Table 2 Questions which can direct the clinician prior to examining a child with abnormal eye movements
Question | Clinical relevance |
|---|---|
Pregnancy, maternal medication/drug use and birth history | Maternal drug exposure and prematurity are associated with an array of eye movement abnormalities |
Family history of eye/neurological disease/systemic disease | Many eye movement disorders have a hereditary component with different inheritance patterns indicating which genes may be involved. Neurological symptoms in relatives can also suggest an underlying aetiology (e.g., Spinocerebellar ataxias) [31] |
Specific questions about visual behaviours—e.g., nyctalopia or photophobia | Photophobia and nystagmus are common findings in disorders of cone function and albinism. High frequency nystagmus with photophobia is more common in cone dysfunction. Nyctalopia is a common symptom in rod dysfunction |
Does the child blink excessively or head thrust towards direction of intended gaze? | Can be seen in Saccadic initiation failure (SIF) |
Open questioning about other visual behaviours | Parents will often report a very detailed description of visual behaviours, which can direct clinical examination such as a child with chin depression and vertically ‘wobbly eyes’ (commonly seen in down beat nystagmus), or pushing/rubbing eyes firmly for retinal stimulation in blind babies/children |
Does the child experience oscillopsia? | Lack of oscillopsia in the presence of involuntary eye movements such as nystagmus, suggests early-onset; constant oscillopsia suggests an acquired disorder |
If oscillopsia is reported, is it when stationary or when moving? | Oscillopsia which is only present during head movement implies a vestibular pathology [32] |
Are there associated speech or swallowing problems? | Possible brainstem pathology or Myasthenia Gravis |
Are there associated coordination problems? | Possible cerebellar pathology |
Is there associated hearing loss or tinnitus? | Possible peripheral vestibular pathology |
Is the patient on any medications? | Many medications can cause abnormalities of eye movement, most commonly anti-epileptic medication |
Are there any concerns about any other aspect of the child’s development or health besides their eyes? | Eye movement abnormalities form a part of many multisystem syndromes and can be the presenting feature |
