What are the symptoms of refractive error in children?

Usually, infants will not be able to express themselves if they cannot see. But, as parents what could be noted is, lack of eye contact and a social smile on their faces while looking at a familiar face, they may even face difficulty in replicating the facial expressions. Among toddlers and pre-school children, one could observe them watching television sitting close to it, squeezing their eyes while looking at something or even developing a certain head posture while looking at the distant things. In school going children, the teacher may notice their difficulty in copying from the blackboard or the children may themselves report their inability to copy correctly or at all.

Refractive errors are treated by the use of glasses or contact lenses.

What is Strabismus?

Strabismus or squint or crossed eyes affects about 3 to 4 % of children in India. Many children manifest strabismus at a very early age. The condition is concerning as it could result from a very simple eye problem like glass power/refractive error to a much-complexed one, such as amblyopia, neurological or brain-related problem or even eye cancer. Like any other eye condition, early diagnosis and subsequent appropriate treatment early on is very significant.

How to identify the squint in a child?

Mostly it is very simple to identify strabismus in a child as the eyes are crossed and not aligned properly. While in some children it may be obvious, few other may exhibit squint intermittently, like; at the time of waking up, before bedtime, during sickness or while daydreaming. Some children may even report double vision if the squint is not present at the time of birth. It is a common superstition and a misconception that having squint is lucky!

How do we treat the squint?

Treatment of squint varies from person to person, depending on the cause and nature of the condition.

While visiting an ophthalmologist, you may expect a comprehensive eye test followed by measurement of squint using a prism. Some children will require MRI Scan of the brain. The later will only be advised if indicated medically, based upon the clinical presentation of symptoms.

Based on the findings, the most appropriate plan of treatment will be decided by the pediatric ophthalmologist. Squint is usually treated with the use of prescribed glasses, surgery, and the combination of both; glasses as well as surgery and with prism glasses prescribed for double vision.

Eye allergies in Children

An eye allergy is otherwise known as allergic conjunctivitis. It is more common in children than in adults. Allergy is usually caused by pollen or allergens in the environment that make direct contact with the surface of eye and trigger inflammation which eventually results in symptoms.

What causes the allergy?

There could be more than one cause for the eye allergy. Environmental pollution in India stands out to be a major contributor. However, the allergy could be caused due to seasonal variations, geographic relocations, and secondary to allergic rhinitis and could be associated with asthma. Some children develop an allergy as a result of using certain medications. Children exposed to the dry environment such as in tropical regions like India are more vulnerable to this condition.

What are the symptoms associated with eye allergy?

Itching, redness and watery eyes are quite common symptoms associated with an eye allergy. In some cases, a yellow mucus component may also be found.

How is this condition treated?

This condition could be treated with eye drops and steroids. Following protective measures; such as wearing protective glasses while going outdoors, cold compression and avoiding pollution and dust could be of great help. If the allergy in children is not monitored and handled with vigilance, there could be some associated complications also.

Pediatric Cataract

Yes you heard it right! Cataracts don’t just form in elderly people. They can occur in children by birth when they are congenital or can occur later if they are developmental or secondary to another disease. Cataract in pediatric age group can lead to lifelong vision diminution due to amblyopia if not treated at the right time. It can be detected as a white reflex in the pupil or the presence of a squint. The treatment involves cataract surgery with intraocular lens implantation that requires special expertise.

Amblyopia

Amblyopia or Lazy eye is a condition with underdeveloped vision in one or both the eyes during infancy. Children under the age of 8 are at much higher risk of developing Amblyopia, as the vision development almost stops at this age. There are chances of improvement in vision after the age of 8, but the extent to which it could improve depends on the prognosis at an early age. If not detected early and treated in time, Amblyopia can even result in permanent vision loss.

How do we detect Amblyopia?

A complete eye examination is warranted which includes vision testing in both the eyesfollowed by the refractive power testing to rule out if there is any refractive error such as hypermetropia, myopia and astigmatism. The eye alignment will be assessed to see if there are any squint which could be a reason for amblyopia which will be followed by general structural examination using a microscope and ophthalmoscope.

How is amblyopia treated?

The amblyopia could be treated with the use of glasses or contact lenses, eye patching, eye exercises, eye drops and in some cases surgical treatment may be required.

Eye Patching: Eye patches are used to occlude the eye with better vision to stimulate the lazy eye to see more. The eye with better vision is patched with the help of a biocompatible eye patch when the child is wearing glasses. In some children both the eyes are required to be patched alternatively. Duration of patching of eyes varies depending on the severity of the condition.

Children who are not co-operative with the patching of eyes can be administered with the eye drops in the eye with better vision to blur its vision temporarily. This way the lazy eye is stimulated or forced to see more.