Neonatology Book

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Newborn Eye Exam

Aka: Newborn Eye Exam, Neonatal Eye Exam
  1. See Also
    1. Pediatric Eye Exam
    2. Neonatal Conjunctivitis
    3. Newborn Exam
  2. Exam: Normal or common eye findings
    1. Following delivery
      1. Subconjunctival Hemorrhages (common)
      2. Lid edema and lid eversion
    2. Dysconjugate gaze
      1. Normal as a newborn due to Decreased Visual Acuity at birth (20/400)
    3. Dacryostenosis (blocked tear ducts)
      1. Very common in newborns, presenting with sticky yellow, non-purulent secretions from the nasolacrimal duct
      2. Responds to medial canthus massage with a warm, moist cloth
    4. Neonatal Conjunctivitis
      1. Distinguish Conjunctivitis from Dacryostenosis
      2. Distinguish chemical Conjunctivitis from Gonococcal Conjunctivitis, Chlamydia Conjunctivitis and HSV Conjunctivitis
  3. Exam: Abnormal funduscopic findings
    1. Lens opacity (Congenital Cataract)
      1. Associated with TORCH Virus infection
    2. White reflex (Leukokoria) on Pupillary Light Reflex
      1. Suggests lens, vitreous or fundus abnormality
      2. Evaluate for Retinoblastoma
  4. Exam: Congenital defect related eye findings
    1. Coloboma
      1. Ocular tissue defect
      2. Associated with Treacher Collins Syndrome and CHARGE Syndrome
      3. May be associated with poor vision (especially if iris is absent)
    2. Inner Epicanthal Fold
      1. Medial eye covered by small folds of skin
      2. Normal variant in asian and native american patients
      3. Associated with many congenital syndromes (e.g. Down Syndrome, Noonan Syndrome, Rubinstein-Taybi syndrome)
    3. Structural eye findings associated with congenital disorders
      1. Orbital Orientation
        1. Downslanting Palpebral Fissure (eyes form a "^" shape, e.g. Marfan Syndrome)
        2. Upslanting Palpebral Fissure (eyes form a "V" shape, e.g. Down Syndrome)
      2. Orbital Size
        1. Short Palpebral Fissure (Narrow Palpebral Fissure, e.g. Fetal Alcohol Syndrome)
      3. Orbital Separation
        1. Hypertelorism (widely spaced eyes, e.g. Trisomy 18)
        2. Hypotelorism (narrowly spaced eyes, e.g. Fetal Alcohol Syndrome)
  5. References
    1. Lewis (2014) Am Fam Physician 90(5): 289-96 [PubMed]

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