Vision Screening Online Training Program

Module 4 (continued): Cross Cover
(C&TC: Often performed by the health care provider)

The Cross Cover test is used to check for the tendency of the eyes to misalign when fusion is interrupted. This misalignment is often reflective of strabismus. The cross cover test, when properly done, is one of the most effective tools in screening for a potential case of strabismus.

Ages: 4 months through 8 years (C&TC) or 3rd grade (Early Childhood and school screenings).
Description: This test is used for observing deviating movement in the eye(s) as the occluder passes between eyes.
Equipment: A small, interesting, target object and occluder are required for this test.
Procedure:

For this procedure, have the child focus on a target object held steady 14-16 inches in front of their eyes. Then, cover the right eye with the occluder and hold it there for a count of three (3). Be careful not to touch the child with the occluder however. Pass the occluder quickly over the bridge of the nose to cover the left eye. Watch the right eye as it becomes uncovered for any movement. Hold the occluder over the left eye for a count of three (3). Pass the occluder quickly back over the bridge of the nose to cover the right eye again. Watch the left eye as it becomes uncovered for any movement. This procedure should be repeated two or three more times.

Photo of a screener covering the child's left eye with an occluder.

Photo of a screener covering the child's right eye with an occluder.

Video 1: Example of Procedure (RealMedia: 579KB)

Video 2: Example of Procedure (RealMedia: 355KB)

Pass: No observable movement of the eye being uncovered.
Re-screen/Refer:

Any movement of the eye when being uncovered by the occluder should lead to a referral or re-screening. Movement of the uncovered eye can be where the eye moves out, up, or down. Another potential aspect to look for when performing this test is repeatable movement or resistance by the child to having one eye covered but not the other. This is potentially indicative of children with strabismus who may become irritable when the occluder covers their good eye and their vision is therefore impeded.

Video 3: Example of Procedure with an Uncooperative Child (RealMedia: 768KB)

   

Question

Having strabismus can lead to or be indicative of:
Problems with visual acuity
Double vision
Amblyopia
Convergence insufficiency
All of the above


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