ARTICLE

Ocular Disorders in the Newborn

Lauren C. Mehner, MD, MPH,* Jasleen K. Singh, MD*
*Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO

PRACTICE GAPS
Eye examination of the newborn is a challenging but essential component
of the comprehensive neonatal examination. Any abnormality noted on
red reflex testing or inspection of the anterior ocular structures most likely
indicates underlying ocular pathology that requires evaluation by an
ophthalmologist. Increased knowledge of the critical ocular anomalies in
newborns that can lead to vision impairment and associated morbidity and
mortality as well as how to identify these anomalies on bedside
examination is essential for all neonatal clinicians.

OBJECTIVES After completing this article, readers should be able to:

1. Recognize the importance of the eye examination as part of the

neonatal examination.
2. Describe the techniques involved in the neonatal eye examination.
3. List common congenital and acquired ocular anomalies in the newborn
period and describe their characteristics.
4. Explain indications for referral to ophthalmology and the timing of this
referral based on the clinical diagnosis.

ABSTRACT
Visual development begins at birth and continues throughout childhood.
Ocular pathology can lead to permanent visual impairment and
subsequent problems in overall development and school performance as
well as signify serious systemic disease or even life-threatening
malignancies. Prompt identification of congenital or early acquired ocular
pathology via regular bedside ocular examinations and assessments of
visual behaviors by neonatal clinicians is a critical component of newborn
care. The goal of this article is to review the components of the newborn AUTHOR DISCLOSURE Drs Mehner and
Singh have disclosed no financial
eye examination, describe key ocular findings and diagnoses that are relationships relevant to this article. This
common or critical to identify in the newborn period, and offer guidance commentary does not contain a
on necessity and timing of ophthalmology referral. discussion of an unapproved/
investigative use of a commercial
product/device.

INTRODUCTION ABBREVIATIONS
The first few months after birth are a critical period of visual development. Poor ASD anterior segment dysgenesis
visual input during this time from a variety of structural or anatomic factors can CVI cortical visual impairment
MRI magnetic resonance imaging
cause severe amblyopia (decreased vision in 1 or both eyes because of abnormal NLDO nasolacrimal duct obstruction
development of vision in infancy or childhood). Therefore, the eye examination ROP retinopathy of prematurity

