Alterations in Ocular Movements Abnormal ocular movements result from oculomotor, trochlear, or abducens cranial nerve dysfunction.

. The three types of eye movement disorders are: 1.Strabismus 2.Nystagmus 3.Amblyopia STRABISMUS - is a condition in which the eyes are not properly aligned with each other. Strabismus can be either a disorder of the brain in coordinating the eyes, or of one or more of the relevant muscles' power or direction of motion.Strabismus can be an indication that a cranial nerve has a lesion.. Causes: neuromuscular disorder of the eye muscle, disease involving the cerebral hemisphere, or thyroid disease. Classified: congenital, acquired or secondary to another pathological. Many infants are born with their eyes slightly misaligned. The best time for physicians to assess this is between ages 3 and 6 months. Strabismus in children requires intervention to prevent Amblyopia(reduced vision in the affected eye caused by cerebral blockage on the visual stimuli). Primary symptoms of strabismus is diplopia (double vision). Pseudostrabismus is the false appearance of strabismus. Todetect the difference between pseudostrabismus andstrabismus, a Hirschberg test may be used. A cover test is an objective determination of the presence and amount of ocular deviation. NYSTAGMUS - rapid irregular involuntary eye movement. Either vertically or horizontally. Its is not a disease in it self but rather a symptom of an underlying condition. 1. Physiologic nystagmus is a form of involuntary eye movement that is part of the vestibulo-ocular reflex (VOR).. 2. Pathologic nystagmus - is the result of damage to one or more components of the vestibular system, including the semicircular canals, otolith organs, and the vestibulocerebellum. AMBLYOPIA -Otherwise known as lazy eye, is a disorder of the visual system that is characterized by poor or indistinct vision in an eye that is otherwise physically normal, or out of proportion to associated structural abnormalities. -One eye looks ahead and the other eye wanders. Children who have an eye like this are constantly looking in two separate images rather than one fused image. To make sense of what they see, they supress one visual image; this leads to suppression of central vision in that eye. Assessment: All preschool children should be screened for amblyopia by vision testing with a preschool E chart at routine health visits. a child with amblyopia has 20/50 vision (normal for preschool age) in one eye, and the other eye shows lessened vision (perhaps 20/100) Therapeutic Management; Is correctable if treated. The good eye is covered by a patch held firmly in place.

 The eye patch will be removed for at least one hour per day. Medication : Levodopa, atropine Nursing Diagnosis Deficient knowledge deficit related to need for consistent wearing of patch. Outcome Evaluation Parents state the reason why is eye patch is placed on the functioning eye. Childs wears patch over functioning eye for all but 1 hour per day. Parents support to be firm with their child about keeping the patch in place. Alterations in Color Vision COLOR VISION DEFICIT- Color blindness or color vision deficiency is the inability to perceive differences between some of the colors that others can distinguish. Inability to distinguish red from green or blue from yellow. -It is most often of genetic nature, but may also occur because of eye, nerve, or brain damage, or exposure to certain chemicals. -High incidence of color vision deficit in children with haemophilia, congenital nystagmus, or glucose-6-phosphate dehydrogenase deficiency. -There is no therapy for color vision deficit, but the condition should bedetected early so the child is not asked to complete color identification assignments in school. -Some children associate color blindness with total blindness, and fear that they will eventually lose their eyesight. Reassure them that, although color blindness means that they have a loss color discrimination their loss will belimited to that one area. -Color vision deteriorates more rapidly for individuals with diabetes mellitusthan for the general population. Diagnosis: The Ishihara color test, which consists of a series of pictures of coloredspots, is the test most often used to diagnose red-green color deficiencies. Congenital Types: 1. Monochromacy - is the condition of possessing only a single channel for conveying information about color. Monochromats possess a complete inability to distinguish any colors and perceive only variations in brightness. a. Rod monochromacy, frequently called achromatopsia, where the retina contains no cone cells, so that in addition to the absence of color discrimination, vision in lights of normal intensity is difficult. b. Cone monochromacy is the condition of having both rods and cones, but only a single kind of cone. A cone monochromat can have good pattern vision at normal daylight levels, but will not be able to distinguish hues. 2. Dichromacy - in humans is a fairly severe color vision defect in which one of the three basic color mechanisms is absent or not functioning. It is hereditary and sex-linked, predominantly affecting males. Itoccurs when one of the cone pigments is missing and colour is reduced to two dimensions. a. Protanopes b. Deuteranopes

c. Tritanopes 3. Anomalous trichromacy a. Protanomaly (1% of males, 0.01% of females) b. Deuteranomaly (most common - 6% of males, 0.4% of females) c. Tritanomaly (equally rare for males and females [0.01% for both]) Total Color Blindness Achromatopsia is strictly defined as the inability to see color. Although the term may refer to acquired disorders such as color agnosia and cerebral achromatopsia, it typically refers to congenital color vision disorders (i.e. more frequently rod monochromacy and less frequently cone monochromacy). In color agnosia and cerebral achromatopsia, a person cannot perceive colors even though the eyes are capable of distinguishing them. Some sources do not consider these to be true color blindness, because the failure is of perception, not of vision. They are forms of visual agnosia. Diagnosis The Ishihara color test, which consists of a series of pictures of colored spots, is the test most often used to diagnose red-green color deficiencies. Because the Ishihara color test contains only numerals, it may not be useful in diagnosing young children, who have not yet learned to use numerals. In the interest of identifying these problems early on in life, alternative color vision tests were developed using only symbols (square, circle, car).