2025 – PAGE 250 – OPHTHALMOLOGY

2025 – Core Study Guide 13 – Ophthalmology 2025 – PAGE 250 – OPHTHALMOLOGY

VISION SCREENING

The AAP recommends that all infants be examined (by pediatricians) by 6 months of age for fixation preference, ocular alignment, and the presence of any eye disease. Formal vision screening evaluations should begin at 3 years of age.

VISUAL ACUITY BY AGE

Refer to an ophthalmologist if a child’s visual acuity in either eye is worse than the acuity listed below for age:

    • Three-year-olds: 20/50
    • Four-year-olds: 20/40
    • Five-year-olds and above: 20/30
  • MNEMONIC: The acuity required to pass the vision screen starts at 50 for three-year-olds and drops by 10 each year after that. So, the cut offs are 50 40, 30 for ages 3, 4 and 5.

VISION SYMMETRY

Symmetry in visual acuity on exam is great! If a child’s visual acuity is asymmetric (more than a 1-line difference on the eye chart), refer to ophthalmology for an evaluation for amblyopia.

STRABISMUS

Strabismus basically means there is improper alignment of the eyes. It could be associated with an esotropia (eye looks more inward/medially) or an exotropia (eye looks more outward/laterally).

IMAGE: www.pbrlinks.com/STRABISMUS1 – A left esotropia

PSEUDOSTRABISMUS

Pseudostrabismus is the appearance of strabismus, or being “cross-eyed,” even though the alignment of both eyes is appropriate. This is often seen in patients with prominent, or uneven, epicanthal folds.

IMAGE: www.pbrlinks.com/PSEUDOSTRABISMUS1

AMBLYOPIA

Amblyopia refers to a structurally normal eye with poor vision; often occurs when one eye can’t see very well. Patients with strabismus are at risk for developing this.

MNEMONIC: The weaker eye “shuts down” as the dominant eye takes over.

ESOTROPIA

Esotropia is an inward deviation of the eye. This is common up until 3 months of age, but it’s abnormal after that. Esotropia can be unilateral or bilateral. If the right eye is staring at you and has a centered red light reflex while the left eye is deviated more inward, the left eye has the esotropia and is likely to have a light reflex that seems laterally displaced in comparison to the center of the pupil. The left eye is at risk for developing amblyopia. Treat by applying a patch to the “strong” right eye.

IMAGE: www.pbrlinks.com/ESOTROPIA1
IMAGE: www.pbrlinks.com/ESOTROPIA2 (copyright free)

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