Blinding diseases can destroy useful vision unless rapidly diagnosed and treated. The initial routine examination of all infants should be carried out by the primary care physician, and should include direct ophthalmoscopy, and an orderly structural examination to include the eyebrows, lids, and lashes and lacrimal system, conjunctiva, sclera, cornea, iris (note pupils), anterior chamber, lens, vitreous, and fundus (especially optic nerve and macula). Look for symmetry of ocular structures and clarity of optical media (clear cornea, lens, vitreous). The red reflex should be bright and symmetrical. In all preterm infants <1250 g at birth, after an initial period of retinal development (from 4 to 6 weeks of life), an ophthalmologist trained to screen retinopathy of prematurity should initiate regular ophthalmologic examinations until inner retinal vascularization is complete, follow the progression and regression of retinopathy of prematurity (ROP), determine the need for surgical therapy for ROP, and follow the infant for the development of refractive errors, strabismus, amblyopia, etc. (all are increased in preterm infants). In any infant suspected of congenital intrauterine infections, genetic syndromes, family history of eye disease in parents or siblings, severe central nervous system abnormalities, maternal drug use or abuse, and obvious eye abnormalities or failure to obtain bilateral red reflexes, an ophthalmology consultation should be considered. The eyes are not completely developed anatomically or functionally at birth and are constantly changing during the neonatal period. It is important to recognize the normal findings during different stages of growth and understand what is abnormal.
tPhotos and text for Chapter 2 provided by Helen A. Mintz-Hittner, M.D., Clinical Professor, Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, and Clinical Professor, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
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