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Eyelids: (check all those that apply)

_____swelling of either eyelid

_____drooping of one or both lids


_____discharge (either watery or pus-like)

_____excess blinking

_____scaley or crusted appearance

White part of eyes: (check all those that apply)

_____yellowish appearance

_____bloodshot, reddish appearance

_____mucous discharge

_____excess tearing


_____obvious discomfort (e.g., itching)

Eyeballs: (check all those that apply)

_____appear to be excessively large

_____appear to be unusually small

_____appear to be "sunken" into the eye socket

Eyes: (check all those that apply)

_____appears to be a "cloudy" film over the front of the eye

_____pupil appears cloudy or whitish

_____abnormal constriction or dilation of the pupil(s)

_____Check here if the child's eyes appear normal (i.e., none of the above were observed); this is to assure that appearance was noted.

See also: "Signs of Eye Trouble in Children" in Preschool Children with Visual Impairments.


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From Infants and Toddlers with Visual Impairments by Virginia Bishop