Ophthalmological examination after a first seizure in paediatric patients are of low diagnostic value

Objective: An ophthalmological examination can lead to diagnosis of metabolic disorders, increased intracranial pressure or retinal haemorrhages. Its value as an acute diagnostic procedure after a first seizure in childhood is seen controversially.

Methods: All children who were admitted at the children's university hospital of Leipzig after a first (epileptic) seizure between 1999 and June 2004 and who were presented to an expert ophthalmologist within 72 hours after the seizure were included in the study. The ophthalmological examination consisted (as far as age related possible) of determination of visus, subjective and objective refraction, binocular status, front parts of the eye and ophthalmoscopy in mydriasis.

Results: A total of 561 children (mean 5.4 years) were admitted after a first seizure, out of these 275 were examined by an ophthalmologist within 72 hours. Out of these 232 patients had a tonic-clonic seizure, 26 a focal and 17 a complex partial seizure. 214 (77.8%) of the ophthalmological examinations were normal. Refractory anomalies and strabism needing long-term therapy were found in 45 (16.4%) patients. 14 children (4.9%) presented with the following pathological findings: 8 partial optic atrophies, 4 eye muscle paresis, 1 partial visual field defect and 1 retinal haemorrhage. One eye muscle paresis was related to a cerebellar tumour, the ophthalmological findings in another child with a frontal tumour were normal. The retinal haemorrhage was associated with a fall during a first generalized seizure, did not lead to visual disturbances and was not detectable any more after three days.

Conclusion: The ophthalmological examinations did not reveal additional information about the seizure aetiology beyond cerebral imaging (here: diagnosis of two brain tumours). No other ophthalmological finding lead to immediate therapeutic consequences. The results of this study do not support the general need of ophthalmological examinations in routine diagnosis after a first seizure in childhood.