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Eye Examination in Children
Aka: Eye Examination in Children, Pediatric Eye Exam, Pediatric Vision Screening
- Epidemiology
- Only 20% of U.S. Children screened for eye disease
- Risk Factors: High risk children (may require eye specialist screening)
- Difficulty testing child on 2 separate attempts
- Age 3: Repeat attempt in 6 months
- Age 4 and older: Repeat attempt in 1 month
- Premature Infants
- Developmental Delay or neurologic disorder
- Down Syndrome
- Cerebral Palsy
- Systemic disease
- Family History of eye disorder
- Retinoblastoma
- Congenital Cataracts
- Metabolic disorder
- Strabismus
- Amblyopia
- Childhood Glaucoma
- Evaluation: Well Child Exam Eye screening
- Newborn Eye Exam
- Red Reflex (Pupillary Light Reflex, Bruckner Test)
- Pupil Response
- Observe constant Eye Deviation
- Observe for Congenital Cataracts
- Infants at 6 months of age to 3 years
- Newborn Eye Exam (as above) and
- Fixation and Following
- Ocular Alignment (Screen for Strabismus)
- Corneal Light Reflex (Hirschberg Test)
- Cover Test
- Children 3 to 5 years old
- Visual Acuity (Tumbling-E Test, Allen OR HOTV Chart)
- Ocular Alignment (Screen for Strabismus)
- Corneal Light Reflex (Hirschberg Test)
- Cover Test
- Children 6 years and older
- Snellen Chart (Letters or Numbers)
- Evaluation: Abnormal Vision testing
- Criteria for abnormal
- Age 3-5 years
- Either eye vision <10/20 or 20/40 (<4 of 6 correct)
- Two-line difference between eyes (20/25 and 20/40)
- Age 6 and up
- Either eye vision <10/15 or 20/30 (<4 of 6 correct)
- Two-line difference between eyes (20/20 and 20/30)
- Additional testing: Pinhole Test
- Distinguishes Refractive Error from Amblyopia
- Indicated for failed Vision Screening
- Differential Diagnosis: Childhood Eye Disease
- High risk diseases
- Amblyopia
- Strabismus
- Anisometropia
- Congenital Cataracts
- Leukocoria (Retinoblastoma)
- Congenital Glaucoma
- Nystagmus
- Common eye problems
- Conjunctivitis
- Uveitis and Iritis
- Eye Trauma
- Resources
- AFP: Childhood Eye Exam
- http://www.aafp.org/afp/2013/0815/p241.html
- References
- Bell (2013) Am Fam Physician 88(4): 241-8 [PubMed]
- Olitsky (1998) Pediatr Clin North Am 45:993-1012 [PubMed]
- Simon (2001) Am Fam Physician 64(4):623-8 [PubMed]