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Pediatric ophthalmologic consultations in a children's hospital setting.

The Journal of Pediatric Ophthalmology and Strabismus is appropriately named for a particular subspecialty in ophthalmology. Not so long ago, there were ophthalmologists who were trained solely as strabismologists. With the increased numbers of trained pediatric subspecialists and hospitals specializing in the care of children, the need for pediatric ophthalmologists grew. It was fitting that the strabismologists, who frequently treated and operated on children, would assume this role. Fellowships in pediatric ophthalmology and strabismus now provide comprehensive training in the care of children’s eye disorders and all patients with strabismus. Nevertheless, some training programs, particularly those at eye hospitals, may provide less exposure to hospital-based ophthalmology. In this issue, the article entitled “The Frequency of Ocular Abnormalities in Inpatient Pediatric Ophthalmology Consultations” describes what we need to know if we practice within a children’s hospital or see inpatient consultations. As would be expected, 42% of the consultations during a 1-year period were for retinopathy of prematurity evaluations. The authors looked at the 445 non-retinopathy of prematurity consultations and found that 56% were performed to rule out ocular disease. The remaining 44% were requested to evaluate ocular complaints and suspected ocular abnormalities. The authors noticed a low yield of finding pathology in the rule out ocular disease group, except in patients with hydrocephalus, where 31% were found to have disc edema or abducens nerve palsy. They point out that pediatric ophthalmologists must have a thorough knowledge of the ocular findings in systemic diseases, such as fungemia and leukemia, and other disorders, such as neurofibromatosis. Helpful suggestions regarding the triaging and timing of consultations as they relate to the specific complaint are given. It is emphasized that patients with ocular symptoms (eg, blurry vision, diplopia, and red eye) are likely to have an ophthalmic diagnosis and urgent consultation is recommended.