Abnormal eye movements

Abnormal eye movements


  • New onset visual abnormality of less than two weeks duration


Review visual symptoms at two weeks after visual abnormality onset, repeat history and examination

Review / Refer

  • New onset non-paralytic squint


Refer for ophthalmological assessment


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


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


  • 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