BABY WATCH EARLY BABY WATCH EARLY INTERVENTION INTERVENTION VISION SCREENING VISION SCREENING TRAININGTRAINING Part III .. Part III ..

MisalignmentMisalignment

Developed by: Darla Developed by: Darla Fowers, R.N., M. Ed.Fowers, R.N., M. Ed.

Instructions for Instructions for completing the completing the Vision Screen Vision Screen Training by CDTraining by CD

III. IS III. IS MISALIGNMENT MISALIGNMENT

OBSERVED?OBSERVED?

MISALIGNMENTMISALIGNMENT Eyes that do not appear to be looking Eyes that do not appear to be looking in the same direction at the same time, in the same direction at the same time,

or ..or ..

Eyes that do not appear to be Eyes that do not appear to be positioned in the eye sockets in the positioned in the eye sockets in the

way you would anticipate, or ..way you would anticipate, or ..

Eyes that do not appear to be lined up Eyes that do not appear to be lined up quite right, in any wayquite right, in any way

… … may be misaligned as seen in the may be misaligned as seen in the following picture:following picture:

MISALIGNMENTMISALIGNMENT It is not unusual to observe that the It is not unusual to observe that the

eyes of a very young infant do not eyes of a very young infant do not always work together, or they drift in always work together, or they drift in

and out of positionand out of position– Both eyes are usually working together, Both eyes are usually working together, and no longer drifting by the time the baby and no longer drifting by the time the baby

is about 6 months of ageis about 6 months of age

However, parent(s) may report the However, parent(s) may report the eyes continue to drift beyond 6 eyes continue to drift beyond 6

months, when the child is tired, or months, when the child is tired, or when the child is ill (that information when the child is ill (that information needs to be noted on the assessment needs to be noted on the assessment

form)form)

MISALIGNMENTMISALIGNMENT As one observes a child for As one observes a child for

possible misalignment it will be possible misalignment it will be important to not be fooled by:important to not be fooled by:– a child with wide epicanthal folds as seen a child with wide epicanthal folds as seen

in children of oriental decent or with a in children of oriental decent or with a diagnosis of Down Syndrome, or …diagnosis of Down Syndrome, or …

– A child with a wide bridge of the noseA child with a wide bridge of the nose

***In the conditions noted above, ***In the conditions noted above, straight eyes may actually straight eyes may actually

appear crossed/misaligned***appear crossed/misaligned***

MISALIGNMENTMISALIGNMENT Misalignment of the eyes is of Misalignment of the eyes is of great concern. The brain will not great concern. The brain will not

tolerate the reception of two tolerate the reception of two conflicting images. In such a case conflicting images. In such a case

the brain will shut one of the the brain will shut one of the images down, effectively blinding images down, effectively blinding

the eye which is shut down. the eye which is shut down.

This condition is known as This condition is known as amblyopia amblyopia

How To Check for How To Check for MisalignmentMisalignment

Observe the child to see Observe the child to see where the eye(s) usually restwhere the eye(s) usually rest

Complete the assessment Complete the assessment form as follows:form as follows:

MISALIGNMENT MISALIGNMENT Continued ….Continued ….DDraw a DDraw a

circle to circle to indicate indicate the where the where the eye the eye usually usually rests.rests.

MISALIGNMENTMISALIGNMENT If misalignment appears to be a If misalignment appears to be a new or isolated happening wait 2 new or isolated happening wait 2

weeks, then rescreen. weeks, then rescreen.

In the meantime have In the meantime have family/caregivers watch for any signs family/caregivers watch for any signs

of the misalignment, especially at of the misalignment, especially at times when the child may be tired or times when the child may be tired or

ill. If the behavior is noted during ill. If the behavior is noted during the observation period or at the time the observation period or at the time

of rescreening, refer to PIP and an of rescreening, refer to PIP and an ophthalmologist. ophthalmologist.

MISALIGNMENTMISALIGNMENT

The second part of The second part of assessing for eye assessing for eye

misalignment involves misalignment involves determining if light is determining if light is

reflected from the same reflected from the same place in each eyeplace in each eye

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.

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

……

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

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

The light should The light should reflect back as seen reflect back as seen

in the following in the following picture …picture …

light reflectionlight reflection

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

light reflectionlight reflection– Indicate, by drawing Indicate, by drawing

a dot, whether the a dot, whether the light reflection is light reflection is centered in both centered in both eyes, centered in one eyes, centered in one eye and off-center in eye and off-center in the other, or off-the other, or off-centered in both. centered in both.

– The following The following demonstrates some demonstrates some examples of this …examples of this …

light reflectionlight reflection

If any misalignment is If any misalignment is noted, refer to PIP noted, refer to PIP

and an and an ophthalmologistophthalmologist