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Common Vision and Eye Problems
Falsely Misaligned Eyes (pseudostrabismus)
Sometimes infants appear to have crossed eyes, yet the
eyes are truly straight. The cause for pseudostrabismus is
presence of a wide nasal bridge or extra folds of skin
between the nose and the inside of the eye that make the
child have a cross-eyed appearance. Most children outgrow
this problem, but you should contact your doctor for an
examination. Your pediatrician can tell whether a child
has misaligned eyes or just pseudostrabismus, but in some
instances, a visit to an ophthalmologist is necessary for
further tests.
Misaligned Eyes (strabismus)
With strabismus, the eyes are not aligned. Strabismus is
quite common and occurs in about 4% of children. One eye
may gaze straight ahead while the other eye turns inward,
upward, downward, or outward. When an eye turns inward,
the child has "crossed" eyes (esotropia). There are two
common causes for esotropia. Some children are born with
crossed eyes (or develop it shortly after birth), and in
this situation the muscles are too tight. Treatment for
this most commonly involves surgery on the eye muscles,
generally performed prior to the age of 2.
The second most common cause for esotropia is excessive
farsightedness. This problem can be present at birth, but
most commonly occurs between the age of 2 and 6 years.
This type of esotropia is corrected with glasses.
When an eye turns outward, the child has exotropia.
Exotropia may be present from birth, but most commonly is
seen in children 2 to 7 years of age. Generally the eyes
turn out on rare occasions at first but with time more
frequent outward turning of the eyes is noted. Children
with exotropia occasionally squint one eye when exposed
to bright sunlight. The treatment for large amounts of
exotropia is usually eye muscle surgery.
Children with misaligned eyes will generally turn off the
vision in the turned eye so that they are not plagued
with double vision. Children with strabismus should have
a careful examination by an ophthalmologist because
untreated strabismus may lead to a lazy eye (amblyopia)
or loss of depth perception. Rarely, strabismus may
indicate a more serious condition, such as cataract or
eye tumor (retinoblastoma).
Lazy Eye (amblyopia)
Lazy eye is reduced vision from lack of use in an
otherwise normal eye. It usually happens only in one eye.
Any condition that prevents a clear image can interfere
with the development of vision and result in amblyopia.
Amblyopia is common, affecting about 2% of children. Some
causes of amblyopia include strabismus, droopy eyelids
(ptosis), cataracts, or refractive errors. Because early
treatment offers the best results, your pediatrician will
refer you to an ophthalmologist.
Cataract (cloudy lens)
A cataract is a clouding of the eye's normally clear lens.
The lens is located behind the pupil and helps focus
images on to the back of the eye (retina). Cataracts may
be present at birth or may appear later in life. Injury
may also cause this condition. Early detection and
treatment are crucial in infants and children so that
normal visual development can occur. For this reason,
most cataracts should be surgically removed soon after
they are discovered. It should be noted that cataracts in
infants and children are uncommon and not related to
cataracts that occur in adults.
Glaucoma (elevated eye pressure)
Glaucoma is a condition in which the pressure inside the
eye is too high. If left untreated, glaucoma will
eventually lead to total blindness. Warning symptoms are
extreme sensitivity to light, tearing, and persistent pain.
Signs include an enlarged eye, cloudy cornea, and lid
spasm. If any of these are present, your pediatrician
will refer you to an ophthalmologist immediately.
Glaucoma in childhood usually requires surgery to prevent
blindness.
Tearing
The tear duct system, which allows the tears to drain from
the eyes into the nose, usually opens in the first few
months of life. In some infants, however, the system
remains blocked, resulting in the eyes overflowing with
tears and collecting mucus. Tearing may result from other
ocular conditions, the most serious of which is glaucoma
(see above). If your child suffers from continued tearing
or watering from the eyes, please consult your
pediatrician. Gentle massage of the tear duct can
occasionally assist in relieving the blockage. If massage
and observation are unsuccessful, a tear duct probe or
more involved surgery is occasionally required.
Ptosis (droopy eyelids)
Ptosis refers to a situation in which the eyelids are not
as open as they should be. This situation is caused by a
weakness of a muscle that opens the upper eyelid. When
ptosis is mild, it is just a cosmetic problem. However,
ptosis can interfere with vision if it is severe enough to
block the vision in the eye. In infancy, it is important
that ptosis be eliminated so that vision will develop
normally. Correction of ptosis usually requires surgery
on the eyelid(s).
Blepharitis (swollen eyelids)
Blepharitis refers to an inflammation in the oily glands
of the eyelid. This usually results in swollen eyelids and
excessive crusting of the eyelashes, most evident in the
morning. Tenderness of the eyelids and a foreign body
sensation in the eye may occur as well. Blepharitis can
be treated with warm compresses and eyelid scrubs using
baby shampoo. If an infection is present, antibiotics may
be necessary. If any of these findings are present, please
consult your pediatrician.
"Pink Eye" (conjunctivitis)
Pink eye appears as a reddening of the white part of
the eye. It is usually associated with excessive tearing,
a discharge, and a foreign body sensation in the eyes.
Conjunctivitis has many causes and can occur at any age.
In infants and children, pink eye is usually caused by a
viral or bacterial infection. In older children, it may
also be caused by allergy. Depending on the cause of
conjunctivitis, eye drops or ointment may be indicated.
If your child has conjunctivitis, regular hand washing
will help prevent the spread of the infection to other
family members. If conjunctivitis occurs, call your
pediatrician's office.
Corneal Abrasion (scratched cornea)
A corneal abrasion refers to a scratch of the front clear
surface of the eye (cornea). These abrasions are very
painful and usually associated with light sensitivity and
tearing. Treatment consists of antibiotics to prevent
infection and a patch to allow for the healing of the
scrape. This may be monitored by your pediatrician
although more serious injuries often need follow up by an
ophthalmologist.
Nearsightedness (myopia)
Children who are "nearsighted" see objects that are close
to them clearly, but objects that are far away are unclear.
Nearsightedness is very rare in infants and toddlers, but
becomes more common in school-age children. Eyeglasses
will help clear the vision but will not "cure" the problem.
Despite using glasses, near-sightedness will generally
increase in amount until the mid-teenage years so that
periodic follow-up examinations by an ophthalmologist are
indicated.
Farsightedness (hyperopia)
A small degree of farsightedness is normal in infants and
children. It does not interfere with vision and requires
no correction. It is only when the farsightedness becomes
excessive, or causes the eyes to cross, that glasses are
required.
Astigmatism
Astigmatism is the result of an eye that has an irregular
corneal shape. Astigmatism may result in blurred vision.
Children with astigmatism may need glasses if the amount
of astigmatism is large.
Learning disabilities are quite common in childhood years
and have many causes. The eyes are often suspected but are
almost never the cause of learning problems. Your
pediatrician may refer you for an evaluation by an
educational specialist to pinpoint the exact cause.
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