Pediatric Ophthalmology

Strabismus (Misaligned)

Strabismus is the medical term used when the eyes are out of alignment. One eye may be drifting in, out, up or down with respect to the other. This may occur at any age for many different reasons.

All children who have strabismus (except for the intermittent horizontal strabismus in the first 3 months of life) should have a complete eye examination performed. Usually, the strabismus is an isolated problem, but occasionally it may be a sign of more serious eye conditions or neurological disease. Even isolated strabismus can cause permanent vision loss if untreated in a child from amblyopia (lazy eye). Treatment of strabismus depends on a number of factors but may include: eyeglasses or surgery.

Amblyopia (Lazy Eye)

Sometimes referred to as “lazy eye,” amblyopia is poor vision in an eye compared to the other eye during early childhood. When one eye develops good vision while the other does not, the eye with the poorer vision is called amblyopic. It is a relatively common condition, affecting two to three percent of the population in the United States.

What causes amblyopia? There are three major causes:

• Strabismus or misaligned eyes, is the most common cause. The misaligned eye “turns off” to avoid double vision, and the child uses only the better eye.
• Uncorrected refractive errors where one eye is out of focus because it is more nearsighted, farsighted or astigmatic than the other is another cause. The blurred eye essentially “turns off.”  Amblyopia can also occur in both eyes if they are both blurred by a significant refractive error.
• An eye disease that causes clouding of an eye such as a cataract interferes with the ability of light to be focused which can cause amblyopia.

Treatment to Prevent Vision Loss
Early diagnosis and treatment is critical to preventing vision loss due to amblyopia. The earlier the treatment is started, the better the prognosis is for reversing vision loss. The best time to correct amblyopia is during infancy or early childhood. Sometimes amblyopia treatment is started and/or continued into the teenage years.
Before treating amblyopia, it is often necessary to first treat the underlying cause. Glasses may be prescribed to correct focusing errors. Often glasses alone do not improve the child’s vision, and patching is necessary. This involves covering the good eye to force the child to use and strengthen the amblyopic eye.
Left untreated, an amblyopic eye may never develop good vision and may even become functionally blind.

Blocked Tear Ducts (Nasolacrimal duct obstruction)

Newborns may be born with blocked tear ducts. Typically, this will cause excess tearing and frequent infections. This is a common condition affecting up to 10 percent of children. In most cases, it will resolve with time. Massaging the tear duct may help. If symptoms persist, then the tear duct may be opened by an ophthalmologist when the child is six to 12 months of age.

Retinopathy of Prematurity

Retinopathy of prematurity (ROP) is a potentially blinding eye disease that occurs in a small percentage of premature babies. With ROP, abnormal bloodvessels grow and spread on the retina -- the light-sensitive tissue that lines the back of the eye and allows us to see.

Sometimes these abnormal vessels shrink and go away without treatment. In other cases, they can lead to:

• retinal detachment
• myopia (nearsightedness)
• amblyopia (lazy eye)
• strabismus (misaligned eyes)
• glaucoma (increased eye pressure)
• vision loss or blindness

Several factors can lead to ROP. The eye’s blood vessels do not typically finish developing until the last few weeks before birth. As a result, the eyes of babies born pre-term may not be fully developed. In addition, premature infants are exposed to high levels of light, oxygen and temperature changes whichcould further impact normal eye development.

Premature babies should be screened for ROP soon after birth.. Additional eye exams are usually necessary to monitor the development of the retina.

Early stages of ROP often do not require treatment. More advanced cases are typically treated with laser therapy or cryotherapy. Both destroy the abnormal blood vessels.

All children who are born premature, even if they do not develop ROP, should be closely followed for vision problems. 

 

Signs and Symptoms of Eye Problems in Children

• For children, regular eye examinations are important to maintain proper eye health, since some serious eye disorders produce no early warning symptoms.
• Any of the following signs or symptoms may be indicative of a number of serious eye problems.
  Pain in or around the eye
• One eye turns in toward the nose or wanders out toward the ear, either constantly or occasionally, eyes that do not appear to look in the samedirection
• Child tilts or turns head when looking intently
• One eye closes occasionally, especially when the child is outside
• Eyes shake or vibrate
• Child covers one eye to look at things
• Squints or squeezes eyes nearly closed to see
• Cannot identify things across the room or farther away
• Frequent rubbing of eye
• Discharge from eyes (stuck together in the morning)
• Droopy eyelids
• A white pupil in either or both eyes
• Eyes tearing or wet-looking, when not crying
• Any swelling or lump in or around the eyes or eyelids
• Any difference in size, shape or color of any part of the eye (i.e. pupil) or eyelids
• Redness of the eye 

Signs and Symptoms of Eye Problems in Infants

Vision is important as a baby begins to grow and learn. Even in infancy, it is important that your child receive regular eye examinations, probably by your pediatrician at first, then later by an ophthalmologist or other eyecare specialist. Certainly by pre-school your child should be having regular eye examinations to maintain proper eye health.

Any of the following signs or symptoms may be indicative of a number of serious eye problems. If your infant experiences any of the following, see an ophthalmologist as soon as possible:

• Discharge from eyes
• Droopy eyelids
• A white pupil in either or both eyes
• Eyes that wander, shake or vibrate
• Eyes tearing or wet-looking, when not crying
• Any swelling or lump in or around the eyes or eyelids
• Child not looking at mother by three months of age
• Eyes that do not appear to look in the same direction
• Any difference in size, shape or color of any part of the eye or eyelids
• Redness of the eye