Common Paediatric Eye Conditions

Strabismus

This is also known as “squint”, “turned”, “crossed” or “lazy” eyes. It refers to any ocular misalignment where both of the eyes are not pointing in the same direction when looking at an object.

The deviating eye can either turn inwards (esotropia), outwards (exotropia), upwards (hypertropia) or downwards (hypotropia).  It may be intermittent or it may be constant.  It can occur in only one eye, or alternate between the two eyes.  It may be present at birth, or develop later on.

Strabismus is one of the most common eye conditions in children, and occurs in up to 5% of the Australian population.

A child will not outgrow strabismus. Treatment may include glasses, patching an eye, exercises, or surgery.  Early detection ensures that any treatment provided will deliver the most benefit possible to straighten the eyes and allow good vision and depth perception to develop.

Patching

Refractive Error

A refractive error is a focusing problem of the eye and occurs when light enters the eye and is not focused on the correct position in the retina (the back of the eye).  Glasses are required to correct the focusing issue.

Hypermetropia (Long-sightedness)

Light focuses behind the retina, as the eye is too short and causes blurred vision for both near and distance.

Myopia (Short-sightedness)

Light focuses in front of the retina, as the eye is too long and causes blurred distance vision.

Astigmatism

The curvature of the eye is shaped more like a football, rather than a soccer ball and causes distortion of vision due to the cornea (the front of the eye) being more curved in one direction.

Amblyopia

Also known as “lazy eye” this occurs when one eye or both eyes do not see a clear image, which in turn causes decreased vision.   The brain will ignore the blurrier image of the two, causing the vision to not develop properly in this eye.

This can be caused by refractive error, strabismus, congenital cataract or ptosis (droopy lid).  If the underlying cause is not treated, then a permanent loss of vision can occur.

Vision can quite often be improved if treatment is undertaken at an early age.  This treatment may involve the use of glasses to improve the quality of a blurred image, or the wearing of a patch over the stronger eye to make the weaker eye with the blurred image work harder, and this in turn encourages the development of vision in the lazy eye.

Learning Disabilities, Dyslexia and Vision

Learning disabilities are complex problems that require complex solutions.  Early recognition and referral to qualified educational professionals for evidence-based evaluations and treatments seem necessary to achieve the best possible outcome.  Scientific evidence does not support the efficacy of eye exercises, behavioural vision therapy, or special tinted filters or lenses for improving the long-term educational performance in these complex paediatric neurocognitive conditions. Diagnostic and treatment approaches that lack scientific evidence of efficacy, including eye exercises, behavioural vision therapy, or special tinted filters or lenses, are not endorsed and should not be recommended.

The diagnosis and treatment of learning disabilities depend on the collaboration of a team that may include educators; educational remediation specialists; audiologists; speech, physical, and occupational therapists; teachers for the visually impaired; psychologists; and physicians. Children with learning disabilities should undergo assessments of their health, development, hearing, and vision and, when appropriate, medical and psychological interventions for associated and related treatable conditions.

For further information please visit the following link to the American Academy of Ophthalmology’s Joint Statement on Learning Disabilities, Dyslexia, and Vision:

http://one.aao.org/clinical-statement/joint-statement-learning-disabilities-dyslexia-vis

Epiphoria (Watery Eye)

The most common cause of Epiphoria in children is a blocked tear duct.  Tears cannot drain normally, causing a watery, irritated or chronically infected eye.

A baby can be born with a blocked tear duct.  It is estimated nearly 30 percent of newborns have a blocked tear duct, but the condition usually resolves on its own within the first year of life.

The use of heat, massage and warm compresses may aid in the resolution of the condition.

If the watery eye persists, it may be necessary for the Ophthalmologist to open the tear duct by a minor surgical procedure where a probe is passed gently through the tear duct to open up any obstruction. Sterile saline is then irrigated through the duct into the nose to make sure that there is an open path.

Chalazion

A chalazion is a blockage within a gland of the eyelid, called the meibomian gland which normally secretes oil to help lubricate the surface of the eye. This blockage can cause swelling and inflammation of the eyelid.  One or more lumps (chalazia) may appear on the eyelid margin.

Usually the application of warm compresses and massage to the area will help a chalazion to resolve without further treatment. Usually, it will resolve on its own, but it may take several weeks or months to completely disappear.

A large, persisting or infected chalazion may require drainage under a general anaesthetic.