If your childs’ eye number is increasing rapidly, see a paediatric ophthalmologist today.
Articles & News
If your childs’ eye number is increasing rapidly, see a paediatric ophthalmologist today.
What is vision screening?
Vision screening is an effective method to identify children with visual impairment or eye conditions that are likely to lead to visual impairment so that a referral can be made to a Paediatric Ophthalmologist/ Child eye specialist for further evaluation and treatment.
How is vision screening performed?
There are a number of methods used to screen a child’s vision.
Inspection of the eye, pupils and red reflex
This method can be used on children of all ages. At each well child visit, the examiner uses a flashlight to inspect the eyes for abnormality of shape or structure and to detect irregularity in pupil shape. An ophthalmoscope is used to observe the red reflex of the eye.
This is an automated technique that uses the red reflex to identify many types of eye problems. An advantage of this screening is that it is quick and thus useful in very young children. The newest generation of photoscreeners provides immediate information about the eye condition.
Corneal light reflex
This simple test can be performed on any child using a penlight. As a child focuses on a penlight, the position of the light reflection from the front surface (cornea) of the eye is observed.
This test detects misalignment of the eyes. While the child focuses on a target, the examiner covers each eye sequentially to look for a “shift” in the alignment of the eyes.
Subjective visual acuity testing
Special vision charts are used to evaluate childs’ vision.
What kinds of eye problems can be detected on a vision screening?
The main goal of vision screening is to identify children who have or are at risk to develop amblyopia, which can lead to permanent visual impairment unless treated in early childhood. Other problems that can be detected by vision screening include squint, cataract, glaucoma, refractive errors, ptosis and other more serious conditions such as tumors or neurological diseases.
Who performs vision screening?
Pediatricians, family physicians, nurses and technicians can perform vision screening at regular visits. In addition, many day care programs, schools and health departments offer vision screening programs for children.
What if a child fails his or her vision screening or cannot cooperate for vision screening?
If a child fails a vision screening at any age, the child should be referred for a comprehensive eye examination.
By age 3 or 4 years, most children are able to cooperate for subjective visual acuity testing using an eye chart. If a child is unable to cooperate for visual acuity testing at age 3, a second attempt should be made within 6 months. If retesting is impossible or inconclusive, then the child should be referred to paediatric ophthalmologist/ child eye specialist.
What is Nerve palsy?
Nerve palsy is a lack of function of a nerve. Nerve palsy may cause a complete or partial weakness or paralysis of the areas served by the affected nerve. Incase a nerve palsy happens in the eye, the eye movements get affected and person sees things double. One can have a sixth, third or fourth nerve (Superior Oblique) palsy. Most common is sixth nerve palsy
What are some causes of Nerve palsy?
A nerve palsy can be congenital, traumatic, or due to vascular disease (hypertension, diabetes, strokes, aneurysms, etc). They can also be due to infections, migraines, tumors, or elevated intracranial pressure.
What are the symptoms of Nerve palsy?
3rd, 4th, 6th nerve palsies can limit eye movements and produce diplopia/ double vision.In addition to limited eye movements, a 3rd nerve palsy can also cause ptosis (droopy eyelid) or mydriasis (abnormally dilated pupil).
Is there any treatment?
Some cases may resolve spontaneously. In other cases, diplopia may be relieved with prism glasses, occlusion therapy, botulinum toxin (Botox), or surgery.
What is keratoconus?
Keratoconus is a degenerative condition in which the normally round, dome-shaped cornea (clear front surface of the eye) progressively thins, causing a cone-like bulge to develop. It can progress over a 10-20 year period.
What causes keratoconus?
The exact cause of keratoconus is not known. Abnormalities in the collagen structure that make up the cornea may also contribute to the development of keratoconus. Keratoconus is more common in patients with Down’s Syndrome and severe allergies, perhaps due to an increase in eye rubbing.
What are the symptoms of keratoconus?
In early keratoconus, patients typically notice blurring of their vision, often worse at night. There may be photophobia (sensitivity or light). Patients often complain of multiple ghost images as well as streaking and distortion around lights. The condition is usually painless, although pain and redness can occur if a corneal blister develops (hydrops). Scarring from hydrops can cause decreased vision.
How is keratoconus diagnosed?
