GENERAL CONSIDERATIONS

Anatomical development of eye is near complete at birth, with its size being ~65% of adult size. However, some development immaturities are common even in term newborns and young infants (Table 26.1) and should be considered during interpretation of ophthalmic findings in this age-group.

While periodic ophthalmic screening is indicated in all children for early diagnosis of: (a) developmental or acquired ocular abnormalities, (b) visual/refractory errors, and (c) disorders of ocular motility, e.g. strabismus; all of whom may hamper development of binocular vision with potential risk of amblyopia in

TABLE 26.1: Developmental ophthalmic immaturities at birth

Anatomical

• Thin, translucent, bluish sclera

• Relatively large cornea

• Shallow anterior chamber

• Lightly pigmented iris

• More spherical lens, with Mitternorf dots*

• Pale retina with peppery/mottled pigmentation

• Relatively pale optic disc

• Immature macula (weak foveal light reflex)

Physiological

• Physiological photophobia

• Low visual acuity (~ 6/120 at birth)

• Physiological hypermetropia till 6-7 years

• Physiological strabismus till 3-6 months

• remnants of fetal hyaloid system

TABLE 26.2: Specific indications for ophthalmic assessment

High-risk cases

• Prematurity

• Perinatal complications/ prolonged NICU stay

• Systemic diseases: Diabetes, hypertension, JIA

• Prolonged steroid therapy

• Family history of ophthalmic disease

Clinical indicators

• Delayed visual milestones

• Craniofacial dysmorphism

• Chromosomal/genetic disorders

• Ocular abnormalities: Cataract, glaucoma, retinopathies

• Abnormal eye movements: Nystagmus, strabismus

Poor school performance

developing eye. However, Table 26.2 enumerates high- risk cases, who need comprehensive and more frequent ophthalmic assessment by experts.

26.2