Eye and Vision Exams in the Outpatient Clinic Erika Beard-Irvine MD LCDR MC (FS) USN
Objective AAP practice parameters for red reflex and vision screening Techniques for red reflex and vision screening Disease processes Referral criteria
Terminology Myopia
Terminology Myopia Hyperopia
Terminology Myopia Hyperopia Astigmatism
Terminology Myopia Hyperopia Astigmatism Amblyopia Anisometropia
Red Reflex Examination Newborn examination All routine health supervision visits
Technique Ophthalmoscope power to 0 Lights off Simultaneously at 2-3 feet away Separately at inches away
Leukocoria
Differential of Leukocoria Retinoblastoma Congenital cataract ROP PFV Coloboma Uveitis Toxocariasis Coats disease Vitreous hemorrhage Retinal dysplasia
Absent Red Reflex
Absent Red Reflex
Asymmetric Red Reflex
Asymmetric Red Reflex
Asymmetric Red Reflex Mills, MD. The eye in childhood, Am Fam Physician Sep 1;60(3):
Eye Evaluation Ocular history Vision assessment External inspection of the eye and lids Ocular motility assessment Pupil examination Red reflex examination Attempt at opthalmoscopy (>3 yo)
Ocular History Does you child seem to see well? Does your child hold objects close to his/her face when trying to focus? Do your childs eyes seem to cross or drift? Do your childs eyes appear unusual? Do your childs eyelids droop or does 1 eyelid tend to close? Have your childs eyes ever been injured? Family history of eye disorders or early eyeglass wear.
Vision Assessment Fix and follow Visual acuity measurement (>3 yo) Photoscreening
Screening for amblyogenic factors: Strabismus Media opacities Significant refractive errors Evaluate photo of red reflex and pupillary light reflex AAP says it could be helpful but recommends more study
External Examination Tearing or discharge Corneal clouding
External Examination Tearing or discharge Corneal clouding Ptosis
External Examination Tearing or discharge Corneal clouding Ptosis Iris abnormalities
Ocular Motility Corneal reflex test Extra-ocular movements Cover-uncover test Random dot E stereo test
Corneal Light Reflex Mills, MD. The eye in childhood, Am Fam Physician Sep 1;60(3):
Ocular Motility Corneal reflex test Extra-ocular movements Cover-uncover test Random dot E stereo test
Ocular Motility Corneal reflex test Extra-ocular movements Cover-uncover test Random dot E stereo test
Random Dot E
Pseudostrabismus
Pupil Exam
Referral Criteria Leukocoria or absent red reflex Any abnormality on exam Persistent torticollis or head tilt FHx of retinoblastoma FHx corrective lenses in preschool or lazy eye Parent concern