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Pediatric Conditions

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Pediatric conditions

Just like any other part of a child’s body, the eye is continuously growing and developing after birth.This leaves children susceptible to different eye conditions or diseases. Catching conditions early is essential to preserving good vision and allowing for the development of healthy eyes. Learning about the different conditions that are commonly found in childhood will help parents screen their children for potential visual ailments. Children who grow up with eye conditions or visual problems do not know that they are seeing differently from others. This means that sometimes there can be something going on even without any complaints from your little one. Most often, symptoms are caught by the adults around them and a comprehensive eye exam would get them on the right track to treatment if needed.

Refractive errors

Refraction refers to the bending of light. When talking about eyes, refraction refers to the purposeful bending of light using lenses in order to get light to fall directly onto the retina (back of the eye). This allows for that perfect 20/20 vision that everyone strives for. When light naturally falls in front of the retina due to a very long eye or a very powerful eye, this is called myopia or nearsightedness. This results in blurry vision in the distance and clear vision at some distance up close. This can be corrected with negative powered lenses that can be put into contacts or glasses. Refractive surgery is also an option to provide adequate vision as long as you meet candidacy requirements such as an adequately thick cornea amongst other things. When light naturally falls behind the retina due to a short eye or a less powerful eye, this is called hyperopia or farsightedness. This can be corrected with positive powered lenses that can be put into glasses or contacts. Clear vision is the foundation to normal eye development and health. See your eye doctor to ensure your child is always seeing clearly and comfortably throughout their early years and beyond.


Amblyopia

Amblyopia is widely referred to as “lazy eye.” This is because the eye’s vision did not develop normally and leads to chronically poor vision. Babies develop into their 20/20 vision and are not born with it. Therefore, during a critical period of birth and about 6-9 years old, any abnormalities in the visual system can result in a permanent decrease in vision. This can occur in patients that were not treated for strabismus, uncorrected blurry vision, droopy eyelids (ptosis), or cataracts. These conditions can create a sort of barrier to vision development which prevents the full functioning of that eye.

Treatment of amblyopia revolves around encouraging that weaker eye to be used by the brain. This is accomplished via patching of the stronger eye or by using eye drops that would temporarily weaken the stronger eye. Covering the stronger eye can also be done with an occluding contact lens which would act as a patch. Patching will occur for weeks and potentially up to months to restore normal vision depending on each individual’s condition. In some cases, cataract surgery may be necessary in cases of congenital cataracts. Studies have shown that occlusion patching is a successful treatment for amblyopia if done before the end of the critical period (age 6-9).

Strabismus

Strabismus is an eye turn or a misalignment of the eyes. You may notice one eye is turned in or out while the fellow eye remains straight ahead. It can also occur in one eye then another at different times. An eye turn in is called an esotropia. An eye turn out is called exotropia. An eye turned upward is called hypertropia. An eye turned downward is a hypotropia. This misalignment produces two separate images that are sent to the brain. Because the brain cannot fuse the two images into one, one eye is essentially ignored. This prevents the development of that eye. An eye that turns tends to have poorer vision. The goal of strabismus treatment is to improve eye alignment. This allows both eyes to better work together. Treatment may include contacts, vision therapy including eye exercises, prisms in glasses, glasses, or eye surgery. In some cases, a child may have facial features that mimics the appearance of an eye turn. However, they may simply have a wide nasal bridge or extra folds of eye skin that they would eventually grow out of. Your eye doctor can perform an assessment to determine if your little one has a true eye turn or a pseudo eye turn.

Accommodative esotropia is a type of esotropia that results from hyperopia (farsightedness). An uncorrected refractive error for farsighted patients may result in an over accommodation by the lens of the eye to try to make up for that power. When the eye accommodates it also converges the eyes towards the midline. Therefore, this condition presents with one eye turned in. Treatment includes places the appropriate power in front of the eye in the form of glasses or contacts. This will result in a normal straight ahead appearance of the eyes. However, when the glasses or contacts comes off the eye turn will still be present and will never fully go away. The glasses with allow for normal binocular vision, clear vision, and eye posture during use.


