Paediatric Ophthalmology

Children can be afflicted by many eye diseases. They may be born with or may develop cataracts, glaucoma, retinal and orbital tumors, or other problems. More commonly, children may need glasses to see more clearly or intervention for misaligned eyes (strabismus) or poor visual development in one eye (amblyopia). The management of eye problems in children requires special knowledge and skills. Even before a child can speak, pediatric ophthalmologists can tell what a child sees, if he or she needs eyeglasses or contact lenses, and if any problems exist with the eyes. Children are not miniature adults, and their eye problems require diagnostic and treatment methods that are usually different from those used in the older age group. Fortunately, most eye problems can be treated without surgery, but about 1,000 children per year undergo surgical correction of their eye problems.

Amblyopia

Amblyopia (lazy eye) is another frequent condition, occurring in about three or four of every 100 children. When a child is born with normal eyes, he or she has the potential for good vision in both eyes, but must learn to see with each of them. If for some reason, the child prefers to use one eye more than the other, the preferred eye learns to see well but the other suffers from lack of use. It does not learn to see as well, even with glasses. The non-preferred eye is said to be lazy or have amblyopia.  This vulnerable period of visual development ends around age eight or nine.

One common cause for lazy eye is strabismus. When the child's eyes are pointed in different directions, the child has to use one eye at a time to avoid seeing double. If he or she uses one eye more than the other, the other eye becomes lazy.
 
Children without strabismus can also develop a lazy eye. Even though their eyes are straight, one eye is preferred more than the other. The non-preferred eye becomes lazy and does not learn to see.
Amblyopia does not bother the child because there are no symptoms. It is found only by checking the vision in each eye. This can be done fairly accurately in any child three years or older. For this reason, all children should have their vision tested by age four.
 
The treatment for amblyopia involves forcing the lazy eye to be used more often. Usually this is accomplished by temporarily blurring the preferred, or good, eye. This can be accomplished with patching or drops.  This treatment may have to be continued for several months until each eye sees equally well. Fortunately when caught at an early age, it is usually successful in restoring good sight. Sometimes the patching must be continued intermittently until age nine. If the lazy eye is out of focus, eyeglasses may be require, in addition to patching the good eye to obtain the best sight.

Esotropia in Children

The most common type of strabismus is esotropia, which occurs when either one or both eyes turn in toward the nose. Some children are born with this condition. Alternatively, it can start at about age two and a half. When esotropia occurs in these older children, eyeglasses can often help to treat the condition by correcting the child's vision for farsightedness or hyperopia. This can reduce or eliminate the crossing by changing the child's need for excessive focusing. 

Exotropia

Exotropia is the second most common kind of strabismus. In this condition, one or both eyes turn out away from the nose. It usually starts at age two or three. In the beginning, the eye may drift out only for a few seconds when the child is tired or ill. It typically occurs when the child looks far away. Closing one eye in bright sunlight when playing outside is also a common early sign.