Eye Examination

Prompt
Introduce yourself and wash your hands

General observation

Dysmorphic features
Thriving
Visual behaviours
o Light gazing
o Eccentric fixation
Glasses

Inspect the eyes

Look for and comment on the presence of:
Squint
Coloboma
Corneal clouding
Iris lesions
Ptosis
Anophthalmia
Microphthalmia

Inspect glasses/visual aids

Having your glasses taken away is a very scary event! Make sure that you
ask carefully, and that you give them back promptly.

Visual Acuity
Small Child (pre-verbal)
Ask the parent to cover one eye at a time
Check fixes on an interesting toy that doesnt make a noise
Follow in vertical & in horizontal plane
Repeat for the other eye
Older Child
Cover one eye at a time
Use what you have available (and will depend on the child):
o Picture book - ask the child to point to objects
o Read from a book
o Snellen chart to check distance vision

Visual Fields

Sit opposite child, 1 metre apart

Cover your right eye; ask the child to cover their left eye (or ask a
parent to help)

Can you say YES when you see my finger move?

Make sure you check centrally first!
Move in from 4 diagonals
Repeat for the other eye

Nystagmus

Use a H shape to make sure you cover all the areas

Observe for nystagmus
Ask to report diplopia at each extremity of the H
o Can you see 1 finger or 2 fingers?

Accommodation

Ask the child to fix on an object at a 1 metre distance

Move the object slowly in towards the childs nose
Observe for:
o Eye movements
o Pupillary responses

Squint Testing
Corneal Reflections
A light shone centrally from approx 30cms distance will reflect the light
centrally symmetrically if there is no squint
Eye Movements
You can observe for eye movements during the rest of the examination
which might give you some clues
Cover Test: Manifest
Ask the child to look at an object 1 metre distant, and then at 6 metres
distant
Observe to see which eye fixes on the objects
If the left eye appears to fix, ask the child or a parent to cover the left
eye
If the right eye now begins to fix, you have demonstrated a manifest
squint of the right eye
Cover Test: Latent
Ask the child to look at an object 1 metre distant, and then at 6 metres
distant
Ask the child or their parent to cover each eye in turn
Observe how the uncovered eye moves:
If the uncovered eye moves to take up fixation, there is a latent squint
of the eye that moves

Fundoscopy
Red Reflexes
Anterior Chamber
Fundus