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 -  Eye Screening, Part 1 Lecture of 0  NEXT»

Warning Signs of Serious Eye Disease in the Newborn and Infant (Part 1)

Eye Health Screening in infancy and childhood begins at birth.  It is best accomplished by parents and care givers including primary care physicians and other health care providers aware of important signs of eye disease.  In an effort to better inform those involved with care of the newborn and infant about importance of newborn and infant eye health screening, The Foundation of the American Academy of Ophthalmology (www.eyenet.org) and the Knights Templar Eye Foundation have initiated the National Children's Eye Care Program (NCECP) in the United States.  As a part of this initiative, a brochure for parents and early care givers lists and illustrates 10 warning signs of treatable eye disease in the newborn and infant.

The first 3 warning signs indicate the need for immediate definitive diagnosis and appropriate treatment.

1 White Pupil

warning sign 1st eye-a

This could indicate a cataract, detached retina, retinal malformation, inflammation, or tumor.  If the tumor is retinoblastoma, the outcome is usually fatal unless early and appropriate treatment is completed.  Large tumors require enucleation; smaller and second eye tumors can be treated with radiation, chemotherapy, cryotherapy, and laser.

Cataract can be removed in infancy but creates different problems compared to adults.  Because:

1) Diagnosis must be early to avoid amblyopia, and nystagmus if cataracts are bilateral.

2) Surgical treatment should be early to reduce amblyopia; ideally at 2 months if unilateral and considered visually significant, 2 to 3 months if bilateral, but before onset of nystagmus.

3) Requires special surgical technique - different from adults.

4) Optical rehabilitation is difficult with contact lenses or glasses.  IOL's are being placed in the first year but this treatment is undergoing study and evaluation.

5) Any delay in treatment or lapse in optical or amblyopia treatment results in amblyopia.

6) Even in the best of circumstances vision after congenital cataract treatment is never normal.

There is a worldwide effort to improve treatment results in congenital cataract - but much work remains.  It is obvious that if these efforts are ever to bear fruit early diagnosis is the necessary start!

2 Drooping Lid

lumpy eye 

Lump or swelling of lids with or without redness, heat, or pain (signs of inflammation) - this can be a sign of cellulitis, tumor, hemangioma, etc. - occlusion of the pupil can cause amblyopia - immediate treatment is indicated.

droopy lid

Drooping of the lid (or lids) covering the pupil - if the only problem is ptosis with obstruction of the pupil amblyopia may result or the child may assume a chin-up head back posture which retards motor development. Surgical or nonsurgical elevation is indicated. 

 bulging eye

Bulging of the eye - proptosis with a normal size eye indicates an orbital mass. This requires immediate diagnosis and appropriate treatment. 

  two facing heads

3 Enlarged Cornea of One or Both Eyes


When a sign of congenital glaucoma, this is associated with tearing and photophobia. Congenital glaucoma requires early and specialized surgical treatment including goniotomy, trabeculotomy, and filtering the condition is not amenable to primary medical treatment.

 The cause - abnormal filtration mechanism

abnorm. filtration mech.

Optic atrophy and blindness is the end result of congenital glaucoma if untreated

  optic atrophy
These first three of the ten warning signs of significant eye disease in infancy and childhood have the most serious implications and most require early definitive treatment.  Fortunately, they are rare!

Cataract - 1 in 250

Glaucoma - 1 in 10,000

Retinoblastoma - 1 in 20,000

However, the incidence of these can increase dramatically on a genetic (recessive equivalent) basis with marriage among cousins or close blood relatives which occurs in many parts of the world.

The other seven warning signs will be covered in the next "Strabismus Minute".

Should be evaluated soon

#4 Tearing, Discharge, Redness

#5 Strabismus

#6 Nystagmus

#7 Prematurity - Low Birth Weight - requires monitoring of the retina for development

Should be evaluated at next routine visit

#8 Abnormal Head Posture

#9 Pupil Defect

#10 Anisocoria


The Strabismus Minute, Vol.2, No. 1 Copyright (C) 2000 Eugene M. Helveston All Rights Reserved

Editor-in-Chief: Eugene M. Helveston, M.D.

Associate Editor: Faruk H. Orge, M.D.

Editorial Board: Bradley C. Black, M.D.

     Edward R. O'Malley, M.D.

     David A. Plager, M.D.

     Derek T. Sprunger, M.D.

     Daniel E. Neely, M.D.

     Naval Sondhi, M.D.

Senior Editorial Consultant: Gunter K. von Noorden, M.D.

Graphics: Michelle L. Harmon

Technical Support: George J. Sheplock, M.D.

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