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Definition of Terms
Neonatal eye examinations are primarily performed to monitor for the presence and progression of Retinopathy of Prematurity (ROP), once considered an untreatable condition leading to blindness. Research has shown that careful screening of the retina of infants at risk, beginning at 30-32 weeks corrected gestational age, can help reduce the occurrence of posterior retinal traction folds and/or retinal detachments, as early laser or cryotherapy may be performed where indicated.In addition, examination of the eye by an ophthalmologist is indicated in newborn infants with other abnormalities, as ocular involvement may occur in several dysmorphic syndromes.
This guideline specifically provides guidance for care of the infant during neonatal eye examinations for ROP, however the management of neonatal eye examinations is the same for indications other than ROP.
Retinopathy of Prematurity (ROP): An alteration of the normal retinal vascular development, mainly effecting premature infants, which can lead to visual impairment and blindness
If the infant is clinically unstable (determined by medical staff and / or AUM) the procedure will need to be re-scheduled to a more appropriate time.
Neonatal medical and nursing staff need to identify all infants at risk of ROP and ensure that a referral to Ophthalmology is made. The Neonatal registrar is required to complete the referral request form in EMR as “Ophthalmology inpatient consult referral”.
For infants on Butterfly Ward, referrals are kept in the Eye Appointment Book in the AUM’s office.
The neonatal eye examination is not thought to cause pain to the infant, however it may cause distress, and some analgesia may be appropriate.
Amethocaine Hydrochloride 0.5% (Tetracaine) topical anaesthetic eye drops
The evidence supporting the benefit of using oral sucrose, in addition to topical anaesthetic eye drops, in neonatal eye examinations, is not conclusive. It may be indicated if the infant is unsettled prior to, or after the procedure. Refer to the Sucrose (oral) for procedural pain management in infants guideline.
Ideally sucrose should not be given during an eye examination. It is more effective when administered in advance, and there is a small risk of eye injury if the infant is stimulated during the procedure.When administering oral sucrose:
The ophthalmologist records the results of the examination and further review or appointments in the Consultation Notes in EMR, and in the Eye Examination Book.
The ophthalmologist will speak to the parents after the examination if parents are available. Otherwise, the managing neonatal team will discuss results with the parents, and if necessary, an appointment will be made with the ophthalmologist if there are any concerns.
Following eye examinations, send used retractors and vectis to CSSD for cleaning and sterilising.
Please remember to read the disclaimer.
development of this nursing guideline was coordinated by Chris Lim, RN, Butterfly Ward,
and approved by the Nursing Clinical Effectiveness Committee. Updated June 2017.