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influences such as alcohol abuse and smoking can result in a decrease in the incidence of
amblyopia.

V. OPTIMAL DIAGNOSTIC CRITERIA, INVESTIGATIONS, TREATMENT

& REFERRAL CRITERIA

*Situation 1: At Secondary Hospital/ Non-Metro situation: Optimal
Standards of Treatment in Situations where technology and resources
are limited

a) Clinical Diagnosis:

The initial strabismus and amblyopia evaluation (history and physical examination) includes
all components of the comprehensive pediatric ophthalmic evaluation, with special

attention to the potential risk factors for amblyopia, such as a positive family history for
strabismus, amblyopia, or media opacity.
The examination of a patient who has childhood-onset strabismus includes all components
of the comprehensive pediatric or adult ophthalmic evaluation in addition to the sensory,

motor, refractive, and accommodative functions.
History
Although a thorough history generally includes the following items, the exact composition
varies with the patient's particular problems and needs:

 The chief complaint and reason for the eye evaluation
 Current eye problems
 Ocular history, including prior eye problems, diseases, diagnoses, and treatments
Systemic history: birth weight, prenatal (e.g., alcohol, tobacco, and drug use during
pregnancy), and perinatal history (e.g. birth asphyxia, trauma) that may be pertinent,

past hospitalizations and operations, general health and development.
 Pertinent review of systems, including history of head trauma and relevant systemic
diseases

 Current medications and allergies

 Family history of eye conditions and relevant systemic diseases
 Review of systems

Examination

The eye examination consists of an assessment of the physiological function and the
anatomic status of the eye and visual system. Documentation of the child’s level of
cooperation with the examination can be useful in interpreting the results and in making
comparisons among the examinations over time. In general, the examination may include
the following elements:

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