Eye Problems in Children

VisionA complete list of the most common eye problems affecting children, according to the American Academy of Pediatrics (AAP):

Amblyopia (lazy eye) – “Lazy eye” refers to reduced vision from lack of use in an otherwise normal eye. It usually occurs only in one eye. Any condition that prevents a clear image can interfere with the development of vision and result in amblyopia. The condition affects about 2 percent of children. Because early treatment offers the best results, your pediatrician will refer you to an ophthalmologist.

Astigmatism Astigmatism is the result of an eye that has an irregular corneal shape. It may result in blurred vision. Children with astigmatism may need glasses if the amount of astigmatism is large.

Blepharitis (swollen eyelids) This inflammation in the oily glands of the eyelid usually results in swollen eyelids and excessive crusting of the eyelashes, most evident in the morning. Tenderness of the eyelids and sensation of a foreign-body in the eye may occur as well. Blepharitis can be treated with warm compresses and eyelid scrubs using baby shampoo. If an infection is present, antibiotics may be necessary.

Conjunctivitis (pinkeye) Pinkeye appears as a reddening of the white part of the eye. It is associated with excessive tearing, discharge and the sensation of a foreign body sensation in the eye. In infants and young children, it is usually caused by a viral or bacterial infection. In older children, it may also be caused by an allergy. Depending on the cause, eye drops or ointment may be prescribed. Regular hand washing will help prevent the spread of the infection to other family members.

Corneal abrasion (scratched cornea) – This is a scratch of the front clear surface of the eye. These abrasions are painful and are usually associated with light sensitivity and tearing. Treatment consists of antibiotics to prevent infection and a patch to allow for healing.

Glaucoma (elevated eye pressure) With this condition, the pressure inside the eye is too high. If left untreated, glaucoma eventually can lead to blindness. Symptoms include extreme light sensitivity, tearing and persistent pain. Signs also include an enlarged eye, cloudy cornea and lid spasm. If any of these are present, your pediatrician will refer you to an ophthalmologist immediately. Glaucoma in childhood usually requires surgery to prevent blindness.

Hyperopia (farsightedness) – A small degree of farsightedness, the ability to see objects at a distance better than those at close range, is normal in infants and children. It doesn’t interfere with vision and requires no correction. It is only when farsightedness becomes excessive, or causes the eyes to cross, that glasses are required.

Myopia (nearsightedness) – Children who are nearsighted see objects that are close to them clearly, but objects that are far away are unclear. Nearsightedness is rare in infants and toddlers, but becomes more common in school-age children. Eyeglasses will help correct the vision but will not cure the problem. Despite using glasses, nearsightedness will generally increase by degrees until the mid-teen years, so periodic follow-up examinations are recommended.

Pseudostrabismus (falsely misaligned eyes) Sometimes infants appear to have crossed eyes, yet the eyes are truly straight. This is caused by the presence of a wide nasal bridge or extra folds of skin between the nose and the inside of the eye, which makes the child have a cross-eyed appearance. Most children outgrow the condition, but a doctor’s examination is still important. Your pediatrician can usually tell whether a child has misaligned eyes or just pseudostrabismus, but, in some instances, a visit to an ophthalmologist is necessary for further tests.

Ptosis (droopy eyelids) This condition is caused by a weakness of a muscle that opens the upper eyelid. When ptosis is mild, it is primarily a cosmetic problem. However, ptosis can interfere with vision. In infancy, it is important that ptosis be eliminated so that vision will develop normally. Correction usually requires eyelid surgery.

Strabismus (misaligned eyes) – With strabismus, the eyes are not aligned. Strabismus occurs in about 4 percent of children, according to the AAP. One eye may gaze straight ahead, while the other eye turns inward, upward, downward or outward. Treatment options for misalignment include patching, glasses and surgery.

One of the most common misconceptions among parents is that an infant with misaligned eyes will “grow out of it,” says Dr. Rosenbaum. “A baby is entitled to have his eyes not be straight until three to four months of age,” he adds. “But I tell parents that after three or four months, if a child with eye misalignment doesn’t have straight eyes all the time, he or she is at risk of losing vision in one eye, or of losing the opportunity to use two eyes together, if the situation isn’t addressed.”

Tearing –The tear-duct system, which allows tears to drain from the eyes into the nose, usually opens in the first few months of life. In some infants, however, the system remains blocked, resulting in the eyes overflowing with tears and collecting mucus. Tearing may result from other ocular conditions, the most serious of which is glaucoma. If your child suffers from continued tearing or watering from the eyes, see your pediatrician. Gentle massage of the tear duct can occasionally relieve the blockage. If massage and observation are unsuccessful, a tear-duct probe or more-involved surgery may be required.

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