Children Eye care

What is Amblyopia?

• Amblyopia or Lazy eye is a condition with underdeveloped vision in one or both the eyes during infancy.
• Children under the age of 8 are at much higher risk of developing Amblyopia, as the vision development almost stops at this age.
• There are chances of improvement in vision after the age of 8, but the extent to which it could improve depends on the prognosis at an early age. If not detected early and treated in time, Amblyopia can even result in permanent vision loss.

How do we detect Amblyopia?

• Usually, Amblyopia cannot be detected by just looking at the child’s eyes. It requires a few simple tests which will be performed by an optometrist and an ophthalmologist.
• A complete eye examination is warranted which includes vision testing in both the eyes by asking the child to read the letter on a visual acuity chart followed by the refractive power testing to rule out if there is any refractive error such as hypermetropia, myopia and astigmatism which will be tested with and without using eye drops.
• The eye alignment will be assessed to see if there are any squint which could be a reason for amblyopia which will be followed by general structural examination using a microscope and ophthalmoscope.

How is amblyopia treated?

• The amblyopia could be treated with the use of glasses or contact lenses, eye patching, eye exercises, eye drops and in some cases surgical treatment may be required.
• Glasses or Contact Lenses: Glasses play a major role in treating amblyopia as this is the only way to correct the refractive error. In some cases where one eye has the higher refractive error than the other eye, use of contact lenses can be of greater value than glasses.
• Eye Patching: Eye patches are used to occlude the eye with better vision to stimulate the lazy eye to see more. The eye with better vision is patched with the help of a biocompatible eye patch when the child is wearing glasses. In some children both the eyes are required to be patched alternatively. Duration of patching of eyes varies depending on the severity of the condition.
• Children who are not cooperative with the patching of eyes can be administered with the eye drops in the eye with better vision to blur its vision temporarily. This way the lazy eye is stimulated or forced to see more.
• Eye Exercises: There are some computer-based eye exercises wherein the child is required to play video games and solve puzzles in a supervised manner wearing 3D glasses.
• Surgery: Children with amblyopia due to squinting of the eye require surgical intervention.
• Duration of the treatment depends on the levels of improvement of vision in the patient which usually continues until equal vision is maintained in both the eyes.

What is a Refractive Error?

1. Refractive error is a problem with focusing light accurately onto the retina due to the shape of the eye, resulting in formation of a blurred image.
2. Refractive error is one of the leading eye problems in children in recent years. The prevalence of refractive error, according to the recent survey, states that 8 out of every 100 children have a refractive error of some kind. Myopia (short/near-sightedness), Hyperopia (farsightedness) and astigmatism are various kinds of refractive error conditions.

What causes refractive error?

1. There is more than one reason that can cause a refractive error. Some children inherit the condition from their parents whereas others could develop it during growing-up.
2. Recent research works suggest that children who involve in more hours of near work are at the risk of developing myopia.
3. Children born prematurely are also highly susceptible to developing refractive error, in most cases myopia.
4. Children having behavioural problems and delayed developmental milestones are also found to have the problem of refractive error.

What are the symptoms of refractive error in children?

• Usually, infants will not be able to express themselves if they cannot see.
• But, as parents what could be noted is, lack of eye contact and a social smile on their faces while looking at a familiar face, they may even face difficulty in replicating the facial expressions.
• Among toddlers and pre-schoolers, one could observe them watching television sitting close to it, squeezing their eyes while looking at something or even developing a certain head posture while looking at the distant things.
• In school going children, the teacher may notice their difficulty in copying from the blackboard or the children may themselves report their inability to copy correctly or at all.

How is refractive error diagnosed?

Diagnosis of refractive error is very simple. The child is asked to read a visual acuity chart, in preverbal children, some different methods along with the use of lenses help in determining the refraction. In a few children, some additional tests could be carried out to confirm the power.

How is refractive error treated in Children?

It is usually treated by prescribing corrective lenses in the form of spectacle or contact lenses.

• An eye allergy is otherwise known as allergic conjunctivitis. It is more common in children than in adults.
• According to a recent epidemiological survey, about 25% of the population in India suffers from allergic conjunctivitis, out of which children contribute to a significant number.
• Allergy is usually caused by pollen or allergens in the environment that make direct contact with the surface of eye and trigger inflammation which eventually results in symptoms.
• In 2001, it was observed that around 2% among children ended up with permanent vision loss and around 8% of children ended with corneal blindness as a consequence of allergic conjunctivitis.

What causes the allergy?

• There could be more than one cause for the eye allergy. Environmental pollution in India stands out to be a major contributor.
• However, the allergy could be caused due to seasonal variations, geographic relocations, and secondary to allergic rhinitis and could be associated with asthma.
• Some children develop an allergy as a result of using certain medications.
• Children exposed to the dry environment such as in tropical regions like India are more vulnerable to this condition.

What are the symptoms associated with eye allergy?

Itching, redness and watery eyes are quite common symptoms associated with an eye allergy. In some cases, a yellow mucus component may also be found.

How is it diagnosed?

A complete eye examination with the help of a microscope will help the pediatric ophthalmologist diagnose this problem.

How is this condition treated?

• This condition could be treated with eye drops and steroids.
• Following protective measures; such as wearing protective glasses while going outdoors, cold compression and avoiding pollution and dust could be of great help.
• In very severe conditions children may need injections in the inner surface of the eyelids.
• If the allergy in children is not monitored and handled with vigilance, there could be some associated complications also.

• Strabismus or squint or crossed eyes affects about 3 to 4 % of children in India. Many children manifest strabismus at a very early age.
• The condition is concerning as it could result from a very simple eye problem to a much-complexed one, such as amblyopia or neurological or brain-related problem.
• Like any other eye condition, early diagnosis and subsequent appropriate treatment early on is very significant.
• Strabismus could be a sign that the child may have another eye condition like the refractive error or lazy eye or eye muscle imbalance.
• It also indicates the possibility of poor vision in one of the eyes, structural abnormalities like underdevelopment of optic nerve, issues in the brain and in very rare cases eye cancer.

How to identify the squint in a child?

• Mostly it is very simple to identify strabismus in a child as the eyes are crossed and not aligned properly.
• While in some children it may be obvious, few others may exhibit squint intermittently, like; at the time of waking up, before bedtime, during sickness or while daydreaming.
• Some children may even report double vision if the squint is not present at the time of birth.

How do we treat the squint?

• Treatment of squint varies from person to person, depending on the cause and nature of the condition.
• While visiting an ophthalmologist, you may expect a comprehensive eye test followed by measurement of squint using a prism. Some children will require MRI Scan of the brain. The latter will only be advised if indicated medically, based upon the clinical presentation of symptoms.
• Based on the findings, the most appropriate plan of treatment will be decided by the pediatric ophthalmologist. Squint is usually treated with the use of prescribed glasses, surgery, and the combination of both; glasses as well as surgery and with prism glasses prescribed for double vision.