Diagnostic pitfalls

• Delays in diagnosis have occurred with:

• • Failure to assess vision in a young/uncooperative child.

• • Failure in communication between community optometry (high street opticians), primary and secondary care.

Examination/assessment

• A full visual assessment including pupil responses, visual fields in school age children, visual acuity, eye movements and optic disc appearance

• Ask specifically about associated symptoms and risk factors:

• • Personal or family history of a brain tumour

• • Leukaemia

• • Sarcoma and early onset breast or bowel cancer prior therapeutic CNS irritation

• • Neurofibromatosis types 1 and 2

• • Tuberous Sclerosis

• • Li Fraumeni Syndrome

• • Family history of colorectal polyposis

• If unable to undertake a visual assessment refer to community optometry (high street optician) or hospital eye service - depending on child's age and ability to co-operate with examination.

• Neurological examination (include assessment of vision (including acuity), gait and coordination

• Plot growth in all children and pubertal status if applicable

• Plot head circumference in children under two