Author: Joshua Alexander, MD
SUMMARY
During a visit with their new doctor, the mother of a 20-month old boy mentions that he holds all his toys ?very close to his face? to see them and that his eyes ?move back and forth a lot?.
The boy was born at 23 weeks gestation (4 and ? months early) and had a history of severe retinopathy of prematurity (an abnormal growth of blood vessels in the eye that can cause a loss of vision) requiring surgery in both eyes.
He also had a history of intraventricular hemorrhage (bleeding in the brain) and hydrocephalus (increased fluid in the brain) that required surgery to insert a shunt tube to drain excess fluid away.
After being in foster care for the past year, he is now living at home with his family. He has a 3-year old sister and a 1-year old brother who have also been brought along to this visit.
When examining the child, the following things are noticed:
? He tends to close his eyes when bright lights are turned on.
? He holds his head up well and looks at and follows brightly colored toys, better on the right side than the left.
? He doesn?t like having a hand covering either eye and tries to push it away.
? He prefers to look at things to his right.
? The nerve and blood vessels in both eyes look normal, but his eyes don?t move together and seem to stay crossed throughout the examination.
? When he moves his eyes to follow a toy, they move in a jerky fashion (called nystagmus).
The doctor begins to discuss the results of his examination with the boy?s mother. While he is talking about his concerns that the boy has a visual impairment and should receive further evaluation by a pediatric ophthalmologist (eye doctor), he notices that the 3-year old sister, who just jumped up onto her mother?s lap has eyes that are crossed and remain so throughout the rest of the visit. The doctor asks the mother a few questions about her daughter?s vision and, when the time comes to finish the visit, and make appropriate referrals, both the boy and his sister get appointments to be seen by the eye doctor.
A note from the eye doctor a month later states that the boy will be getting eye glasses to help correct his vision and the girl is being evaluated for eye surgery.
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