Paediatric Ophthalmologists are doctors who specialise in eye conditions that affect children. Children and young people (under 18 years) may be referred to this service by their opticians, GPs or by other paediatric specialist doctors. The Paediatric Ophthalmology Service at CUHFT also supports other ophthalmology services in the eastern region who may refer children to us for a second opinion or for specialised management and surgery.
Non-urgent advice: Telephone and Video Consultations
After reviewing your child’s notes before their clinic appointment, the clinical staff may consider that either a telephone or video consultation may be appropriate. You will be contacted before your child’s appointment if the appointment will be by telephone or video. This could save you the time and expense of coming to the hospital and enable your child to have an appointment more quickly.
Find out more about video appointments here
Wards
Information for patients
At the clinic your child may see different health professionals, depending on why they have been referred:
- a doctor specialising in ophthalmology
- an optometrist: a specialist in testing vision and prescribing glasses for older children - also known as an optician
- an orthoptist: a specialist in testing the vision and ocular movements of infants, children and young people of all ages
Reasons for referral include treatment for cysts, strabismus (squint), lazy eye, refractive error / amblyopia management, neuro-oncology, neuro-ophthalmology, metabolic conditions, genetics, congenital ocular problems like cataract and glaucoma – to name a few!
In clinic:
- your child might have their eye sight tested and to get glasses or contact lenses if necessary
- have their visual development monitored
- photographs may be taken of your child’s eyes, if required
- your child’s visual field (peripheral vision), colour vision, contrast sensitivity or intraocular pressures may also be tested
- your child may have eye drops
- if your child wears glasses it is really very important that you bring your child’s glasses along to their appointment.
If any of the things listed above need to happen during your visit to Clinic 3 you and your child will receive a full explanation before anything takes place.
If your child is ill and you are unable to attend their clinic appointment (or you are unable to attend for other reasons) please contact the clinic to rebook their appointment. Please do not bring your child to their appointment if they have chicken pox, or any other illness that may be contagious.
Despite our best efforts, delays do occur in clinic and although we do have some entertainment facilities it would be helpful if you could bring something with you to keep your child amused. For example: quiet toys, games consoles that can be switched onto quiet mode, books/magazines and colouring in. It is also a good idea to bring some snacks, drinks and nappies with.
Top tips for GPs
Possible squint
A squint is a misalignment of the eyes, one eye may turn in (esotropia), out (exotropia) or sometimes the squint can flip between each eye. It is normal for babies to have variable eye alignment until 12 weeks of age. Many infants have a broad nasal bridge which gives the optical illusion that one eye is turning in – assessing the symmetry of the corneal light reflections in each eye is helpful, especially in photos.
Things to do when considering referral:
- Ask about family history of childhood glasses or patching – this increases the risk of squint
- Ask about prematurity and general developmental milestones
- Always assess the red-reflex and note this in the referral letter (an opacity within the eye e.g. retinoblastoma or cataract can cause a constant squint)
- Check that the child can follow a toy with each eye and that eye movements are full (cranial nerve palsies and orbital pathology will limit eye movements – a red flag)
- If the child has a definite squint they should be referred, even if it is intermittent
- Children 5 years and older should see an optometrist whilst they are waiting their hospital appointment so that glasses can be prescribed without delay, if needed
Useful documents: pseudo strabismus info leaflet
Sticky eyes in infancy
Sticky eyes due to congenital naso-lacrimal duct obstruction is very common but the vast majority of babies outgrow the problem. It may affect one or both eyes. Check with parents that the child is not unduly light sensitive.
- Check that the eyes are WHITE – if so, no microbiological swab is needed
- Using your little finger-tip, press and roll the finger firmly just below the medial corner of the eye
- This will express mucus and tears into the eye, clean this away with a damp cotton pad
- Parents should repeat this every time the baby feeds
- Only refer if the problem persists to a year of age
Useful document for parents: sticky eyes in infancy info leaflet
Lid cysts
Meibomian cysts occur within the tarsal plates of the eyelids and most lid cysts will resolve with conservative treatment.
- Advise hot compresses every evening using a seed or gel bag heated in the microwave
- Chloramphenicol ointment applied to the lid margins with a finger-tip if the cyst is inflamed
- If severe multifocal cysts and red-rimed, crusty eyelids consider an oral course of erythromycin or azithromycin
- If the eye is red, the child is photophobic and in discomfort, refer
Useful document: blepharitis in children
Assessing the red-reflex
How to do it:
The red reflex is the normal reflection of light from the back of the eye which is seen as a red glow in the pupil on ophthalmoscopy, similar to the red-eye effect seen on flash photography.
- Dim the overhead lights and settle the baby
- Holds the eyepiece of the ophthalmoscope up to your eye, at arm’s length from the baby’s face
- Direct the circle of light from the ophthalmoscope towards the baby’s eye whilst gently parting the baby’s eyelids, if necessary
- View the red-reflex through the ophthalmoscope eyepiece noting the colour, brightness and presence of any shadows on the red reflex in each eye
- The reflex can be less bright and appear “magnolia” in colour in black, Asian or minority ethnic babies. If the assessment is difficult, it can be helpful to assess the parents’ red reflexes to determine the expected reflex colour
- The red-reflex is abnormal if it is completely or partially obscured, is abnormal in shape (iris coloboma or aniridia), white (leukocoria) or asymmetrical in colour or brightness to the other eye
Shadow on the red-reflex - cataract
A cataract is an opacity within the lens of the eye. Congenital cataract affects 3;10,000 babies. The opacity is usually central since that part of the lens is the first to develop, with layers of lens cells being laid down afterwards, like the layers of an onion. The opacity may appear as a tiny speck on the red reflex, a shadow or may obscure the red-reflex completely. Severe cataracts may make the pupil appear white with the naked eye.
Referrals should be made urgently, aiming for specialist review within 2 weeks.
Whitish reflex -Leukocoria
Leukocoria is a white or pale yellow (rather than a red) reflex. Defects in the retina and choroid (the vascular layer underneath the retina) make the white of the sclera visible at the back of the eye, creating the bright white reflex. Causes include chorio-retinal coloboma and retinoblastoma. A severe cataract can also look white when viewed with the naked eye.
Patient information leaflets
Patient gallery
Useful links
Peppa Pig - The Eye Test (16 episode / 2 season)
The paediatric ophthalmology service is supported by Cam Sight and the Cambridge Eye Trust.