Age | Examinations | Indications for referral |
---|---|---|
Newborn | Appearance of the eyes | Abnormal structure of the eyes or eyelids, abnormal shape of the pupil or its reaction to light, constant unilateral strabismus |
Red reflex | Dim or missing red reflex | |
4-6 weeks | Eye contact | Missing or abnormal eye contact Parent-child interaction has not started. |
Appearance of the eyes | Abnormal structure of the eyes or eyelids, abnormal shape of pupil or its reaction to light, constant unilateral strabismus | |
Red reflex | Dim or missing red reflex | |
Record any eye and vision problems in the immediate family (amblyopia, refractive errors, strabismus, tumours) | Eye examinations indicated in Down's syndrome Hypotonic infants | |
4 months | Eye contact, smile response | Missing or abnormal eye contact Problems with early interaction: vision (accommodation, problems with fixation) and hearing should be examined |
Appearance of the eyes | Abnormal structure of the eyes or eyelids, e.g. difference in the size of the eyes (glaucoma) | |
Red reflex | Dim or missing red reflex | |
Fixation and convergence | Inaccurate eye tracking | |
Hirschberg's test | Manifest, constant or frequently recurring strabismus | |
8 months and 18 months | As at 4 months | As at 4 months + problems with lacrimal passages |
Cover test | Even intermittent strabismus (may not be present during the examination); refer without delay if the eyes were previously correctly aligned and strabismus is of acute onset | |
Examination of pinch grip | Employment of vision does not correspond to age, the child looks at things close up, is not interested in pictures, hand-eye coordination is inaccurate. | |
Does the child recognize family members before they say anything? | Does not recognize faces but recognizes a person by the voice. | |
3 years | Near vision acuity (if the child co-operates) | Binocular visual acuity is less than 0.5 OR A difference of 2 rows or more between the eyes in the near visual acuity, provided that the near visual acuity of both eyes can be measured Abnormal head posture, e.g. tilting |
Hirschberg's test | Manifest strabismus | |
Cover test | Manifest strabismus or asymmetric reaction to covering of the eye | |
4 years | Near and distance visual acuity | Near vision: binocular acuity less than 0.5 Distance vision: binocular acuity less than 0.5, unless near visual acuity is 0.5 or better (= myopia) OR A difference of 2 rows or more between the eyes in the near and distance visual acuity Binocular near visual acuity more than 2 rows worse than far visual acuity (possible causes are impaired accommodation or hyperopia) |
Hirschberg's test | Manifest strabismus | |
Cover test | Manifest strabismus or asymmetric reaction to covering of the eye | |
5 or 6 years | Examine as at 4 years, as necessary. Examine especially if - the child is about to be investigated by a psychologist - the child has disorders of visual perception | Near vision: binocular acuity less than 0.63 Distance vision: binocular acuity less than 0.63, unless near visual acuity is 0.63 or better (= myopia) OR A difference of 2 rows or more between the eyes in the near and distance visual acuity Binocular near visual acuity more than 2 rows worse than far visual acuity (possible causes are impaired accommodation or hyperopia) Manifest strabismus, abnormal head posture |