ALL EYE DISORDERS IN CHILD HEALTH NURSING

1. INFECTIOUS AND INFLAMMATORY CONDITIONSOF EYES
CONJUNCTIVITIS
Definition:
Conjunctivitis (“pink eyes”) is an inflammation of the conjunctiva of eye.
Etiology:
Conjunctivitis during childhood is caused due to allergy or infection by bacteria or
virus. The most common bacterial causes are hemophilus influenza, streptococcus
pneumoniea and Chlamydia. Viruses that cause conjunctivitis are Adenovirus and Herpes
virus.
Pathophysiology:
Microbes enter the eye on contactwith infected object
Inflammation of eye
Dilation of blood vessels of eye
Swelling, redness, exudates and discharge
Clinical features:
 The clinical features of conjunctivitis include –
 Redness of eye (Hyperemia)
 Tearing and itching in eyes
 Exudation (flaky and sticky substanceon eye lid margins)
 Other symptoms may include –
 Photpphobia
 Pseudoptosis (droping of upper eye lid)
 Periorbital cellulitis
 Pain in eye
 Fever

2.  When a viral infection is the cause, the child may also have fever, sore throat and
runny nose.
Diagnostic evaluation:
The diagnosis is made mainly on the basis of clinical features. A culture of the
drainage may be obtained to confirm the diagnosis.
Causes Associated symptoms Management
1. Viral Often associated with other
symptoms of generalized viral
illness.
 Hygiene
 Rest
1. Bacterial Yellow, green or white pus with
photophobia.
 Antibiotic eye
drops or ointment
with hygiene.
1. Chlamydial Cough, history of maternal
infection. Pain, photophobia and
skin lesions.
 Systemic
antibiotics
 Evaluation by
specialist.
 Antiviral agents
1. Allergic Itching, seasonal onset of
symptoms, other allergic
features, watery discharge.
 Antihistamine
eye drops
 Avoidance of
allergens.
1. Chemical Watery discharge, onset of
symptoms when exposed to
cigarettes or other irritants.
 Avoidance of
irritating
substances.
1. Trauma Pain, photophobia and increased
tear production
 Eye patch
 Referral to

3. specialist
Prevention:
 If conjunctivitis is allergic or viral in origin, nursing management focuses
primarily on comfortmeasures. Following nursing care needs to be given –
 Apply cold compress on the eye.
 Reduce exposure to light.
 Prevent rubbing of the eye.
 Acetaminophen may be administered to relieve discomfort.
 If conjunctivitis is caused by bacterial agents, nursing care includes:
 Clean the eye using sterile water and cottonswabs, from inner canthus to outer
canthus.
 Apply the prescribed antibiotic ointment or eye drops.
 Use of dark glasses is advised, in presence of photophobia.
Family Teaching:
 Advise the following ways to prevent transmission of infection to others:-
 Use good hand washing after touching the eye.
 Use separate towel, sheet and pillow case for infected child.
 Do not allow the medicine dropperto touch child’s eyes during medication
instillation.
 Discard old contact lenses (if child is using) and use new ones after infection has
resolved.

4. OPHTHALMIA NEONATRUM
Definition:
Purulent discharge from eye of a newborn, within 21 days of birth is known as
ophthalmia neonatrum. Most cases develop this condition within 48-72 hours of life. It is
mostly bilateral.
Etiology:
The organisms that may cause ophthalmia neonatrum are – Neisseria gonorrhoea,
Staphylococcus aureus, E.coli, pseudomonas aeruginosa, certain viruses and Chlamydia
trachomatis.
Mode of infection:
 The mode of infection include:-
 Intrauterine infection
 Infection during the process ofdelivery (most common)
 Infection after birth
Pathology:
Due to infection, the blood vessels dilate and there is formation of new blood
vessels around the papillae. Numerous polymorphs are present in the epithelium which
leads to purulent discharge and exudates formation in the eye.
Clinical features:
 It is a bilateral infection which has the following clinical manifestations:-
 Eyelids are tense and swollen.
 Conjunctiva is congested and swollen.
 Excessive tearing or turbid and thick discharge from eyes.
Management:
A swab must be taken from purulent eye discharge and sent for culture and sensitivity.
Depending upon the result, the physician prescribes appropriate antibiotic ointment or
eye drops. Crystalline Penicilline, Chloramphenicol, Erythromycin or Gentamycin eye
drops may be prescribed by the physician. Polymixin is used for pseudomonas infection.
Eye care:

