HOLY FAMILY COLLEGE OF NURSING

EVALUATION PERFORMA FOR SEMINAR/PRESENTATION

Name- Mary Menu Ekka Class: M.Sc. 2nd year

S.NO. CRITERIA ALLOTED MARKS OBTAINED MARKS
1. Lesson plan (organization and adequacy of content, 20
submission, planning)
2. Preparation of class 5
3. Introduction 5
4. Subject matter and depth of knowledge 5
5. A.V aids 30
6. Confidence 10
7. Language and voice 10
8. Grooming 5
9. Summary & conclusion 5
10. Punctuality 5

Total 100

Remarks:

Signature of the Supervisor:

 HOLY FAMILY COLLEGE OF NURSING
NEW DELHI.

PEER GROUP TEACHING

ON
DISORDERS OF EYE

SUBMITTED TO: SUBMITTED BY:

MADAM JIBANLATA MARY MENU EKKA
ASSOCIATE PROFFESOR. M.Sc. 2ND YEAR NURSING STUDENT.
HOLY FAMILY COLLEGE OF
NURSING
SUBMITTED ON:
IDENTIFICATION DATA

NAME : MARY MENU EKKA

CLASS : M.Sc. 2nd YEAR

SUBJECT : CHILD HEALTH NURSING

TOPIC : PEER GROUP TEACHING ON DISORDERS OF EYE.

DATE OF PRESENTATION :

PLACE : CLASSROOM

DURATION : 60 MINS.

METHOD OF TEACHING : LECTURE CUM DISCUSSION

SUPERVISOR : MADAM JIBANLATA

AV AIDS : CHARTS, FLASH CARDS, POWERPOINT

GENERAL OBJECTIVES:

Group point of view:

At the end of the teaching session the group will be able to

 Gain knowledge about the topic.
 Able to assess the condition in the clinical areas.

Student teacher point of view:

 Teach the group effectively.

 Realize the cognitive functions.
 Develop and improve professional efficiency.

SPECIFIC OBJECTIVES:

- Introduce the topic.

- Define conjunctivitis.
- Explain the management of conjunctivitis.
- Discuss the prevention of conjunctivitis.
- Define ophthalmia neonatorum.
- Enlist the clinical feature of ophthalmia neonatorum.
- Explain the management of ophthalmia neonatorum.
- Define retinitis.
- Explain the management of retinitis.
- Define stye and its management.
- Define cataract and Explain the management of cataract.
- Explain the refractory errors and the management.
- Discuss about the disorders of impairment of eye muscles.
- Enlists the less common diseases in children.
Time Specific Content Teaching and Learning Evaluation
Objectives Activity
 Introduction:
I am Mary Ekka M.Sc.
2nd year student and I am
going to give a teaching
on some “Disorders Of
The Eye”.

DISORDERS OF EYE.

A. INFECTIOUS AND INFLAMMATORY CONDITIONS OF

EYES

5mins Define 1. CONJUNCTIVITIS Student teacher defines What is

conjunctivitis Definition about conjunctivitis. conjunctivitis?
Conjunctivitis during (“pink eye”) is an inflammation of the conjunctiva
of eye.

Etiology
Conjunctivitis during childhood is caused due to allergy of infection by
bacteria of virus. The most common bacterial causes are Hemophilus
influenza, Streptococcus pneumonia and Chlamydia. Viruses that cause
conjunctivitis are Adenovirus and Herpes virus.

Clinical Features
The clinical features of conjunctivitis:
 Redness of eye
 Tearing and
 Exudation (flaky and sticky)

Time Specific Content Teaching and Learning Evaluation

Objectives Activity
2mis Explain the Management Student teacher explains Explain
management of Treatment depends upon the type conjunctivitis- about conjunctivitis. management.
conjunctivitis.
Causes Associated Management

a. Viral Associated with other symptoms Hygiene and rest.

of generalized viral infections.
Antibiotic eyedrops
b. Bacterial Yellow, green or white pus with or ointment with
photophobia. hygiene.

c. Chlamydia Cough, history of maternal Systemic

l infection. pain, photophobia and antibiotics,
skin lesions. evaluation by
specialists, antiviral
d. Allergic Itching, seasonal onset of agents.
symptoms, other allergic Antihistamine
e. Chemical symptoms and watery discharge. eyedrops,
avoidance of any
Watery discharge, onset of any allergens.
f. Trauma symptoms exposed to cigarettes
or any other irritants. Avoidance of any
other irritants
Pain, photophobia and increased
tear production. Eye patch, referral
to physical.

