What is Paediatric eye care

Paediatric ophthalmology is a sub-specialty of ophthalmology that focuses on children’s ocular medical care and the process of diagnosing and treating eye conditions that develop in children.

In most cases, eye problems can be identified and treated even in the earliest days of life. Most children will have healthy eye development as they grow, but some serious eye diseases and disorders may not always be obvious to the parents. Because of this, infants should be checked by their pediatrician to monitor eye health in their first year, especially if they are considered at risk for vision problems.

If any issues are present, an examination should be scheduled right away to know whether medical eye care is needed or not. Another indicator of the need for early screenings is genetics. If you or members of your family have a history of eye disease or if they needed to wear glasses at a young age, it is a good idea to have your child examined at an earlier age, as they are at a higher risk of developing vision problems.

Issues not detected and treated before age five can cause a child’s eye condition to be so serious that he or she could experience severe vision loss or blindness.
We encourage parents to get their child’s eyes checked by a pediatrician or eye doctor at the first sign of any problem.

When to schedule an eye examination

If there are no signs of any vision problems, all children should have at least one eye examination before they reach age five. However, if any issues are present, an examination should be scheduled right away to know whether medical eye care is needed or not.

You should schedule an appointment for your child if you notice:

  • Frequent rubbing of the eye
  • Squinting
  • Poor hand-eye coordination
  • Constant headaches
  • Extreme sensitivity to light
  • Abnormalities such as a white pupil
  • Chronic redness or tearing of the eyes

As your children enter school, they will continue to require regular check-ups to monitor their vision. Poor vision can lead to difficulties in school, and it is common for teachers to alert parents if there are concerns about a child’s ability to see. If any vision problems are identified after a thorough exam, your child may need to wear glasses or contacts. Annual exams are necessary after an initial prescription is given in order to monitor any changes in eyesight

Common Paediatric Eye Conditions

There are many eye conditions that can arise in childhood or be present at birth, including:

Amblyopia

Amblyopia is a type of poor vision that usually happens in just 1 eye but less commonly in both eyes. It develops when there’s a breakdown in how the brain and the eye work together, and the brain can’t recognize the sight from 1 eye. Over time, the brain relies more and more on the other, stronger eye — while vision in the weaker eye gets worse.

It’s called “lazy eye” because the stronger eye works better. But people with amblyopia are not lazy, and they can’t control the way their eyes work.

Amblyopia starts in childhood, and it’s the most common cause of vision loss in kids. Up to 3 out of 100 children have it. The good news is that early treatment works well and usually prevents long-term vision problems.

Cataracts

Although cataracts typically occur later in life, they can also develop in childhood. In some cases, cataracts may be present at birth in one or both eyes in an infant. 

If cataracts are present at birth, it is called congenital cataracts. Regardless of age, cataracts are caused when the eye’s natural lens becomes cloudy and hardened, which causes blurry vision. 

Certain factors like genetics or eye injury may cause a cataract to form in childhood or infancy.

If cataracts are not causing any problems, immediate treatment may not be necessary.

Instead, your child may only need regular check-ups to monitor their vision.

If your child’s vision is affected by cataracts, they’ll usually need to have surgery to remove the cloudy lens (or lenses) followed by the long-term use of glasses or contact lenses.

Glaucoma

Glaucoma is a chronic eye condition that can cause progressive and permanent vision loss if left untreated. Pediatric glaucoma occurs in children when damage is caused to the optic nerve.

Treatment for pediatric glaucoma begins by lowering your child’s intraocular (inside eye) pressure (IOP).
This is done by using eye drops or prescription medicine your child takes by mouth.

If the medicine doesn’t work, other options include the following:

  • Trabeculotomy (surgery to help eye fluid drain)
  • Goniotomy ( procedure to open up the drainage angle)
  • Trabeculectomy (a surgery to help drain eye fluid in children)
  • Tube shunt
  • Laser procedure to destroy some of the ciliary body that makes the fluid

Children with glaucoma often have many surgeries and appointments because if the pressure in the eye is not controlled for even a short time, the vision can be damaged forever.

Keratoconus

Keratoconus is a progressive eye condition that occurs when the cornea, the transparent window at the front of the eye, is shaped more like a cone rather than a sphere.

It is important to get diagnosed and treated for keratoconus as early as possible to prevent the condition from worsening and causing further damage to your eyesight.

Most cases of keratoconus can be corrected. In mild cases, prescription eyeglasses or contact lenses may be sufficient to improve a child’s vision.

An ophthalmologist may suggest a procedure called corneal cross linking to increase the rigidity of the cornea and prevent the condition from progressing further.

Severe cases of keratoconus require corneal transplant. In this procedure, a surgeon replaces the damaged corneas with healthy ones

Strabismus

Strabismus (crossed eyes) is a common eye condition that can present in adulthood but frequently shows beginning signs in childhood. Those with strabismus may have one or both eyes that turn out, in, up, or down to varying degrees

Six Eye Muscles Control Eye Movement

There are six muscles that attach to each eye and control its movement. One muscle moves the eye to the right, and one muscle moves the eye to the left. The other four muscles move the eye up, down, and at an angle. In order to focus on a single image, all six eye muscles in each eye must work together

There are many reasons a child’s eyes may point in different directions. One of the most common reasons is if the child is nearsighted or farsighted. If a child’s vision is blurry because of nearsightedness or farsightedness, their eyes may have to strain to see clearly. This straining can cause a child’s eyes to cross or drift apart. But when these kids wear glasses to improve their blurry vision, their eye alignment can improve too.

Other causes of strabismus include:

  • premature birth
  • neurological (brain-related) disorders
  • Down syndrome

In many children, strabismus can happen without an obvious cause. 

If eyeglasses, eye patching, and/or atropine drops can’t fix a child’s strabismus, eye muscle surgery might be needed. Surgery involves loosening or tightening the muscles that cause the eye to wander.
Most kids can go home the same day of surgery.

Refractive Errors

Although some people do not develop issues with refractive errors until adolescents, children can develop refractive errors and experience blurry vision due to them. If your child’s teacher notices signs of vision struggles, they may recommend a vision screening to determine if there is a vision deficit.

These vision issues are related to refractive errors such as nearsightedness, farsightedness, or astigmatism. Once your child’s eye doctor can perform an evaluation, they will be able to determine what glasses prescription will best correct your child’s vision. 

Most children with refractive errors can be treated successfully with glasses or even contact lenses. But for those who cannot wear corrective lenses, refractive surgery may be an alternative. Fortunately, the population of children who might require refractive surgery is quite small

Retina and vitreous diseases

A retinal disorder occurs when the retina malfunctions. The retina is the light-sensitive tissue on the inside and back of the eye. Vision originates in the retina which contains photoreceptor cells that convert light into electrical impulses. These impulses are the visual information or “pictures” that travel to the brain via the optic nerve. Most retinal disorders involve a disruption in the transmission of these impulses.

There are many kinds of retinal disorders with a wide variety of causes and symptoms.

Those include:

  • A white pupil
  • A loss or partial loss of vision
  • Night blindness
  • A shower of black floaters in vision
  • Sudden, persistent flashing lights
  • An intolerance of light

The treatment of retinal disorders varies widely depending on the type of disease.