5. The infected eye or eyes are cleaned with strile swabs moistened with normal
saline. Each swab will be used once only for wiping the eye from inner canthus to outer
canthus. Wash eyes as frequently as possible with warm sterile normal saline.
After cleaning of eyes, instill crystalline penicillin eye drops.
Every 5 minute for ½ hour
Every 1 hour for 12 hours
Every 2 hourly for 3 days.
In case of Gonococcalor Chlamydia infection, systemic antibiotic therapy is required.
Prevention:
Ophthalmia neonatrum can be prevent by following simple measures:-
Properantenatal care of pregnant women.
Treatment of infected vaginal discharge during pregnancy.
Use of aseptic techniques while delivery and in care of newborn.
Cleaning of each eye with sterile swabs dipped in sterile water, as soonas the head is
delivered and instillation of chloramphenicol eye drops in each eye as a prophylactic
measure.
Complications:
If the condition is not treated, there can be generalized haziness of cornea or
corneal ulcers, which may lead to blindness.
RETINITIS:
Definition:
Inflammation of retina is known as retinitis. It usually occurs in association with
inflammation of choroid (chorio-retinitis) or optic nerve (neuroretinitis). Primary
retinitis is rare.
Etiology:
Primary retinitis may be an allergic reaction to some endogenous toxin. In few
cases, the toxin is produced from some active or latent septic focus (like dental sepsis,

6. septic tonsils) but in most of the cases it is tuberculoprotin from a latent focus in lung or
any lymph node.
Pathophysiology:
Due to infection, inflammation occurs
Exudates formation
Exudates pass through the brunch’s membrane and reach retina
Exudates from the retina reach the vitreous
Floating of black spots in front of eye and retina becomes oedematous
Distortion of image and blurring of vision
Clinical features:
The child presents with the following clinical features:-
Floating black spots in front of eye.
Metamorphopsia (distortion of image)
Micropsia (objects appear smaller)
Photopsiaor subjective flashes of light due to retinal irritation.
Diagnostic Evaluation:
The diagnosis of retinitis is established with the help of fundoscopy, which
show:-
Localized grey patch with blurred margins in retina.
Few hemorrhagic spots orexudates on retina.
If the gray patch is close to optic disc the margin becomes oedematous.

7. Vitreous humour is slightly hazy.
If central area is affected, there is permanent defect of visual acuity with central
scotoma.
Management:
Management of retinitis is as follows:-
Protect the eye from light by wearing dark goggles.
Atropine eye drops are instilled thrice daily.
Eye care should be done using warm sterile water.
Sub conjunctival or retro-bulbar injection of corticosteroid may be helpful in arresting
the inflammatory process.
Sodium salicylate may be given for pain relief.
Systemic antibiotics are prescribed to treat focal sepsis, if present anywhere in the body.
Antihistamines are helpful in allergic type.
Systemic corticosteroids are effective in controlling inflammation.
STYE:
Definition:
Stye or hordeolum is an infection of the sebaceous glands near the eye lashes.
A pustule in the eyelash follicle is known as stye.
Etiology:

8. A stye may be caused by bacterial or viral infection. It is most often caused by
staphylococcus infection.
Clinical features:
The clinical features of hordeolum are as follows:-
Pustule in eyelash
Pain and tenderness
Localized swelling of eyelid
Redness in eye
As hordeolum forms, it gets filled with purulent material and becomes red and
painful.
Management:
Warm compress must be applied on eye, several times in a day.
Eye care is done frequently.
Antibiotic eye drops are instilled.
If the hordeolum does not resolve spontaneously, incision and drainage of purulent
material is be done.
Prevention:
This type of infection can be prevented by observing hand washing practice and
maintaining personal hygiene.
NON IFLAMMATORY CONDITIONSOF EYE:
Cataract: Definition:
Cataract is the development of opacity in the crystalline lens of eye. As light cannot
pass through the opacity, vision becomes blurred.
Incidence:
Congenital cataract affects 1/in 250 newborns.

9. Types:
Cataract can be of the following types:-
 Unilateral or bilateral
 Partial or complete
 Congenital or acquired
Etiology:
Cataract
 Intrauterine infections in early
months of pregnancy like German
measles and toxoplasmosis
 Maternal mannutrition
 Galactosemia
 Chromosomalanomalies like Down’s
syndrome
 Ocular malformation
 Mental retardation
* Trauma
* Retrolantal
fibroplasias
* Uveitis
* Glaucoma
Pathophysiology:
The lens capsule is formed during the fourth and fifth week of gestation. It is a clear
membrane which allows light to enter the eye and refract the rays for a clear image on
retina. If there is any reason that interferes with lens development, the lens becomes milky
white and cloudy, obscuring light rays and thus vision.
Diagnostic evaluation:
Infants with a family history or prenatal history paving them at risk for cataract
should be assessed soonafter birth. The opacity or cloudiness of lens can be seen with
naked eye. When the nurse does eye examination using a penlight, it reveals absence of red
light reflex and white papillary reflex.