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2mins Discuss the Prevention Student teacher discusses What preventive
prevention of  If conjunctivitis is allergic or viral in origin, nursing management about the prevention of measures can be
conjunctivitis. focuses primarily on comfort measures. Following nursing care conjunctivitis. taken for
needs to be given- conjunctivitis?
 Apply could compress on the eye.
 Reduce exposure to light.
 Prevent rubbing of the eye.
 Acetaminophen may be administered to relieve discomfort.

 If conjunctivitis is caused by bacterial agents, nursing care

includes:
 Clean the eye using sterile water and cotton swabs, from inner
canthus to outer canthus.
 Apply the prescribed antibiotic ointment or eye drops.
 Use of dark glasses is advised, in presence of photophobia.
Family Teaching
Advise the following ways to prevent transmission of infection to others-
 Use good hand washing after touching the eye.
 Use separate towel, sheet and pillow case for infected child.
 Do not allow the medicine dropper to touch child’s eyes during
medication instillation.
 Discard old contact lenses (if child is during) and use new ones
after infection has resolved.

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Objectives Activity
 2. OPHTHALMIA NEONATRUM

2min Define ophthalmia Definition Student teacher defines Define

neonatorum Purulent discharge from eye of a newborn, within 21 days of birth is about ophthalmia ophthalmia
known as ophthalmia neonatorum. neonatorum neonatorum
Most cases develop this condition within 48-72 hours of life. It is mostly
bilateral.

Etiology
The organisms that may cause ophthalmia neonatorum are- Neisseria
gonorrhoea, Staphylococcus aureus
E. coli, Pseudomonas aeruginosa, certain viruses and Chlamydia
trachomatis.

Mode of Infection

The mode of infection include-

a. Intrauterine infection
b. Infection during the process of delivery (most common)
c. Infection after birth
Pathology

Due to infection, the blood vessels dilate and there is formation of new
blood vessels around the papillae.Numerous polymorphs are present in
the epithelium which leads to purulent discharge and exudate formation in
eye.

Time Specific Content Teaching and Learning Evaluation

Objectives Activity
1min Enlist the clinical Clinical Feature Student teacher enlists What is the
feature of It is a bilateral infection which has the following clinical manifestations- the clinical feature of clinical feature
ophthalmia  Eyelids are tense and swollen. ophthalmia neonatorum of ophthalmia
neonatorum  Conjunctive is congested and swollen. neonatorum?
 Excessive tearing or turbid and thick discharge from eyes.
Management
Explain the Student teacher explains What
3mins i. A swab must be taken from purulent eye discharge and sent for culture
management of the management of management of
and sensitivity. Depending upon result, the physician prescribes
ophthalmia ophthalmia neonatorum ophthalmia
appropriate antibiotic ointment or eye drops. Crystalline penicillin,
neonatorum. Chloramphenicol, Erythromycin or Gentamycin eye drops may be neonatorum
prescribed by the physician. Polymyxin is used for pseudomonas
infection.
ii. Eye Care
The infected eye or eyes are cleaned with sterile swabs moistened with
normal saline. Each swab will be used once only for wiping the eye from
inner canthus to outer canthus. Wash eyes as frequently as possible with
warm sterile normal saline.
iii. After cleaning of eyes, instill crystalline eye drops.
 Every minute for ½ hour
 Every 5 minute for next ½ hour
 Every 1 hour for 12 hours
 Every 2 hourly for 3 days
In case of Gonococcal or Chlamydia infection, systemic antibiotic therapy
is required.

