Abstract
BackgroundEstablishing eye contact between infants and parents is important for early parent-child bonding and lack of eye contact may be a sign of severe underlying disease. The aim of the study was to evaluate the causes of poor or lacking eye contact in infants.MethodsCross-sectional study reviewing all referrals of infants ≤1 year of age from January 1rst, 2016 to December 31rst, 2018. Medical information was retrieved from patient files covering pregnancy, birth, diagnostic work-up and ocular parameters such as refraction, visual acuity and structural findings.ResultsWe identified 99 infants with poor or lacking eye contact. The relative frequency of causes was neurologic disease 36.4% (36/99), delayed visual maturation 24.2% (24/99), ocular disease 21.2% (21/99) and idiopathic infantile nystagmus 4.0% (4/99). Fourteen infants had a visual function within age-related norms at first examination despite poor eye contact at the time of referral. Of the infants with available data, 18/27 (33.3%) with neurologic cause, 15/23 (65.2%) with delayed visual maturation and 9/21 (42.9%) with ocular cause had visual acuity within the age-related norm at latest follow-up (0-41 months). In 23 infants, a genetic cause was found.ConclusionPoor eye contact in infants may be a sign of severe underlying disease, such as neurological or ocular disease. Close collaboration between pediatric ophthalmologists and neuro-pediatricians are warranted in the management of these infants.
Highlights
Establishing eye contact between infants and parents is important for early parent-child bonding and lack of eye contact may be a sign of severe underlying disease
Problems encountered during pregnancy ranged from gestational diabetes mellitus to severe structural malformations detected in the fetus
We evaluated the degree of diagnostic work-up to help health care personnel decide how best to perform the investigative work-up among infants with poor eye contact
Summary
Establishing eye contact between infants and parents is important for early parent-child bonding and lack of eye contact may be a sign of severe underlying disease. The anterior segment of the eye bends incoming rays of light to ensure that images are formed on the retina These refractive components change significantly throughout childhood but mainly in the first year of life with decreasing power of both cornea and lens as the axial length elongates [1, 2]. Visual input from the eyes is transmitted via the optic nerves to form synapses in the lateral geniculate nucleus (LGN), from which the optic radiations extend to the primary visual cortex in the occipital lobes. These central projections undergo significant changes in early infancy and throughout childhood.
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