Download Vision Screening and Ophthalmology

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
Birth
4 or 5 years
GP
Paediatrician
Orthoptist
6 Week Check
 Vision: fixing & following
 External examination
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lids
cornea
pupil
 Red reflex
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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
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
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Retinoblastoma
Cataract
Toxocariasis
Uveitis
Retinal detachment
Other causes