Vision Screening Online Training Program

Module 3: External Inspection
(C&TC: Often performed by the health care provider)

External inspection means looking at the eyes with your own eyes. Look to see that the whites of the eyes are white and not reddened or have exudate. Look at the iris (the colored portion of the eye) to make sure that the eyes are the same color and that there are not any brown spots or unusual markings. Also look at the sclera (the white portion of the visible eye) and note if there is any discoloration (i.e., yellowing or redness of the sclera, etc.) or unusual spots or markings.

Look at the pupils to make sure that they are round and the same size. They should also be black and not cloudy or white. If they are white (leukocoria) then an immediate referral to an ophthalmologist is required. Also, look at the lids and lashes for any abnormalities.

Ages: Birth through 20 years (C&TC) or birth through all grades (Early Childhood and school screenings).
Purpose: To check for signs of external eye disease or abnormalities.
Description: A systematic inspection of observable parts of the eye and surrounding tissue.
Equipment: None.
Facilities: Well-lit area.

If the child is wearing glasses, remove them or have the child remove them in order to have an unobstructed view of the area around the eyes. Check the area around the eyes for swelling and/or discoloration or excessive tearing.

Check the eyes themselves in the order suggested by the acronym "WIPL" (Whites, Irises, Pupils, Lids and Lashes).

See the illustration below to view what a normal eye should look like. Click on the links below to see what kind of abnormalities (e.g., Whites, Iris, Pupil, and Lids/Lashes) would require referral.

Image of a normal eye that shows the names and locations of the parts of the eye.

W - Whites: The sclera should be white. There should be no discoloration or growths.

I - Iris: The iris should be a complete circle. Both should be the same color.

P - Pupil: The pupils should be clear and dark. There should be no cloudiness or white discoloration. The pupils should be of equal size and circular shape.

L - Lids and Lashes: The lids in their natural, open position should give a full view of the pupil. The margin of the lid should be flush against the surface of the eye. The child should show normal blinking during observation period. Lashes should be present on the top and bottom lids of both eyes. Lashes should not turn in causing them to contact the conjunctiva.

Pass:  Normal appearance of all parts of the eye.
Any abnormality noted.



If a child appears to have conjunctivitis, the screener should refer the child?
After the rest of the vision screening has been completed
Not at all. It is not needed to refer a child for conjunctivitis.

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