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Objectives Activity
 Prevention

Ophthalmia neonatorum can be prevent by following simple measures.

 Proper antenatal care of pregnant women.
 Treatment of infected vaginal discharge during pregnancy.
 Use of aseptic techniques while delivery and in care of newborn.
 Cleaning of each eye with sterile swabs dipped in sterile water as
soon as the head is delivered and instillation of Chloramphenicol
eye drops in each eye as a prophylactic measure.
Complications

If the condition is not treated, there can be generalized haziness of cornea

or corneal ulcers, which may lead to blindness.

3. RETINITIS

Definition

2mins Inflammation or retina is known as retinitis. It usually occurs in Student teacher defines
Define retinitis Define retinitis
association with inflammation of choroid (chorion- retinitis) or optic retinitis
nerve (neuroretinas). Primary retinitis is rare.

Etiology

Primary retinitis may be an allergic reaction to some endogenous toxin. In

few cases, the toxin is produced from some active or latent septic focus

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Objectives Activity
 (like dental sepsis, septic tonsils) but in most of the cases it is
tuberculoprotein from a latent focus in lung or any lymph node.

3mins Enlist the clinical Clinical Features Student teacher enlist the What are the
features of clinical features of clinical features
retinitis. The child presents with the following clinical features- retinitis of retinitis?
 Floating black spots in front of eye
 Metamorphopsia (distortion of image)
 Micropsia (objects appear smaller)
 Photopsia or subjective flashes of light due to retinal
irritation
Diagnostic Evaluation

The diagnosis of retinitis is established with the help of fundoscopy,

which shows-
 Localized grey patch with blurred margins in retina
 Few hemorrhagic spots or exudates on retina
 If the grey is close to optic disc the disc margin becomes
edematous.
 If central area is affected, there is permanent defect of visual
acuity with central scotoma.

Time Specific Content Teaching and Learning Evaluation

Objectives Activity
2mins Explain the Management Student teacher explains What is the
management of the Management of management of
retinitis. Management of retinitis is as follows- retinitis retinitis?
 Protect the eye from light by wearing dark goggles.
 Atropine eye drops are instilled thrice daily.
 Eye care should be done using warm sterile water.
 Sub conjunctival or retro-bulbar injection of corticosteroid may be
helpful in arresting the inflammatory process.
 Sodium salicylate may be given for pain relief.
 Systemic antibiotics are prescribed to treat focal sepsis, if present
anywhere in the body.
 Antihistamines are helpful in allergic type.
 Systemic corticosteroids are effective in controlling inflammation.

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Objectives Activity
 4. STYE (HORDEOLUM)
2mins Define stye. Definition Student teacher defines What is
Stye or hordeolum is an infection gland near the eye lashes. A pustule in Stye. definition of
the eyelash follicle is known as stye. stye.

Etiology
A stye may be caused by bacterial or viral infection. It is most often
caused by staphylococcus infection.

Clinical Features
The clinical features of hordeolum are as follows-
 Pustule in eyelash
 Pain and tenderness
 Localized swelling of eyelid
 Redness in eye
As hordeolum forms, it gets filled with purulent material and becomes red
and painful.

Management
 Warm compress must be applied on eye, several times in a day.
2mins Explain the
management of  Eye care is done frequently. Student teacher explain
What is the
stye.  Antibiotic eye drops are instilled. the management of stye.
management of
 If the hordeolum does not resolve spontaneously, incision and stye?
drainage of purulent material is to be done.

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Objectives Activity
 Prevention
This type of infection can be prevented by observing hand washing
practice and maintaining personal hygiene.

B. NON- INFLAMMATORY CONDITIONS OF EYE

1.CATARACT

1min Define cataract. Definition Student teacher defines What is

Cataract is the development of opacity in the crystalline lens of eye. As cataract. cataract?
light can not pass through the opacity, vision becomes blurred.

Incidence
Congenital cataract affect 1/in 250 newborns.

