FIX AND FIT

Got Your Nose!

Though cute as a button, a child’s nose poses fitting challenges

it’s so adorable we are often trying to steal it, but a young child’s nose is no game when it comes to frame fit. The eyewear often comes to us with the nose pads crammed into the lenses, allowing the eyewire to rest directly on what little nose there is.

Proper attention and a few little, well-focused adjustments to ensure a good fit go a long way in making sure the child is seeing as well as his prescription intends.

THE SOLUTION

A child’s nose has no bridge to speak of—it’s mostly a protrusion at the bottom forming that cute little button surrounding the nostrils. This doesn’t leave much room to rest nose pads and certainly not much area for the downward force of the weight they have to bear.

So how do we properly fit these little patients? Here are three steps that will get you where you need to be. As we look at these steps, visualize what effect they will have on the position of the frame by separately considering the three angles of the nose of a child.

STEP 1: Narrow the space between nose pads

STEP ONE: The first step is to narrow the space between the nose pads. This can usually be done with pad-adjusting pliers that hold the face of the pad and the box at the end of the pad arm. To start, be sure that you grip the eyewire on the same side of the nose pad you are narrowing, keeping your wrist locked while using upper body strength to simply move the pads straight toward the center. Do this evenly on both sides. One small bend in the wrist and you will accidentally change the frontal angle in a manner that will be counterproductive.

This narrowing will allow you to take advantage of what small amount of the septum has developed at this point in your young patient’s growth. Although at first glance it may appear that kids have no bridge, they often do have a little bit, and we can use that to our benefit.

STEP 2: Splay the pads toward the face

STEP TWO: The second step is to splay the face of the nose pads toward the face of the patient. This is accomplished with the same pair of pliers used in the first step. As you become proficient at making these bends, it can be done without removing the pliers after narrowing.

To splay the pads requires a turn of the wrist, rotating the pad on its vertical axis. Many consider splaying a pad as laying it over, but this is not the case.

Care should be taken here not to change the narrowing you have already done in Step One.

This adjustment addresses the flatness of the underdeveloped bridge and allows the face of the pad to lay flat on the surface which is, after all, the most important thing we do with nose pads.

STEP 3: Adjust the bottom of the pads away from the face

STEP THREE: The third step is to increase the vertical angle. This is usually done better by using flat/round snipe-nosed pliers, reaching from the side and grasping the pad arm close to the box where the pad attaches. Rotate the wrist to cause the bottom of the pad to move away from the face.

If this step is omitted, the bottom of the nose pad will likely put too much pressure on the area of the lower portion of the nose that begins to protrude from the face. You might be inclined to try to add this bend with the pad-adjusting pliers used in the first two steps, but you will find that the pliers will bump into the eyewire before enough movement can be accomplished.

This bend also depends upon the need for more or less vertex distance. If more distance from the eyes is required, you should grasp the top loop of the “horseshoe” pad arm and pull it away from the frame, stretching it toward the face.

The end result

ALL DONE: Using this three-step method and a bit of practice should allow you to take good care of those little noses. You may find that a bit of change in the frontal angle will help, as well, but it is often not needed.

Some fine tuning with the fingers to even things up, and you’ll have a happy patient and parent.

— Alex Yoho, ABOM