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
years of age
Treatment—If correction is required, use convex lenses to focus rays
on retina.
Astigmatism
Unequal curvatures in refractive apparatus
Pathophysiology—Results from unequal curvatures in cornea or lens
that cause light rays to bend in different directions
Clinical manifestations
• Depend on severity of refractive error in each
eye
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
years of age
Treatment—If correction is required, use convex lenses to focus rays
on retina.
Astigmatism
Unequal curvatures in refractive apparatus
Pathophysiology—Results from unequal curvatures in cornea or lens
that cause light rays to bend in different directions
Clinical manifestations
• Depend on severity of refractive error in each
eye
