Acute Disturbance of Vision

Abstract

Vision loss in children may be of sudden onset or may be long standing but suddenly discovered. The neurologist must determine which children need urgent diagnostic neurologic or ophthalmic evaluation. Systematic assessment of visual acuity, eye movements, pupil response, visual fields, and optic nerve and fundus evaluation will enable the practitioner to refine the differential diagnosis and streamline evaluation and treatment. For parents, there are few conditions that are more anxiety provoking than the discovery that their child has poor vision in one or both eyes. Their concern is often in contrast to the child’s seeming indifference to the poor vision or wandering eye. There are also patients without any obvious visual loss where eye examinations may help diagnose neurologic damage, like retinal hemorrhages, suggestive, for example, for shaken baby syndrome. In this chapter, we will provide the clinician with a systematic approach to the child with apparent sudden onset of poor vision, strabismus, or abnormal pupil.