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External observation (3)
1. Appearance of eye
- position: squint, nystagmus
- colour: red eye, white pupil, cloudy cornea
- shape/ size: exophthalmos, endophthalmos, megalocornea, pupil size
2. Appearance if nearby structure
- lid: ptosis, blepharitis, dermoid cyst
- facial abnormalities: middle malformation, e.g. cleft palate
3. Pupil response
- direct response, consensual response, Marcus Gunn
- pupil size, shape, colour, symmetry
- infant: small pupil, children: large pupil
Slit lamp (3)
Fluorescence (3)
Slit lamp
1. Age 3 can perform
2. Younger: Burton lamp/ penlight
3. Hand held slit lamp
Fluorescence
1. Infant: no need unless indicated
2. Young children: may try but not a must unless indicated
3. Procedure
- ask child to look nasal/ up
- pull down lower lid
- fluorescein strip: slight touch on tarsal plate
Internal ocular health (4)
1. Red fundus reflex for younger
- confirm media are clear
2. Full ophthalmoscopy in 4-5 years
3. White pupil/ abnormal pupil reaction
- check fundus after history
4. DFE with tropicamide
- cycloplegic effect
- <1 year: 0.5% 1gtt
- >1 year: 1% 1gtt
Tonometry (3)
1. Tonopean: younger kid, NCT: older kid
2. Tonometry: esp. children with steroid, if cornea is large/ haze
3. Palpation by hand if all fail
Visual field (confrontation) (3)
1. Infant:
- attract fixation in front
- hold another object from side
- if detect, will turn to look at target at side
2. Young children:
- finger counting in 4 quadrants
- if child keeps looking at your hand, flash fingers
3. Older children
- standard perimetry test if indicated
Common external ocular health problems (7)
Cause involuntary closure of eyelid
1. Dacryostenosis (excess tearing)
- congenital obstruction of nasolacrimal duct
2. Congenital ptosis
3. Entropion/ trichiasis
4. Blepharospasm
- abnormal contraction or twitch of the eyelid
- normally resolve spontaneously when older
5. Blepharitis
6. Conjunctivitis
7. Vernal keratoconjunctivitis
- associated with atopy/ asthma/ hay fever/ dermatitis
- recurrent, bilateral
- affect children, young adult
- more common in male and warm climate
- itching, mucoid discharge, lacrimation
- topical mast cell stabilizer, topical steroid
Common internal ocular health problems (4)
1. Retinopathy of prematurity (ROP)
2. Congenital cataract
3. Congenital glaucoma
4. Retinoblastoma
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