Common Pediatric Eye Problems


Tearing

The tear duct system, which allows the 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. Antibiotics are not necessary to treat the mucus.  Gentle massage of the tear duct often relieves the blockage. Most blocked tear ducts resolve by the age of one. If massage and observation are unsuccessful and the tearing is still present after the age of one, minor surgery to gently open the blocked tear duct may be needed.


Stye  (bump on eyelid)

When one of the oil glands in the eyelid gets plugged up, the gland gets swollen and results in a stye.  Styes are very common.  They are treated by applying warm compresses to the eyelid 5 times a day for 5 minutes each time.  Most will resolve within a few weeks.  However, some can take up to 6 months to resolve.  Antibiotics are usually not helpful.  Surgery to drain the stye is only needed if your ophthalmologist feels that the stye is obstructing the child's vision.


Blepharitis (swollen eyelids)

Blepharitis refers to an inflammation in the oily glands of the eyelid. This usually results in swollen eyelids and excessive crusting of the eyelashes, most evident in the morning. Tenderness of the eyelids and a foreign body sensation in the eye may occur as well. Blepharitis can be treated with warm compresses and eyelid scrubs using baby shampoo.


"Pink Eye" (conjunctivitis)

Pink eye appears as a reddening of the white part of the eye. It is usually associated with excessive tearing, a discharge, and a foreign body sensation in the eyes. Conjunctivitis has many causes and can occur at any age. In infants and children, pink eye is usually caused by a viral or bacterial infection. In older children, it may also be caused by allergy. Depending on the cause of conjunctivitis, eye drops or ointment may be indicated. If your child has conjunctivitis, regular hand washing will help prevent the spread of the infection to other family members. 


Nearsightedness (myopia)

Children who are "nearsighted" see objects that are close to them clearly, but objects that are far away are unclear. Nearsightedness is very rare in infants and toddlers, but becomes more common in school-age children. Eyeglasses will help clear the vision but will not "cure" the problem. Despite using glasses, near-sightedness will generally increase in amount until the mid-teenage years so that periodic follow-up examinations by an ophthalmologist are indicated.


Farsightedness (hyperopia)

A small degree of farsightedness is normal in infants and children. It does not interfere with vision and requires no correction. It is only when the farsightedness becomes excessive, or causes the eyes to cross, that glasses are required.


Astigmatism

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

Learning disabilities are quite common in childhood years and have many causes. The eyes are often suspected but are almost never the cause of learning problems. Your pediatrician may refer you for an evaluation by an educational specialist to pinpoint the exact cause.


Falsely Misaligned Eyes (pseudostrabismus)

Sometimes infants appear to have crossed eyes, yet the eyes are truly straight. The cause for pseudostrabismus is presence of a wide nasal bridge or extra folds of skin between the nose and the inside of the eye that make the child have a cross-eyed appearance. Most children outgrow this problem, but you should contact your doctor for an examination. Your pediatrician can tell whether a child has misaligned eyes or just pseudostrabismus, but in some instances, a visit to an ophthalmologist is necessary for further tests.


Misaligned Eyes (strabismus)

With strabismus, the eyes are not aligned. Strabismus is quite common and occurs in about 4% of children. One eye may gaze straight ahead while the other eye turns inward, upward, downward, or outward. When an eye turns inward, the child has "crossed" eyes (esotropia). There are two common causes for esotropia. Some children are born with crossed eyes (or develop it shortly after birth), and in this situation the muscles are too tight. Treatment for this most commonly involves surgery on the eye muscles, generally performed prior to the age of 2.

The second most common cause for esotropia is excessive farsightedness. This problem can be present at birth, but most commonly occurs between the age of 2 and 6 years. This type of esotropia is corrected with glasses.

When an eye turns outward, the child has exotropia. Exotropia may be present from birth, but most commonly is seen in children 2 to 7 years of age. Generally the eyes turn out on rare occasions at first but with time more frequent outward turning of the eyes is noted. Children with exotropia occasionally squint one eye when exposed to bright sunlight. The treatment for large amounts of exotropia is usually eye muscle surgery.

Children with strabismus should have a careful examination by an ophthalmologist because untreated strabismus may lead to a lazy eye (amblyopia) or loss of depth perception. Rarely, strabismus may indicate a more serious condition, such as cataract or eye tumor (retinoblastoma).


Lazy Eye (amblyopia)

Lazy eye is reduced vision from lack of use in an otherwise normal eye. It usually happens only in one eye. Any condition that prevents a clear image can interfere with the development of vision and result in amblyopia.

Amblyopia is common, affecting about 2% of children. Some causes of amblyopia include strabismus, droopy eyelids (ptosis), cataracts, or refractive errors.