Children are not ‘little adults’.
Eye problems in children are unique and need specialized management. The problems affecting children are quite distinct from those affecting adults.
Every child should undergo an eye examination by the age of 3 years or before attending school as advised by the American Association of Pediatric Ophthalmology and Strabismus (AAPOS).
An eye examination is surely recommended if the child has
In this condition the vision of one eye or sometimes both eyes is less as compared to normal. The most common causes include refractive error, misalignment of the eyes or visual deprivation due to an opacity before the eyes. Cure is most likely if treatment is undertaken during the critical period of visual maturation usually up to the age of 8 years, but present research gives new for vision improvement up to the age of 17 years.
Nearly one fourth of cases will resolve on prescription of appropriate glasses. Most children are advised patching of the better eye with usage of the worse eye and especially performance of near activities for a couple of hours daily based on the severity of vision loss. Drops to blur the good eye can also be prescribed. This can be difficult as the child does not like to see poorly with the weaker eye and needs a lot of perseverance and encouragement from the parents.
In this condition the rays of light do not come to a focus on the retina or back of the eye due to which the child is unable to see clearly. The child can be farsighted ( hypermetropic) or near sighted ( myopic). Proper prescription of glasses is essential. Unlike adults, prescription of glasses in children is based on the age and on factors like the alignment of the eyes. Many cases of squint can be corrected by simple prescription of glasses. There are scientifically proven non-surgical methods to reduce the progression of minus powers in near sighted children. In addition, there are methods to reduce the plus power in farsighted children through a method called emmetropization. These methods rely on optical manipulation of spectacles and are occasionally facilitated using drugs like atropine or pirenzipine.
Cataracts in children can occur later in life or can be present since birth. The first few weeks of life are crucial for the development of vision in a child. If there is significant cataract it needs to be removed as early as 8 weeks when both eyes are affected. Cataract in one eye is more harmful to visual development and needs to be removed by 6 weeks. Management of pediatric cataract is different from adult cataract and needs meticulous post-operative follow up with correct prescription of glasses and patching therapy if needed. With newer lenses and advanced technology, implantation of intraocular lens can be even in the first year of life.
Normally the tears drain from the eyes to the nose through channels in the lids and nasal bones. Some children have a block in the drainage channels leading to a watering eye. While most cases resolve with massage and antibiotic drops in cases of infection, some need probing to bypass the channel. Nasal endoscopy is also performed to evaluate the block. Rarely the child may need surgery in the form of dacryocystorhinostomy with silicon intubation to bypass the obstruction.
Children are more prone to allergy. The eyes become itchy, watery and slightly discolored. With proper treatment the condition improves, though recurrences are common.
Children born premature are more prone to develop refractive errors like myopia and squint. In addition they need to be reviewed for retinopathy of prematurity. The optimal time for reviewing the baby is about 30 days after birth. If needed, laser treatment is given to the eye to stem the disease.
This is the most common malignancy in the eyes in children. It can be detected by the presence of a white reflex, squint or poor vision in one or both eyes.
Every child with a squint needs to undergo a dilated eye examination and evaluation of the retina by a pediatric ophthalmologist.
It is recommended by the American Academy of Pediatric Ophthalmology and Strabismus, that children should undergo their first eye examination by the age of 3 years. Dr Ramesh Murthy is a chosen member of the American Association of Pediatric Ophthalmology and Strabismus.
The vision is checked by using special picture or grating charts or letter charts if the child can read. Most children also need a dilated eye examination for checking the refraction. If performed on the same day, the consultation can last for an hour or so as the drops take time to start acting on the eyes.
No. This is not harmful. However it is not recommended as it can cause eye strain.
Excess near activities can trigger the development of myopia. It is not advisable that a child spends a lot of time on the mobile or TV
Yes, outdoor activities and exposure to sunlight is known to reduce the chances of developing myopia.
The progression of myopia can be slowed down using atropine eye drops in the recommended concentration. This can be instilled once at night.
Glasses are not prescribed for small refractive errors in children. Only when the number is significant glasses are prescribed. The eye tries to become normal by a process of emmetropization. Unnecessary prescription of glasses can lead to disturbance of this process of normalization of the eyes.
The best option is patching the good eye and making the weaker eye work hard. Atropine ointment can be used to blur the vision of the good eye. Bangerter foils can also be used to partially occlude the good eye. Newer options are the use of Occlusion glasses and dichoptic therapy using red blue glasses.