Pediatric Ophthalmology is a subspecialty dedicated to visual disorders of children and adolescents—everything from routine eye exams to complicated surgery. Common problems include focusing or refractive errors such as nearsightedness (myopia), farsightedness (hyperopia) and astigmatism. Other common disorders include strabismus (eye muscle imbalance or misalignment) and amblyopia (“lazy vision”). Less common, but serious problems include congenital cataracts (lens opacity), infantile glaucoma (elevated eye pressure), congenital ptosis (droopy upper eyelid), inherited genetic or metabolic diseases such as juvenile diabetes, retinitis pigmentosa, albinism, or neurofibromatosis, and very serious and even life-threatening ocular tumors such as retinoblastoma.

What is strabismus?

Strabismus is a condition in which the eyes are misaligned and point in different directions. Most strabismus develops during infancy or early childhood. Strabismus which develops later in adults should be carefully evaluated for medical or neurological causes such as:

• Diabetes
• Thyroid disease
• Myasthenia gravis
• Brain tumors or aneurysm
• Head injuries or stroke

If strabismus develops in early childhood, symptoms are usually minimal. The child’s immature brain and visual system quickly learn to ignore the image from the deviating eye, which in turn usually leads to amblyopia. If strabismus develops in older children or adults, the most common symptom is double vision. Other symptoms include:

• Eye strain
• Headache
• Loss of depth perception
• Abnormal head posture

How is strabismus treated?

Strabismus is more than a cosmetic problem. Treatment is highly effective for both children and adults. Options may include:

• Eyeglasses
• Prisms
• Orthoptic exercises
• Botulinum injections
• Eye muscle surgery

What is amblyopia?

Over 80% of what we learn comes through vision. This is especially important for children because during our years of growth and development, the brain is expanding in many ways, and since the eye is actually part of the brain, vision itself must be “learned.” From the first moment newborns open their eyes, nerve cells begin making complicated connections from the eyes to the brain, building a netrwork which will not be complete until the child reaches 6 to 9 years of age. Unfortunately, anything which interferes with a well-focused image reaching both eyes simultaneously during this critical period of visual development can lead to a permanent loss of sight called amblyopia or “lazy eye.” Amblyopia only develops in young children, but if not corrected early, becomes irreversible and may lead to a lifetime of visual disability.

What causes amblyopia?

Although serious problems like cataracts and glaucoma can cause amblyopia, more commonly it results from strabismus (misalignment of the eyes) and from refractive errors (nearsightedness, farsightedness or astigmatism). Amblyopia occurs in 5% of otherwise normal children, affecting 60,000 young people each year in the U.S. Unfortunately, children with poor vision in one eye can look and act perfectly normal—you and your child may never know there is a problem until school starts, and by then, it is already too late. For this reason, regular eye examinations are recommended for all children beginning at an early age. No child is too young for a complete eye exam, and even premature infants can be examined by a trained professional.

How is amblyopia treated?

Therapy for amblyopia may include:

• Eyeglasses or contact lenses
• Patching of the dominant eye
• Atropine (dilating drops or ointment)

Eye injuries are another common problem in the pediatric age group, and actually represent the leading cause of preventable blindness in children and young adults. One-third of all serious eye injuries occur in children age 18 years and under. Seventy percent of children who sustain a serious eye injury will require major eye surgery and 30% will require two or more operations. One-half will suffer permanent loss of vision, even blindness, and 10% will require removal of the damaged eye.

Among school-aged children, sports injuries are the leading cause of eye trauma, and baseball is the sport most likely to cause serious eye injury. Activities such as fishing, darts, biking, and tennis, not normally considered dangerous, actually pose a significant risk for both youngsters and innocent bystanders. Other common causes of severe eye injuries in childhood include BB guns, fireworks, motor vehicle accidents and handheld sharp instruments. Most serious eye injuries could be easily prevented by avoidance of high-risk activities, and most importantly, by wearing simple eye protection. It takes only a second to put on a pair of safey glasses, but it can takes years to rehabilitate an injured eye.

For more information, visit the following websites:

American Academy of Ophthalmology

American Association for Pediatric Ophthalmology and Strabismus