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

6 weeks
Birth
Eye Screening
4 or 5 years
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
 Severity
 Age
 Full or part-time patching
 Always with glasses
 Preferably 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

A
C
Cover Test
B
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