Pediatric Ophthalmology

William S. Potter, M.D.

• Medical School: New York Medical College
• Residency:New York, Eye and Ear Infirmary
• Fellowship: Pediatric Ophthalmology: Wills Eye Hospital
• Board Certified: American Board of Ophthalmology

Impaired Vision in Children:

Impaired vision in children may go unnoticed for a long time, often until the child is in elementary school. Most toys are large and children tend to hold them quite close. Preschool children may function very well with poor vision. Of note, watching television at close range does not necessarily mean there is a vision problem. Once in school and the child needs to see the chalkboard, even mild vision problems become apparent. These children do not have a dramatic decrease in vision, but the demands on their vision have changed, thus making the loss more noticeable.

Excessive Tearing and Associated Problems:

Many infants experience excessive tearing during the first few months after birth. The tear ducts that drain the tears from the eyes to the nose often don't open until nearly the child's first birthday. When they do open the problem goes away.

Many pediatric ophthalmologists do not offer any type of treatment except massage and warm compresses until the child is at least a year old. If the tearing does not clear up after the first year, or if it is extremely bad before then, a surgical probing may be recommended to open the tear ducts. If a child is sensitive to light or if the eye looks pink or red, there may be more to the tearing symptoms than just a blocked tear duct.

An ophthalmologist should evaluate the child to determine the cause for the discomfort.

Strabismus and Amblyopia:

At birth, most babies do not have perfectly straight eyes. By 2 or 3 months of age the child is usually able to focus on a person or object and use their eyes as a team, in unison, whether looking up or down, left or right.

The condition in which 2 eyes are looking in different directions is called strabismus. Strabismus is the term used to note misalignment of the eyes. One of the eyes is looking directly at the object and presumably sees it clearly. The other eye is deviating and not looking directly at the object. Strabismus usually starts in early childhood. The vision in the deviating eye tends to get "shut off" or suppressed. In an adult this deviation would manifest itself with double vision or diplopia, however in young children by suppressing this eye, they prevent double vision. This ability to suppress the deviating eye can remain throughout a lifetime. This suppression is not necessarily good however. It can make the suppressed eye "forget" how to see because of lack of use. This condition is known as amblyopia .

The term "lazy eye" is sometimes used to mean strabismus. That isn't quite correct; lazy eye should be used to note a loss of vision from amblyopia. Children whose eyes turn have few other symptoms. Toddlers and older children may experience visual discomfort when the eye first begins to turn. Signs that can sometimes indicate strabismus include closing or covering one eye, tilting the head to a peculiar position, or even double vision if the child is able to convey it.

Strabismic amblyopia, if recognized and treated in early childhood can usually be cured. Strabismus and hyperopia sometimes go hand in hand. Although not all children who are hyperopic have strabismus and vice versa, the crossing of one eye is often how some parents discover their child is significantly farsighted.

Prevention and early detection:

A thorough examination by a pediatric ophthalmologist, especially if there is a history of eye disorders in the family, should be performed at an early age. Your pediatrician can usually guide you with information regarding the best course for you to follow with your child.

Appropriate supervision and instructions should always be the norm for children using pointed objects, BB guns, and tools. One of the most important instructions a parent can give a child is to use protective eyewear. Sports involving vigorous physical contact or fast moving objects should always have the child wearing either sports goggles or protective headgear. Helmets are required for bicycle riding, protective eyewear should be considered a requirement a s well. Especially any child with impaired vision in one eye should wear such protection.

Even if the child doesn't need glasses to correct their vision, safety glasses should be worn. Many optical shops, ours included, have a variety of sport goggles that are fashionable, and very comfortable to wear.

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