The clever girl holds in hand the eyeglasses

Pediatric Comprehensive Eye Exam

A comprehensive eye exam is needed on all new patients.  In children this requires the use of eye drops for pupil dilatation and relaxation of accommodation (an ability to focus) which may last 12 to 24 hours.  The exam includes a review of history, an evaluation of medical and social concerns, evaluation of family history, visual acuity testing, color vision testing, binocular (use of the two eyes together) function evaluation, ocular alignment evaluation, eye pressure evaluation, anterior segment evaluation, posterior segment evaluation and determination of power of the eye (refraction).

Upon completion of exam the findings are discussed with the patient and/or their parent.  A treatment plan is determined including a plan for follow-up.  An opportunity for questions is provided if any clarification is needed.  Any deviation from the treatment plan by either party (the physician or the patient or patient’s parent) should be communicated immediately to the other party to maximize the benefits of the treatment plan.

Examinations and visits with children can be highly variable in length due part to difficulty in eliciting information by history or exam from younger patients.  Variation in ability to cooperate may necessitate more frequent visits if the information being obtained is determined to be less reliable.  In general, initial  pediatric examinations usually take more than two hours.

Most common pediatric problems

Strabismus – misalignment of the eyes including crossed eyes (esotropia), outward drifting eye (exotropia) or a vertical misalignment (Hyper  or Hypo tropia).

Amblyopia – abnormal development of vision at the level of the brain

Diplopia – double vision – rare in children, more common in adults

Epiphora – tearing – most common cause in children is abnormal drainage system.

Eyelid Ptosis   Droopy eyelid

Eyelid lesions

Orbital lesions

Cataracts

Refractive errors

Myopia (nearsightedness – inability to see distances clearly without correction with lens)

Hyperopia (farsightedness) – inability to focus without the use of  accommodative power from the patient’s own adjustable

Multifocal lens (inside the eye) – this condition is asymptomatic in most children and often does not require correction

Astigmatism – an optical term referring for the need for a corrective lens that does not function as a sphere, but rather is elongated more in one direction than another (i.e. is more football shaped than baseball shaped).