Encyclopedia - Pediatric Wellness

Which childhood eye diseases are serious?
What are some common childhood eye problems?
When should a baby’s first eye exam take place?

Pediatric eye care begins at birth, when doctors and parents should be alert for congenital conditions and other problems. A newborn baby is vulnerable to infection, and it is standard to administer an antibiotic eye ointment in the first days of life. Some children may nevertheless have multiple infections or excessive tearing, because the tear duct that drains from the eye into the nose is not open properly. If this is the case, the duct can be opened easily by a pediatric ophthalmologist.

Which childhood eye diseases are serious?

A serious, but rare, newborn problem is an eye tumor called a retinoblastoma. It can occur in one or both eyes and requires radiation therapy or removal of the eye to prevent the tumor from spreading to the rest of the body. Retinoblastoma is fortunately rare although its incidence appears to be increasing. It is one cause of white pupil syndrome, in which the pupil of the eye is white, instead of the normal black.

Another cause is congenital cataract. The cataract must be removed within six weeks, or permanent vision loss may result.

There is another childhood cancer, rhabdomyosarcoma, which can make its appearance at age 2, causing a detectable bulge in the eyelid. Quick surgical removal is needed when it is detected.

One potential problem for babies born prematurely is retinopathy of prematurity (ROP), which can result if the blood vessels supplying the part of the retina governing peripheral vision are not fully developed at birth. High levels of oxygen can cause those blood vessels to grow abnormally, damaging the eye and perhaps causing retinal detachment. Any premature baby should be watched closely, by parents and an ophthalmologist, to detect ROP, which can be treated by laser therapy or cryotherapy, which is freezing the affected area. A baby with ROP should be followed over the years because the child runs a high risk of nearsightedness and strabismus, or crossed eyes.

What are some of the common childhood eye problems?

Any child is vulnerable to strabismus, which can result from poor coordination of the muscles that move the eyes. Untreated, strabismus can lead to amblyopia, or lazy eye, in which the two eyes are not used equally. Strabismus can also be a symptom of more severe disorders, including an injury, stroke, or a central nervous system disorder such as cerebral palsy. The doctor will evaluate the degree of strabismus by using prisms to determine the amount of eye crossing. Eye patches, glasses, or surgery can correct the condition.

Amblyopia occurs when the brain receives such divergent signals from the two eyes that the brain shuts off reception of one signal, causing deterioration of vision of one eye. Detected early, it can be treated by placing a patch over the good eye, forcing the brain to accept the signal from the other eye. The treatment can work even if the patch is worn for only a few hours a day. Surgery is sometimes needed, and eyeglasses may be needed before or after surgery.

When should a baby’s first eye exam take place?

Even if all appears to be well, ophthalmologists agree that a first eye examination should be conducted between the ages of 3 or 4, when the child can give coherent answers to questions, with another done when the child begins school. Parents should always be alert for signs of eye problems — frequent rubbing of the eyes, frequently closing one eye or covering it, problems doing work that requires close vision, frequent blinking or squinting, or complaints about bright lights. Reddened eyes, unusual sensitivity to light, and eye irritation can be symptoms of an eye infection. Color blindness or poor color vision can be detected only by an examination, because a child will not realize that he or she does not perceive colors normally. One of every 8 Caucasian boys and one of every 30 girls have some degree of poor vision. The incidence is lower for Asians, Native Americans, and African-Americans.

As a child starts reading, signs of vision trouble include:

Losing the place frequently
Skipping lines or small words
Moving the head instead of the eyes while reading
Using a finger to keep the place
A teacher’s report that the child has an attention problem while reading

Note that reading problems may be due to the learning disability, known as dyslexia, which can require a consultation with a neurologist.

During the early years, any child may suffer an eye injury, which can cause permanent damage to vision. The symptoms of an eye injury can include:

A change in the color of any part of the eye
Persistent redness or tear formation
Swollen eyelid
Double vision
Unusual sensitivity to light
Vision that is cloudy, blurred, doubled, or wavy
Eye pain
Sudden, temporary loss of vision

A child should be able to tell the parent about any blow to the eye.

To reduce the risk of eye injury, children should wear protective eyeglasses when playing sports, and they should avoid toys that can propel objects into the eye.

In general, parents should be watchful for indicators of eye trouble, and they should consult an ophthalmologist or pediatrician as soon as any are detected. An eye injury, blood in the eye, or a complaint by the child about inability to see may justify a trip to a hospital emergency room.