We report on a survey of the referral of 525 children making their first visit to an ophthalmology department. Information was gathered by interviewing the parents and reviewing the case notes. Parents and relatives initiated the referrals in 223 cases (42%) and health visitors initiated a further 123 cases (23%). General practitioners were rarely the first to notice a condition, though they played a major part in the subsequent referral process. Of 556 reasons for referral squint was the most important (319 cases, 57%), followed by poor vision (106 cases, 19%). There were 44 confirmed cases of amblyopia, of which 15 (34%) were not detected until the child was aged 5 years or over. The overall accuracy of referral was 66% (367 reasons for referral confirmed). In 109 cases (21%) the child was found to be normal. Parents and relatives first noticed 54% of cases of confirmed squint but only 15% of the cases of poor vision. Health professionals, especially health visitors, were of great importance in first detecting poor vision.
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