Common Childhood Eye Problems
Ophthalmologists have long recognized that children’s eyes are unique and quite different from adult eyes. Parents should be on the lookout for a number of conditions that can develop throughout a child’s life.
Robert S. Gold, M.D., F.A.A.P.
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.
Newborn Eye Misalignment
It is also common also for the eyes of newborns to be intermittently out of alignment. If this persists longer than 3 months, further evaluation is needed.
Most young children are farsighted (hyperopic). They can compensate for this farsightedness by focusing the lens within their eye and therefore, can see well at any distance. Most young children do not require glasses for farsightedness. However, even an infant can wear glasses if necessary for higher levels of farsightedness, nearsightedness (myopia) or astigmatism (irregular curvature of the eye).
Strabismus is the medical term used when the eyes go out of alignment. One eye may be deviated 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: patching, eyeglasses, exercises and surgery.
Headaches are common in childhood and are most often caused by other factors unrelated to the eyes. There are times when headaches may be caused by a need for glasses or difficulty using the eyes together. A child’s primary care doctor may request an examination to look for eye or vision related factors that may contribute to headaches.
One of the most common reasons for a child to see a pediatrician is for a red eye, commonly referred to as "pink eye." The medical term for a red eye caused by inflammation is "conjunctivitis." It can be caused by bacteria, a virus, an allergic reaction, an irritative source such as smoke or pollutants, or trauma.
The most common type of conjunctivitis is viral and is usually associated with upper respiratory infections. It should be considered contagious. Viral conjunctivitis often starts in one eye and goes to the other. If yellowish or greenish discharge accompanies the redness and watering, then bacteria may be the cause of the infection, and antibiotic eye drops are often prescribed. Antibiotics will not cure a viral conjunctivitis which may take from three to 14 days to resolve.
Dr. Louis C. Blumenfeld
In contrast, allergic conjunctivitis will show itching as its most common symptom. It almost always involves both eyes with a whitish mucus discharge and mild eyelid swelling. Allergic conjunctivitis can be treated with cold compresses and antihistamine eye drops for symptomatic relief, but often recurs due to the chronic nature of the allergic condition.
When a red eye occurs in one eye only, an early bacterial or viral conjunctivitis can be present. However, conditions such as corneal abrasions from trauma or from herpetic corneal disease have to ruled out.
It is important to have your pediatrician evaluate your child’s red eye completely. If there are any questions as to its cause, a prompt referral to an ophthalmologist is appropriate. A good medical history can tell the ophthalmologist whether or not the red eye is due to an infectious, allergic, or traumatic cause and will aid in the treatment course prescribed for the patient.
Trouble Reading/Convergence Insufficiency
Some children may have difficulty bringing their eyes in together to focus for reading. This is called convergence insufficiency. Common symptoms include headaches when reading, words appearing to move on the page, difficulty keeping one’s place while reading and double vision when looking near.
Abnormal Red Eye/Retinoblastoma
Retinoblastoma is a cancer that may affect the eyes of young children. An irregularity in the red reflex or "abnormal red eye" seen in digital photographs may be the first sign of this serious eye condition.
Retinopathy of prematurity (ROP) is a potentially blinding eye disease that occurs in a small percentage of premature babies. With ROP, abnormal blood vessels 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 which could further impact normal eye development.
Premature babies should be screened for ROP soon after birth. The pediatric ophthalmologists at Eye Physicians of Central Florida can examine a baby’s eyes in the hospital neonatal intensive care unit (NICU) or nursery. 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.
Ptosis is a condition where the upper eyelid droops. It can affect one or both eyelids, and if it is present at birth, it is called congenital ptosis. It is caused by poor development of the muscle that lifts the eyelid, and typically does not improve on its own. If the ptosis is mild, treatment is not necessary unless desired for cosmetic reasons. However, if a baby is born with moderate to severe ptosis, treatment is required to ensure proper visual development.
Left untreated, ptosis can lead to amblyopia or a "lazy eye" as well as astigmatism and blurred vision. It is typically treated with surgery.
Most people think of cataracts as an adult eye problem. In fact, they are quite common and often occur as we age. So when parents first hear their child may have a cataract, they often express surprise and disbelief. Cataracts in children are relatively uncommon, affecting approximately three out of every 10,000 children.
What is a Cataract?
A cataract is a clouding of the normally clear lens of the eye. The lens is responsible for focusing light rays on the retina at the back of the eye to produce a sharp image of what we see. When the lens becomes cloudy, the light rays cannot pass easily through it, and the image becomes blurry.
How Do Children Develop Cataracts?
There is a wide range of cataracts that affect children. Some are severe at birth, requiring surgery within the first weeks or months of life. Others are extremely mild and may never require surgery. A cataract is typically discovered by a pediatrician or other health care provider looking at the light reflection from the back of the eye. A clear red-orange reflection should be seen in both eyes similar to the red eyes often seen in photographs. A cataract would block all or some of this light.
Cataracts in babies can occur as an isolated problem with no known cause. In some, this propensity to develop cataracts is inherited. In others, the cataract may be part of a medical problem affecting more than the child’s eyes or a problem affecting multiple parts of the eye. Sometimes the cataract is actually the first indication of a larger medical problem, requiring the child to undergo additional diagnostic testing.
Not all cataracts in children are present from birth. Some develop or worsen during childhood. Eye trauma is one example of a way a child may develop a cataract.
How are Cataracts Different in Children?
One of the biggest differences from adult cataracts is that in a child, it is often important to promptly remove the cataract to allow the visual part of the brain to develop properly. The visual pathways in the brain continue to form during childhood. As a result, anything -- including a cataract that prevents a clear image being transmitted to the brain from the eye -- may prevent this development. The medical term for this is amblyopia, often referred to as a lazy eye.
Best results are generally obtained when a pediatrician or other primary care provider promptly discovers the problem, and the cataract and amblyopia are appropriately managed by an ophthalmologist.