The infant's first eye examination is performed sometime after birth and prior to discharge home. The extent of the examination should be appropriate to the infant's condition. This initial selective screening examination assesses structural development of the eyes and the relationship of the eyes to the overall facies. In addition, reactivity of the pupils and the red reflex are assessed. The eye examination also provides a good opportunity to observe an infant's resting state and his or her ability to transition from one state to another. Observations that give information about the infant's general well-being and maturity include apparent awareness and visual interest in the surroundings as opposed to abnormal staring or absent visual fixation. In otherwise healthy infants, assessment of visual acuity is delayed until early childhood when cooperation with the eye examination can be expected. Normal findings that resolve include edema, eversion, bruising, hemorrhage, and nevus simplex. (See also Chapter 6.)
The American Academy of Pediatrics (AAP) recommends an age-appropriate assessment in the newborn period: ocular history, vision assessment (ability to fix and follow objects after 3 months of age), external inspection of the eyes and lids (conjunctiva, sclera, cornea, iris, and lids), ocular motility assessment, pupil examination (equal, round, and reactive to light), red reflex examination (should be bright reddish-yellow, or light gray in brown-eyed infants, and identical in both eyes). Newborns should be evaluated for cataracts, ptosis, and corneal opacities. Any abnormalities on examination should be referred to a pediatric ophthalmologist. Infants at high risk of eye problems (premature, significant neurological or developmental difficulties, metabolic or genetic diseases, positive family history of congenital cataracts, retinoblastoma, any systemic diseases associated with eye abnormalities) should be referred for a specialized eye examination by a pediatric ophthalmologist.