Approach to the pediatric patient with vision change
- Karen Dull, MD
Karen Dull, MD
- Instructor in Pediatrics
- Harvard Medical School
- Section Editor
- Stephen J Teach, MD, MPH
Stephen J Teach, MD, MPH
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics and Emergency Medicine
- George Washington University School of Medicine and Health Sciences
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
A change in vision may result from numerous diseases and injuries. A systematic approach is necessary to reach a correct diagnosis and to identify serious underlying etiologies. The patient’s age, underlying disease conditions, visual history, and history of possible injury must be determined. The extent of the visual impairment, the rapidity of its onset, and the association with other systemic findings are vital pieces of information.
This topic will review the causes of vision change (eg, diplopia, blurry vision). The approach to a child with vision loss is discussed separately. (See "Approach to acute vision loss in children".)
CAUSES OF DIPLOPIA
When a child complains of diplopia, a prompt evaluation should be initiated. Younger children may not be able to complain of diplopia. Instead, they may squint, cover one eye with their hand, or tilt their head to one side. Diplopia may be binocular or monocular (see "Overview of diplopia", section on 'Diplopia'):
●Binocular diplopia is present with both eyes open and absent when either eye is closed. Binocular diplopia reflects conditions in which the visual axes are misaligned. In general, most patients will close the eye with the dysfunctional muscle unless that is the eye with the much better vision. Binocular diplopia will be discussed here.
●Monocular diplopia is present if the diplopia occurs when either eye is closed. This condition is very rare in children and is typically caused by local eye disease or refractive error.
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- CAUSES OF DIPLOPIA
- Third cranial nerve palsy
- Fourth cranial nerve palsy
- Sixth cranial nerve palsy
- Toxic ingestion
- Cavernous sinus thrombosis
- Orbital fractures
- Orbital cellulitis
- Graves' ophthalmopathy (orbitopathy)
- Myasthenia gravis
- Tick paralysis
- Miller Fisher syndrome
- Conversion disorder
- CAUSES OF BLURRY VISION
- Corneal abrasion
- Traumatic hyphema
- Branched retinal artery occlusion
- Branch retinal vein occlusion
- Conversion disorder
- Physical examination
- Diagnostic studies