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 is an essential component of the newborn assessment, as
early diagnosis and ophthalmology referral can have a crit-
ical impact on the prognosis for many potentially blinding
but treatable ocular conditions. (1)
EYE ANATOMY AND NORMAL DEVELOPMENT
The axial length of the eyeball undergoes rapid growth af-
ter birth, starting at approximately 16 mm and extending
to 20.3 mm by 18 months of age. The newborn pupil size
is roughly 70% of the adult pupil, and the pupil response
is present by 31 weeks’ gestation. An estimated 21% of
term infants have physiologic anisocoria (unequal pupil
size, typically <1 mm). Pupil asymmetry greater than 1
mm, poor light response, or other irregular shape (eg, co-
loboma) should prompt an ophthalmology referral. (2)
Visual development begins immediately after birth, with the
blink to light response as the earliest assessment of visual func-
tion. Fixation and more definitive visual behavior become evi-
dent around 6 to 8 weeks of age, though eye alignment can be
quite variable in the first 3 to 4 months of age. Intermittent exo-
tropia is evident in up to 70% of term infants in the first 2
months after birth and decreases significantly in incidence by 4
months; whereas esotropia is less common at birth, typically
small angle, and rare beyond 2 months of age. (2)
Nystagmus, or involuntary rhythmic abnormal eye
movements with a slow movement away from the visual
target followed by a second movement back to the target,
can have a wide variety of causes. Infant idiopathic nystag-
mus and sensory nystagmus (caused by anatomic disor-
ders of the eye resulting in poor vision) are the most
common forms seen in the neonatal period, and usually
manifest a few months after birth. Therefore, poor visual
behavior, persistent strabismus, or abnormal eye move-
ments beyond age 3 months warrants thorough evaluation
by an ophthalmologist.
EYE EXAMINATION TECHNIQUES
The newborn eye examination consists of assessment of the
visual system via blink to light response; external examina-
tion of the orbit, eyelids, and anterior segment; pupil exami-
nation; and red reflex test to assess for media opacities or
posterior segment abnormalities. Shining the light of a direct
ophthalmoscope into each eye individually should illicit a
blink or startle response in a newborn with normal visual
function. Attention should then be paid to symmetry of pupil
size, equal constriction to light, and any abnormalities in the
shape or appearance suggestive of an anatomic defect.
Evaluation of the external and anterior ocular structures in-
cludes inspection of the eyelids, orbits, cornea, conjunctiva,
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sclera, and iris. Using the direct ophthalmoscope, the red re-
flex from the retina is seen through the pupil. The test is per-
formed in a darkened room to facilitate maximal pupil
dilation without the use of dilating eye drops. The ophthalmo-
scope is held at arm’s length from the neonate and both eyes
are viewed simultaneously to assess for symmetry in the col-
or, brightness, and size of the red reflex. This is called the
Bruckner test. Each eye can then be assessed individually for
more detail. The reflection can vary from a yellow-orange to a
darker red depending on the pigmentation of the individual
but should be symmetric. A dull, absent, white (leukocoria)
(3) or asymmetric red reflex or black spot within the reflex in-
dicates media opacity (eg, cornea opacity, cataract) blocking
the reflection or posterior segment abnormality (eg, tumor,
retinal detachment) that necessitates ophthalmology referral
for complete evaluation. (1) Figure 1 demonstrates the various
possible results of the red reflex test, and a more complete
differential for an abnormal red reflex in an infant is demon-
strated in the Table.
EYELIDS AND ORBITS
Proptosis
Proptosis, or relative anterior bulging of 1 or both eyes in
the orbit, is rare in the neonatal period and typically the
result of an orbital mass (vascular tumor, teratoma, der-
moid) or craniofacial malformation, in which case other
clinical examination findings can provide clues to the diag-
nosis. Orbital imaging is often indicated and an ophthal-
mic examination is required to rule out compromise to
other ocular structures (eg, extraocular muscle restriction,
globe or optic nerve compression) that may lead to vision
loss if not adequately addressed.
Ptosis
Congenital ptosis is most commonly the result of a devel-
opmental anomaly of the levator muscle and is typically
unilateral and sporadic. Neurologic causes of ptosis in-
clude congenital Horner syndrome (unilateral ptosis with
ipsilateral iris heterochromia and miosis), cranial nerve III
palsy (ptosis with ‘down and out’ position of the globe),
and Marcus Gunn jaw-winking syndrome (synkinesis of
cranial nerves III and V resulting in unilateral ptosis with
eyelid excursion during chewing/sucking often seen while
feeding). (4) An eyelid mass can produce a mechanical
ptosis. Severe ptosis that obstructs the visual axis is highly
amblyogenic and requires urgent ophthalmology referral.
Nonobstructive ptosis can still cause amblyopia because of
strabismus or asymmetric refractive error and therefore
necessitates routine ophthalmic evaluation.
 Table. Differential Diagnosis for Abnormal Red Reflex
Location Diagnosis
Anterior segment  Corneal opacity
 Congenital cataract
Inherited
Persistent fetal vasculature
Metabolic
Infectious
Posterior segment (leukocoria)  Retinal detachment
Coats disease
Norrie disease
Retinopathy of prematurity
Incontinentia pigmenti
 Retinoblastoma
 Coloboma
Retina
Optic nerve
 Vitreous hemorrhage
 Infection
Toxocariasis
Endophthalmitis
 Uveitis
 Myelinated nerve fiber layer

Coloboma
Eyelid colobomas are full-thickness defects in the lid
caused by failure of closure during development (Fig 2A).
They are typically sporadic and located in the medial up-
per eyelid; however, they are associated with 2 common
syndromes that should be kept on the differential when
evaluating patients with eyelid defects (Goldenhar syn-
drome—upper lid location, Treacher Collins syndrome—
lower lid location). (5) Close monitoring of the ocular sur-
face is important because exposure can lead to corneal
scarring and vision loss if left untreated and is often the
leading factor in timing of surgical repair.

