Paediatric Ophthalmology

Eye conditions in children

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Diagnosing Eye Conditions in Children

Children of all ages can develop problems with their eyes and vision.  Some of these are obvious (such as strabismus/turned eyes), but some may not be.  This may be because the child does not have sufficient language skills to describe their vision, and even if they can, a condition that has been present since a young age may seem ‘normal’ to that child.

Detecting these eye conditions early is important, as a child’s visual system (the eyes and the vision parts of the brain) are constantly developing and forming connections, which is influenced by the quality of his/her vision in early years.  Problems that may be easily corrected if they develop in an adult (such as significant refractive/focus issues) can affect this development, and if not corrected in time, result in permanent reduced vision in one or both eyes.  This is the reason why a basic vision screening program is offered to every Prep student in Queensland.

Any child detected to have an abnormality with their eyes or vision, or with risk factors for this, can be referred to a Paediatric OphthalmologistExamining children’s eyes requires a very different set of skills and techniques to examining an adult, and Paediatric Ophthalmologists have undertaken extra training to become proficient in these.  At Maroochy Eye Specialists, we aim to make children feel as comfortable as possible during their visit – expect some parts of the examination to feel like playtime!

Amblyopia

Amblyopia (often called ‘lazy eye’, but this term can be used for other conditions as well) means reduced vision in one eye (most commonly), or both, due to abnormal stimulation of the visual system in the early years of life.  The abnormal vision affects the important connections developing between the eyes and brain during this time, which can result in an eye that looks perfectly normal, but doesn’t see as well as it should.

Causes of amblyopia include:

  • Strabismus (turned eyes): can cause amblyopia if the child always uses the same eye to look at what they are interested in (meaning the eye that is seen to be turning does not change)
  • Visual deprivation: meaning anything that blocks an image forming on the back of the eye, including cataract, ptosis (drooping upper eyelid) or problems with the cornea (the clear window on the front of the eye).
  • Refractive error: if the child needs glasses that are very strong, or significantly different between the left and right eyes

Treatment is possible for many cases of amblyopia, especially if detected early, but some children can experience improvement into their teenage years with treatment.  As well as correcting the underlying cause of the amblyopia (eg with glasses or surgery), a child may need additional treatment with patching or drops to encourage them to use the weaker eye.  A Paediatric Ophthalmologist can recognise the need for, and direct this treatment.

Strabismus

Strabismus refers to any condition where the 2 eyes are not aligned to point in the same direction.  This is most commonly seen in children, but can occur in adults as well.  The eyes can be convergent (‘cross-eyed’ appearance), divergent (turned out), or even vertically or obliquely misaligned.

There are many different causes of strabismus in children.  Most of these are benign, and may relate just to a small problem during the very early development of eye alignment.  However, occasionally strabismus may relate to eye or neurological conditions, that need to be considered.  Therefore children with strabismus should be assessed by a trained professional.

Treatment of strabismus in children depends on the cause.  Some cases may respond very well to prescribed glasses, some to patching, and some will require surgery to alter the position of the muscles that move the eye.  Ideally strabismus will be treated in a timely fashion, as children’s vision development can be affected by persisting strabismus.  A paediatric ophthalmologist will be able to perform a complete assessment, as well as advise on and carry out the appropriate treatment.

At Maroochy Eye Specialists, we also offer consultations in adult strabismus.

Refractive Error in Children

Some children need glasses to help them see clearly, or to correct strabismus or amblyopia (see above).  Glasses can be prescribed in children who are not yet talking, and occasionally even in infants well under 1 year old. Accurate prescription in these ages is obviously very different to assessing adults for glasses, and will almost always require drops to be placed in the child’s eyes. Paediatric Ophthalmologists are trained in techniques of assessing even very young infants for glasses, and recognising when they are necessary and when not.

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