2mins Enlist the types of Types

cataract. Cataract can be of the following types- Student teacher enlist the What are the
1. Unilateral or bilateral types of cataract? types of
2. Partial or complete cataract?
3. Congenital or acquired
Etiology

The aetiology of congenital or acquired cataract is as follows-

Time Specific Content Teaching and Learning Evaluation

Objectives Activity
 Cataract
Congenital or Primary Acquired or Secondary
Intrauterine infections in early Trauma
months of pregnancy like Retrolental
German measles and Toxoplasmosis
fibroplasia Uveitis
Glaucoma
Maternal malnutrition

Galactosemia
Chromosomal anomalies like
-Down’s syndrome
-Ocular malformation
-Mental retardation

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Objectives Activity
 Diagnostic Evaluation
Infants with a family history or prenatal history placing them at risk for
cataract should be assessed soon after birth. The opacity or cloudiness of
lens can be seen with naked eye. When the nurse does eye examination
using a penlight, it reveals absence of red-light reflex and white pupillary
reflex.

2mins Explain the Management

management of The definitive treatment for cataract is surgical removal of the cataract Student teacher explain What is the
cataract. from affected eye. The affected lens is removed and artificial intraocular the management of management of
lens is put in the affected eye. cataract. cataract?
The time at which cataract surgery is performed, is crucial to prognosis. If
cataract is noticeable at birth; surgery must be done before 8 week of age,
to prevent irreversible visual impairment.

Post-Operative Care
- After surgery the child needs eye patching or shielding for several
days.
- Instillation of antibiotic and steroidal eye drops several times a
day.

2. GLAUCOMA
Definition
Glaucoma is the condition of increased intra ocular pressure (IOP),
causing gradual loss of sight.
Types
i. Congenital or infantile glaucoma: It occurs in children under 3 years
of age. It may be present at birth.
ii. Juvenile glaucoma: It affects children older than 3 years of age and is
usually secondary to some other disease.
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Objectives Activity
 Clinical Feature

The clinical feature of glaucoma are-

 Excessive tearing (epiphora)
 Involuntary closing of eyelid
 Photophobia
 Enlargement of eyeball (Buphthalmos)
 Pain in the eyeball
Diagnostic Evaluation

Intra ocular pressure of eye is measured by tonometry. The normal

pressure is 12 to 20 mm Hg. For measurement of intro ocular pressure in
infants and young children, anaesthesia may be required. Assessment of
corneal diameter and examination or retina is done to assess any damage
to optic nerve due to increased pressure.

Management

The definitive treatment is surgery. Goniotomy or Trabeculotomy is done

to open the channel of outflow of aqueous humor from the anterior
chamber of the eye, thereby reducing intra ocular pressure.

Post-Operative Care
The post operative nursing care aims at the following:
 Management of intro ocular pressure
 Management of pain

Time Specific Content Teaching and Learning Evaluation

Objectives Activity
  Reducing fear and anxiety
 Teaching care givers about home management
4. REFRACTORY ERRORS
2mins Explain the Student teacher explains What are
refractory errors. Refraction is the process by which the cornea and lens of the eye bend about refractory errors. refractory
light rays. Focus on the retina. errors?
When the bending of rays and length of eyeball are uncoordinated, the
image does not fall on a single point on retina. This results in refractory
errors. When refraction in normal it is known as ‘emmetropia’

Incidence and Etiology

Refractory disorders are the most common type of visual disorders in
children that occur due to the

Following reasons-
a. Abnormal curvature of refractive surfaces
b. Abnormal position of refractive surfaces
c. Abnormal anterior-posterior length of eyeball
d. Abnormal refractive index of refractive media of eyeball i.e lens (as in
cataract) and vitreous humor (after vitrectomy).

Types
Enlist the types of
2mins Student teacher enlists the What are the
refractory errors. The following Refractive disorders may be present in children- types of types of the types
a. Myopia (Near sightedness) of
refractory errors.
b. Hyperopia (Far sightedness0 refractory
c. Astigmatism (Blurred vision) errors.

