Paediatric Ophthalmology

Children’s eyes are different from those of adults because they’re still developing. Good vision is dependent on the proper development of the eye and good connections between the eye and the brain. Any condition affecting a child’s vision must be treated at the earliest. This is why pediatric ophthalmology has become a separate speciality.

Many conditions associated with blindness are also causes of child mortality; for example, vitamin A deficiency, measles, prematurity, congenital rubella syndrome and meningitis. Loss of vision has a significant impact on the child’s psychological, educational and socio-economic conditions not only during childhood but extending into adulthood as well.

Any of the below symptoms or complaints from your child should not be neglected. Some eye conditions and diseases are hereditary and can affect your child as well. Consult your child’s paediatrician or an ophthalmologist at the earliest for early detection and treatment of eye disorders.

Signs of eye & vision problems

Any of the below symptoms or complaints from your child should not be neglected. Some eye conditions and diseases are hereditary and can affect your child as well:

• Complaints of discomfort and fatigue
• Frequent eye rubbing or blinking
• Short attention span
• Avoiding reading and other close activities
• Frequent headaches
• Covering one eye
• Tilting the head to one side
• Holding reading materials close to the face
• An eye turning in or out
• Seeing double
• Losing place when reading
• Difficulty remembering what they read

Our team serves children with a variety of conditions, including:

• Refractive errors including myopia
• Amblyopia or lazy eyes
• Squint
• Retinopathy of prematurity
• Keratoconus and corneal disorders like corneal opacity, infections
• Paediatric cataracts
• General eye problems such as sore eyes, allergic conjunctivitis and eyelid lump
• Paediatric lids/orbits, glaucoma, retina, neuro-ophthalmology problems
• Paediatric ocular trauma
• Paediatric ocular inflammatory conditions (uveitis, orbital inflammatory syndrome, scleritis, episcleritis and neuritis)
• Eye screening for systemic disease/congenital ocular anomaly
• Paediatric eye emergencies

AMBLYOPIA

Amblyopia, commonly known as lazy eye, is a condition where vision does not develop properly during early childhood. After the age of seven to eight years, the development of the part of the child’s brain that processes vision is almost complete. If the brain has not received clear images from the weak eye prior to that, it would be difficult to improve vision in that eye after the visual part of the brain development is complete. The eye is then said to be “amblyopic” or “lazy”. If left untreated, visual impairment can become permanent.

The main causes of amblyopia are uncorrected high refractive error (astigmatism, hyperopia, myopia), large differences in refractive power between the two eyes, and/or squint (strabismus). A minority are due to conditions that obstruct vision, such as droopy eyelids and childhood cataracts.

How do I know if my child has amblyopia?

Children with amblyopia often do not complain of poor vision, and the problem may only be detected when vision testing is done. Occasionally, parents may notice a squint (where one eye appears to be misaligned), or a droopy upper eyelid in their children. Amblyopia is typically detected during an eye check-up since the child is usually too young to complain of poor vision. This should be carried out around the age of four by the family doctor, paediatrician or ophthalmologist.

To correct amblyopia, the child needs to be encouraged to use the lazy eye. This is usually done by patching the good eye, often for several hours a day. Patching therapy may take months or even years and is often more effective when it is started at a younger age. The basis of patching is to allow the lazy eye to be used more often than the other eye so that the lazy eye gets a chance to develop normal vision. If spectacles are required, the child must wear them at all times. When amblyopia is detected too late (beyond 8 years old), it may not be possible to reverse the visual impairment. It is therefore important that you have your child’s eyes checked if you suspect a visual problem, or are advised by the school health services to consult an ophthalmologist.

SQUINT

Squint or strabismus is a condition in which both eyes look in different directions. Squint is one of the most common eye problems in children and may lead to loss of vision in the affected eye if not detected on time.

This loss of vision, if not treated on time, may become permanent. Squint occurs in babies and younger children and should be detected early with the help of paediatric ophthalmology. Squint is sometimes congenital. It may also occur as a result of refractive errors in the eye.

PAEDIATRIC CATARACT

Cataract is defined as any opacity of the crystalline lens of the eye, which causes reduced visual acuity. Cataracts in children may be congenital or acquired, unilateral or bilateral and in most cases, treatable. Although it is rare, childhood cataract is one of the most important causes of blindness and severe visual impairment in children and is responsible for 12–40% of paediatric blindness in India.

PAEDIATRIC CORNEAL DISEASES

The cornea is a small transparent structure in the eye which contributes significantly to the clarity of vision. Corneal conditions that affect children include corneal opacity by birth, infections, corneal tear, corneal dystrophies (abnormal deposits within the layers of the cornea), and corneal ectasia (change in the shape of the original structure). One of the very common causes that damage cornea is an injury. Children use sharp pencils or pens or some children even play with sharp instruments which could critically injure the cornea.

Corneal infections may be treated with eye drops or tablets. In some cases, glasses or contact lenses may be prescribed. In the cases where the transparency of the cornea is affected, surgical procedures such as complete or partial corneal transplant may be needed.

Congenital corneal opacity where vision is significantly affected

Pediatric Penetrating Keratoplasty is done to restore vision

Paediatric ophthalmologists are an important part of your regular healthcare checkup team for your children. Your child’s paediatrician will do a basic eye checkup at birth, but it is also necessary to get regular eye checkups done to maintain the good eye health of your child. Infants should have an eye checkup within 6 months of birth. After that, it is advised to get an eye checkup done every 1 or 2 years.