Abnormal eye movements

New onset:

Papilloedema
Optic atrophy
Nystagmus
Reduced visual acuity not attributable to an apparent cause in the eye itself
Reduced visual fields not attributable to an apparent cause in the eye itself
Proptosis
Paralytic squint
Consistent or persistent symptoms or signs of loss of visual function plus any other associated neurological or endocrinological symptoms or signs, including growth faltering

Delays in diagnosis have occurred with:

Failure to assess vision in a young/uncooperative child
Failure in communication between community optometry (high street opticians), primary and secondary care

A full visual assessment including pupil responses, visual fields in school age children, visual acuity, eye movements and optic disc appearance
If unable to undertake a visual assessment refer to community optometry (high street optician) or hospital eye service - depending on child's age and ability to co-operate with examination
Ask specifically about associated symptoms and risk factors:
- Personal or family history of a brain tumour
- Leukaemia
- Sarcoma and early onset breast or bowel cancer prior therapeutic CNS irritation
- Neurofibromatosis types 1 and 2
- Tuberous Sclerosis
- Li Fraumeni Syndrome
- Family history of colorectal polyposis
- Gorlins Syndrome
- Other familial genetic syndromes
Neurological examination (include assessment of vision (including acuity), gait and coordination)
Plot growth in all children and pubertal status if applicable
Plot head circumference in children under two