Chapter 99 My child seems to hate the bright light
Although mild photophobia is fairly common in normal young children, photophobia must be taken seriously as there are a wide variety of conditions including serious disorders such as infantile glaucoma and anterior visual pathway tumors which may present with photophobia.
A variety of behavioral patterns suggest a child is sensitive to light. Babies and young children may get upset and close their eyes when outside, in the car, or under fluorescent lighting, but play happily under natural light indoors. Photophobic children are often thought of as shy or sad as they have a tendency to look down, furrow their brows, and screw up their eyes. Frequent blinking, watering, and rubbing of the eyes are common. Children may complain of pain in their eyes, blurred vision, and headaches, especially when it is bright.
It is critical that a good rapport is built with the child and as much information as possible gathered before formal examination is attempted. The lighting in the examination room should be lowered to aid the child’s comfort. The differential diagnosis for photophobia is considerable. Taking into consideration the age of the child (see Table 99.1) and getting a good history (see Table 99.2) help to focus the examination toward finding the diagnosis.
|Recent onset or present since very young?
|Associated redness of eyes?
|One or both eyes?
|Constant or intermittent?
|Family history or history of consanguinity?
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