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Oxford University Hospitals NHS Foundation Trust
Craniofacial

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Orthoptics

Orthoptists investigate, diagnose and manage disorders of binocular vision, ocular motility and problems relating to reduced vision.

Our role in the Craniofacial clinic

Our Orthoptic Team provides a specialist service for all children under the care of Oxford Craniofacial Unit.

An Orthoptist will be present at your child's multidisciplinary clinic appointment, where you will have the opportunity to ask questions about your child's eyesight.

If your child is already under the care of a local eye service, it is useful for us to be up-to-date with their current orthoptic and ophthalmological status.

We offer children routine orthoptic assessments at key stages in their care:

  • pre-operatively
  • at age 4 or 5 years.

We also offer orthoptic, optometric and ophthalmological assessments at any time when a clinical need arises during the course of a patient's care.

What a child's eye test involves

A child's eye test may involve one or more of the following:

  • Orthoptist
  • Optometrist
  • Ophthalmologist

Orthoptist

When your child attends their craniofacial appointment, they may see our Orthoptists, who work as part of our multidisciplinary team.

Craniosynostosis may be associated with raised pressure inside the skull. Orthoptists use a camera to scan the inside of your child's eyes: if there is increased pressure, this can press on the back of the eye and make the optic nerve look swollen.

A scan can also show our Orthoptists what your child's optic nerve looks like normally. On subsequent visits, scans can be compared to look for subtle changes.

The camera is attached to a large machine and the scan is taken by holding the camera very close to your child's eyes one at a time. The camera comes very close but does not touch the eye. The Orthoptist may touch your child's head to help keep them steady.

The scan only takes a few seconds, but your child has to look into the camera for us to get a good image, so it may take a couple of tries. If your child is struggling to stay still, and is due for a nap, it may be easier to let them fall asleep first, and then do the scan.

To confirm what is found on the scan, the consultant may ask us to put some eye drops in your child's eyes, to enlarge their pupils, and take you round to the Eye Hospital so an Ophthalmologist can also have a look.

We will explain the effects of the eye drops before we put them in.

If your child is of school age and has not had their sight tested, our Orthoptists may assess their vision and eye movements, and check for signs of a squint.

Some types of craniosynostosis are associated with squints and the need for glasses, so the Orthoptist may refer you to a service local to you to address any issues.

Optometrist

The Optometrist performs a glasses test (refraction). This can be done at any age. Glasses may or may not be prescribed depending on the result of the test.

Ophthalmologist

The Ophthalmologist checks the health of the eyes (fundus examination). They will look carefully at the optic nerve head.

The last two checks require the use of dilating eye drops. If your child needs a refraction or fundus examination, the Orthoptist will instil the drops into both eyes at the end of their testing. The drops take about 30 minutes to take effect so if your child needs to see the Optometrist and/or Ophthalmologist as well, the whole process may take a couple of hours.

At the end of each consultation the Orthoptist, Optometrist and Ophthalmologist will provide feedback. This may involve no further eye care, continuing with local care or a referral to eye services locally.