Pediatric ophthalmology is a sub-specialty of ophthalmology concerned with eye diseases, visual development, and vision care in children. Pediatric ophthalmologists focus on the development of the visual system and the various diseases that disrupt visual development in children. Pediatric ophthalmologists also have expertise in managing the various ocular diseases that affect children. Pediatric ophthalmologists are qualified to perform complex eye surgery as well as to manage children’s eye problems using glasses and medications. Children may not complain if they do not see out of one or both eyes. Sometimes the only clue may be poor performance in School, as well viewing the blackboard at a very close distance. Hence all children need an eye exam at the time of starting Schooling. Of the eye problems in children, the most important are Refractive Errors, Squint and Amblyopia.
Eye problems in Children- Children experience a variety of eye problems, many quite distinct from adult eye diseases. Pediatric ophthalmologists are specially trained to manage the following disorders:-
a) Infections (Conjunctivitis)- Conjunctivitis, also known as Pink Eye, is inflammation of the outermost layer of the white part of the eye and the inner surface of the eyelid. It makes the eye appear pink or reddish. There may also be pain, burning, scratchiness, or itchiness. The affected eye may have increased tears or be “stuck shut” in the morning. Swelling of the white part of the eye may also occur. Itching of the eye is more common in cases due to allergies. Conjunctivitis can affect one or both eyes.
b) Strabismus- is a misalignment of the eyes that affects 2-4% of the population; it is often associated with amblyopia. The inward turning gaze commonly referred to as “crossed-eyes” is an example of strabismus. The term strabismus applies to other types of misalignments, including an upward, downward, or outward turning eye.
c) Amblyopia (Lazy Eye)- occurs when the vision of one eye is significantly better than the other eye, and the brain begins to rely on the better eye and ignore the weaker one. Amblyopia affects 4% of the population and is clinically diagnosed when the refractive error of one eye is more than 1.5 diopters different from the other eye (anisometropia) or one of the eye is misaligned for a long period of time (Strabismus). The management of amblyopia involves correcting of significant refractive errors and using techniques that encourage the brain to pay attention to the weaker eye such as patching the stronger eye (occlusion therapy).
d) Ptosis- is a drooping or falling of the upper eyelid. The drooping may be worse after being awake longer, when the individual’s muscles are tired. This condition is sometimes called “lazy eye”, but that term normally refers toamblyopia. If severe enough and left untreated, the drooping eyelid can cause other conditions, such as amblyopia or astigmatism. This is why it is especially important for this disorder to be treated in children at a young age, before it can interfere with vision development.
e) Retinopathy of prematurity (ROP)- or Terry syndromeis a disease of the eye affectingprematurely-born babies generally having received intensive neonatal care, in which oxygen therapy is used on them due to the premature development of their lungs. It is thought to be caused by disorganized growth of retinal blood vessels which may result in scarring and retinal detachment. ROP can be mild and may resolve spontaneously, but it may lead to blindness in serious cases. As such, all preterm babies are at risk for ROP, and very low birth weight is an additional risk factor. Both oxygen toxicity and relative hypoxia can contribute to the development of ROP.
f) Nystagmus- is a condition of involuntary (or voluntary, in rare cases) eye movement, acquired in infancy or later in life, that may result in reduced or limited vision. Due to the involuntary movement of the eye, it is often called “dancing eyes”. In a normal condition, while the head rotates about any axis, distant visual images are sustained by rotating eyes in the opposite direction on the respective axis. The semicircular canals in the vestibule sense angular acceleration. These send signals to the nuclei for eye movement in the brain. From here, a signal is relayed to the extraocular muscles to allow one’s gaze to fixate on one object as the head moves. Nystagmus occurs when the semicircular canals are being stimulated while the head is not in motion. The direction of ocular movement is related to the semicircular canal that is being stimulated.
g) Paediatric Glaucoma- is glaucoma that develops due to ocular hypertension and is evident either at birth or within the first few years of life. It is caused due to abnormalities in the anterior chamber angle development that obstruct aqueous outflow in the absence of systemic anomalies or other ocular malformation. The typical infant who has congenital glaucoma usually is initially referred to an ophthalmologist because of apparent corneal edema. The commonly described triad of epiphora (excessive tearing), blepharospasm and photophobia may be missed until the corneal edema becomes apparent.