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Focus On: Pediatric Emergency Eye Exam

 

Emergency Eye Exam in Children is Modified

  • Visual acuity – either with fix and follow for preverbal children or Snellen chart for verbal children

  • Extraocular movements

  • Lids/lashes, Conjunctiva/Sclera, Cornea

  • Symmetry with the Hirschberg test

  • Confrontation (cover/uncover test)

  • Red reflex test (visual axis through to the retina)   Leucokoria – a “white reflex” – gets immediate referral to an ophthalmologist for possible retinoblastoma

 

The outstanding ophthalmologist and medical educator, Tim Root, MD says it all best here:

Pediatric Eye Exam (Video)

Selected References

American Academy of Pediatrics; Section on Ophthalmology; American Association for Pediatric Ophthalmology And Strabismus; American Academy of Ophthalmology; American Association of Certified Orthoptists. Red reflex examination in neonates, infants, and children. Pediatrics. 2008 Dec;122(6):1401-4. doi: 10.1542/peds.2008-2624. Erratum in: Pediatrics. 2009 Apr;123(4):1254.

Root T.  Basically Anything He Does.  Check out his educational videos and publications here: https://timroot.com/

Simon JW, Kaw P. Commonly missed diagnoses in the childhood eye examination. Am Fam Physician. 2001 Aug 15;64(4):623-8. PMID: 11529261.