Paediatric ophthalmology

Ophthalmologic care of children is very important, because the first years of life are fundamental for the development of one’s vision. The eye of a child is immature and is constantly growing until seven or eight years old. In fact, visual acuity reaches 100% at five years of age.

An eye problem that is not diagnosed early can stop vision development and leave defects that continue throughout life.

When to take children to the ophthalmologist

There are two different situations in which children should be taken to the ophthalmologist: when a child complains or has eye pain and routine visits that should be carried out even if a child does not have eye problems.

The most common reasons that make it necessary for a child to visit the ophthalmologist are:

• Getting too close to the television or paper when they read or write.
• Squinting eyes when looking at far objects.
• Headache after straining sight.
• Common occurrence of red eyes.
• Deviation of the eyes.
• Differences in vision when covering one eye or another.
• White or greyish pupil (leucocoria).

Regarding routine visits by the ophthalmologist, the following checks are recommended:

• During the first month of life: rule out serious eye diseases or malformations (glaucoma or congenital cataracts).
• At seven months old: diagnosis of strabismus.
• At 18 months old: diagnosis of retinoblastoma (most common malignant tumour in childhood).
• At four years old: visual acuity and refractive errors.
• Every two years until reaching 14 years old.

Refractive errors

They are commonly referred to as eyeglass defects. In a normal eye, rays of light converge on the retina and create a sharp image. Refractive errors make it so objects are not seen with clarity. There are three types: hyperopia, myopia and astigmatism.

It is important to detect them early on, since they can lead to poor performance at school. They must be corrected using eyeglasses or contact lenses and, after 20, when degrees of error are stabilised, it is possible to operate with a laser. A baby can be visited to check for these errors, even if he/she is not able to talk.

What strabismus is and how to treat it

It is the abnormal deviation of one or both eyes in one or more sight positions. It can be a horizontal deviation (the eye deviates inward or outward) or a vertical deviation (the eye deviates upward or downward).

All children that deviate an eye intermittently should be visited when they are six to seven months old. Children that have a permanent deviation should be visited even before this age.

Strabismus can be corrected using eyeglasses, surgery or both. Surgery isolates the muscles responsible for the eye’s mobility and it positions them in another place in order to weaken or strengthen their effect. General anaesthesia is required for children.

What is lazy eye?

Amblyopia or lazy eye is the eye that didn’t develop properly during childhood and, consequently, has worse vision than the other eye.

Amblyopia affects 4% of children and can only be treated before eight to nine years of age; otherwise, it can cause a severe and irreversible visual defect.

It is usually detected in routine vision checks by a paediatrician or by a paediatric ophthalmologist, since it causes very few symptoms and usually goes unnoticed by parents.

Its most common causes are strabismus, refractive errors and, less commonly, eye diseases that prevent light from reaching the retina in a normal way (cataracts).

Treatment consists of forcing the child to use the lazy eye by patching the good eye.

Lacrimal obstruction

Tears normally lubricate the surface of the eye and drain through the lacrimal points toward the nose.

Lacrimal obstruction is when the tear path from the eye to the nose is obstructed. In children, it causes tearing and secretion (rheum) from birth.

Ninety percent of the time, the problem is solved spontaneously during the first six months of a child’s life. Antibiotic eye drops and massaging the lacrimal sac are beneficial. If the condition is not cured in this way, it is necessary to carry out a tear duct probe.