Chapter 103 My child’s teacher says she can’t see properly!

Hanne Jensen

Mode of presentation

If parents bring their child to the ophthalmologist because of the teacher’s suspicion of reduced vision, this indicates that the parents have not been aware of any vision or eye problems. This may be because the child’s visual disability has been constant and non-progressive, or that the parents do not expect the child to see any better. The child who never had normal vision will not complain, but as education makes increasing visual demands, problems may become apparent.

The teacher may observe problems with reading (near work), when looking at the blackboard (distance vision), problems with color plates in the book or strange color combinations, or strange behavior in class. The child may miss what is going on or appear uninvolved. The child may need extra time to keep up with the class. There may be recreation problems: the child doesn’t want to play, often falls, is photophobic, or has an abnormal head posture. Other symptoms might be squeezing the eyes or complaining of headaches.

In Table 103.1, the signs and symptoms are presented in combination with what may be found at the examination.

Table 103.1 Symptoms and signs giving clues to examination and diagnosis

The teacher described	Examination	Results
Reading difficulties	Refraction	Refractive error:
Problems with the blackboard Un-concentrated Squeezing the eyes Headache/asthenopia		Hypermetropia/myopia/
		Astigmatism
Abnormal head posture
Reading difficulties Un-concentration/asthenopia Problems with the blackboard	Accommodation/convergence nearpoint	Reduced ANP/CNP Accommodative spasm
Reading difficulties Un-concentrationNeed extra time to keep up Abnormal head posture Behavioral problemsPhotophobic	Motor functions/nystagmus	Retinal dystrophies Neurologic disease Metabolic disease
	Motility/paresis
	Pupillary reflex
	Pursuit/saccade/ataxia
Problems with the blackboard	Visual field	Retinal dystrophies
Problems in the dark Overlooks/falls Behavioral problems		Neurological disease
		Optic nerve disease
Problems with color plates	Color vision tests	Retinal dystrophies
Strange match with color		Optic nerve disease
		Congenital color vision defect
Problems in the dark	Contrast sensitivity	Media opacities
Overlooks/falls		Optic nerve disease
Reading difficulties	Slit-lamp examination	Media opacities:
Problems with the blackboard		Corneal dystrophies
Photophobic		Keratoconus
Squeezing the eyes		Anterior chamber (uveitis/glaucoma)
Un-concentrated
		Lens anomalies (cataract/ectopia)
		Corpus vitreum (degeneration/heme/infection)
Reading difficulties	Ophthalmoscopy	Retinal dystrophies
Problems with the blackboard		Macular dystrophies
Photophobic		Optic nerve disease
Problems in the dark
Overlooks/falls

Diagnosis

History

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