Eye Examination in Children

History

Visual acuity

Refraction

Binocular vision and

motility

Pupillary reactions

Slit lamp
biomicroscopy

Dilated examination
of posterior segment
 History
Age of baby, Informant
Nature of presenting problem, including chief
complaint
Visual behaviour and ocular history
General health history, including prenatal,
perinatal and postnatal history
Developmental history
 Visual acuity
Infant- Fixation preference tests
Preferential looking test
Pre school children- Cardiff acuity
Lea symbol
Sherridan Gardner test

School going children-Snellens letter chart

Number chart
 Refraction
Objective refraction- Cycloplegic retinoscopy

< 5 years- Atropine refraction

> 5-8 years- Homatropine refraction

> 8 years- Cyclopent refraction

 Binocular Vision and Ocular Motility
Cover test
Hirschberg test
Krimsky test
Versions
Near point covergence
 Pupillary reactions
Direct reflex
Consensual reflex
Swinging flash light test- RAPD
 Slit lamp biomicroscopic examination
For anterior segment evaluation
For corneal, conjunctival, anterior chamber or
lenticular abnormalities.
Common condtions diagnosed- Infective and
allergic conjunjunctivitis, Corneal scars/
Dystrophies/ anterior chamber inflammation
viz cells or flare/ Lenticular
opacities(Congenital/ developmental catarcts)
etc.
 Posterior segment and Fundus
examination
Dilated examination is done for evaluation of
posterior segment and fundus examination
Mydriatic agents used-

Infants- Diluted T+ (1:1 with distilled water)

>1 year-T+
 Technique of Fundus examination
Direct ophthalmoscopy
Indirect ophthalmoscopy
 Direct ophthalmoscopy
Semi-dark room
Patient in sitting position looking straight
Observer standing or seated slightly towards side
of the eye to be examined
Patients right eye-Examiners right
Reflect beam of light in patients pupil
Focus retina
Examine disc, blood vessels, 4 quadrants, macula
 Indirect ophthalmoscopy
Semi dark room
Patient in supine position
Hold hand and legs of un-cooperative child, lid
speculum can be used to keep eyes open
Light thrown from self illuminated
ophthalmoscope
Interpose +20D condensing lens in path of
light close to Pts eye-slowly move lens
towards examiner until image on retina is
clear.- Disc, vessels, 4 quadrants and macula
examined.
Slit lamp and Fundus photos
 Metabolic diseases

Mucopolysachharoidosis type 2
KF ring in Wilsons disease
Congenital and developmental cataract
Ocular Cystinosis
Cherry red spot in Niemann Pick
Retinopathy of Prematurity
ROP with RD
Retinal detachment
Retinitis pigmentosa
Retinoblastoma clinical presentation
and Fundus
Retinoblastoma Cryotherapy
Optic atrophy in cases of GDD/HIE
Morning glory syndrome-Fundus
Thank you