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An examination of the eyes should be part of every well-child visit. In most cases the children and parents will have no concerns, and the evaluation will consist of screening questions and a brief physical examination of the eyes. In some instances, the child or parents may express specific concerns about vision or the appearance of the eyes. In these cases, a focused history and a more detailed physical examination will be indicated.

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This chapter is divided into four sections:

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  • The first section describes the important aspects of the medical history for children with ocular problems.
  • The second section describes a quick screening examination for eye problems that can be performed during well-child evaluations in the pediatric office.
  • The third section describes additional examination techniques that pediatricians can use for evaluation of children with specific ocular problems.
  • The fourth section describes the examination techniques and tools used by pediatric ophthalmologists.

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As with any well-child examination, basic questions about the child’s general medical history should be asked. This is part of the routine evaluation of new patients, and the information will already be known for established patients. General questions about vision and the eyes should be included in well-child visits, whereas additional questions may be indicated if specific problems are identified. A family history and review of systems are also important components of the evaluation.

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General Medical History

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The pediatric history should include questions about the pregnancy and birth. Prenatal exposure to infectious diseases or teratogens may cause specific ocular problems. The parent’s reports of the child’s general health and development should be obtained. Vision problems may occur in many pediatric systemic diseases. In some diseases, specific ocular abnormalities are present. In many systemic disorders associated with developmental delay, however, the ocular problems are nonspecific. Delayed visual tracking and strabismus are common features of global developmental delay from many causes (Table 1–1). The appropriate evaluation is influenced by this information. For instance, it will take longer for an infant born at 28 weeks gestation to begin tracking consistently than it will for a full-term infant. Therefore, additional investigations might not be indicated unless a tracking problem in a pre-term infant persists beyond the first few months of life.

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Table 1–1. Systemic Disorders Associated with Delayed Vision and Strabismus
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Ocular History

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during General Well-Child Screening

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General questions about vision should be part of every well-child evaluation. This may be as simple asking the parents whether they have any specific concerns about their child’s vision and whether they feel their child sees well. Additional questions could address whether ...

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