During assessment of a child's visual acuity, which finding indicates that the child has myopia?

Appeared in: HPSSC - 2015

Explanation

Myopia, also known as nearsightedness, is a condition where distant objects appear blurry, but near objects are seen clearly.
This occurs because the eye's shape causes light rays to focus in front of the retina, rather than directly on it.
A characteristic sign in children is holding books, tablets, or other objects very close to their face to see them clearly, as this brings the object within their limited range of clear vision.
The image provided perfectly illustrates this classic compensatory behavior for myopia.

Option B: Rapid eyeball movements describe nystagmus, which is an involuntary, rhythmic movement of the eyes. It is typically a sign of a neurological or inner ear problem, not a refractive error like myopia.
Option C: While children with myopia may squint to try to see distant objects more clearly (the 'pinhole effect'), squinting is a non-specific symptom. It is also seen in other refractive errors like hyperopia (farsightedness) and astigmatism.
Option D: Closing one eye is a common behavior in children with strabismus (misaligned eyes) or significant amblyopia ('lazy eye'). This action helps to eliminate double vision (diplopia) or suppress a blurry image from one eye.

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical signs of myopia in children to guide bedside assessment, documentation, and the next nursing action.
Early detection of myopia is crucial as uncorrected vision problems can significantly impact a child's learning, social development, and safety.
Nurses play a key role in vision screening during well-child visits and in school settings, using tools like the Snellen or LEA chart.
What if? If the child were observed holding the book far away from their face and complaining of headaches after reading, the nurse should suspect hyperopia (farsightedness), not myopia.

How to Approach the Question

First, identify the key term in the question: 'myopia'. Recall its definition, which is 'nearsightedness' (difficulty seeing distant objects).
Analyze the provided image. The child is holding a book very close to his face, which is a direct attempt to compensate for poor vision.
Evaluate each option based on the definition of myopia and the visual cue from the image.
Option A: Holding a book close directly aligns with the definition of myopia, as near objects are clear.
Options B, C, and D describe behaviors associated with other eye conditions (nystagmus, general refractive error, strabismus).
Conclude that holding a book close to the face is the most specific and classic sign of myopia among the choices.

Concept Tested & Keywords

Concept Tested: Clinical signs of myopia in children
Stem keywords: visual acuity, child, myopia
Lead-in keywords: indicates
Clinical cues: The image of a child holding a book close to his face is a strong visual cue for myopia.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1720-1722

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