Paediatrics: Visual development and examination

Visual development and examination

Normal visual development

• Vision develops rapidly after birth. By 6wks a baby should have eye contact with the mother when feeding and be able to fix and follow a face.

• Early variable angle squints are common and usually resolve as vision improves and binocular function develops.

• Congenital ocular pathology (e.g. dense cataracts) left untreated by 3mths of age will result in permanently poor vision. Since the visual system retains its plasticity over the first 8yrs of life, any ocular abnormality acquired during this period may also disrupt visual development.

• Parental concerns about a baby’s vision are usually well founded, so take them seriously.

·Nystagmus, roving eye movements and/or lack of eye contact warrant referral.

Causes of visual impairment in the UK

One in 1000 children have visual acuity worse than 6/18 in the UK, 70% have an additional disability. Children with visual impairment should receive early specialist educational and mobility support.

Causes of visual impairment

Prenatal (50%)

•   Genetic/hereditary (e.g. Down, retinal dystrophies, cataract)

•   Hypoxia/ischaemia

•   Infection/drugs (e.g. CMV, rubella)

Peri/neonatal (30%)

•   Hypoxia/ischaemia (e.g. cerebral visual impairment and retinopathy of prematurity)

·  Infection

•   NAI

Childhood  (20%)

•   Tumour (e.g. retinoblastoma, craniopharyngioma)

•   Raised ICP

•   Hypoxia/ischaemia

•   Accidental and NAIs

Specific systemic disorders (e.g. uveitis)