Abnormal eye movements
Reassure
- New onset visual abnormality of less than two weeks duration
Action
Review visual symptoms at two weeks after visual abnormality onset, repeat history and examination
Review / Refer
- New onset non-paralytic squint
Action
Refer for ophthalmological assessment
Scan
New onset:
- Papilloedema
- Optic atrophy
- Nystagmus
- Reduced visual acuity not attributable to an apparent cause in the eye itself
- Reduced visual fields not attributable to an apparent cause in the eye itself
- Proptosis
- Paralytic squint
- Consistent or persistent symptoms or signs of loss of visual function plus any other associated neurological or endocrinological symptoms or signs, including growth faltering
Action
Scan – visual symptom plus one or more other symptom
Diagnostic Pitfalls
Delays in diagnosis have occurred with:
- Failure to assess vision in a young/uncooperative child
- Failure in communication between community optometry (high street opticians), primary and secondary care
Examination/assessment
- A full visual assessment including pupil responses, visual fields in school age children, visual acuity, eye movements and optic disc appearance
- If unable to undertake a visual assessment refer to community optometry (high street optician) or hospital eye service – depending on child’s age and ability to co-operate with examination
- Ask specifically about associated symptoms and risk factors:
- Personal or family history of a brain tumour
- Leukaemia
- Sarcoma and early onset breast or bowel cancer prior therapeutic CNS irritation
- Neurofibromatosis types 1 and 2
- Tuberous Sclerosis
- Li Fraumeni Syndrome
- Family history of colorectal polyposis
- Gorlins Syndrome
- Other familial genetic syndromes
- Neurological examination (include assessment of vision (including acuity), gait and coordination)
- Plot growth in all children and pubertal status if applicable
- Plot head circumference in children under two