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.
This chapter is divided into four sections:
- 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
- The fourth section describes the examination techniques and
tools used by pediatric ophthalmologists.
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.
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.
Table 1–1. Systemic
Disorders Associated with Delayed Vision and Strabismus |Favorite Table|Download (.pdf)
Table 1–1. Systemic
Disorders Associated with Delayed Vision and Strabismus
|• Marked prematurity|
|• Serious systemic illnesses in infancy|
|• Many metabolic disorders|
|• Infantile spasms|
|• Perinatal asphyxia|
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