In pediatric ophthalmology we take care of different eye problems in children’s between new born to 15 year of age.
Dr Pratibha Patil Chumbale is has done long term fellowship from renowned Sankara Nethralaya.
She has more than 8 years experience in pediatric eye care.
We will discuss few common conditions here.
1.Refractive Error and Glassesn conditions here.
If your child is complaining of headache, blurring of vision, or watches TV from a very close distance or prefers squeezing of eyes, please consult to the pediatric eye specialist.
First eye check up should be done at the age of 1 year so that we can diagnose and treat refractive error or squint or lazy eye early. We do cycloplegic refraction and dilated fundus and eye examination in each child to diagnose eye problems early.
Myopia is minus number increases with age till 18 years of age. So child need every 6 monthly eye check up till 18 years of age
Astigmatism is the cylinder number usually remains stable needs yearly eye check up
Hyperopia is plus number reduces with age and needs yearly eye check up. Sometimes it is associated with squint.
- Proper correction of refractive error with glasses is treatment of choice in children
- Frequent follow up every 6 month till age of 18 years is must to see if any change in number
- Contact lenses can be prescribed for children >12-13 yrs of age
- LASIK treatment is recommended only after age of 18 years and once power remains constant for at least 1 year
- Recently medical therapy with Atropine0.01% and full glass correction are under trial for cases of high myopia.
2. Amblyopia (Lazy eye)
Ambylopia or Lazy eye means reduced vision in one or either eye.
Early childhood vision deprivation can lead to amblyopia if not treated early. Reversal of amblyopia possivle if treated early. It is proved in studies that if amblyopia can not be treated after age of 13-14 year by any means.
- Refractive error – high hyperopia / myopia/ or astigmatism in one or either eye
- Squint/ strabismus
- Cataract in developing age
- Ptosis/ drooping of eyelid
Reversal of amblyopia or Lazy eye is possible, if diagnosed early and treated early.
So Our Doctors always advise to have First eye check up at age of 1 year for children.
For that we need to find out the cause of amblyopia and the treat that first.
Refractive Error– treats with prescription of proper glasses first
Cataract– Treatment by removal of cataract and put intraocular lens and after that proper prescription of glasses
Ptosis covering pupillary margin– surgery for ptosis is advised first
Squint or strabismus– in this case first treat amblyopia first then surgery for squint is required.
How is amblyopia treated?
Patching therapy or occlusion therapy (Patching of normal eye) is gold standard treatment of choice. In this as we patch normal eye we force weak or amblyopic eye to see. We do prefer part time occlusion than full day occlusion of normal eye.
Hours of patching depends on severity of amblyopia.
Frequent follow up every six months is important to check improvement of visual acuity and glass prescription.
Once vision improves in amblyopic eye, patching therapy is not stopped abruptly. We slowly taper it by reducing hours of patching then stop.
Along with patching we can try vision therapy with synaptophore exercises.
3. Pediatric Cataract
Pediatric Cataract needs urgent attention as it can cause permanent visual damage if not treated early. It can be seen in new born babies or small children.
- History of childhood cataracts to parents.
- Infections during pregnancy like rubella, CMV infections
- We see for papillary reaction and dilated cataract and fundus evaluation
- TORCH test
- B-scan if required
- Systemic evaluation by pediatrician and anesthetist to get fitness for general anesthesia
- If child is< 1year – removal of cataract with lensectomy and correction with glasses or contact lenses is the treatment of choice.
- If child is > 1 year- removal of cataract by phacoemulsification with intraocular lens implantation with primary posterior capsulorrhexis is treatment of choice.
We do dilated refraction as frequent change of glasses is required at each follow up.
If required glasses + patching of good eye to avoid amblyopia or lazy eye is necessary.
Horizon Hospital has Best Pediatic Cataract Specialist In Pun
4.Watering of Eyes
Any child complaining of watering of eyes need to be evaluated to rule out nasolacrimal duct obstruction, pediatric glaucoma, refractive error etc.
Watering of eyes Due to blocked Nasolacrimal duct–
Child complains of watering and sticking of eyes. Mostly this is due to blocked nasolacrimal duct. Simple Criggler’s massage helps to open blocked duct till age of 6-9 months.
For child > 9 month require a very simple probing procedure to open this block in the duct. Repeat probing can be needed after 6 month and can be repeated till age of 2 yr. after 2 yr of age child may need a procedure of silicon intubation.
If Child continues with watering even after these procedures then at 5 -6 years of age DCR(Dacryocystorhinostomy) Surgery need to plan.
5. Pediatric Glaucoma
Pediatric Glaucoma is a major blinding disease and can affect newborn or child of any age.
Child may present with
- Watering of eyes
- Large size of eyeball
- Hazy cornea
- Photophobia(inability to tolerate light)
The main goal in managing primary congenital glaucoma is early diagnosis and early surgical treatment to normalize IOP, in order to allow possible reversal of cupping and thus to minimize the impact on vision.
- Medical treatment with antiglaucoma drugs is stared to lower intraocular pressure and to clear cornea before surgery
- Once child gets fitness for surgery- goniotomy or Trabeculotomy. These procedures have high success rate >90 percent
- For non responding case- valve implants, trabeculectomy, laser cyclophotocoagulation is planned
Child with childhood glaucoma needs early and continued treatment and may bring failures also sometimes.