#1. Get a history from the mother. What is the eye problem? Was the child born pre-mature. ? Does the mother think the child can see? Has any other eye doctor seen the patient. What was their opinion? Ask the child some easy questions. Establish eye contact with the child.
#2. Let the child sit in the mother’s lap. Seat yourself at the child’s eye level. Don’t touch child initially but just look. Are the eyes white? Any strabismus ( squint ) ? Any nystagmus ( dancing eyes )? Nystagmus in a small child usually indicates poor vision bilaterally.
#3. Try to check pupils with flashlight. Children can have small pupils which can be difficult to check.
#4. Can often see a red reflex after dilation even if child will not allow fundus exam.
#5. If the mother claims there is a squint but you don’t see anything wrong, then the mother is probably correct.
#6. If in doubt you can always have the child come back in a few months.
#7. See if the child will follow a flashlight. Nice to have small toys, pictures to have child look at.
#7. Also if in doubt, you can always refer.
#8. A four year old child can usually be taught the E- game . Draw the E and teach the child with both eyes open initially.
#9 Check each eye separately using the CSM method. “ C “ refers to location of corneal light reflex. The “ S “ refers to steadiness of fixation. Will pt hold fixation with that eye. “ M “ is tested with both eyes open. Will child maintain fixation with that eye when both eyes open.