HESI TIPS PEDS HELP
Review Materials from Exam:
PN Pediatrics 2
Assessment of Vision
Major Developmental Characteristics of Vision
Birth
• Visual acuity 20/100 to 20/400*
• Pupillary and corneal (blink) reflexes present
Able to fixate on moving object in range of 45
• degrees when held 20 to 25 cm (8 to 10 inches)
away
Cannot integrate head and eye movements well
• (doll's eye reflex—eyes lag behind if head is
rotated to one side)
4 weeks of age
• Can follow in range of 90 degrees
Can watch parent intently as he or she speaks to
•
infant
• Tear glands begin to function
Visual acuity is hyperoptic because of less
•
spherical eyeball than in adult
6 to 12 weeks of age
• Has peripheral vision to 180 degrees
Binocular vision begins at age 6 weeks, is well
•
established by age 4 months
Convergence on near objects begins by age 6
•
weeks, is well developed by age 3 months
• Doll's eye reflex disappears
12 to 20 weeks of age
• Recognizes feeding bottle
Able to fixate on a 1.25-cm (0.5-inch)
•
block
Looks at hand while sitting or lying on
•
back
• Able to accommodate to near objects
20 to 28 weeks of age
• Adjusts posture to see an object
• Able to rescue a dropped toy
• Develops color preference for yellow and red
Able to discriminate among simple geometric
•
forms
, • Prefers more complex visual stimuli
• Develops hand-eye coordination
28 to 44 weeks of age
• Can fixate on very small objects
• Depth perception begins to develop.
• Lack of binocular vision indicates strabismus.
44 to 52 weeks of age
• Visual acuity 20/40 to 20/60
• Visual loss may develop if strabismus is present.
• Can follow rapidly moving objects
Clues for Detecting Visual Impairment
Refractive Errors
Myopia
Nearsightedness—Ability to see objects clearly at close range but not
at a distance
Pathophysiology—Results from eyeball that is too long, causing
image to fall in front of retina
Clinical manifestations
• Rubs eyes excessively
• Tilts head or thrusts head forward
Has difficulty in reading or performing other close
•
work
• Holds books close to eyes
• Writes or colors with head close to table
• Clumsy; walks into objects
Blinks more than usual or is irritable when doing
•
close work
• Is unable to see objects clearly
Does poorly in school, especially in subjects that
•
require demonstration, such as arithmetic
• Dizziness
• Headache
• Nausea following close work
Treatment—Corrected with biconcave lenses that focus image on
retina
Hyperopia
Farsightedness—Ability to see objects at a distance but not at close
range
Pathophysiology—Results from eyeball that is too short, causing
image to focus beyond retina
Clinical manifestations
Because of accommodative ability, child can
•
usually see objects at all ranges.
• Most children normally hyperopic until about 7
Review Materials from Exam:
PN Pediatrics 2
Assessment of Vision
Major Developmental Characteristics of Vision
Birth
• Visual acuity 20/100 to 20/400*
• Pupillary and corneal (blink) reflexes present
Able to fixate on moving object in range of 45
• degrees when held 20 to 25 cm (8 to 10 inches)
away
Cannot integrate head and eye movements well
• (doll's eye reflex—eyes lag behind if head is
rotated to one side)
4 weeks of age
• Can follow in range of 90 degrees
Can watch parent intently as he or she speaks to
•
infant
• Tear glands begin to function
Visual acuity is hyperoptic because of less
•
spherical eyeball than in adult
6 to 12 weeks of age
• Has peripheral vision to 180 degrees
Binocular vision begins at age 6 weeks, is well
•
established by age 4 months
Convergence on near objects begins by age 6
•
weeks, is well developed by age 3 months
• Doll's eye reflex disappears
12 to 20 weeks of age
• Recognizes feeding bottle
Able to fixate on a 1.25-cm (0.5-inch)
•
block
Looks at hand while sitting or lying on
•
back
• Able to accommodate to near objects
20 to 28 weeks of age
• Adjusts posture to see an object
• Able to rescue a dropped toy
• Develops color preference for yellow and red
Able to discriminate among simple geometric
•
forms
, • Prefers more complex visual stimuli
• Develops hand-eye coordination
28 to 44 weeks of age
• Can fixate on very small objects
• Depth perception begins to develop.
• Lack of binocular vision indicates strabismus.
44 to 52 weeks of age
• Visual acuity 20/40 to 20/60
• Visual loss may develop if strabismus is present.
• Can follow rapidly moving objects
Clues for Detecting Visual Impairment
Refractive Errors
Myopia
Nearsightedness—Ability to see objects clearly at close range but not
at a distance
Pathophysiology—Results from eyeball that is too long, causing
image to fall in front of retina
Clinical manifestations
• Rubs eyes excessively
• Tilts head or thrusts head forward
Has difficulty in reading or performing other close
•
work
• Holds books close to eyes
• Writes or colors with head close to table
• Clumsy; walks into objects
Blinks more than usual or is irritable when doing
•
close work
• Is unable to see objects clearly
Does poorly in school, especially in subjects that
•
require demonstration, such as arithmetic
• Dizziness
• Headache
• Nausea following close work
Treatment—Corrected with biconcave lenses that focus image on
retina
Hyperopia
Farsightedness—Ability to see objects at a distance but not at close
range
Pathophysiology—Results from eyeball that is too short, causing
image to focus beyond retina
Clinical manifestations
Because of accommodative ability, child can
•
usually see objects at all ranges.
• Most children normally hyperopic until about 7