Nasolacrimal System Abnormalities

Figure 1. Red reflex examination: A) Normal: Child looks at light. Both red
reflections are equal. B) Unequal refraction: One red reflection is brighter
than the other. C) No reflex (cataract): The presence of lens or other media
opacities blocks the red reflection or diminishes it. D) Foreign body/abra-
sion (left cornea): The red reflection from the pupil will back-light corneal
defects or foreign bodies. Movement of the examiner’s head in 1 direction
will appear to move the corneal defects in the opposite direction. E) Stra-
bismus: The corneal light reflex is temporally displaced in the misaligned
right eye, indicating esotropia. (Used with permission of Alfred G. Smith,
MD, #1991.)
A dacryocystocele is a congenital distention of the lacrimal
sac that manifests at birth as a cystic subcutaneous nodule
with a bluish hue located inferior to the medial canthus
(Fig 2B). Risks of congenital dacryocystoceles include in-
fection, with reported rates of acute dacryocystitis (Fig 2C)
developing in 20% to 75% of patients, as well as respirato-
ry compromise and feeding difficulty caused by the intra-
nasal extension of the cyst and the obligatory nasal
breathing of neonates. (6)(7) Therefore, in addition to sys-
temic antibiotics for infected dacryocystoceles, this condi-
tion also requires urgent referral for decompression and
probing of the nasolacrimal system.
In contrast to a dacryocystocele, a typical nasolacrimal
duct obstruction (NLDO) presents 1 to 2 weeks after birth
with persistent tearing and intermittent mucoid discharge of
1 or both eyes without associated palpable nodules and low

