systemic disease; for example:
  • blurred vision with uncontrolled diabetes due to change in lens shape
  • uveitis or dry eyes with rheumatoid arthritis.