Pediatric Plastic Surgery, PLLC - the Craniofacial Center
The Craniofacial Center
Medical City Dallas Children¡¯s Hospital
Craniomaxillofacial, Cleft, Plastic and Reconstructive Surgery
Jeffrey A. Fearon, M.D., F.A.C.S., F.A.A.P., Director
EYE EXAMINATIONS FOR PATIENTS WITH CRANIOSYNOSTOSIS
Please have your child¡¯s eye doctor check the following items during the eye
examination:
Patient Name:
Date of Exam:
Yes
No
Changes in visual acuity
[ ]
[ ]
Changes in appearance of optic nerve
[ ]
[ ]
Papilledema
[ ]
[ ]
Clinically significant strabismus
[ ]
[ ]
Corneal scarring
[ ]
[ ]
Any comments for Dr. Fearon:
Name of Specialist Performing Exam: __________________________________
Please forward completed form to our office at your earliest convenience.
7777 Forest Lane, Suite C700, Dallas, Texas 75230
Telephone: (972) 566-6464 FAX: (972) 566-6279
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