Nystagmus

Nystagmus refers to an uncontrollable jiggling of the eyes. As a result, the eyes cannot stay focused on one object because of all the movement. This results in decreased vision. Nystagmus that is present in children can have associated conditions, such as: aniridia, coloboma, achromatopsia, optic nerve hypoplasia, and severe refractive error. All these conditions result in moderate to severe vision impairment which causes a sensory nystagmus in which the eyes have an impaired ability to sense vision. This typically is present in young children, starting around 2-3 months old. If the nystagmus develops later on and was not present before, this is referred to as an acquired nystagmus. It can be associated with medications, structural or functional brain abnormalities, cancer, or other disorders. This can be associated with serious medical conditions. Schedule to see an eye doctor if one suspects their child to have some form of nystagmus to rule out any serious conditions.


Retinoblastoma

A retinoblastoma is the most common eye cancer in children younger than 5. It can be seen in one or both eyes. This form of cancer typically remains in the eye and doesn’t spread to other tissues. Retinoblastoma can be hereditary and have an increased association of secondary malignancies if so. It is imperative to treat to prevent blindness. Retinoblastoma can be suspected if one eye appears white instead of red behind the pupil or if there are limitations in eye movements. Treatment involves surgery, chemotherapy, cryotherapy, light coagulation, or radiation. The eye is spared whenever possible depending on the stage of retinoblastoma the child prevents with. See an eye doctor immediately if you notice any whitening of the pupil or limited eye movements in your child.

Congenital Cataracts

Congenital cataracts are clouding of the crystalline lens upon birth. These cataracts can occur during pregnancy if the mother develops an infection such as rubella or herpes. It may result from diabetes, trauma, inflammation or drug reactions. This is an emergent condition and must be treated immediately with surgery to remove the lens from the eye. This is because a dense cataract in young children can prevent the input of light and visual stimuli into the eye. The deprivation of visual stimuli would ultimately result in a lack of normal development in vision which is crucial at a young age. In some cases, an artificial lens may be inserted in replacement of the natural lens. However, in some cases a contact lens is used to help restore vision instead. Your eye doctor will go over your options with you and determine what is the best course of treatment for the child.


Congenital Glaucoma

Congenital glaucoma involves abnormal development of the aqueous draining system of the eye. Aqueous is the fluid filling the front part of the eye that maintains the shape and provides nutrition to eye structures. If the drainage system isn’t properly developed, drainage can be affected and result in an increase in eye pressure. A buildup in eye pressure can put pressure on the structures of the eye that allows us to see. This results in irreversible vision loss. If caught early, congenital glaucoma is associated with very few vision problems in the future. Treatment involves eye drops to control pressure or surgery. Surgery is the main treatment option for congenital glaucoma. A comprehensive eye exam is necessary to accurately assess the child’s eye health and initiate proper treatment.


Childhood tearing/ epiphora

Excessive tearing of one of your child’s eyes can mean a number of things. Some babies are born with a blocked tear duct which prevents tears from draining properly. Since the tears don’t drain correctly, the tears will pour over the edge of the eyelid onto the child’s cheek. The blockage can lead to infected and irritated eyes. Treatment for this condition typically involves a special massage technique to the inner corner of the eyes near the nose. Your doctor may show you this technique if they suspect your child has a blocked tear duct. If this doesn’t work after a few months, surgery is performed to open the ducts. On the other hand, tearing can signify something irritating in your child’s eye like dust, pollen, or foreign bodies. It can also be present in dry eye or congenital glaucoma. Schedule your child for a comprehensive eye exam if you notice excessive tearing in order to ensure nothing is awry with their visual system.

Retinopathy of prematurity

A child that was born premature (<31 weeks) and was put on supplemental oxygen while in the hospital is at risk for retinopathy of prematurity (ROP). Babies that are 1250 grams or less are at higher risk of the condition. When a baby is born early, the blood vessels that supply the eye do not have the ability to grow properly. Their growth continues early. Most babies with ROP will have normal vision until the disease progresses to the most severe stages. It is in these stages that vision is threatened. Your eye doctor can diagnose retinopathy of prematurity by looking in the back of the eye once dilated. Treatment includes lasers or injections of medications that prevent abnormal blood vessels from forming. These abnormal blood vessels are what may lead to severe and permanent vision loss. If your child was born premature, have them looked at by an eye doctor to ensure their visual system developed correctly.