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Although eyes occupy a prominent position in the human face, the information they can provide about presence of communication disorders often goes unnoticed during an oral-facial examination. Many speech-language pathologists (SLPs) associate eye examination with vision testing, and rightly believe that vision assessment does not fall within the responsibilities of a speech-language pathologist. Visual acuity, however, is only one aspect of eye examination. Eye orientation, color, and appearance can provide useful diagnostic information as to presence and type of communication disorders, particularly those disorders having hearing loss as a component. Observation of external eye appearance can yield information about health conditions such as otosclerosis; neurological disorders like Wilson’s disease; first arch and mid-face anomalies including Treacher Collins and Crouzon; hearing loss due to genetic conditions like Waardenburg syndrome; and dual sensory disorders, such as CHARGE syndrome. This article describes several diagnostically significant anomalies of eye structure, but does not address anomalies of eye function, disorders of visual acuity, or eye muscle-related problems. This article also describes the relationships between external eye appearance and communication disorders, and suggests a simple protocol for observing, treating, and referring patients with eye anomalies.
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