Paediatric ophthalmology is a speciality in ophthalmology dealing with eye diseases, visual development and vision care in children.

Various eye diseases affect children in ways that are quite distinct from the adult, and fortunately, most are treatable if detected early.

It is a fact that more than 80% of the information a child receives is obtained visually. Early detection and treatment of eye diseases are of the utmost importance in promoting normal visual development and in preventing significant visual loss.

Below are a few common eye conditions that are encountered by the ophthalmologist.

Lazy Eye

“Lazy eye” or amblyopia is reduced vision in an eye that has not received adequate use or visual stimulation during early childhood. Commonly, it results from either a “squint” or a difference in image quality between the two eyes due to refractive errors.

In both cases, one eye becomes dominant, suppressing the image on the other eye. If this condition persists, the weaker eye may eventually become “impractical”.

Before treating amblyopia, we have to treat the underlying cause first. Spectacles are frequently prescribed to improve focusing of the eyes, and eye muscle surgery is performed to straighten the eyes.

Subsequently, amblyopia treatment is carried out by patching or occluding one eye for a period ranging from weeks to years. The idea is to force the lazy eye to work, thereby strengthening its vision.

Alternatively, topical eye drops may be used to blur the vision of the “good eye” and force the lazy one to work, but this is a less successful approach.

An amblyopic eye may never develop good vision and may even become functionally blind if not treated early.

Squinting

Another common condition encountered is misalignment of the eyes, better known as a squint (strabismus), whereby the eye appears crossed or drifts in respect to the other eye.

The crossing may be occasional or constant. Signals from the crossed eye are “turned off” by the brain to avoid double vision, and will later on lead to lazy eye (amblyopia) and/or loss of three-dimensional or stereo vision.

Treatment depends on the severity and type of squint, and encompasses glasses, patching of the eye, and even corrective eye/strabismus surgery.

It is a misnomer to think that a child can grow out of strabismus on its own and early treatment is imperative.

Short- And Long-Sightedness

Children, spectacles, short-sighted, eye problem, Star2.com

Short- and long-sightedness can occur in children from a young age, and can be corrected with prescription spectacles, as seen in this filepic posed by models.

Abnormal refractive states of the eye such as myopia (short-sightedness) and hyperopia (long-sightedness) can occur in children from a very young age.

Refractive errors cause incorrect focusing of light onto the retina, leading to blurry images.

As a result, the child may complain of frequent headaches, eye strain and difficulty with near or distant vision.

Late detection and correction of refractive errors can ultimately lead to lazy eye.

Altogether, this can be avoided simply by prescribing corrective spectacles.

Cat Eye

A child may have a white “cat eye” (leukocoria), which is more noticeable in photographs. Amongst the commonest cause of this in children is cataract.

A cataract is an opacity of the lens in the eye. It can develop during pregnancy or in early childhood, and it can affect one or both eyes.

Other signs to look for in a child with cataracts include abnormal rapid eye movements, eye misalignment, or merely a child who is unable to see, particularly if both eyes are affected.

The key difference in managing a child with cataract in comparison to adults is that it is crucial that the child is referred early so that surgical treatment can be carried out without delay to avoid permanent visual loss due to lazy eye. The earlier the surgery is performed, the better the visual outcome.

Leukocoria is also an ominous sign of another more serious ocular pathology – retinoblastoma.

It is vital that all children with leukocoria be examined because of the potential life-threatening nature of retinoblastoma, which is the most common eye cancer in children.

Most of the time, vision problems in children are not evident, and the best way to detect them early is to schedule routine comprehensive vision screenings with an ophthalmologist.

Nevertheless, parents, as well as teachers, should be aware of signs that a child’s vision is affected, such as sitting too close to the television, squinting of the eye or tilting of the head, frequent eye rubbing, excessive tearing or glaring, and receiving lower grades than usual.

It is advisable that all children should have their eyes screened at six months of age, followed by a second eye exam at age three, and once more before starting school.

Children with risk factors such as history of premature birth or low birth weight should have their eyes examined earlier than six months of age followed by more frequent eye exams throughout childhood.

Most of the eye diseases in children can be preventable or treated if detected early. Do include eye checks as part of your child’s routine health checks.

Prof Dr Visvaraja Subrayan is a senior consultant ophthalmologist. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, visit www.mypositiveparenting.org or e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.