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Chapter: Paediatrics: Special senses

Paediatrics: Vision screening in the UK

Paediatrics: Vision screening in the UK
To detect congenital ocular abnormalities, e.g. cataract, corneal opacities, microphthalmia, glaucoma and retinoblastoma.

Vision screening in the UK

 

Neonatal examination

 

   To detect congenital ocular abnormalities, e.g. cataract, corneal opacities, microphthalmia, glaucoma and retinoblastoma.

   Ask about family history of these disorders.

   Use a (bright) ophthalmoscope to examine the eye and red reflex.

   An indistinct red reflex can be caused by cataracts/corneal opacities.

   Retinoblastoma or abnormal retina can cause a white reflex.

   The red reflex may be darker in Asian and Afro-Caribbean babies.

   Refer on if in doubt.

 

Community screening

 

   At 6wks: GP asks parents about their baby’s visual behaviour. Baby should be able to fix and follow a face and large toy. Red reflexes checked with an ophthalmoscope. Squint assessment.

 

   At 7–8wks: health visitor observes visual behaviour. Parents advised of what to look for regarding expected future visual development.

   At 4–5yrs: orthoptist checks monocular visual acuity and ocular alignment, children achieving <6/9.5 are referred.

 

Secondary screening 

Orthoptic programme for children referred by par-ents, health visitors and GPs whenever a concern regarding vision or squint is raised.

 

Eye examination techniques

 

Visual examination

 

   6–8wks: baby should fix and follow a bright target and your face.

 

   4mths: baby should not squint and should fix and follow toys.

 

   6mths: baby should reach out for toys.

 

   2–3yrs: use picture charts (e.g. Kays pictures).

 

   4–5yrs: use letter charts (e.g. Snellen +/– matching letter card).

 

Eye movements

 

   Use a bright toy to attract attention and move in a ‘H’ shape to assess the action of each muscle.

   Cover test for squint assessment (see Fig. 24.1).

 

Anterior segment examination

 

   Use ophthalmoscope set on +20 for a magnified view of the front of the eye, click in the cobalt filter for fluorescein examination.

   Instill anaesthetic drops prior to examination if the child is in pain.

   Check the diameter of the corneas are equal and that the light reflection from each is bright.

   Check the red reflex in both eyes is equally bright.

 

Posterior segment examination

 

   Ask the child to look at an interesting target over your shoulder when trying to examine the optic disc.

   Dilating drops are safe to use, but will interfere with neuro-

 

observations for 24hrs: use 1% cyclopentolate (if <1yr old use 0.5%)

 

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Paediatrics: Special senses : Paediatrics: Vision screening in the UK |


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