Chapter 103 My child’s teacher says she can’t see properly!
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 blackboardUn-concentratedSqueezing the eyesHeadache/asthenopia | Hypermetropia/myopia/ | |
| Astigmatism | ||
| Abnormal head posture | ||
| Reading difficultiesUn-concentration/asthenopiaProblems with the blackboard | Accommodation/convergence nearpoint | Reduced ANP/CNPAccommodative spasm |
| Reading difficultiesUn-concentrationNeed extra time to keep upAbnormal head postureBehavioral problemsPhotophobic | Motor functions/nystagmus | Retinal dystrophiesNeurologic diseaseMetabolic disease |
| Motility/paresis | ||
| Pupillary reflex | ||
| Pursuit/saccade/ataxia | ||
| Problems with the blackboard | Visual field | Retinal dystrophies |
| Problems in the darkOverlooks/fallsBehavioral 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 |
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