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

  • • 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


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