Pediatric Opthalmology

When the eyes are oriented in different directions, the brain receives 2 different visual signals. To avoid double vision, the brain may ignore the image from the misaligned eye, resulting in poor vision development of that eye.

Also, an eye that sees poorly may become misaligned, perpetuating this cycle.

Most strabismus is the result of an abnormality of the neuromuscular (including brain) control of eye movement. A problem with the eye muscles or glass power or poor vision may also cause strabismus.

Also, an eye that sees poorly may become misaligned, perpetuating this cycle.

Strabismus often occurs in children who are otherwise completely normal, without any family history of squint or glasses.

Strabismus may also develop in children with uncorrected refractive errors, amblyopia or cataracts.

Stroke or systemic conditions like diabetes can cause strabismus in adults.

Trauma ( to the brain or eye), neurological problems like myasthenia gravis and thyroid eye disorders are other common causes of strabismus. Older children and adults with recent onset squint usually present with complaints of double vision.

The two most common types of strabismus are esotropia, where an eye turns in and exotropia, where an eye turns out. It gives the person a “cross-eyed” appearance.

A problem affecting any of the six extra ocular muscles, or the muscle’s nerve supply, in either eye will cause misalignment. Misalignment results in a problem in binocular vision.

Treatment options are non- surgical or surgical.

Non surgical options for Strabismus include use of spectacles, prisms, eye exercises or vision therapy and patching. Botulinum toxin injection can be used in some cases.

Surgery for Strabismus is performed on the extraocular muscles in an attempt to give binocular single vision, to relieve double vision, or to cosmetically restore the eyes to their regular state of alignment.

The optimal time for surgical intervention is as early as possible. In case of associated amblyopia or cataract, it is recommended to treat it prior to surgery to improve the long-term success rate of eye alignment.

Both the parent and surgeon have to be committed to regular follow up and prolonged management to obtain good alignment.

The type of surgery, amount of surgery, number of muscles, and which muscles will be operated on is dependent on the type and amount of deviation.

The aim of strabismus surgery is to adjust the muscle tension on one or both eyes in order to pull the eyes straight.

General anesthesia is required in children. Most adults may prefer local anesthesia.

Recovery time is rapid and the patient is usually able to return to normal activity within a few days. Frequent follow ups are required within 1-2 weeks of surgery and then in a few months. You may have to take some antibiotics and anti-inflammatory medication for 4-6 weeks.

Please don’t hesitate to discuss any questions you may have about the squint procedure with our eye surgeons.

As with any surgery, eye muscle surgery has certain risks. There is a small risk of infection, bleeding, excessive scarring, and other rare complications, which can lead to loss of vision.

Esotropia is a form of strabismus (eye misalignment) characterized by an inward turn, i.e towards the nose, of one or both eyes.

It may be intermittent or constant and may occur with near fixation, distance fixation, or both. The deviating eye may always be the same eye or may alternate between the two eyes.

Exotropia is another common type of strabismus. It is an outward turning of one or both eyes.

Often the exotropia will occur intermittently, particularly when the child is daydreaming, ill, or tired or focusing at distant objects.

Pseudo-strabismus is a common condition in which the eyes appear misaligned when in fact they are not.

With pseudo-esotropia, the infant usually has a wide nasal bridge and wide and prominent lid folds. When the child looks to either side, the eye hides behind the eyelid folds or wide bridge and looks like they are crossing.

Childhood cataracts may be

Congenital cataracts – cataracts which are present when a baby is born or shortly afterwards. This category is the reason behind the majority of cataracts in children.

Developmental, infantile or juvenile cataracts – cataracts diagnosed in older babies or children.

Light enters the eye and is projected to the retina (inner surface of the back of the eye) which senses the light and transmits the visual signal to the brain.

A cataract may stop light from reaching the retina and prevent the eye from seeing. A clear image forming in the retina is essential for the stimulation of the visual cortex and development of proper vision in children.

Pediatric cataracts can

-occur in one eye (unilateral) or both eyes (bilateral).

- be complete or partial

- be present at birth or occur sometime after birth.

-partial at birth and later progress to become visually significant.

The prognosis in children is worse with an earlier onset, more dense and longer duration of cataract.

But there is hope!
Advances in medicine, new techniques and materials have made the prognosis better. Now, we are able to operate as early as the first few weeks of life and visually rehabilitate the child with either glasses or contact lenses.

Children born with cataracts are also at risk of developing:

Glaucoma

Strabismus

Nystagmus

Amblyopia

This complicates successful cataract surgery in children.

It's not usually possible to prevent cataracts, particularly those that are inherited (run in the family).

If you have previously had a baby with childhood cataracts and are planning another pregnancy, please talk to your obstetrician. They may advise genetic counseling to reduce the risk of your next child developing a cataract or vaccination to prevent infections in pregnancy.

Cataract surgery in children is done under general anesthesia. It involves removal of the cataractous (opaque) crystalline lens.

This is often accompanied by surgical measures (primary posterior capsulorrhexis and anterior vitrectomy) to ensure the clarity of the central visual axis after the surgery- which can otherwise get obscured by the ‘after cataract’ (collection of inflammatory cells and fibrous tissue) formation.

An IOL is preferred for children over one year of age.

We currently consider IOL implantation in patients who are one year or older where appropriate and IOL implantation is the procedure of choice in children 2 years and older.

The use of aphakic glasses or contact lenses continues to be the treatment of choice for congenital cataracts in neonates

Once the surgery is done, your child will still require glasses after the IOL implantation. They may also require occlusion therapy for the management of amblyopia.

In most cases, it is the willpower and resolve of the parents or caregivers to follow post-operative management that determines visual success for the child.

Regular lifelong follow up is needed to detect late complications like secondary glaucoma and retinal detachment.