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

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 blackboard
Squeezing the eyes
Abnormal head posture    
Reading difficulties
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
Pupillary reflex
Problems with the blackboard Visual field Retinal dystrophies
Problems in the dark
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)
    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    

Jun 4, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on My child’s teacher says she can’t see properly!

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