KAREN ESTRELLA H.
PEDS PGY-2 SBH
EYE EXAMINATION IN INFANS, CHILDREN AND YOUNG
ADULTS BY PEDIATRICIANS
Early detection and treatment of ocular disorders in
children is important to avoid life-long visual
TIMING OF EXAMINATION AND
1st visual acuity at 3y/o
WHEN TO REFER?
Fhx: congenital cataracts, Rb, metabolic or genetic diseases
Systemic disease associated with eye abnormalities
Any child unable to be tested after 2 attempts
Abnormal eye exam
BIRTH TO 3Y/O -Ocular hx
-External inspection of the eyes
-Ocular motility assessment
-Red reflex examination
3y/o AND OLDER -Same
-age-appropriate visual acuity
-attempt at opthalmoscopy
Does your child seem to see well?
Does your child hold objects close to his or her face when trying to
Do your child’s eyes appear straight or do they seem to cross or
drift or seem lazy?
Do your child’s eyes appear unusual?
Do your child’s eyelids droop or does 1 eyelid tend to close?
Have your child’s eye(s) ever being injured?
FHX: early childhood use of glasses in parents or siblings
Evaluating the child’s ability to fix and follow objects.
Binocularly and then monocularly
Awake and alert
LH symbols or Allen
Tumbling E test and
the HOTV test
How to do it?
Child should be comfortable Non-literate: matching
and in good health
On parent’s lap
Or sitting on a chair
At 10 feet from wall chart
Keep eyeglasses exc if only
Good occlusion of eye
Tell child to keep both eyes
Cover the left eye first
Start with the top line and
continue downward showing one
letter/symbol per line.
If the child reaches the 10/10 line,
show the remaining (3)
*Be careful not to cover up any
part of the box surrounding the
letters with your finger as this can
affect the sensitivity of the test.
• If the child misses a letter/symbol, go to the line above and show 4
• If the child matches all of them , proceed downward.
• The number recorded for vision acuity is the smallest line the child can
Penlight evaluation of lids, conjuntiva, sclera, cornea
Persistent d/c or tearing
(ocular infection, allergy, Glaucoma)
Lacrimal duct obstruction
Should be equal, round and reactive to light BL]
Slow or poorly reactive: retinal or optic nerve
Asymmetry: Horner sd (sympathetic) or 3rd nerve palsy
Evaluate for strabismus
The eyes are not aligned with each other
Esotropia (ET): The eyes are turned inwards
Exotropia (XT): The eyes are turned outwards
Eso/Exo-phoria: Phorias are eye deviations that are only
present some of the time, usually under conditions of stress,
illness, fatigue, or when binocular vision is interrupted.
Corneal light reflex test
Cross cover test
Corneal Light Reflex test
2 feet in front of the face
Detect opacities: cornea, lens or retina
HOW TO DO IT?
Direct ophtalmoscope focused on each eye(12-18inches
away) and then both eyes simulataneoulsy at 3feet away
Cross cover test
Child looking ahead 10 feet from
•As child looks for the object, cover
the eye and see movement of other
•Any movement in or out when
shifting the cover indicates a
strabismus is present