Evaluación de los ojos en niños

American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Pediatric eye evaluations: I. Screening; II. Comprehensive ophthalmic evaluation. San Francisco (CA): American Academy of Ophthalmology; 2007. 32 p.

Describe los metidos clínicos de cribado de la visión y los problemas oculares, los aspectos más relevantes de la anamnesis para detectar problemas oftalmológicos en atención primaria y los factores de riesgo detectados que son criterio de derivación al especialista:

INDICATIONS FOR REFERRAL FOR A COMPREHENSIVE PEDIATRIC OPHTHALMIC EVALUATION
Risk factors (general health problems, systemic disease, or use of medications that are known to be associated with eye disease and visual abnormalities):
• Prematurity (birthweight less than 1500 grams or gestational age 30 weeks or less)
• Retinopathy of prematurity
• Intrauterine growth retardation
• Perinatal complications (evaluation at birth and at 6 months)
• Neurological disorders or neurodevelopmental delay (upon diagnosis)
• Juvenile idiopathic arthritis (upon diagnosis)
• Thyroid disease
• Cleft palate or other craniofacial abnormalities
• Diabetes mellitus (5 years after onset)
• Systemic syndromes with known ocular manifestations (at 6 months or upon diagnosis)
• Chronic systemic corticosteroid therapy or other medications known to cause eye disease
• Suspected child abuse
A family history of conditions that cause or are associated with eye or vision problems:
• Retinoblastoma
• Childhood cataract
• Childhood glaucoma
• Retinal dystrophy/degeneration
• Strabismus
• Amblyopia
• Eyeglasses in early childhood
• Sickle cell anemia
• Systemic syndromes with known ocular manifestations
• Any history of childhood blindness not due to trauma in a parent or sibling
Signs or symptoms of eye problems by history or observations by family members* :
• Defective ocular fixation or visual interactions
• Abnormal light reflex (including both the corneal light reflections and the red fundus reflection)
• Abnormal or irregular pupils
• Large and/or cloudy eyes
• Drooping eyelid
• Lumps or swelling around the eyes
• Ocular alignment or movement abnormality
• Nystagmus (shaking of eyes)
• Persistent tearing, ocular discharge
• Persistent or recurrent redness
• Persistent light sensitivity
• Squinting/eye closure
• Persistent head tilt
• Learning disabilities or dyslexia
NOTE: These recommendations are based on panel consensus.
* Headache is not included since it is rarely caused by eye problems in children. This complaint should first be evaluated by the primary care physician.

Ambliopia

American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Amblyopia. San Francisco (CA): American Academy of Ophthalmology; 2007. 28 p

Documento editado por la Academia Americana de Oftalmologia, accesible a texto completo, donde explica los criterios diagnósticos mediante anamnesis y examen clinico para el diagnóstico temprano de ambliopia en atención primaria describiendo el modo de realización de cada una de las pruebas . Igualmente describe los métodos de tratamiento propuestos por oftalmología:

DIAGNOSIS
The initial amblyopia evaluation (history and physical examination) includes all components of the comprehensive pediatric ophthalmic evaluation,1 with special attention to the potential risk factors for amblyopia, such as a positive family history for strabismus, amblyopia, or media opacity.
History
Although a thorough history generally includes the following items, the exact composition varies with the patient's particular problems and needs:

• Demographic data, including identification of parent/caregiver, and patient's gender and date of birth[A:III]
• Documentation of identity and relationship of historian[B:III]
• The identity of other pertinent health care providers[A:III]
• The chief complaint and reason for the eye evaluation[A:III]
• Current eye problems[A:III]
• Ocular history, including prior eye problems, diseases, diagnoses, and treatments[A:III]
• Systemic history; birth weight; prenatal and perinatal history that may be pertinent (e.g., alcohol, tobacco, and drug use during pregnancy); past hospitalizations and operations; general health and development[A:III]
• Current medications and allergies[A:III]
• Review of systems[B:III]

Examination
The eye examination consists of an assessment of the physiological function and the anatomic status of the eye and visual system. Documentation of the child’s level of cooperation with the
examination can be useful in interpreting the results and in making comparisons among the examinations over time. In general, the examination may include the following elements:

• Assessment of visual acuity and fixation pattern[A:III]
• Ocular alignment and motility[A:III]
• Red reflex or binocular red reflex (Brückner) test[A:III]
• Pupil examination[A:III]
• External examination[A:III]
• Anterior segment examination[A:III]
• Cycloplegic retinoscopy/refraction[A:III]
• Funduscopic examination[A:III]
• Binocularity/stereoacuity testing[A:III]