Eye Problems In Childhood

The eyes of a neonate are normally examined for such problems as congenital glaucoma and congenital cataracts . However, children can suffer from many different kinds of vision problems that can seriously affect their development in other areas. There is a long list of illnesses and injuries that can cause vision problems. Sometimes the damage is in the eye itself and sometimes it's in the part of the brain that receives messages for sight. When a baby is born with severe vision problems or blindness, the cause is often one of the following:

• An infection before birth.
• Too little oxygen reaching the brain before or during birth.
• A physical injury (trauma) around the time of birth.
• A genetic disease .

As children grow, some of the most common vision problems seen by parents are crossed eyes , cataracts and nearsightedness . Other eye problems include conjunctivitis and severe bacterial eye infections (such as periorbital cellulitis , and orbital cellulitis .

1. Amblyopia (crossed eyes) describes below normal vision in one or both eyes. It may stem from visual problems early in life that result in developmental disorders such as uncorrected difference in visual acuity between each of the two eyes ( lazy eye ) or misalignment of the eyes ( strabismus ). Amblyopia is a common condition that affects approximately 4% of children before age 6. Untreated, up to 50% of children with this condition will develop secondary visual loss. Farsightedness, nearsightedness, astigmatism and cataracts can also result in amblyopia.
   In amblyopia, the strong eye becomes dominant and maintains good vision while the weak eye fails to develop a clear visual image. An infant and toddler up to age 3 is at greatest risk, but amblyopia can occur up to age 9 when full visual stability has been achieved.
2. Cataracts are dense, cloudy areas in the lens of a child's eye. The lens is normally clear and its job is to focus images on the retina (the place at the back of the eye that transforms images into nerve impulses that travel to the brain). When cataracts block out parts of the lens, the child's lens cannot focus images clearly on the retina, and this causes vision problems.
   Eye trauma (physical injury to the eye) is one important cause of cataracts in children. Cataracts are often seen in children who are victims of child abuse. Steroid medicines can also cause cataracts. So can certain metabolic diseases .
3. In nearsightedness , also called myopia , a child has problems seeing objects that are far away. Nearsightedness tends to run in families, and it happens because of a simple physical problem. In a nearsighted eye, images fall short of the retina and come out blurry.
   Nearsightedness is common in infants, pre-schoolers and in pre-term infants. A family history also predisposes a child to this condition. One in five persons needs to wear eyeglasses for nearsightedness. Children often become nearsighted at about age 12, and their condition may get worse as they go through their teens. After age 20, their vision usually stabilises.
   Farsightedness , also called hyperopia , is the reverse of the above. The child has problems seeing objects that are near. In this condition the visual images fall behind the retina. A family history of farsightedness is a risk factor.

Diagnosis and Treatment

When a baby is born with eyes that have developed abnormally, the child's vision can be tested immediately. Ophthalmologists (eye-doctors) use specially designed vision tests for children who are too young to say how much they can see. In infants with normally formed eyes, parents can check the child's vision at home by watching how the baby's eyes follow their faces, a moving toy or mobile. Remember, all babies are naturally nearsighted until they are about 3 months old many babies occasionally have crossed eyes as their eye co-ordination develops until about the same age. However, after the first 3 months or thereabouts, the baby's eyes should be able to follow a moving object at a distance of about 20 cm (8 inches) from their face (for some milestones in a child's first year, go here ). When children are about 3 years old, they are usually old enough to take a simple vision test using picture cards.

A child with misalignment of the eyes should start treatment before age 2. For several hours each day, the child wears a patch over the "good" eye. This forces the "lazy" eye to work harder. Children with severely crossed eyes sometimes need surgery to shorten the muscles around the eye. This surgery should bring the crossed eyes back into alignment, but is also best performed before a child is 2 years old.

Nearsighted children can wear eyeglasses or contact lenses to correct their vision. Also, a new type of surgery, called radial keratotomy , is now being used to treat nearsightedness. In radial keratotomy, small cuts are made in the cornea to flatten its shape and help correct nearsightedness. Experts are still evaluating the risks and results of this new surgery. A farsighted child may accommodate to the condition if it is mild. If more serious, the child may squint, rub her eyes or be uninterested in reading. Eyeglasses or contact lenses can rectify the problem.

The information in this page is presented in summarised form and has been taken from the following source(s):
1. Intelihealth.com, Children's Health Section: http://www.intelihealth.com/