A national study was conducted in children attending six schools for the blind in Malaysia to identify the anatomical site and underlying causes of blindness (BL) and severe visual impairment (SVI), with a view to determine the potentially preventable and treatable causes so that appropriate control measures can be implemented in the future. The standardized clinical examination of eyes was performed and the findings were recorded on the WHO Prevention of Blindness Programme eye examination record form for children with blindness and low vision. A total of 358 children aged between 7 and 17 years were examined, of whom 332 (92.7%) were blind or severely visually impaired. The results relate to these 332 children. Lens was the major anatomical site (22.3%) of visual loss followed by retina (20.8%), whole globe (17.2%), cornea (15.1%), optic nerve (8.7%) and uvea (5.1%). Glaucoma was responsible for BL/SVI in 7.2% and others in 3.6% of cases. Hereditary diseases were responsible for visual loss in 29.5%, intrauterine factors in 4.5%, perinatal factors in 9% and childhood factors in 7.8% of cases. However, the aetiology was unknown in 49.1% of cases which included congenital anomalies of the globe. Childhood cataract and corneal scarring are major treatable causes of BL/SVI that can benefit from future intervention strategies. Perinatal screening for intrauterine factors and hereditary eye diseases, and appropriate interventional therapy will help in reducing the prevalence of childhood blindness.

Background: Acute lymphoblastic leukaemia (ALL) is the commonest childhood malignancy and ocular manifestations are uncommon in ALL. Patients may present with non-specific systemic symptoms which are overlooked and life threatening symptoms of leukostasis often present late. Here, we present a rare case of ALL where ocular symptoms preceded constitutional symptoms. Materials and Methods: A case report. Result: A 11-year-old girl presented with a syncopal attack during the fasting month to a primary health center. She was investigated at a tertiary center and diagnosed to have ALL. Further history revealed she had sudden painless severe reduced vision in the right for one month prior to this. Ocular assessment noted her right visual acuity was 5/60 and left visual acuity was 6/6. Her right fundus had a large subhyaloid haemorrhage over the macula and multiple large white-centered haemorrhages (Roth's spot); while the left fundus showed multiple large Roth's spots and some intraretinal haemorrhages. Chemotherapy was instituted after immunophenotyping was reported as precursor B-cell ALL. Ocular condition was managed conservatively. There was total resolution of the subhyaloid haemorrhage and retinal haemorrhages in both eyes and she regained full vision bilaterally while on induction therapy over 5 months. Conclusion: Life threatening conditions such as ALL should be considered in children with sudden, painless, reduced vision and urgent ophthalmology assessment is important for early detection. Blurry vision could be the earliest symptom in ALL. Awareness on eye health must be emphasized in school by the educators for early detection of both sight and life threatening condition among children.