Paeditaric Ophthalmology

Pediatric ophthalmology is the specialized part of children’s vision problems. For this reason, the prevention and early detection of ocular pathologies in childhood is very important. The visual acuity of a child’s eye improves from birth.

At 3 years his visual acuity reaches 50%, reaching 100% at 5 years. For this reason, the first years of life until the age of 7 or 8 are crucial for proper visual development. During this period of life, it is essential to detect anomalies that prevent normal visual evolution and anomalies that, if not detected in time, could cause irreversible sequelae for life.

Dr. Puneet Solanki insists that not only the role of the doctor is important, but also that of the parents, who play a transcendental role because they are the first to detect signs in their child that something is wrong. works well and they should assess in time that their son needs an ophthalmological check-up.

An early diagnosis, followed by an adequate and effective treatment is the necessary way to guarantee our children a good visual quality in the future.

When to go to the ophthalmologist?

It will be necessary to visit the pediatric ophthalmologist in these cases:

• Premature delivery.
• If either of the parents has a refractive defect or ocular pathology such as glaucoma.
• If the baby’s eyes water frequently.
• If the whitish pupil is observed.
• If there is any deviation in any of the newborn’s eyes or drooping eyelids.

Visual diseases in children

Lazy eye or amblyopia

Amblyopia or lazy eye is one of the main causes of irrecoverable vision loss in developed countries.

This may be due to a refractive error (myopia, hyperopia, astigmatism), a strabismus, a cataract, or any defect that does not allow the eye to receive a sufficiently clear image.

Child squint

Childhood strabismus is the abnormal deviation of one or both of the child’s eyes in one of the gaze positions.

The parallelism of the ocular axes is lost, which causes an alteration of binocular vision. This lack of alignment means that both eyes cannot focus on the same point simultaneously. When this occurs in childhood, there is an adaptation phenomenon by which the brain selects the best quality image and disconnects the vision of the other eye, thus avoiding double vision that would appear as a consequence of not being able to see exactly the same image with both eyes. same image.

Lacrimal obstruction

Lacrimal obstruction in childhood, what we call congenital dacryocystitis, occurs when the lacrimal duct, which is the route of tear removal from the eye to the nose, is not fully formed at birth, it is blocked. Consequently, the child has constant tearing from birth and, on occasions, rheum.

We know that in most cases, approximately 90%, these obstructions are resolved spontaneously during the first months of life. For this reason, in principle, we carry out a conservative treatment with massages in the lacrimal sac area and antibiotic eye drops when necessary. Only in very few cases in which the obstruction is not resolved with these measures, we must perform a lacrimal probing.

During its diagnosis it is important to rule out congenital glaucoma, it is a pediatric glaucoma that tends to be bilateral, more frequent in males and is caused by malformations during development (in the trabeculum and neighboring structures). Congenital glaucoma will cause buphthalmus (increase in corneal diameter due to increased intraocular pressure).

Pediatric inflammations

The most frequent pediatric inflammations are:

• Blepharitis is an inflammation of the eyelid margin that can be associated with conjunctival and/or corneal disorders.
• Conjunctivitis can arise for viral, bacterial or allergic reasons.
• Keratitis or corneal ulcer is corneal inflammation due to dry eyes or caused by various infections.
• Cellulite is a periorbital inflammation that requires a quick diagnosis. The main cause in childhood is ethmoid sinusitis.
• Uveitis is an intraocular inflammation related to juvenile rheumatoid arthritis or other infectious processes.

Refractive errors

Refractive errors that can appear from childhood are myopia, astigmatism, and hyperopia. They cause a blurred vision, without sharpness. Its early detection is very important because it can lead to poor school performance and it must be taken into account that children may not complain, despite noticing poor vision, for fear of needing glasses.

Symptoms of childhood eye disorders

Some symptoms that may be a warning sign for parents to consult with a pediatric ophthalmologist are:

• Continuous tearing in one or both eyes.
• Frequent rheum when getting up.
• The pupil must be black, if it is white (leukocoria) or is not round, you must go to the ophthalmologist.
• Drooping of the upper eyelids (palpebral ptosis).
• Involuntary back and forth movements (nystagmus).

In addition, parents should look to see if their child leans too close to the paper when reading, looks away frequently when reading, rubs his eyes more than usual, or has a lot of headaches.

How to detect visual problems in my child?

There are different symptoms that should make us suspect that there may be a visual problem. The following is a simple test that can help us assess whether we should take our child to a pediatric ophthalmology consultation.

1. Have you noticed if your child averts one eye, even slightly?
2. Have you noticed if the child often winks with the same eye when he is in the street?
3. Does he turn his head when he pays attention to something?
4. Cover one eye and then the other. Do you notice differences when it comes to recognizing an object?
5. Do you get very close to the television or the paper when you draw?
6. Do you narrow your eyes when you look at something far away?
7. Do you blink frequently?
8. Do you complain of a headache in the afternoon?
9. Do you have red eyes very often?
10. Do you have flaking skin between the eyelashes or do you get styes frequently?

Answer yes to questions 1, 2 and 3.

If this occurs after six months of age, it is very likely that your child has a problem with strabismus. Do not neglect this disorder, however small it may be, vitamins and time do not fix it.

Affirmative answer to question 4.

Your child has a vision defect in one of the two eyes (lazy eye). He should see an ophthalmologist as soon as possible.

Affirmative answer to question 5.

All children tend to be closer to television and drawing. This detail without other symptoms does not imply vision defects

Answer affirmative to questions 6, 7, 8, 9 and 10.

Normally the child usually complains of seeing poorly when there is a serious refraction problem. If this is not the case and after your observations you have answered YES to all or at least two questions in this block, you should consult an ophthalmologist. He will indicate the necessary treatment.

Frequent questions

When should I do my child’s first eye exam?

At 3-4 years is the ideal age, provided that before we have not noticed any signs that call our attention.

Can a child’s vision problem influence school failure?

Yes. We know that a high percentage of school failures may coincide with visual disturbances, and that 20% of school-age children have visual problems.

Does a newborn see well?

When babies are born they already see, what happens is that they do not see like an adult; that is, they do not yet have a mature vision. Mainly they see relatively well everything that is approximately 30cm from them. As they grow, their vision improves and they learn to focus on the same point with both eyes at the same time and their eyes stop being asymmetrical. This happens from the second or third month.