Paediatric Ophthalmology

Paediatric Ophthalmology

Paediatric Cataract

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 .The treatment of cataract in a child is very different to that of an adult. Most cases require surgery as soon as the diagnosis is made. 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.

 

Differential diagnosis –

 

  • Retinoblastoma
  • Rop
  • Coats didease
  • Persistent hyperplastic primary vitreous

 

Treatment options –

 

  • Wait & watch if cataract is minimal
  • Operate early in unilateral cataracts
  • Both eyes can be operated in same sitting
  • Phaco with anterior vitrectomy & ppc done in children younger than 7 yrs

 

Amblyopia

The eye looks perfectly normal from outside as well as inside.
Amblyopia is a medical term for poor vision in one or both the eyes .Amblyopia is treated by occlusion (patching) which involves closing the good eye thus forcing the child to see with the eye with poor vision. .Earlier the treatment started faster is the visual recovery. Treatment has to be started before 7 yrs of age to be more effective.

 

Squint

Squint is a misalignment of the eyes. It can be constant (when the eye turns all of the time) or intermittent If the squint is not corrected in time, it can lead to progressive and permanent deterioration of vision in the squinting eye which may not be reversible after some period.Squint can be corrected by giving proper refractive correction (spectacles) to the child. Surgery is required when squint persists inspite of using glasses. Amblyopia treatment to be given simultaneously.

 

Watering Eyes (CNLDO)

Congenital nasolacrimal duct obstruction (CNLDO) is a common disease in children most of the cases are self resolving.

Treatment Includes:- Observation and Massage, Probing, Endoscopic dacryocystorhinostomy. Single point pressure applied during massage by ophthalmologist gives excellent results in children below 6-8 months of age.

 

Buphthalmos (Congenital Glaucoma)

Buphthalmos is enlargement of the eyeball.
It usually appears in the newborn period or the first 3 months of life. and in most cases indicates the presence of congenital (infantile) Glaucoma
Patients with glaucoma often initially have no symptoms; later, they can exhibit excessive tearing (lacrimation) and extreme sensitivity to light (photophobia)
All infants should be examined by paediatricians for any signs of buphthalmos before 3 months of age & referred to ophthalmologist when required.

 

Retinopathy of Prematurity (ROP)

Retinopathy of Prematurity (ROP) is a disease that affects immature vasculature of retina in the eyes of premature babies.
In general, more than 50% of premature infants weighing less than 1250 g at birth show evidence of ROP. All babies less than 1500 g birth weight or younger than 32 weeks’ gestational age at bIrth are at risk of developing ROP.The baby presents with a white reflex in pupillary area.screening of all premature infants is recommended at 4-6 wks of life. Treatment options include cryotherapy & laser therapy.