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Pediatric Ophthalmology

Examinations for Newborns

There are 2 categories for the assessment of newborns:

  1. ROUTINE EXAM FOR LOW-RISK CHILDREN: All children that are not high-risk must have their eyes examined by the pediatrician or family doctor. The exploration procedures for the eyes are with a pocket light, corneal light reflex test, and simultaneous examination of the red reflection of the retina with an ophthalmoscope.
  2. CONSULTATION WITH AN OPHTHALMOLOGIST FOR HIGH-RISK CHILDREN:     Due to the urgency and great benefit of the exam, the ophthalmologist must assess those children at risk of developing PREMATURE RETINOPATHY, and those with a family history of RETINOBLASTOMA, or METABOLIC disease.

The premature retinopathy (ROP) particularly occurs in premature children with a low birth weight (less than 1,700 gr.) and or the administration of oxygen, but can also occur in the absence of these conditions. Every year, ROP causes some degree of visual damage en approximately 1,300 children and severe damage en 400 to 800 children in the U.S. In the majority of the children, ROP es a transitory disease with a spontaneous regression. However, there are patients with progressive ROP.

A recent multicenter study revealed that cryotherapy (freezing of the retina) reduces by 50% the number of patients with disfavorable evolution (such as a detachment of the retina) in the short term.  The evolution in the long term is still unknown. Right now, the recommendation is that as a rule, premature children should be examined between the ages of 6-9 months to discard the development of ROP.

Retinoblastoma is a condition which threatens the patient's life and must be detected inside the first months of life. It's the most common malignant intraocular tumor in children and it occurs in 1 in every 20,000 cases of live births, resulting in between 200-300 new cases in the U.S. Of those, 25% of patients have a family history of retinoblastoma, 60% of the patients with retinoblastoma will present a white fondus reflection and an additional 20% with strabismus (deviated eye). The visual and life prognosis is directly related to the size and the extension of the tumor.

Cataract is the most common cause for a white pupil (leucocoria) at birth. The white incidence can be as high as high as 1 in every 1,000 live births in the U.S. Because they interfere with the eye's normal development, children with cataracts require surgery within the first weeks of life, followed by the use of contact lenses or glasses and the treatment for amblyopia.

Examination at the age of 6 months

The exploration must include determining the child's capacity to fixate on a light or toy, the aversion to the occlusion of one eye and the exclusion of external abnormalities such as proptosis or eye-lid tumors.

To evaluate the ocular alignment, the examiner must utilize the corneal light reflex test and the alternate occlusion test.


The simultaneous evaluation of retina red reflex as well as the ocular alignment is useful for discarding abnormalities.

The indications to refer a patient include being unable to fixate on a light, aversion to the occlusion of one eye, abnormalities in the eye lids or cornea, strabismus, nistagmus, abnormalities in the red reflex.

Examination at 3 ½ years of age

The exploration at this age must include visual acuity, alignment and ocular mobility and fondus. The visual acuity test can be done with the use of the Allen figure cards, Snallen's “E” or ABCs. The test must be completed with the corneal light reflex test, an alternate occlusion test (cover and uncover an eye) and the fondus. Children with a visual acuity of 20/50 or worse or with 2 lines difference between both eyes with strabismus or any abnormality must be referred to an ophthalmologist.

Examination at 5 years of age

The visual examination at this age must include the visual acuity (Snell card) and the corneal light reflex. Children with a visual acuity of 20/40 or worse than 2 lines difference between both eyes (for example OD 20/30 and OS 20/20).

Strabismus or any other ocular abnormality must be referred to an ophthalmologist.

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