Who needs regular eye and Ear, Nose, and Throat (ENT) check-ups?

Who Needs Eye and ENT Check-ups

All healthy children should receive vision screening beginning in the newborn period and at every well-child visit, with comprehensive eye examinations reserved for those who fail screening, have symptoms, or possess risk factors for eye disease, while adults without risk factors need comprehensive eye evaluations starting at age 40, then every 2-4 years until age 55, and more frequently thereafter. 1

Pediatric Eye Screening and Examination

Universal Screening for All Children

• Every infant should undergo red reflex testing and external eye inspection before hospital discharge to detect structural abnormalities like cataracts, corneal opacity, and ptosis 2, 3
• Vision screening should continue at all well-child visits from birth onward, not just at a single "first" examination 2
• Instrument-based screening should be attempted between 12 months and 3 years of age, and may be offered at 12-month, 24-month, and 3-5 year visits 2
• Direct visual acuity testing begins at age 4 years using age-appropriate symbols, with routine screening at ages 4 and 5 years (and in cooperative 3-year-olds) 2

When Comprehensive Eye Examination is Required

Children need referral to a pediatric ophthalmologist when they:

• Fail vision screening at any age 1, 2
• Have persistent eye misalignment after 6 months of age, as this indicates strabismus that can cause amblyopia 2
• Present with any ocular structural abnormality 2, 3
• Have underlying medical or genetic conditions (Down syndrome, prematurity, juvenile idiopathic arthritis, neurofibromatosis) 1
• Have family history of amblyopia, strabismus, retinoblastoma, congenital cataracts, or congenital glaucoma 1
• Show poor eye contact after 8 weeks of age 2
• Have learning disabilities or developmental delays that make them untestable by other caregivers 1

Adult Eye Examinations

Healthy Adults Without Risk Factors

Adults with no eye disease risk factors should have their first comprehensive eye evaluation at age 40, then follow this schedule: 1

• Ages 40-54 years: Every 2-4 years
• Ages 55-64 years: Every 1-3 years
• Age 65 and older: Every 1-2 years

High-Risk Adults Requiring More Frequent Examinations

Certain populations need closer monitoring:

• Individuals of African descent require more frequent examinations due to higher risk for earlier onset and more rapid progression of glaucoma 1
• All patients with diabetes type 2 need a comprehensive dilated eye examination shortly after diagnosis, as up to 30% have retinopathy at diagnosis and 3% already have sight-threatening disease 1, 4
• Patients with diabetes type 1 should have their first examination within 3-5 years after onset (generally not before age 10), then annually thereafter 1
• Pregnant women with pre-existing diabetes need comprehensive eye examination in the first trimester and close follow-up throughout pregnancy due to risk of retinopathy progression 1, 4

ENT Examinations

Neonates with Specific Conditions

• Newborns with collodion baby or harlequin ichthyosis require ENT evaluation as part of their multidisciplinary team, with regular removal of skin debris from the auditory canal 1
• Extremely premature infants (≤28 weeks gestation, ≤1000g birth weight) admitted to specialized centers receive combined eye and ENT care for retinopathy of prematurity screening 5

Genetic Tumor Predisposition Syndromes

Specific populations with genetic conditions need scheduled ENT surveillance:

• Children with DICER1-related tumor predisposition need ophthalmologic examination (visual acuity testing) annually from ages 3-10 years to screen for ciliary body medulloepithelioma (3% risk) 1
• These same children need ENT examination only if signs or symptoms develop, to evaluate for rare nasal chondromesenchymal hamartoma 1
• Patients with xeroderma pigmentosa require ophthalmologic and ENT examinations every 6-12 months starting at diagnosis due to severe sun sensitivity and associated malignancies 1

General Population

• The general population does not require routine scheduled ENT examinations unless symptoms develop 6
• ENT and ophthalmology specialties share anatomic boundaries and collaborate on conditions like orbital complications of sinusitis, lacrimal apparatus problems, and trauma 7

Critical Pitfalls to Avoid

Do not delay referral for comprehensive examination when red flags are present. The most common errors include:

• Assuming that passing a vision screening means no eye examination is ever needed—children with risk factors still require comprehensive evaluation 1
• Waiting for proliferative diabetic retinopathy to develop before referring to ophthalmology—patients with severe nonproliferative retinopathy need prompt referral, as early treatment reduces severe visual loss risk by 50% 1
• Dismissing eye misalignment in infants under 6 months as "normal"—while alignment establishes by 6 months, any persistent misalignment after this age is abnormal 2
• Forgetting that gestational diabetes does NOT increase retinopathy risk and these women do not need the same screening as those with pre-existing diabetes 1