Professional Documents
Culture Documents
Catherine Qui-Macaraig, MD
10 warning signs of treatable eye disease in the newborn
Needs early definitive treatment
1. Leukocoria
2. Drooping Eyelid
3. Enlarged Cornea of one or both eyes
10 warning signs of treatable eye disease in the newborn and infant.
Congenital Cataract
1) Diagnosis must be early to avoid
- amblyopia
- nystagmus if bilateral
2) Surgical treatment should be early
3) Requires special surgical technique - different from adults.
4) Optical rehabilitation is difficult with contact lenses or glasses.
5) Any delay in treatment or lapse in optical or amblyopia treatment results in
amblyopia.
6) Even in the best of circumstances vision after congenital cataract treatment is never
normal.
Congenital Cataracts
Bilateral Retinoblastoma
2. Drooping Lid
Capillary Hemangioma
Marcus Gunn Jaw-Winking Phenomenon
LATE:
- corneal diameter greater than 10.5 mm
- increased anterior chamber depth
- corneal opacity
Congenital Glaucoma
7 year old with microcephaly
Cong. GL OU
Goniotomy at 12 days
Repeat surgery 2 weeks later on OS-
Trabeculectomy-trabeculotomy
4 Excessive Tearing or Discharge
This can be a sign of
glaucoma
infection
light sensitivity – from corneal problems, uveitis, etc.
NLD Obstruction
gentle probing done before age 1 year.
Persistent tearing usually requires probing with general anesthesia often with placement
of a silicone tube
5 Crossed Eyes
6 Nystagmus
Dancing Eyes
-usually indicates subnormal vision
-also often present in cerebral visual impairment
Recommendation
Screen 32 weeks and below
Or < 1500g
Methods:
Observation
response to light- blinks, flinches
fixes and follows objects
OKN Drum
Clinical Assessment in the Nursery
neonates fix and follow gross fixation targets
human face is most attractive
absence of fixation may mean lack of attention
babies follow a full arc of 180 degrees only at 4 months
2 months to 6 months
Acuity 20/50 +
Methods:
Observation:
blink to threat
reach for objects
OKN Drum
Lid Responses
Suddenly reduce room light
Upper lids should retract to expose 1 to 2 mm of sclera
In newborn to 6 month old infants
Absent in significant retinal or optic nerve abnormalities
May be present in milder forms of visual loss
OKN Drum
An involuntary pursuit response
CF at 3 to 5 feet
Pursuit and saccadic systems can be investigated
Requires the child’s attention
More for evaluation of movement disorders
Nystagmus
Wandering – poor prognosis
Pendular – often secondary to central visual loss
Jerk – more commonly of motor origin; with unexpectedly good vision in a
compensatory head position
Visual Acuity
In Pre-verbal Children
Visual Acuity Assessment in Preverbal Children
Sheridan-Gardner Test
HOTV
‘E’ Game
Landolt C
Lea Symbols
HOTV
matching each test letter to one of the four letters H, O, T, and V printed on a
card that can be held in the child's hands
Illiterate E
indicate with fingers the direction of the legs of a letter E that is rotated to point up,
down, left or right
Snellen Equivalents
Lea Symbols
Lea Symbols
more similar in configuration to Snellen letters than the Allen pictures
carefully calibrated and assessed for reliability
Testing Procedure
Position the child 20 feet from the chart
Cover one eye
Prompt her to read one line at a time
Read until majority of responses on a line are erroneuous
Acuity is recorded as the line above the last
Points to Consider
Normal preschoolers often test no better than 20/30 or 20/40
May do better on 2nd eye tested because of practice with 1st eye
May do worse on 2nd eye tested because of waning interest or fatigue
What to do
Short attention span
Have several brief sessions beginning with alternate eyes
Test only a few sample letters per line
Record observations relating to the child's general behavior during testing as well as the
numeric result
What to do
Kids like to peek and memorize
Be constantly alert to peeking and guessing or memorization
Hold the occluder yourself
Test eye in question first
Snellen Acuity
Number
- distance in feet or m from which a normal eye can read all the letters
Basic Ophthalmologic Exam:
Visual Acuity Testing
Example:
20 testing distance
60 distance at which N eye can see same line
Subjective Acuity Assessment
Motoric responses required
Fixation preference persists in non-amblyopic patients
Bilateral loss may be missed
Requires highly skilled personnel
Objective Tests
Motor response not required
Less dependence on examiner
Visual Evoked Potentials
Flash-presence of LP
-albinism testing
Pattern Reversal VEP
Sweep VECP
Flash VECP
Sweep (cont’d)
Pediatric applications:
Pathophysiology of amblyopia
No retinal changes - ERG OK
Lateral geniculate layers subserving amblyopic eyes atrophic
Cortical ocular dominance columns representing amblyopic eye less responsive to
stimulus and show changes microscopically
Clinical Behavior in Amblyopia
Ametropic Amblyopia
The Ophthalmologist treats amblyopia but the primary care physician detects
amblyopia.
Vision Screening
Purpose: to identify children with one or more of the following conditions:
eye crossing
"wall" eye
nystagmus
droopy lid
abnormal head positions
Thank you!