Moore, Experts in Pediatric care

Common Eye Problems in Children

Amblyopia (“lazy eye”)

Amblyopia is poor vision in one or both eyes, even though the eyes appear healthy. Any condition that causes a child to favor one eye over the other can result in amblyopia.

Amblyopia can be caused by eyes that are misaligned (strabismus). When the two eyes do not point in the same direction, the brain begins to favor one eye over the other. The brain begins to “ignore” the non-dominant eye and the vision becomes weakened. This form of amblyopia is called strabismic amblyopia.

Amblyopia can also be caused by high amounts of uncorrected refractive error (myopia, hyperopia or astigmatism), or by unequal amounts of refractive error between the two eyes. This is called anisometropic amblyopia.

Amblyopia can also result from conditions that block the vision in the eye, like pediatric cataracts or corneal problems.

The treatment of amblyopia consists of identifying and treating the underlying cause. This could involve prescribing glasses and/ or patching of one of the eyes. In some cases, eye drops may be prescribed to temporarily blur the vision in the dominant eye so that the brain is forced to use the weaker eye. In cases that are caused by misalignment of the eyes, eye muscle surgery may be necessary.

It is extremely important that amblyopia be diagnosed and treated as early as possible. If treated at a young age, amblyopia can usually be significantly improved or completely reversed. Once a child reaches the age of 9, vision loss from amblyopia is typically not reversible. Therefore, if you or your pediatrician suspects your child has a vision problem, a full examination by a pediatric ophthalmologist should be performed as soon as possible.

Strabismus (misaligned eyes)

It is perfectly normal for eyes to cross or drift occasionally during the first two months of life. However, ocular misalignment occurring more frequently or occurring after the first two months of life is abnormal and should be evaluated by a pediatric ophthalmologist.

Strabismus is typically described by the direction of ocular misalignment. Common types are esotropia (crossing inward), exotropia (drifting outward), hypertropia (drifting upward), and hypotropia (drifting downward). Strabismus may be present from birth (congenital), or it may develop at a later time (acquired). If strabismus develops late in childhood or in adulthood it often results in double vision.

Childhood strabismus is usually caused by an abnormal communication between the brain and the eyes. It typically occurs in children who are otherwise completely healthy, although children with certain conditions (cerebral palsy, Down Syndrome, hydrocephalus, etc.) may be at higher risk. Occasionally strabismus may result from a problem with the eye muscles, poor vision, or injury.

The treatment of strabismus varies depending on the type and severity of the problem. The goal of treatment is to improve the alignment of the eyes so that the eyes may function together. In most cases, the earlier the treatment is initiated, the higher the long-term success rate. Treatment may involve glasses, patching, eye drops and/ or eye muscle surgery.

Adults who develop strabismus should be evaluated for underlying medical conditions such as stroke, thyroid disease, myasthenia gravis, etc.

Nasolacrimal Duct Obstruction (Blocked Tear Duct)

This is a very common problem in infants. Approximately 2-3% of infants will have some degree of nasolacrimal duct obstruction. The most common symptom of nasolacrimal duct obstruction is frequent or constant tearing from the eye. Often there is also a yellow discharge from the eye and crusting of the eyelids. This problem results from narrowing or complete blockage of the series of tubes that normally drains the tears from the eyes. The result is a backup of tears in the eyes which overflow.

A high percentage of blocked tear ducts resolve spontaneously within the first year of life. During this time, however, babies are at risk of developing infections from the build-up of stagnant tears and mucus. Typically the treatment of a blocked tear duct initially consists of massage of the nasolacrimal sac (to help express stagnant tears and to apply pressure over the duct in attempt to open it), and treatment of any secondary infections. If the blocked tear duct does not resolve as a child approaches a year of age, often a probing and irrigation procedure is indicated. This procedure is performed with the infant sedated in the operating room so that they are not in any discomfort. A small probe is inserted into the nasolacrimal duct to gently open the blocked area. After the procedure, the symptoms resolve immediately, and typically no further treatment is needed.

On rare occasions, symptoms of nasolacrimal duct obstruction return after a probing procedure is performed. In this case, the procedure is repeated and a thin, flexible silicone tube is inserted into the nasolacrimal duct to insure that it reamains open. The tube causes no discomfort to the child. After three months, the tube is removed in the office.