CHILD HEALTH SURVEILLANCE Vision Screening & Eye Problems

Gordon N Dutton

Emeritus Professor of Visual Science

Paediatric Ophthalmologist

Importance of surveillance

Detects life threatening conditions - very rare

Detects sight threatening conditions- common

Detects genetic conditions- occasionally

Detects cosmetic conditions- fairly common

Eye Screening

6 weeks 4 or 5 years Birth

GP

Paediatrician Orthoptist

6 Week Check

Vision: fixing & following External examination

lids cornea pupil

Red reflex direct ophthalmoscope

Visual Assessment in Children

Visual acuity Corneal light reflection Cover test Eye movements Tests of stereopsis Refraction Red reflex Dilated fundoscopy

Visual Acuity in Kids

Fixing and following light or toy

“Objection to occlusion”

Preferential looking tests

Identifying or matching pictures or letters

Vision reduced in both eyes

Wrong test for age or ability Poor attention Refractive error Structural problem with eye Central visual problem Want glasses !

Vision reduced in one eye

Loss of attention Refractive error Amblyopia Structural problem with eye Central problem

Amblyopia

Unilateral poor vision in childhood in a normal eye

Treat by patching the “good eye”

Glasses are often required

Easier to reverse the younger the child

If not reversed by age 7 or 8 then permanent

Amblyopia Treatment

SeverityAgeFull or part-time patchingAlways with glassesPreferably with close work

What Is an Orthoptist?

Responsible for the diagnosis and management of patients presenting with defects of binocular vision and disorders of eye movement, e.g. squint, amblyopia, diplopia and ocular muscle palsy.

Screening Role

Visual field assessment

Corneal light reflex

Strabismus

= Squint – eyes not pointing in same direction

Esotropia

Convergent squint Associated with hypermetropia

(longsightedness)

Pseudoesotropia - frequently seen if prominent epicanthic folds (broad nasal bridge).

Esotropia

Accomodative Esotropia

Exotropia

Divergent squint Often intermittent

Cover Test

A B

C D

Refraction

Test focus of eye by refraction with a retinoscope and lenses.

Most glasses prescribed in childhood for hypermetropia (longsightedness).

If difference in focus between the eyes (anisometropia) then risk of amblyopia.

Red Reflex

Blocked Nasolacrimal Duct

Most resolve spontaneously Refer if no resolution by 1 year of age No antibiotics unless “white of eye” is red Massaging lacrimal sac may help

Congenital Glaucoma

Photophobia Watering Redness Enlarged eye Cloudy cornea

Chalazion

Apply local heat with a clean facecloth

Massage towards eye

10 mins twice daily

Surgery not required in child

Beware Leukocoria !

= White Pupil

Retinoblastoma Cataract Toxocariasis Uveitis Retinal detachment Other causes