Squint and Paediatric Ophthalmology

Paediatric Cataract

Congenital or developmental cataract is an important cause of childhood blindness. Not everybody is aware that cataracts can occur even in small children or it may even be present since birth. In nearly half of all paediatric cataracts the cause cannot be found out. Paediatric cataracts are responsible not only for blocking the light rays from reaching the retina but also can cause lazy eyes if not treated at the right time.

It is usually present at birth or soon after birth and is diagnosed by the appearance of white dots in the center of the eyes without the use of any special instrument. Some children may fail to show visual awareness of the world around him or her (if cataracts present in both eyes). Some others may develop ‘cross eyes’(squint) or ‘dancing eyes’ (nystagmus).

It is best treated by a paediatric ophthalmologist who is trained specifically in dealing with eye problems occurring in children. The treatment of cataract in a child is very different to that of an adult. These growing eyes are technically more difficult to operate on and react more aggressively to the surgical trauma. Most cases require surgery as soon as the diagnosis is made. With the advent of new techniques younger and younger children are being operated these days. The surgeon may or may not decide to implant an intraocular lens depending on the age of the child, the general condition of the eyes and the status of the other eye. If a lens is not placed during the first surgery it is implanted later when the child is slightly older and the growth of the eyeball has stabilised. The results of the surgery are excellent. The child is often required to do patching exercises and wear spectacles after the surgery.

Dealing with childhood cataract on an urgent basis is of utmost importance as childhood blindness rates could be reduced and the quality of life of children could also be improved. Cataract surgery in children is a very cost effective procedure, second only to immunization to prevent vaccine-related diseases. Parents should immediately take their children to a paediatric ophthalmologist if they notice that one or both eyes appear white or cloudy in the center. People with a strong family history of congenital cataract or some metabolic disease causing cataracts should also get their child’s eyes examined in infancy.

Allergic Conjunctivits

Vernal keratoconjunctivitis is a type of allergic disorder of the eye that usually affects children in the age group 3 to 15 years. It is a recurrent eye inflammatory disorder that has a seasonal incidence. Some people experience symptoms year round, however the peak season for vernal conjunctivitis is between March and August. It tends to occur more in dry, warm climates. Exposure to dust and other allergens like pollen can exacerbate the condition.

Patients usually complain of redness, itching and mucoid discharge of eyes. Some children have severe itching and keep rubbing their eyes vigourously throughout the day. The rubbing of eyes increases the redness in the eyes. Children with severe form of the disease also develop intolerance to bright light and avoid going outdoors. The disease usually does not threaten the vision unless in very advanced conditions. The symptoms described above may not necessarily mean that you have vernal keratoconjunctivitis. However, if you experience one or more of these symptoms, contact your eye doctor for a complete exam.

The parents of these children are explained that this is a self limiting disease in most cases. most children get rid of the problems due to this condition around puberty. The medicines and life style changes help in keeping the symptoms under control till then. Children are advised to avoid playing in dry and dusty surroundings. They are counselled about the need for frequent face washing and cold compresses. Numerous eyedrops are available to keep the patient symptom free. These include steroids and anti-allergics. Steroid eyedrops should never be used without the guidance of an eye specialist as they are known to cause vision threatening complications on a long run. Eye surgery may be required only in advanced and complicated cases.


Strabismus

A “squint” is the common name for ‘strabismus’ or ‘heterotropia’, which is the medical term used to describe eyes that are not pointing in the same direction, or which are misaligned. Squint occurs due to a lack of coordination between the eyes resulting in a crossed eyed appearance. When looking at an object the eyes will turn without unison.
It can be classified into two general categories:

  • Constant Strabismus - When the eye is turned all of the time.
  • Intermittent Strabismus - When the condition occurs only some of the time (usually under periods of stress and/or illness).

Squints can be classified according to the direction of the turn of the eye: esotropia (convergent) refers to an eye that turns inwards towards the nose; exotropia (divergent) refers to an eye that points outwards; hypertropia is when eye is upwards.

  • In children, if the condition is not corrected, the brain will ignore one of the eyes input and could result in a loss of vision.
  • In adults, the other eye will gradually turn outward; a condition known as exotropia.

Squints are best managed by specialists in paediatric ophthalmology & strabismus. They have undergone special training in diagnosis and treatment of squints and other eye disorders in children. Squints cannot be outgrown, not will it improve by itself. Treatment to straighten the eyes is required. The types of treatments may be used alone or in combination, depending on the type of strabismus and its cause.

  • Glasses are commonly prescribed to improve focusing and redirect the line of sight, enabling the eyes to straighten.
  • Medication in the form of eye drops or ointment may be used, with or without glasses. Injected medication may be used to selectively weaken an overactive eye muscle.
  • Surgery may be performed on eye muscles to straighten the eyes if nonsurgical means are unsuccessful.
  • Eye exercise, your doctor may recommend eye exercises either before or after surgery.

The surgical aims are re-alignment of the eye muscles where necessary to achieve satisfactory function and cosmetic appearance. It usually is a day care procedure. Since it is an extraocular procedure the postoperative recovery is pretty rapid. The patients are back to their daily routine in a weeks period. The surgery usually does not lead to change in vision or glasses power.

Equipments in Department of Paediatric Ophthalmology & Strabismus:

  • Cambridge single and Crowded vision charts for vision assessment in preschool children.
  • Sheridan Gardiner matching optotypes for testing vision in very young children.
  • TNO Stereopsis test and Titmus fly test for assessment of stereopsis at near.
  • Contrast Sensitivity Charts
  • Laneau loose prisms and prism bar.
  • Synaptophore.
  • 3M Fresnel prisms trial set.
  • Shin Nippon hand-held slit lamp for detailed anterior segment examination in very young and un co-operative children.
  • ROP screening Unit.