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 weeks4 or 5 years Birth GP PaediatricianOrthoptist

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

Cover Test AB CD

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