Abnormal eye movements

Abnormal eye movements

Reassure

  • New onset visual abnormality of less than two weeks duration

Review/refer

  • New onset non-paralytic squint

Scan

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

Diagnostic pitfalls

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

Examination/assessment

  • 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