The baby with poor visual contact

Normally, full term babies show evidence of visual fixation at birth or shortly afterwards.1 Visual following responses have even been observed in prematurely born babies.2 The absence of visual responsiveness in a baby of more than 8 weeks old has to be taken seriously and warrants careful investigation. Parents are anxious to understand the reason why the baby seems not to see, and want to know the visual prognosis. Visual inattentiveness in a baby can be due to very heterogeneous causes. Obvious causes of visual impairment are bilateral cataracts, persistent hyperplastic primary vitreous, retrolental fibroplasia, chorioretinal colobomata, etc. However, in many babies no underlying cause can be found on routine ophthalmological examination. There are also many pitfalls. For example, the infantile optic disc can be paler than that of an older child and the macula and fundus may be more mottled, which could lead to erroneous diagnoses of optic atrophy and retinal pathology. An incorrect diagnosis of visual impairment in an infant can be devastating to the family. Clinical signs can be typical, but additional technical examinations are necessary in most patients.