Required Materials
- Penlight [Figure 38].
- Finger puppets.
Figure 38
Procedure
Under the age of 6 months (but often between 6 to 9 months), infants have insufficient neck control to reliably carry out the examination of the position of the eyes. There is also a certain degree of cooperation required from the child and their attention span is often short. If the infant is capable of complying, the examination can be conducted as described for children of 9 months and older. Even at that age, the examination is often difficult to carry out, because children are easily distracted.
Examination From The Age Of 9 Months
Hirschberg’s Test:
From the age of 9 months, the child will have enough neck control to reliably carry out the examination of the position of the eyes, and the movements of the eyes.
- Allow the child to sit in front of you on the examination table at arm length’s distance, with their back leaning against the chest of the guardian.
- Hold the fixation light at a distance of 40 cm, at eye level and in between both eyes, so that the fixated eyes are in the neutral position
[Figure 39].
Figure 39
- Assess the location of the light reflex in the pupil. This should be symmetrical and just beside the middle of the pupil.
- Briefly cover one eye and check if the other eye makes a fixation movement.
- Then, briefly cover the other eye and check if the first eye makes a fixation movement.
- Cover the first eye for a slightly longer period to dissociate the vision and allow binocular vision to return after 10-15 seconds by taking away your covering hand.
- Check what the uncovered eye does when it is no longer covered.
- Repeat this procedure with the other eye.