Abstract
This chapter covers general bedside and chairside examination procedures and instruments used to examine a pediatric patient in an acute care setting. Pediatric patients may present to an emergency room or present emergently in any clinical setting with a wide variety of acute ocular conditions. When working in an emergency room or hospital-based setting, it is unlikely that a clinician will have all of the exam equipment typically used for routine care. The authors review the various ocular imaging techniques used to obtain a view of the internal structures of the eye, orbit, head, and brain when external examination is not sufficient. The procedures described aid the clinician in appropriately and thoroughly evaluating pediatric patients presenting with ocular emergencies.
TopBedside And Chairside Examination Techniques
Indication
Bedside and chairside examinations are useful for infants and toddlers who are usually in the lap of the guardian. Additionally, bedside/chairside exam techniques are indicated when young patients are unable to fit into commonly used equipment due to body habitus or if a patient uses a wheelchair or other assistive devices. These techniques are also useful when certain equipment is unavailable or if a child is unable to be transported from the emergency department for an eye examination.
Background
There are situations where patients are unable to be examined with traditional examination equipment, particularly in the pediatric population. This may be because the patient is an infant, the patient is a toddler who cannot sit in a slit lamp or other eye apparatus, or if it is unsafe for the child to be transferred into a traditional eye examination apparatus due to different abilities. This is even more magnified in an acute-care setting, where an eye examination lane may not be available. In these cases, it is best to adapt the examination to evaluate the child where they can most comfortably sit or rest.
Chairside and bedside techniques discussed largely deal with examination of the front surface of the eye. The posterior segment of the eye can be well viewed with a binocular indirect ophthalmoscope and a condensing lens with the child in almost any position.
Disadvantages
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The view of the eye is less stable
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Examination is more ergonomically taxing for the clinician
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Less detailed view of the eye
- 1.
Near visual acuity card
- 2.
Adjustable visual acuity chart (ETDRS, Feinbloom number chart)
- 3.
Occluder with pinhole
- 4.
Transilluminator or penlight
- 5.
20D condensing lens
- 6.
Portable IOP measuring device (i.e. Tonopen, iCare)
- 7.
Eyedrops
- a.
Sodium Fluorescein containing ophthalmic solution (or sodium fluorescein strips)
- b.
Proparacaine ophthalmic solution 0.5%
- c.
Tropicamide 1% ophthalmic solution
- d.
Phenylephrine 2.5% ophthalmic solution
- 8.
Binocular indirect ophthamoscope
- 9.
Direct ophthalmoscope
Key Terms in this Chapter
pH Testing: Measurement of acidity of the ocular surface after exposure to chemical substances.
Magnetic Resonance Venography: An imaging technique using a magnetic field and radio pulses to examine venous blood flow. This allows for the evaluation of the drainage system of the brain.
Neurological Testing: Evaluating the function of the cranial nerves.
CT Scan, Imaging, Commuted Tomography: An ocular imaging technique that uses multiple x-ray scans obtained from a revolving unit to form a two-dimensional image.
B-Scan Ultrasound: An ocular imaging apparatus that uses sound waves to create two images of the eye and orbit.
Seidel Sign: A clinical sign indicating a ruptured globe.
Ocular Imaging: An armamentarium of devices utilized to provide improved understanding of ocular pathology and sequelae of ocular trauma not easily visible during clinical examination.
Ocular Emergency: A serious vision threatening and/or painful occurrence requiring immediate medical attention.
Magnetic Resonance Angiography: An imaging technique employs the same radio waves as with an MRI but is used to look at the arterial blood flow.
Magnetic Resonance Imaging: A sensitive imaging modality that uses a magnetic field and radiofrequency pulses to view internal structures of the body.
Corneal and Conjunctival Culturing: Sampling and subsequent analysis of causative infectious material of the cornea and conjunctiva.