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Table 2

Screening Eye and Vision Examinations

HistoryFamily history of strabismus or other ocular problems like amblyopia. Have the parents seen any misalignments? Does the child focus on an object (after 3 months of age)?
InspectionSimple observation is useful and should lead the clinician to potential problems. Check the lids and the eyeballs. Check for asymmetry. Can the child (older than 3 months) focus on an object? Check for symmetrical eye movements.

Corneal light reflex/Hirschberg light reflexThis is performed by shining a light (using a penlight) in the child’s eyes and observing where it reflects off the corneas in both eyes. In a child with normal ocular alignment the light reflex lies slightly medial from the center of the cornea. Look for asymmetrical findings comparing the 2 eyes. A possible squint can be detected/suspected. Can be performed from the age of 4 months.

Red reflexView each red reflex, in a darkened room, individually 30-45 cm from patient’s eyes, and then perform both reflexes simultaneously at a distance of 0.6-0.9 m. A symmetric orange-red light should reflect from each fundus. Any abnormal finding, like an asymmetry of color or occurrence of dark and white spots or lack of red reflex, is a reason for referral to an ophthalmologist.