My child could see perfectly but now the vision is weak

Chapter 104 My child could see perfectly but now the vision is weak



Luis Carlos Ferreira de Sá


Visual loss in an otherwise healthy child is an alarming finding for both the family and clinician. Children often do not complain of decreased vision, and it is common for them to present with severe visual loss. Visual loss may result from congenital problems, only noticed later in life when visual requirements increase at school or when the child had normal vision followed by chronic or acute visual loss (Fig. 104.1).


image

Fig. 104.1 Guidelines for diagnosis of acquired poor vision in childhood.


When investigating acquired visual loss, a comprehensive medical history is essential. Ask about the pregnancy, delivery, gestational age, birth weight, perinatal problems, developmental milestones, ocular and medical anomalies, medications, and family history of systemic and/or visual problems (Fig. 104.2). Seek details regarding trauma, timing, duration, and severity of visual loss.


image

Fig. 104.2 Guidelines for investigation of acquired vision loss in childhood.


Irrespective of whether the onset of visual loss is acute or chronic, ophthalmic examination may in most cases reveal abnormalities in the anterior and/or posterior segment, although the site of visual loss may be intracranial (see Chapters 54 and 56). Details about photophobia and eye movement disorders, including strabismus and nystagmus, may be especially helpful in reaching a diagnosis.



Examination


First, observe the child’s visual behavior. There may be different degrees of visual loss, including visual inattention. The child may not respond to visual stimuli such as lights, faces, or toys. The examiner should not use animated and noisy objects; the child may be attracted to the sound rather than the visual stimulus. Whenever possible, visual acuity should be measured with different methods appropriate for the age.


Pupillary responses (grade of reactions, presence of an afferent pupillary defect, or paradoxical reaction) and assessment of alignment and eye movement disorders provide the clinician with important diagnostic clues.



Anterior segment



Cornea


Various diseases may affect the cornea. Developmental glaucoma may present with increased corneal diameter because of the elasticity of the collagen fibers in young children. Corneal transparency may be reduced by several conditions, including developmental glaucoma (see Chapter 37), infectious keratitis (see Chapter 33

Only gold members can continue reading. Log In or Register to continue

Related posts:

  1. Visual electrophysiology: how it can help you and your patient
  2. My child just will not let me put the eye drops in!
  3. Strabismus: non-surgical treatment
  4. Retinopathy of prematurity

Stay updated, free articles. Join our Telegram channel
Tags:
Jun 4, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on My child could see perfectly but now the vision is weak

Full access? Get Clinical Tree
Get Clinical Tree app for offline access