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Common Eye Problems in Children

Parenthood Magazine February'13 issue









These are just a few of the common complaints that parents present with in my clinic. Children themselves are usually unaware that they have a problem. They will seldom complaint because they assume everybody else sees the same way as they do. Parents therefore have to be very observant and may need to depend on another person’s view to pick up on the signs that their child may have an eye problem. Children’s eye problems are not always easy to find and most cannot be detected by the common school vision screening. 

There are certain conditions that may make your child more likely to develop an eye problem. Children that are born prematurely or those with a family history of amblyopia or squints and of course children with a history of eye injury may develop an eye problem later in life.

The common eye problems in children that usually present in my clinics are:

1.      Refractive errors:

It is an error of the focusing mechanisms of the eye and is a frequent reason for reduced vision and is divided into:

a.      Myopia: This is also known as “shortsightedness”. It simply means that the child is unable to see distant objects clearly but is able to see near objects well. Depending on the severity of the myopia, parents usually notice that the child would sit closer to the television or computers. Teachers may also complaint to the parents that their child frequently copy notes or homework wrongly. Some children may even be labeled as a slow learner or reader.


b.      Hyperopia: This is also known as “farsightedness”. Differing to myopia, a child with hyperopia can see things at a distance more easily than things at near. Depending on its severity, a child may compliant of headaches, eyes feeling tired and will have difficulty reading or so show little interest in reading.


c.       Astigmatism: This is a form of refractive error due to an irregular curvature of the cornea or the lens. This simply means the eye instead of being round like a basketball is shaped more like a rugby ball. A normal eye will be able to focus an object that it sees onto a single focal point on the retina. This allows us to be able to see objects clearly. An eye with astigmatism has multiple focal points, hence the image is blurred. Astigmatism usually occurs together with myopia or hyperopia, but may also occur on its own. Children with severe astigmatism may complaint of blurring of vision or have a peculiar head posture when looking at objects and may frequently rub their eyes.


Refractive errors are treated with corrective lenses; therefore the child would have to wear glasses or contact lenses, to ensure that the child will achieve the best vision as possible as an adult.

Some parents are concerned that by wearing glasses, their children’s refractive error would only worsen. This is a common misunderstanding. The glasses neither change the eyes nor does it “cure” the refractive errors. It only aids in focusing the images that is blurred due to the refractive error. It’s like changing the lenses on your camera, it does not change the camera just allows you to focus differently. The need to change glasses is due to the growth of your child’s eyes.

 

2.      Lazy eye: The medical term for it is Amblyopia.

Most of the parents that I talk to are confused about this condition. Especially, when they are informed that there is nothing physically wrong about their child’s eye. The term lazy eye itself is inaccurate. The more appropriate term would probably be Lazy Brain. In a child with a lazy eye, the brain focuses on one eye more than the other, virtually ignoring the lazy eye. To explain it simply, this occurs because when we are born, our brain is not aware that we have two eyes. If the visual development in both eyes are not progressing at the same rate and both eyes are not seeing equally clear, the brain (in this case, the visual cortex) will suppress the image that is produced by the weaker eye. This would cause the visual brain cells to not mature normally.

The main problem with lazy eye is that it may be detected too late. If adults suddenly were to lose sight in one eye, it would become immediately obvious. However, in a growing child, the brain and the remaining good eye may be able to make up for the shortfall so well that the child and their parents do not notice this problem. A lazy eye may only be noted after a routine eye test. Children with lazy eye may also present with blurred or double vision, poor depth perception or a squint.

Treatment of children with lazy eye begins by detecting the problem and then identifying and treating the causative factor. Cataracts and squints may need surgical correction whereas refractive errors would need the appropriate corrective lenses. Unfortunately the treatment does not end here. Once the causative factors have been treated, the lazy eye would now need to be retrained to see again. This involves a process called “Patching”.

This is done by applying a patch to cover the good eye! Therefore preventing it from seeing and forcing the child to use (hence retrain) the lazy eye. By doing this, it is hope that the visual brain cells can now mature normally. The good eye may need to be patched a few hours a day and during this period the child must be encourage to use the lazy eye as much as possible. Obviously the earlier patching is done the better the visual outcome.

 

3.      Strabismus: This is also known as Squint

In this condition, both of the eyes are not properly align. In other words, they don’t look at the same object at the same time. One eye may consistently look away (inwards, outwards, upwards or downwards) all the time or the eyes may alternate. A strabismus may always be present or they may only appear during certain activity or when the child is fatigued. Parents may only notice the strabismus when the child is ill or has been playing or if the child has been doing a lot of near activity such as reading.

Strabismus is usually due to an imbalance in the eye muscles coordination but an uncorrected refractive error may also cause strabismus. Strabismus may be a causative factor an Amblyopia.

Any refractive errors must be corrected and surgical intervention may be necessary if there is muscle imbalance. 

 

4.      Conjunctivitis: Usually referred to as a Red eye.

Conjunctivitis means inflammation of the conjunctiva which is the transparent outermost layer of our eye. It is usually due to an infection or a form of allergic reaction.

Infectious conjunctivitis may be bacterial or viral. Typically in bacterial conjunctivitis the eye is red, there is a purulent discharge. In viral conjunctivitis there is redness, clear tearing or crusting. Usually there would be a history of exposure to someone with conjunctivitis or a preceding history of flu like infection. Cases of infective conjunctivitis are usually self-limiting but may require some antibiotic eyedrops.

Allergic conjunctivitis is characterized by ocular redness and itching. Parents would complaint that the child frequently rubs their eyes. Tearing (clear tears), crusting of the eye lids and photophobia may also be seen. Clinical examination may show papillary hypertrophy. The condition is often recurrent, and chronic.

Children who have allergic conjunctivitis often have a history of other atopic diseases, particularly allergic rhinitis, eczema or asthma. They are treated with antihistamine eyedrops or mast cells stabilizers. Severe cases may require steroid eyedrops. Any concurrent atopic diseases must be treated as well especially allergic rhinitis.