What are the key signs and symptoms of common paediatric eye conditions that should prompt referral to ophthalmology?

Key signs and symptoms of common paediatric eye conditions that should prompt referral to ophthalmology include:

• New-onset squint (strabismus): Immediate referral is required if it occurs with loss of the red fundal reflex in one or both eyes, as this may indicate serious pathology such as retinoblastoma. Urgent referral is also indicated if the squint is paralytic or associated with neurological symptoms like ataxia, vomiting, or headache. Non-paralytic squint without these features should still be referred to ophthalmology ¹.
• Absent or abnormal red fundal ('red') reflex: This is a critical sign that may indicate retinoblastoma or other serious intraocular pathology and warrants urgent ophthalmological assessment via a suspected cancer referral pathway ¹.
• Persistent or severe eye pain, redness, or photophobia: These symptoms may indicate conditions such as uveitis, corneal abrasion, or infection and require prompt ophthalmology evaluation (Aguilera and Chen, 2016).
• Visual disturbance or sudden vision loss: Any new or unexplained visual impairment in a child should prompt referral to ophthalmology to exclude serious causes (Wong and Anninger, 2014).
• Parental or carer concern about the child’s eye symptoms: Persistent parental anxiety or concern, even if symptoms appear benign, should be taken seriously and may justify referral for specialist assessment ¹.

In summary, urgent referral to ophthalmology is indicated for new-onset squint with abnormal red reflex or neurological signs, absent red reflex, significant eye pain or photophobia, sudden visual changes, and persistent parental concern. These criteria help identify children at risk of serious eye conditions including retinoblastoma and neurological causes requiring specialist input ¹; (Wong and Anninger, 2014); (Aguilera and Chen, 2016).