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 Figure 2. A) Right eyelid coloboma. B) Congenital dacryocystocele in a 1-week-old infant. C) Dacryocystitis in a 5-day-old infant requiring intravenous
antibiotics and surgical decompression.
risk of infection. Initial management for an NLDO con-
sists of observation and lacrimal sac massage; 80% or
more of congenital NLDO cases resolve spontaneously
by age 12 months. (8) If not resolved by then, ophthal-
mology referral for surgical probing of the nasolacrimal
system to relieve the obstruction is indicated. When
making this diagnosis, clinicians should take care to rule
out more serious causes of persistent tearing such as
congenital glaucoma, infection, or corneal injury/foreign
body.
ANTERIOR SEGMENT
Infection
Neonatal conjunctivitis occurs within the first 30 days after
birth by definition and is an increasingly uncommon but se-
rious complication in the newborn period. All clinicians
should be able to quickly diagnose and initiate treatment of
neonatal conjunctivitis to minimize the risk of permanent vi-
sion loss or progression of systemic illness. Diagnostic clues
include timing of onset, appearance and amount of dis-
charge, and associated maternal or newborn illness.
1. Chemical conjunctivitis presents within the first 24
hours after birth with bilateral conjunctival injection
and watery discharge and spontaneously resolves within
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2 to 4 days. Largely attributed to the application of sil-
ver nitrate previously used as prophylaxis against
bacterial conjunctivitis, chemical conjunctivitis is ex-
ceedingly rare in developed industrialized countries af-
ter the switch to erythromycin ointment or 2.5%
povidone-iodine solution (not currently approved for
use in the United States).
2. Neisseria gonorrhea conjunctivitis presents with bilateral
conjunctival injection, chemosis, significant mucopuru-
lent discharge, and eyelid edema 3 to 5 days after birth.
Rapid progression to corneal involvement leading to ul-
ceration and perforation is the most feared complication,
necessitating prompt diagnosis and treatment with irriga-
tion with sterile saline to remove the discharge and mem-
branes, topical erythromycin ointment, and intravenous
or intramuscular ceftriaxone. Hospitalization is usually re-
quired to monitor for disseminated N gonorrhea infection
as systemic complications include arthritis, meningitis,
and septicemia. These infants and their mothers should
also be treated concurrently for Chlamydia.
3. Chlamydial conjunctivitis presents 5 to 14 days after birth
with conjunctival hyperemia and scant mucoid discharge,
with more severe cases developing chemosis, eyelid ede-
ma, and pseudomembrane formation (Fig 3A). Because
pneumonia develops in up to 20% of these infants,
 hospitalization may be required. Treatment consists of
oral erythromycin and topical erythromycin ointment.
4. Herpes simplex virus keratoconjunctivitis presents at 1 to 2
weeks of age with periocular vesicular skin lesions, eyelid
edema, conjunctival injection, and a nonpurulent discharge.
Corneal involvement includes microdendrites and geograph-
ic ulcers that can be identified with fluorescein staining and
slit-lamp examination. Systemic infection can be concurrent
so patients should be monitored closely. Treatment consists
of oral or intravenous acyclovir and topical antiviral medica-
tions, if there is corneal involvement, to minimize risk of cor-
neal scarring and subsequent vision loss. (9)
In addition to a thorough clinical examination, neonates
with conjunctivitis should have conjunctival scrapings sent
for Gram staining and culture to help identify the organism
and direct treatment; this is because other bacteria such as
Staphylococcus aureus, Pseudomonas, and other pathogens can
sometimes be the infective organism. Depending on the clin-
ical context, polymerase chain reaction testing, blood cul-
ture(s), and further evaluation for other infections may be
warranted. Although the neonatal clinician is critical in mak-
ing the initial diagnosis of conjunctivitis and initiating treat-
ment, it is beneficial to involve ophthalmology early in the
clinical course, especially if corneal involvement is suspected.
Cornea
Corneal clouding or opacity is associated with a wide variety
of pathology and necessitates ophthalmology consultation to
help determine the etiology, early treatment, and prompt
evaluation for any associated syndromes, if indicated.

Figure 3. A) Mucopurulent discharge in a 10-day-old infant with chlamydial conjunctivitis. B) Cloudy cornea in a newborn with Peters anomaly. C) Con-
genital cataract viewed by retroillumination on red reflex testing. D) Persistent fetal vasculature cataract.

