Consultation with the specialist. Eye examinations in infants and children.

Abstract

1. Joseph H. Calhoun, MD* 1. 2. *Director, Pediatric Ophthalmology and Strabismus, Wills Eye Hospital, Philadelphia, PA. Typically the pediatrician is the first physician who recognizes the signs or symptoms of possible eye disease in children. Therefore, it is incumbent upon him or her to be cognizant of those signs or symptoms that merit referral to an ophthalmologist for further evaluation and treatment. As in many other diseases in the field of pediatrics, appropriate examination and evaluation vary with the age of the child. In the first several days of life, examination of the eyes can be difficult. The lids may be swollen from the birthing process and from chemical conjunctivitis caused by the required gonococcal prophylaxis. The newborn usually will be sleeping and the eyes closed at the time of examination. In spite of these difficulties, it is important to exclude any major anomalies of eye development. The examination should include an inspection of the external surface of the eyeball, using any direct source of light, such as a penlight, a flashlight, or room light in the nursery. If the lids are closed and cannot be opened by active movement or twirling of the infant, cotton-tipped applicators may be used to open them. The applicators are placed on the lid margins, at the lashes, and are directed so as to push each lid margin against the cornea while at the same time separating the lids. This should allow a view of at least half of the cornea and the iris. This lid separation may be manipulated to view most of the front surface of the eyeball. If the applicators are placed away from the lid margins in the middle of each lid, the lids will evert, revealing only their back surfaces. The examiner should determine that each eye is the same and has a transparent cornea that provides a clear view of each iris (usually blue) …