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 a. Myopia (Near sightedness)

Types

i. Congenital myopia: It is present at birth and may be unilateral. It

is usually associated with convergent squint.
ii. Simple myopia: This is the commonest type and is not associated
with any degenerative changes in retina and choroid. It starts in
early adolescence during school years and becomes stationary
after the age 25 years.
iii. Progressive myopia: This type progresses rapidly and is
accompanied by degenerative changes in vitreous, choroids and
retina.

Clinical Features

The clinical feature of myopia are as follows:

 Dimness of vision for distant objects:- The child usually
complains that he/she cannot see the writing on blackboard in
school.
 If the defect is severe, apart from dimness of vision for distant
objects, the child complains of headache of reading.
 The child is seen holding books closely to eyes, while reading.

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Objectives Activity
 Management

The defect should be corrected by prescribing a concave lens of

appropriate strength for the child. Photorefractive keratectomy laser
surgery may be used to correct myopia.

b. Hyperopia (Far Sightendness)

Definition

Hyperopia is the condition in which parallel rays from a distant object

focus behind the retina. This is the most common refractory error.

Clinical Features

The Clinical features of hyperopia are as follows-

 Diminished vision, both for near and distant objects.
 In less severe hyperopia, the child complains of reading problem.
 There may be headache, transient blurring of vision (particularly
while reading), pain in eyes, heaviness of eyelids and redness of
eyes.
Management

This refractory error can be corrected by using convex lens or proper

strength.

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 6.ASTIGMATISM
Definition

Astigmatism is the refractor error in which refraction differs in different

meridians of eye. In the horizontal meridian, the eye is emmetropic while
in the vertical meridian, it is hypermetropia or myopic.

Types

i. Irregular astigmatism: Here the rays of light are reflected very

irregularly corneal curvature, as in case of corneal scar.
ii. Regular astigmatism: In this type, the meridians of greatest and least
curvature are at right angles to each other. They are called principal
meridians.

For the correction of regular astigmatism, cylindrical lens of proper

strength is prescribed. In case of irregular astigmatism, correction in eye
sight can’t be made with cylindrical lens, but use of contact lens can be
helpful.

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5mins Discuss about the DISORDERS OF IMPAIRMENT OF EYE MUSCLES Student teacher discusses
disorders of about the disorders of
impairment of eye Eye movements are coordinated and controlled by six small muscles, impairment of eye
muscles. innervated by cranial nerves III, IV and VI. If these muscles are affected, muscles.
vision becomes impaired. Disorders of eyes related to impairment of
muscles are- Strabismus and Amblyopia.

1.STRABISMUS (SQUNIT)

Definition

The deviation of visual axis from normal alignment is know as

strabismus. The visual line of each eye does not simultaneously focus on
the same object due to lack of muscle coordination resulting in a crossed-
eye appearance.

Incidence

Strabismus occurs in 2-3% of all children. Approximately half of these

children have a family history for the defect. Transient strabismus is
normal in first 4-6 months of life and is attributed to physiologic
hypermetropia.

Types

Strabismus is of two types-

i. Paralytic or non-concomitant type
ii. Non paralytic or concomitant type

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 i) Paralytic or non-concomitant type

This type occurs due to weakness or paralysis of one or more extra ocular
muscles. There is limitation in movement of eye and diplopia occurs.

Congenital paralytic strabismus occurs due to neuromuscular anomalies

or birth trauma. Acquired strabismus results due to intracranial tumors,
myasthenia gravis, CNS infections, polio, encephalitis, diphtheria toxin,
lead toxicity, botulism, thiamine deficiency and fracture of base of skull.

ii. Non paralytic or concomitant type

This is the commonest type. The movements of individual ocular muscles

are present, but coordination is lacking. Diploma does not occur in this
type.

Another classification of strabismus classifies it into three type-

i. Esotropia (convergent): in this type, the eyes turn towards the midline.
ii. Exotropia (Divergent): In this type, the eyes turn away from the
midline.
iii. Hypertropia: In this type, the eyes are out of vertical alignment. One
pupil appears higher than the other.