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 Trauma
Birth trauma, typically involving forceps delivery, can
cause vertical tears in Descemet membrane (posterior cor-
neal layer), resulting in unilateral corneal clouding. Most
clouding resolves within a few months, but these infants
should be followed by an ophthalmologist because this
opacification can be amblyogenic if persistent and located
within the visual axis. These patients can also develop sig-
nificant astigmatism, which can also be amblyogenic.
Congenital Glaucoma
The classic triad of photophobia, tearing, and blepharo-
spasm is diagnostic for congenital glaucoma. Persistently
elevated intraocular pressure results in breaks in Desce-
met membrane (horizontal tears called Haab striae) and
corneal clouding. It also leads to optic nerve damage, in-
creased corneal diameters, and buphthalmos (enlarged
globe) as a result of rapid axial length elongation. Neo-
nates with suspected congenital glaucoma require urgent
ophthalmology referral as surgical intervention is the pri-
mary treatment modality and prompt lowering of intraocu-
lar pressure can prevent and even reverse damage to the
optic nerve and associated vision loss. (10)
Corneal Ulcer
Corneal ulcer presents as an infiltrative opacification and
associated thinning of the cornea. Most commonly, ulcers
are the result of infection (see the Conjunctivitis section
above) and require urgent ophthalmology consultation for
culture and initiation of topical antibiotic drops. Sterile
ulceration can develop from exposure related to eyelid
defects, lagophthalmos, or neurotrophic cornea.
Anterior Segment Dysgenesis
Anterior segment dysgenesis (ASD) encompasses various
developmental disorders of the components of the anterior
segment of the eye (cornea, iris, lens, and aqueous hu-
mor). Often, the presenting clinical feature is an opacifica-
tion or clouding of the cornea or other structural
abnormalities of the iris or lens visible on penlight exami-
nation. Secondary glaucoma is common in these patients.
The most common ASD disorder is Peters anomaly,
which presents with variable central corneal opacity often
with iris strands adherent to the posterior cornea (Fig 3B).
The lens is sometimes involved as well. On the far end of
the spectrum is Peters-plus syndrome, which is a bilateral
Peters anomaly with associated congenital brain defects,
heart defects, and craniofacial anomalies. All patients with
suspected ASD require ophthalmic evaluation and possibly
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a full systemic evaluation depending on the presumed di-
agnosis. (11)
Sclerocornea is a congenital corneal opacification result-
ing from ingrowth of scleral tissue into the peripheral cor-
nea. It is a nonprogressive condition and may be part of
the ASD spectrum or occur in isolation.
Metabolic
The most common metabolic cause of corneal opacity or
clouding is mucopolysaccharidosis and its variants. The
clouding is a result of accumulation in the cornea of the
metabolic pathway products and presents as bilateral dif-
fuse corneal haze. If a metabolic etiology is suspected, fur-
ther systemic evaluation is indicated. Dense clouding is
amblyogenic so in addition to treating the underlying dis-
order, the main ocular intervention is eventual corneal
surgery.
Edema
Several congenital corneal dystrophies present at or just
after birth with varying degrees of corneal opacity or
clouding, usually caused by a defect in the endothelium,
or most posterior corneal layer. The pattern of opacity may
be patchy or diffuse, and usually both eyes are involved.
Most dystrophies are hereditary and not associated with
systemic disease. Like the metabolic disorders mentioned
earlier, the mainstay of ocular intervention is surgery.
Dermoid
A dermoid is an overgrowth of normal, benign tissue in
an abnormal location. It can grow anywhere on the body,
including the orbit or on the ocular surface. Typically, ocu-
lar surface dermoids grow at the limbus, or the junction
of the cornea and sclera, and look like a white nodular le-
sion covering a portion of the cornea. Because these can
cause amblyopia if obstructing the visual axis as well as ir-
ritation, ophthalmology referral is warranted for possible
surgical intervention.
Iris Coloboma
Often identified during the pupil examination, iris colobo-
mas present as an irregularly shaped pupil or iris tissue,
often with a keyhole appearance. Colobomas are a result
of incomplete closure of the embryonic fissure during the
early weeks of development, and typically occur in the in-
ferior nasal quadrant of the iris. They can be sporadic in
occurrence or associated with several genetic syndromes,
including CHARGE syndrome (colobomas, heart defects,
atresia of the nasal choanae, restriction of development,
genitourinary abnormalities, ear and hearing anomalies)
and renal coloboma syndrome among many others, so a
genetics consultation is often warranted. In addition, rou-
