headsmartjordan

Blurred or double

vision

Reassure

• New onset visual abnormality of less than two weeks duration

Action

Review visual symptoms at two weeks after visual abnormality onset, repeat history and examination

Review/refer

• New onset non-paralytic squint

Action

Refer for ophthalmological assessment

Scan

New onset:
• Papilloedema
• Optic atrophy
• Nystagmus
• Reduced visual acuity not attributable to an apparent cause in the eye itself
• Reduced visual fields not attributable to an apparent cause in the eye itself
• Proptosis
• New onset paralytic squint
• Consistent or persistent symptoms or signs of loss of visual function plus any other associated neurological or endocrinological symptoms or signs, including growth faltering

Action

Scan - visual symptom plus one or more other symptoms

Diagnostic pitfalls

• 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

Blurred or double

vision

Reassure

Action

Review/refer

Action

Scan

Action

Diagnostic pitfalls

• 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

Persistent/recurrent headache

Balance/co-ordination/walking problems

Persistent/recurrent vomiting

Abnormal eye movements

Blurred or double vision/loss of vision

Behaviour change

Fits or seizures

Abnormal head position such as wry neck, head tilt or stiff neck

Delayed puberty

Increasing head circumference

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