Pediatric ophthalmology is a highly specialized branch which focuses on the eye problems in children, belonging to the age groups from “newborns” to “teenagers” as well as for adults with squint.
Common Eye Problems In Children
- Pediatric Cataract
- Pediatric Glaucoma
- Childhood Refractive Errors
- Amblyopia (Lazy Eye)
- Allergic Conjunctivitis
- Retinopathy of Prematurity (ROP)
- Congenital Dacryostenosis
Childhood Refractive Errors
- Vision is important in development because it allows children to interact with their environment.
- Vision in pre – school children is uniquely important because their visual system is still developing and they are at risk of developing “Lazy Eye” (Amblyopia) from some forms of uncorrected refractive errors. Its consequences have a profound effect on the overall development of the children, most importantly on educational and psychosocial development.
- Children often do not complain of defective vision and may not even be aware of their problem. They may adjust to poor vision by strategies such as changing position in the classroom, moving objects closer and tending to avoid tasks that require more visual concentration.
- Common Refractive Errors
- Myopia (Near – Sightedness) : In myopia, the rays of light are focused at a point in front of the retina; either because the eyeball is longer than normal or the cornea is too steep. Near vision is clear but distant vision is blurred.
- Hyperopia (Far – Sightedness) : In hyperopia, the rays of light are focused at a point behind the retina; either because the eyeball is shorter than normal or the cornea is flat. Distant vision is clear but near vision is blurred.
- Astigmatism : In astigmatism, the rays of light are not focused to a point but form a line; resulting in distortion / blurring of vision for both distance & near. In astigmatism, the cornea is curved or more steep in one direction than in the other, like a rugby ball. It is possible to have astigmatism in combination with myopia or hyperopia.
- It is a heterogenous group of diseases that damages the eye’s optic nerve & can result in irreversible vision loss & blindness. The optic nerve supplies the visual information to the brain from the eyes. Glaucoma is usually, but not always, the result of abnormally high pressure (intraocular pressure, IOP) inside the eye.
- The classical symptoms include the triad of “Epiphora” (excessive tearing), “Photophobia” (hypersensitivity to light) & “Blepharospasm” (squeezing of eyelids).
- Very high eye pressure can present dramatically in a newborn as cloudy, enlarged corneas. A slow rise in eye pressure results in a less acute presentation with “Buphthalmos”(Ox Eye : Enlarged Eye) but no corneal clouding or photophobia.
- Generally, the preferred mode of treatment for pediatric glaucoma is surgical, not medical.
- The treatment needs a team approach to normalize eye pressure, correct existing errors of refraction and eye architecture and to enable physiologic maturation of the visual pathway to achieve as much as vision as possible.
- It is a condition of misalignment of the eyes. Misalignment means that the eyes are not lined up to look at the same thing.
- In every case of misalignment, one eye is fixed on what the person intends to look at (fixing eye) and the other eye is looking at something else (deviated eye).
- Ocular misalignment can involve one or both eyes and occur in any direction.
- When the direction of deviation of the eyeball is :
- Inwards, towards the nose, it is called Eso – deviation
- Outwards, towards the ear, it is called Exo – deviation
- Upwards, it is called Hyper – deviation
- Downwards, it is called Hypo – deviation
- In a person with squint, the eyes are looking at different things; therefore each eye is sending a different image to the brain. This can result in :
- Double vision
- Reduced depth perception
- Lazy eye (Amblyopia)
- Head tilt or Chin lift
- Blurred vision
- Treatment is guided by the exact nature of the squint and by the patient’s age.
- The most common treatments for squint are glasses, management of amblyopia and surgery.
Amblyopia (Lazy Eye)
- Amblyopia or Lazy Eye refers to a unilateral or bilateral functional decrease of vision, in one or both eyes, caused by abnormal visual development in childhood or infancy.
- Normally, our brain processes the images sent by both eyes equally. This is needed for the best possible vision.
- In some children, though one eye is favored by the brain because it provides a sharper image. As a result, the brain neglects the images from the other eye, which affects the child’s visual development.
- Lazy eye cannot be fixed instantly by putting on eyeglasses that correct the problem. But there are a number of different ways to improve vision in the weaker eye or at least to help make sure that the problem does not get worse over time.
- In the pediatric age, allergic conjunctivitis occurs frequently with a peak age in late childhood and young adulthood.
- Allergic conjunctivitis is caused by airborne allergens that come in contact with the eye.
- Symptoms may be sudden in onset, seasonal or present year – round, depending upon the allergen.
- The most common symptoms include redness, watery discharge and itching of both eyes. Other symptoms can be burning sensation, sensitivity to light and swelling of eyelids.
- Both eyes are usually affected, although symptoms may be worse in one eye. Rubbing the eyes can worsen the symptoms.
- Treatment depends upon severity and cause of symptoms.
- There are a number of treatments available for the symptoms of allergic conjunctivitis including artificial tears, anti – allergic medications, immunomodulatory agents and corticosteroids.
- In addition, basic eye care is important.
- Avoid rubbing of eyes
- Use cold compress
- Minimize exposure to pollen by staying indoors when possible
- Use protective eye glasses when outdoors
Retinopathy of Prematurity (ROP)
- When children are born prematurely, the blood vessels that feed the retina (light – sensitive part of the eye) usually haven’t finished growing.
- ROP occurs when the vessels actually stop growing for a time and then begin growing abnormally and randomly. The new abnormal vessels are fragile and can leak, leaving the retina scarred.
- Risk Factors :
- Babies born before 31 weeks
- Birth weight of 1250 grams or less
- Supplemental oxygen
- In general, the smaller and the more premature the baby, the more likely the possibility of developing ROP and the more likely to need treatment.
- In most cases, ROP resolves without treatment, causing no damage. Advanced ROP, however, can cause permanent vision problems or blindness.
- Treatment consists of laser therapy, cryotherapy and medication eye injections.
- Tears are produced in the lacrimal gland, located under the bone of eyebrow and flow over the eye through tiny ducts along the eyelids. After draining away from the eye through two small openings at the inner corner of the eyelids, tears drain into a larger passage from the eye to the inside of the nose, called the nasolacrimal duct (NLD).
- In some babies, the openings into the NLD have’nt formed properly. This causes a blockage and the tears have no place to drain.
- The result is an overflow of tears (epiphora) that run down the cheek or causes persistent crusting.
- Obstruction usually resolves with a conservative approach within the first year of life in two – thirds of children; for this parents should be properly instructed to perform massage on sides of the nose just near the inner corner of the eyes. If conservative methods fail, invasive treatment is recommended including probing, balloon catheter intubation and dacryocystorhinostomy (DCR).