tine ophthalmology referral is indicated to evaluate for co-
lobomas or dysgenesis in other ocular structures.
Aniridia
Aniridia refers to hypoplasia or absence of iris tissue. On ex-
amination, iris tissue can range from the appearance of a
persistently large or dilated pupil to a mere iris stump near
the limbus. Roughly two-thirds of aniridia cases are isolated
abnormalities inherited in a dominant genetic fashion with
variable expressivity. Important to note is that a subset of the
sporadic cases of aniridia is part of the WAGR syndrome
(Wilms tumor, aniridia, genitourinary anomalies, and intel-
lectual disability [formerly known as mental retardation]) and
therefore, these patients are at risk of developing a Wilms tu-
mor. Additional ocular disorders associated with aniridia in-
clude foveal hypoplasia, cataract, glaucoma, and corneal
abnormalities. Ophthalmic referral is therefore warranted in
all cases of aniridia and visual prognosis is widely variable
depending on the extent of additional structural defects. (12)
Lens
Congenital cataracts can vary from a small white central dot
to a diffuse lens opacification visible on red reflex testing as a
black dot or smudge in the reflex (Fig 3C) to a significant
dimming of the reflex or leukocoria because of blockage of
the light by the opacified lens. Unilateral cataracts are typical-
ly sporadic. Persistent fetal vasculature is a type of unilateral
congenital cataract associated with microphthalmia, elonga-
tion of the ciliary processes, and stalk extending from the
posterior lens surface to the optic nerve (Fig 3D). Severe cases
can involve retinal detachments. Bilateral cataracts, in con-
trast, are more commonly caused by an inherited genetic mu-
tation or associated with systemic abnormalities such as
metabolic disorders (galactosemia, hypocalcemia, etc), infec-
tion (eg, TORCH [toxoplasmosis, other agents, rubella, cyto-
megalovirus, and herpes simplex] infections), or syndromes
such as trisomy 21. Although it is important to pursue the ap-
propriate evaluation in these cases, most bilateral cataracts
have no identifiable cause. (13)
POSTERIOR SEGMENT
Retinoblastoma
Retinoblastoma is the most common primary ocular tumor
in children and can affect 1 or both eyes. The most common
presenting sign is leukocoria on the red reflex test.
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Retinoblastoma is covered in detail in a separate article in this
issue of NeoReviews and therefore not discussed further here.
Retinopathy of Prematurity
Retinopathy of prematurity (ROP) is a prematurity-related
ocular complication distinguished by neovascularization of
the retina, leading to retinal detachment and blindness in
the most severe cases. Because ROP is associated with
lower gestational age and birthweight, the criteria for
screening include: 1) birthweight of 1,500 g or less, 2) ges-
tational age of 30 weeks or less, or 3) infants with an un-
stable clinical course believed by their attending
neonatologist/pediatrician to be at high risk for ROP. (14)
A detailed review of this topic can be found in a recent is-
sue of NeoReviews (15) and therefore not discussed further
in this review.
Retinal Hemorrhages
Fundus hemorrhages are common among newborns, pre-
sent in an estimated 20% to 34% of infants. (16)(17) The
hemorrhages can involve all 4 quadrants and multiple retinal
layers. They are more common in vaginal deliveries (specifi-
cally vacuum-assisted deliveries) compared with cesarean sec-
tions and are thought to be caused by an acute rise in
intracranial pressure as the head passes through the birth ca-
nal. They can be an incidental finding on dilated eye exami-
nation for other reasons and do not require any intervention
because most cases resolve within 2 weeks of the initial find-
ing. (17) Similarly, subconjunctival hemorrhages are also a
common finding in the newborn period among both vaginal
and cesarean deliveries because of elevated venous pressure
in the head and neck from uterine contractions. (18) It is im-
portant to remember that ocular hemorrhages can also be ev-
idence of abusive head trauma in infants in the appropriate
context, and suspicion for this should be investigated with
the applicable team of subspecialists.
Retinal/Optic Nerve Colobomas
Similar to iris colobomas, colobomas of the retina or optic
nerve are the result of incomplete closure of the embryon-
ic fissure during development. The most common location
is the inferior nasal quadrant of the involved structure. De-
pending on the size and location of the coloboma, visual
acuity can vary significantly, with early associated nystag-
mus a poor prognostic sign for vision. Posterior segment
colobomas may be identified on newborn eye examination
as a dull or white red reflex. Numerous syndromic and ge-
netic abnormalities are associated with ocular colobomas
so a multidisciplinary approach to evaluation and
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 diagnosis should include the neonatologist or pediatrician,
