Eye Examination in Children

Difficulty testing child on 2 separate attempts
1. Age 3: Repeat attempt in 6 months
2. Age 4 and older: Repeat attempt in 1 month
Premature Infants
Developmental Delay or neurologic disorder
1. Down Syndrome
2. Cerebral Palsy
Systemic disease
Family History of eye disorder
1. Retinoblastoma
2. Congenital Cataracts
3. Metabolic disorder
4. Strabismus
5. Amblyopia
6. Childhood Glaucoma

Protocol
1. AAP/AAOS recommend Vision Screening at ages 4, 5, 6, 8, 10 and 12 years
2. Refer if Visual Acuity worse than 20/40
Newborn Eye Exam
1. Red Reflex (Pupillary Light Reflex, Bruckner Test)
2. Pupil Response
3. Observe constant Eye Deviation
4. Observe for Congenital Cataracts
Infants at 6 months of age to 3 years
1. Newborn Eye Exam (as above) and
2. Fixation and Following
3. Ocular Alignment (Screen for Strabismus)
  1. Corneal Light Reflex (Hirschberg Test)
  2. Cover Test
Children 3 to 5 years old
1. Visual Acuity (Tumbling-E Test, Allen OR HOTV Chart)
2. Ocular Alignment (Screen for Strabismus)
  1. Corneal Light Reflex (Hirschberg Test)
  2. Cover Test
Children 6 years and older
1. Snellen Chart (Letters or Numbers)

Criteria for abnormal
1. Age 3-5 years
  1. Either eye Vision <10/20 or 20/40 (<4 of 6 correct)
  2. Two-line difference between eyes (20/25 and 20/40)
2. Age 6 and up
  1. Either eye Vision <10/15 or 20/30 (<4 of 6 correct)
  2. Two-line difference between eyes (20/20 and 20/30)
Additional testing: Pinhole Test
1. Distinguishes Refractive Error from Amblyopia
2. Indicated for failed Vision Screening