Common Pediatric Eye Problems
Children can get almost every kind of eye disease that adults get, from glaucoma to retinal detachments. However, the most common reasons for a referral are amblyopia and strabismus. Other commonly treated conditions in children are lacrimal duct obstructions, congenital cataracts, and just needing glasses. Retinopathy of prematurity (ROP) is a special condition that is treated in conjunction with our retina service.
Amblyopia
Amblyopia is the most common cause of vision loss in the United States, and also the most preventable. Amblyopia means "weak vision" and refers to a healthy eye that is not seeing to its full potential because it has lost connections to the brain. This usually occurs either because of strabismus (see below) or because the eye is very out of focus.
The first step in treating amblyopia is recognizing that there is a problem. Children usually do not complain of poor vision in one eye, and many times amblyopia is discovered during a screening examination. Treatment may involve patching one eye, putting drops in one eye, and/or using eyeglasses. Rarely there is a role for surgical intervention as well.
As with other pediatric eye conditions, the earlier the problem is recognized, the more hope there is for restoring normal vision.
Strabismus
Strabismus in Children
Strabismus refers to any misalignment of the eyes, such as a "crossed" or "wandering" eye. Most children with strabismus are otherwise healthy children, although some have specific neurologic conditions that lead to abnormal eye movements.
Some strabismus can be treated with glasses and/or patching, but many children require surgery to improve the alignment of the eyes. Benefits of strabismus surgery can include an improvement in depth perception, an expansion of visual field, an improved ability to communicate with other people through eye contact, and overall improvement in self esteem.
Strabismus surgery involves changing the way the eye muscles interact with the eye, usually by removing the muscles from the white of the eye, and reattaching them in a different position.
Adult Strabismus
Just like in children, strabismus in adults refers to a misalignment of the eyes.
There are roughly two types of adult strabismus: (1) childhood strabismus that was either untreated or has re-occurred; and (2) strabismus caused by an acquired medical condition. These conditions come in many forms, and can be neurologic (e.g. stroke, nerve palsy), neuromuscular (e.g. myasthenia gravis), orbital (e.g. Grave's disease, orbital tumors), or ophthalmologic (e.g. after cataract or retinal surgery). Adults who have strabismus from other ophthalmologic or neurologic conditions are managed in conjunction with the physician treating the underlying condition.
The problems reported by adults with strabismus, and the benefits of treatment, are often quite different from their pediatric counterparts. Adults who have a new misalignment of the eyes may have double vision, which younger children rarely experience, and loss of depth perception. Many adults with strabismus are very aware of maintaining poor eye contact with others, and would benefit from an improved position of the eyes.
The treatment of adult strabismus may be a combination of prisms, surgery, and treating the underlying condition.
Cataracts
A cataract is a loss of clarity of the lens inside the eye. A cataract affects vision by preventing the light entering the front of the eye from forming a clear image on the retina in the back of the eye. Although cataracts are common in older adults, some people are actually born with cataracts or develop them during childhood. Some cataracts are genetic (inherited from parents), some are associated with other medical conditions or infections, and some have no known cause.
A very severe cataract can be seen as a white appearance to the pupil of the eye, but less severe cataracts may not be readily apparent to family and friends. Screening examinations at birth and early in life may reveal a difference in the way light reflects off the back of the eye, and may be the first sign of a problem. For cataracts that develop later in childhood, a decrease in vision may be reported.
Cataracts in infancy require urgent evaluation because the first few months of life are crucial to the developing visual system. Severe cataracts in both eyes must be removed surgically very early in life to allow useful vision to develop. Some cataracts can be managed without surgery.
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