Keratoconus is diagnosed by a careful eye examination by an ophthalmologist. Vision will be measured, and a slit lamp and dilated examination will be performed. Corneal topography or mapping helps to confirm the diagnosis.
How is keratoconus treated?
Mild cases of keratoconus may be treated with glasses or soft contact lenses. Most cases require rigid gas permeable contact lenses to provide the best vision. About 10-25% of patients may progress with decreased vision and scarring and require corneal transplantation (Penetrating Keratoplasty). Newer treatments are being done with the insertion of corneal rings (Intacs) which may help to reduce the cornea’s cone shape, and Corneal Collage Crosslinking with Riboflavin (CCR), a non-surgical treatment which causes new bonds to form across collagen bands, increasing corneal strength. LASIK is generally not recommended.
Why do children get headaches?
Headaches in children are common and usually not serious. Causes include migraines, stress and tension headaches, trauma, sinus disease and eye problems. Certain foods with nitrate preservatives can trigger headaches. Brain tumors in children as a cause for headaches are extremely rare, and are usually associated with additional neurologic symptoms such as dizziness and fits.
How are children with headaches evaluated?
Children should have a thorough physical examination with a pediatrician. He/ she may refer to a neurologist. It is helpful to keep a headache diary so that possible triggers (certain foods or activities) can be discovered. Sometimes an EEG and/or MRI Brain is needed to rule out the cause.
If the pediatrician finds no obvious medical cause for the headaches, a referral to an ophthalmologist is required to perform a complete eye exam. Examination includes refractive error (the need for glasses), eye alignment, and binocularity (the ability to use both eyes together).
How do eye problems cause headaches in children?
Hyperopia (farsightedness) requires extra effort to focus clearly while reading. This can sometimes lead to fatigue and headache. Glasses can reduce the effort required to see clearly at near and improve the headache.
Other causes may be convergence insufficiency, acute infections and inflammation of the eye or acute attack of glaucoma. In children acute attack of headache and redness can happen after ingestion of antiepileptic drugs like topiramate.
What is a fourth nerve palsy?
The fourth cranial nerve innervates the superior oblique muscle, so weakness of the nerve is also known as superior oblique palsy.Weakness of the superior oblique muscle causes a combination of vertical, horizontal and torsional misalignment of the eyes. This condition is usually unilateral (one eye) but can be bilateral (both eyes).
Does superior oblique palsy cause double vision (diplopia)?
Superior oblique palsy may cause double vision because of misalignment of the eyes (the brain perceives an image from two different directions). The double visionmay be vertical (one image on top of the other), diagonal (vertically and horizontally separated) and less often torsional (rotated or twisted). The torsional phenomenon occurs more frequently with acquired cases superior oblique palsy.
Is the head tilted with superior oblique palsy?
Head tilt and/or turn is common with superior oblique palsy. The abnormal head position allows better alignment of the eyes, sometimesaiding in relief of diplopia. A child with a head tilt should be evaluated by an ophthalmologist for superior oblique palsy and other possible eye problems.
What causes superior oblique palsy?
Superior oblique palsy is most commonly congenital (present at birth) or may be associated with craniosynostosis. A common cause of superior oblique palsy is head trauma, including relatively minor trauma. A concussion or whiplash injury from a motor vehicle accident may be sufficient to cause the problem. Rare causes of superior oblique palsyare stroke, tumor and aneurysm.
How is superior oblique palsy treated?
During that period, diplopia can be managed with prism glasses. Prisms merge two images into one but do not strengthen the eye muscles. If prism is not effective, patching or covering one eye can alleviate the double vision. If the palsy does not recover over this 6 months period and if prisms are not able to adequately control the diplopia, surgery may be indicated.
What is esotropia?
Esotropia is in-turning of one or both eyes.
Is esotropia ever ‘normal’?
Esotropia in infants less than 4-5 months old frequently resolves spontaneously, especially when the misalignment is intermittent and small in magnitude. However, one should see a squint specialist if there is persistent or constant eye crossing immediately.
What problems can esotropia cause?
The effect of esotropia on the visual system depends on the frequency/severity of eye crossing and age. Eye crossing affects the ability of the eyes to work together. Older children and adults with a new onset esotropia often experience diplopia (double vision) and or decreased binocular visual field. Children can lose stereopsis (3-D vision) and binocularity (simultaneous use of the eyes) in addition to loss of vision in the crossing eye (amblyopia).