ophthalmologist, geneticist, and other subspecialists,
based on clinical examination findings. Although there is
currently no definitive treatment for ocular colobomas in
the posterior segment, these patients should be followed
by an ophthalmologist to ensure optimization of vision via
correction of refractive error, strabismus management,
and overall ocular health.
Optic Nerve Hypoplasia
Optic nerve hypoplasia is characterized by a decreased
number of optic nerve axons resulting in a nerve that is
small and often pale or gray in appearance. It can be a
unilateral or bilateral finding, nonprogressive, and the as-
sociated visual acuity can vary widely from 20/20 to no
light perception. Because of the common association with
midline cerebral structural defects (absent septum pelluci-
dum, agenesis of the corpus callosum, pituitary gland dys-
function, etc), magnetic resonance imaging (MRI) is
indicated in patients with this diagnosis, as well as referral
to appropriate subspecialties such as endocrinology, de-
pending on the imaging findings. (19) Similarly, MRI
findings suggestive of septo-optic dysplasia or other optic
nerve abnormality should prompt ophthalmology referral.
Cortical Visual Impairment
Cortical (cerebral) visual impairment (CVI) is currently the
leading cause of significant vision impairment in children in
developed countries as a result of increased survival of pre-
mature infants. (20) It is characterized by a decreased visual
response caused by a neurologic problem affecting the visual
part of the brain. This can manifest as decreased visual acu-
ity, visual field deficits, or visual processing abnormalities.
CVI has multiple etiologic factors, all of which stem from
brain damage occurring in the perinatal period or structural
abnormalities in the visual processing centers of the brain.
The most common cause is hypoxic-ischemic brain injury;
often CVI can coexist with other neurologic disorders. Typi-
cally, these children have normal findings on anatomic eye
examination or an ocular condition that cannot account for
the degree of the abnormal visual function observed. (21)
Often, visual impairment secondary to the aforemen-
tioned neurologic causes is not readily apparent at birth,
but rather signs and symptoms manifest over time. In the
absence of any structural or anatomic abnormality noted
on careful eye examination by the neonatologist or pedia-
trician that would prompt sooner referral, poor visual be-
havior, persistent strabismus, or abnormal eye movements
beyond age 3 months warrants thorough evaluation by an
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ophthalmologist. Early intervention with low vision serv-
ices is important to help affected children optimize their
visual function and overall development.
Summary
• Based on current practice guidelines, the eye
examination is a critical component of the
comprehensive newborn and infant examinations. (1)
• Studies suggest that an abnormal red reflex test,
when performed correctly, is highly specific in
detecting ocular pathology that requires
ophthalmology referral. (22)
• Knowledge of the common ocular anomalies as
well as how to identify them on routine
examination is an essential skill for all neonatal
clinicians.
American Board of Pediatrics
Neonatal-Perinatal Content
Specifications
• Know the normal anatomy and ophthalmologic findings
of the developing eye.
• Recognize the importance of corneal opacifications.
• Know the syndromes associated with abnormalities of
the eye including cranio-facial abnormalities, coloboma,
abnormalities of the orbit, the eyebrows, the eyelids, the
eyelashes, the cornea, the iris, and the retina.
• Identify the conditions associated with a white pupil (ie
leukokoria).
• Recognize the signs of and know the conditions
associated with congenital glaucoma.
• Recognize the signs of, and know the conditions
associated with, neonatal cataracts.
• Know the ocular findings associated with congenital
infections.
• Know the benefits and complications of eye prophylaxis
(e.g. obstructed nasolacrimal duct).
• Know the causes and clinical and laboratory features of
acute neonatal infections of the eyes, including
ophthalmia neonatorum.
• Know the management and complications of acute neonatal
infections of the eyes, including ophthalmia neonatorum.
• Know the findings and management of the ophthalmic
complications of eye trauma that may occur in difficult
deliveries or in the "shaken baby" syndrome.
• Know the causes and management of excess tearing.

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Vol. 22 No. 7 JULY 2021 e469
 Ocular Disorders in the Newborn
Lauren C. Mehner and Jasleen K. Singh
NeoReviews 2021;22;e461
DOI: 10.1542/neo.22-7-e461

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 Ocular Disorders in the Newborn
Lauren C. Mehner and Jasleen K. Singh
NeoReviews 2021;22;e461
DOI: 10.1542/neo.22-7-e461

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
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