Why is Pediatric Ophthalmology regarded as a separate specialty? What is the scope of pediatric Ophthalmology?
Pediatric ophthalmologists treat all eye problems in children under the age of 15 years. As strabismus is one of the common problems in children, pediatric ophthalmologists are trained to treat strabismus in children and adults. A child should not be regarded as a small adult. Children have unique needs and concerns. An incorrect treatment decision or a delayed treatment could result in a permanent impairment of vision. Children do not volunteer complaints, and may not give a reliable history. Many a time they would not cooperate for an exam either. There are special techniques to assess vision in children. Special hand held instruments are needed to examine very young children. A child friendly atmosphere is also required in the examination area to win the confidence of children. A play area and a feeding room for babies are an integral part of a pediatric ophthalmology unit.
What are the common eye problems in children?
We can divide the eye problems in children into two categories – the serious ones and the ones that are common and not so serious. Let us discuss the serious ones first.
- Strabismus in children is often misconstrued as a sign of good luck. It could be the harbinger of a serious underlying disease. Strabismus disturbs the alignment of the two eyes and impairs three dimensional viewing of objects ( what we call stereopsis ). Further strabismus can result in one eye becoming amblyopic, which needs to be treated with patching the good eye. All this apart, strabismus in children has important cosmetic ramifications and reduce the self confidence of the child
- Cataracts in children: it is a misnomer that cataracts occur in adults only. Cataracts in children are rarer, but assume the same significance if we consider the concept of blind years as children would live longer. Further delay in treatment can result in amblyopia, which can be very difficult to treat
- Tumors in children – a number of tumors like retinoblastoma and rhabdomyosarcoma can occur in children. Regular reviews are needed if the child has received radiation for any reason or if the parents have a history of malignancy.
- Vitamin A deficiency and keratomalacia: Unfortunately this continues to be a serious problem. This can be common in nutritionally deprived children especially if there is an inter current illness. Exclusive breast feeding is mandatory in the first four to six months of life. Children who are weaned early are at particular risk for vitamin A deficiency. This condition can result in corneal melting and permanent often untreatable loss of vision
- Amblyopia – also known as lazy eye, this could result from strabismus, refractive errors and disorders of the ocular media. If not treated, permanent visual loss may result. Treatment is usually given by glasses and patching of the good eye. The treating ophthalmologist decides the exact modality of treatment.
- Ptosis – this refers to drooping of the eyelids. This could be either myogenic or neurogenic. When severe it can interfere with vision and result in amblyopia. Milder cases are associated with refractive errors.
- Glaucoma – this serious disorder if not treated early can result in irreversible loss of vision. It presents with large corneas since birth. The child may have watering and photophobia. Treatment is only surgical and medical therapy is only of adjunctive value
- Watering – Fig 3. Often a symptom of congenital nasolacrimal duct obstruction. Other than causing annoying epiphora, it can also result in pooling of infective bacteria in the conjunctival sac. This could cause serious infections with minor trauma. Recurrent infection of the sac could also occur. Treatment is by sac massage in infancy and with probing and syringing later on
- Corneal and conjunctival foreign bodies – One reason why redness and foreign body sensation in children should never be taken lightly. Maggots have also been reported in the conjunctival sac. Delay in removal could result in serious infections
- Eyelid hemangiomas – Fig 4 – this mimics a swelling of the eye lid. Can cause ptosis and refractive errors. Many of these respond to topical beta blockers.
Common but less serious issues
- Acute conjunctivitis: Quite common in children and spreads very easily espcially among those who live in dormitories. Spread can be checked by good hand hygiene. Often presents as redness of the eye with discharge. It can also occur in newborn babies if aseptic precautions have not been observed in labor and also in premature rupture of membranes. Some virulent bacteria and viruses can cause devastating infections in neonates
- Ocular allergies: again a common condition among children. Many times the allergies could be recurrent and will need repeated consultations with the pediatric ophthalmologist. It is important to counsel parents and practitioners to avoid abuse of steroids and to discourage eye rubbing
- Refractive errors: they occur in around 2.5% of school going children in urban areas. Children often do not complain and the resultant poor vision hampers school performance. There may be unrelated complaints like headache, watering, redness of the eye etc. There are many misconceptions among parents on wearing glasses in children. However failure to comply with glasses when needed can result in amblyopia and strabismus