Definition and Overview

A pediatric eye problem refers to any conditions or diseases, which are either congenital or acquired, that affect a child’s eyes or vision. Most of these problems specifically affect visual focus and alignment.

Fortunately, there is a wide range of treatment options available for these problems. When they are diagnosed and treated early, the risk of them progressing into adulthood is significantly minimized. Early treatment also makes the problems easier to treat as well as reduces the risks of complications.

Causes of Condition

  • Causes of Congenital Pediatric Eye Problems

Congenital eye problems are caused by abnormalities that occurred while the fetus is developing inside the womb. They can also be the direct result of genetic or hereditary conditions. Some examples are congenital cystic eye, which occurs when the globe of the eye fails to develop fully, or anophthalmos, wherein the entire optic vesicle fails to develop.

Irregularities during embryonic development are mostly attributed to factors affecting the mother during pregnancy and these include:

  • Exposure to drugs and/or alcohol
  • Infection – as an example, there is a high risk for a child to suffer from congenital cataracts if the mother suffers from a rubella infection during pregnancy.
  • Another congenital condition - One example is heterochromia, when the two irises are of different colors, which is linked with a condition called congenital Horner’s syndrome.
  • Causes of Acquired Pediatric Eye Problems

Some vision problems are acquired or developed during childhood. However, in most cases, there is an underlying cause, such as an illness, trauma, or, more commonly, an infection.

One example is a retinal hemorrhage, which may result from shaken baby syndrome, often linked either to head trauma or child abuse. However, this problem may also be caused by certain infections.

Another example of an acquired problem is a lazy eye, or when vision in one eye becomes compromised. This is often caused by a weakness in the affected eye, relative to the other eye. Over time, the stronger eye becomes more dominant, causing the brain to ignore signals from the weaker eye. Eventually, the nerve connections of the weaker eye will cease to develop, leading to complete vision loss.

Key Symptoms

The symptoms of pediatric eye problems tend to vary depending on the affected part of the eye. However, children are not readily able to inform parents of vision problems such as blurriness or an uneven focus. It may be that since their vision has always been that way, the child is not aware that there is a problem. Thus, parents should watch out for other signs, such as:

  • Squinting
  • Constantly rubbing the eyes
  • Having to stay too close to the television to see
  • Tearing
  • Redness and inflammation
  • Pus
  • Crusting
  • Bulging eyes
  • Drooping eyelids
  • Light sensitivity
    It also helps to bring the child to regular vision screenings at least once a year.

Some problems, however, have more pronounced symptoms. One example is crossed eye, also known as a wandering eye, a condition that affects up to 5% of children and is characterized by one eye drifting or appearing to be crossed with the other eye.

Who to See and Types of Treatments Available

Pediatric eye problems can be brought to the attention of the child’s pediatrician, who can make the referral to a pediatric ophthalmologist, if deemed necessary. Based on general guidelines for pediatric vision care, pediatricians should refer their young patients to a specialist if:

  • Visual acuity is less than 20/40
  • Visual acuity is significantly different between the two eyes
  • The child has a family history of pediatric eye problems
    Some optometrists and ophthalmologists also believe that parents should bring their children to an eye specialist for a comprehensive eye exam, especially if the child’s pediatrician does not include vision screenings during routine monthly checkups. Generally, vision screenings should begin at age 3.

If any pediatric eye problems are detected during a routine screening, the first step is to seek a comprehensive exam to determine the cause, extent, and possible treatment options, which include:

  • Eye patches – these work by covering the stronger eye to stimulate the weaker eye. With the stronger eye unable to function properly, the brain is forced to send better visual signals to the other eye. Once the weak eye starts performing better, the treatment can be stopped. This period usually takes up to a year, but may take longer for some kids.
  • Eye drops
  • Prescription lenses or corrective lenses – Prescription lenses help improve focus and misalignment issues. This option is typically recommended for patients with accommodative esotropia or the inward deviation of the eye.
  • Surgery – Some eye conditions may require surgery. One example is strabismus, or when the eyes are deviated or misaligned, which can be treated by surgically re-aligning the eyes. Another example is congenital or acquired cataracts, characterized by the clouding of the lenses, which can only be treated surgically.
    Using eye patches or eyeglasses at such an early age, when the child does not fully understand the need for them, can be difficult, so it is important for parents to provide the support and comfort the child needs. Despite this challenge, parents are encouraged to seek treatment as early intervention will give their children a chance at having a normal vision when they grow older.

When a child’s vision problem is caught early, corrective actions can be taken to completely reverse the problem. Also, children who receive treatment at a younger age generally recover faster and their vision is restored completely. Thus, most pediatric eye problems should be addressed before the child reaches the age of 9 or 10. When the problem is caught at a later time, there is a higher risk of permanent damage, which means the problem can no longer be corrected.

References

  • American Academy of Family Physicians: "Amblyopia: Causes & Risk Factors," "Amblyopia: Treatment."

  • American Optometric Association: "Infant Vision: Birth to 24 Months of Age."

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