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 2. AMBLYOPIA

Definition
Amblyopia means poor vision in one eye that has not developed normal
sight. It is unrelated to an organic cause. The condition is sometimes
called ‘lazy eye’ It occurs when visual acuity is better in one eye than the
other.

Clinical Features

Infants and children with Amblyopia often do not display any symptoms.
They may occasionally overreach for an object.

Management

If the cause of Amblyopia is strabismus, surgery may be required. If the

cause is a cataract, then cataract removal surgery is done. Refractive
Amblyopia is treated by correcting refractive error with corrective lenses.

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5mins Enlists the less E. LESS COMMON EYE DISEASES IN CHILDREN Student teacher enlists
common diseases While the above eye disorders are common and easy to correct. If the less common
in children. detected and treated early, eye diseases can be much more serious. Some diseases in children.
of them can be treated and cured, others are incurable. Fortunately, these
diseases are rare. Example of such eye diseases are:

1. RETINOPATHY OF PREMATURITY (ROP)

Babies born with a very low birth weight have an increased risk of
developing abnormal peripheral retinal blood vessels that can cause the
retina to become lose (detached retina), which can lead to blindness.
/those babies who do not develop this problem in childhood still have an
increased risk of retinal detachment later in life and should be seen
regularly by an eye doctor to check for retinal detachment.

2.FAMILIAL (CONGENITAL) BLINDNESS

If there is a history of blindness in the family of either the father or

mother, parents need to seek genetic counselling to help determine the
risk of blindness in their children.

3.RETINITIS PIGMENTOSA
In this inherited disease, the retina in eye degenerates more and more over
time (progressively). Children are unable to see at night (develop night
blindness) and then lose their side (peripheral) vision.

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 Tunnel vision (no side vision at all, as if in a tunnel) develops, followed
by complete blindness.

4.LEBER’S CONGENITAL GLAUCOMA

Blindness or near-blindness occurs in children with this disease because

of loss of nerve function in the retina of both eyes. A jerky movement of
the eyes (nystagmus) may occur along with hypersensitivity to light and
sunken eyes.

5.CONGENITAL GLAUCOMA

In this disease, high pressure of the fluid within the eye together with an
enlarged cornea can cause nerve damage in newborns and infants. A
common cause is malformation of some parts of the eye. Too much
tearing (excessive watering) can be a warning sign of congenital
glaucoma but may also indicate less srious conditions, such as blocked
tear duct.

6.DERMOID CYSTS

These are bumps usually found on the side of the head near the eyebrow.
They are not cancer, but are actually capsules containing skin tissue, hair,
fat, or other body tissue. Dermoid cysts should be removed before the
child begins to walk because they can break open during a fall and cause
painful inflammation.

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 Warning Signs

An eye doctor-either an optometrist or an ophthalmologist must be

consulted, if any of the following sing are present in the child.
 Eyes flutter quickly from side to side (nystagmus).
 Eyes are watery all the time.
 Eyes are always sensitive to light.
 Eyes change in any way from their usual appearance.
 White or yellow material appears in the pupil.
 Redness in either eye persists for several days.
 Pus or crust appears in either eye.
 Eyes look crossed or “wall-eyed”
 The child constantly rubs his or her eyes.
 The child often squints.
 The child’s head is always titled.
 Eyelids tend to droop.
 One of both eyes seem to bulge.
 One pupil is larger or smaller than the other (asymmetric pupil
size).
 Baby does not make eye contact by 3 months of age.
 Baby does not focus on and follow objects by 3 months of age.
 Baby does not reach for objects by 6 months of age.
 Baby covers or closes one eye.

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  One eye constantly or sometimes (intermittently) turns in, out, up
or down.

Summary & Conclusion:

Therefore, at the end of the topic I would like to conclude that we have
discussed about the common and less common diseases of the eye and I
hope that the topic is understood.

Bibliography:

Dutta Parul, “Paediatric Nursing”, Second edition. Jaypee Publishers.

Sharma Rimple “Essentials of Paediatric Nursing”, First edition, Jaypee
Publishers.