Are there conditions that increase the risk of esotropia?
Prematurity, a positive family history, and various neurological and genetic disorders increase the risk of eye misalignment. Also some systemic disorders like hyperthyroidism, diabetes cause squint.
How does a Pediatric Ophthalmologist/ Squint specialist evaluate a child with suspected esotropia?
After taking a careful history, the child eye doctor assesses the visual acuity in a manner appropriate for age. It is important to determine whether the acuity is equal in each eye or if one eye is stronger than the other. Squint, if detected, is quantified using prisms. The childs’ eye is assessed for any refractive error.
What are the treatment options for esotropia?
Treatment modalities used to realign the eyes include spectacles (sometimes with prism or bifocal), squint surgery (eye muscle surgery) or botulinum toxin.
What is endophthalmitis?
Endophthalmitis is an infection of the eyeball. Because the tissues within the eyeball are very delicate, endophthalmitis is very serious and can lead to blindness and even loss of the eye itself.
How does endophthalmitis occur?
There are two ways in which endophthalmitis occurs. Exogenous endophthalmitis is the most common form and occurs after penetration of the eyeball from trauma, surgery or erosion of an external eye infection into the eye. It is among the most serious complications of eye surgery. In contrast, endogenous endophthalmitis occurs when infectious organisms invade the inside of the eye from the bloodstream. This occurs more commonly in individuals with severe blood born infections, often when the immune system is compromised.
What are the symptoms of endophthalmitis?
The symptoms of endophthalmitis include progressive deterioration of vision, light sensitivity, pain and swelling around the eye. Endophthalmitis typically occurs between 2 and 5 days after surgery but some mild forms may occur weeks after surgery.
How is endophthalmitis diagnosed and treated?
Prompt diagnosis of endopthalmitis is essential. Evaluation, in addition to a regular eye exam, may include a needle into the eye to check for infection or to inject antibiotics directly into the eye. Topical eye drops, oral or intravenous antibiotics may be prescribed. If the infection is severe, a surgery called a “vitrectomy” may be performed to remove infectious material from the inside of the eye.
What is the prognosis from endophthalmitis?
Prognosis of endophthalmitis varies widely depending upon the severity of the infection, the organism involved and the amount of damage the eye sustains from inflammation and scarring. Mild cases of endophthalmitis can have excellent visual outcomes. Severe cases may result not only in loss of sight, but eventually in loss of the entire eye.
What is Duane syndrome?
Duane syndrome, also called Duane retraction syndrome (DRS), is a group of eye muscle disorders that cause abnormal eye movements. People with Duane syndrome have difficulty rotating one or both eyes outward (abduction) or inward (adduction).
What is the cause of Duane Syndrome?
Duane syndrome is due to miswiring of the eye muscles. In Duane syndrome, the sixth cranial nerve that controls the lateral rectus muscle (the muscle that rotates the eye out towards the ear) does not develop properly. dfThus, the problem is not primarily with the eye muscle itself, but with the nerve that transmits the electrical impulses to the muscle. There is also irregular innervation of a branch from the third cranial nerve, which controls the medial rectus muscle (the muscle that rotates the eye toward the nose). This is why abnormalities may be found in both left gaze and right gaze.
Who gets Duane syndrome?
Duane syndrome affects girls more often than boys. In addition, the left eye is more likely than the right eye to be affected. The reason for this is not known. Around 20% of Duane syndrome patients have both eyes affected. No particular race or ethnic group is more likely to be affected.
What are the other characteristics of Duane syndrome?
Squint, Abnormala head posture, Amblyopia (Lazy eye), Narrowing of palpebral fissure or smaller looking eye and abnormal upward or downward movements of eye.
Is Duane syndrome congenital (present from birth)?
Duane retraction syndrome is present from birth, even if it is not recognized during infancy. An abnormal head posture and strabismus are often visible in old photographs taken in early childhood.
When do we treat Duane syndrome?
Surgery for Duane syndrome is indicated for one of four reasons:
To reduce the squint
To eliminate a socially unacceptable head position
To eliminate a significant upshoot or downshoot
To eliminate disfiguring enophthalmos (Smaller looking eye).