10. Management:
The definitive treatment for cataract is surgical removal of the cataract from affected
eye. The affected lens is removed and artificial intraocular lens is put in the affected eye.
The time at which cataract surgery is performed, is crucial to prognosis. If cataract is
noticeable at birth; surgery must be done before 8 weeks of age, to prevent irreversible
visual impairment.
Postoperative care:
After surgery the child needs eye patching or shielding for several days.
Instillation of antibiotic and steroidal eye drops several times a day.
GLAUCOMA
Definition:
Glaucoma is the condition of increased intra ocular pressure (IOP), causing gradual
loss of sight.
Types:
Glaucoma has two forms:-
 Congenital or infantile glaucoma:
It occurs in children under 3years of age. It may be present at birth.
 Juvenile glaucoma:
It affects children older than 3 years of age and is usually secondaryto some other
disease.
Incidence and Etiology:
Congenital or infantile glaucoma occurs in 1 out of 10,000 live births. It occurs due to
defect in the drainage system of eye. It is usually caused by a developmental anomaly of the
iridocorneal angel of eye known as trabeculodysgenesis.
Juvenile glaucoma occurs secondaryto some other disease like retinoblastoma, trauma
to the eye etc.

11. Pathophysiology:
Due to defective development of the trabecular meshwork, sufficient amount
of aqueous humor is not drained out of the intra ocular space. This leads to
accumulation of aqueous humour in the anterior chamber of eye, resulting in
increased intra ocular pressure. This increased pressure causes damage to the
ganglion cells of retina, leading to necrosis of the optic disc, which results in
blindness.
Clinical features:
The clinical features of glaucoma are:-
 Excessive tearing.
 Involuntary closing of eyelid
 Photophobia
 Enlargement of eyeball (Buphthalmos)
 Haziness or clouding of cornea
 Pain in the eyeball
Diagnostic evaluation:
Intraocular pressure of eye is measured by tonometry. The normal pressure is 12 to 20
mm Hg. Formeasurement of intraocular pressurein infants and young children, anesthesia
may be required. Assessment of corneal diameter and examination of retina is doneto
assess any damage to optic nerve due to increased pressure.
Management:
The definitive treatment is surgery. Goniotomy or Trabeculotomy is done to open the
channel of outflow of aqueous humour from the anterior chamber of the eye, thereby
reducing intra ocular pressure.
Postoperative care:
The postoperative nursing care aims at the following:-
 Management if intraocular pressure
 Management of pain

12.  Reducing fear and anxiety
Teaching care givers about home management These aims can be achieved by taking
the following steps:-
 Prevent increase of intra ocular pressure by preventing straining, crying and getting
startled.
 Eye patch must be applied.
 Administer the prescribed analgesic and antibiotics
 Educate the care givers about recognition of signs of increased intra ocular pressure,
signs of infection, instillation of eye drops and need for follow up.
PTOSIS:
 Definition:
 Drooping of upper eyelid by weakness of ocular muscles is known as ptosis. It
occurs due to weakness of levator palpebrae or less frequently, the muller muscles.
 Etiology: Ptosis occurs onfollowing conditions:
 Myasthenia gravis
 Eyelid injuries
 Third nerve palsy
 Diagnostic evaluation: Assessmentof the child shows drooping of eyelid and
impaired vision as the eyelid covers the pupil.
 Management: The problem needs surgical correlation to raise the eyelid and
increase visual field. Patching of the eye is needed postoperatively for few days.
REFRACTORYERRORS:
Refraction is the process bywhich the cornea and lens of the eye bend light rays, to
focus on the retina. When the bending of rays and length of eyeball are uncoordinated,
the image does not fall on a single point on retina. This results in refractory errors. When
refraction is normal it is known as ‘emmetropia’.

13. Incidence and etiology:
Refractory disorders are the most common type of visual disorders in children that occur
due to the following reasons:-
Abnormal curvature of refractive surface
Abnormal position of refractive surfaces
Abnormal anterio-postetior length of eye ball
Abnormal refractive index of refractive media of eyeball i.e. lens (as in cataract) and
vitreous humor (after vitrectomy)
Types :
He following Refractive disorders may be present in children:-
Myopia (Nearsight)
Hyperopia (Far sightedness)
Astigmatism (Blurred vision)

14. MYOPIA (NEAR SIGHTEDNESS)
Definition
Myopia is the condition in which the parallel rays from distant object focus in front of
retina.
Types
i. Congenitalmyopia: It is present at birth and may be unilateral or bilateral. It is
usually associated with convergent squint.
ii. Simple myopia: This is the commonest type and is not associated with any
degenerative changes in retina and choroid. It starts in early adolescence, increases
during schoolyears and becomes stationary after the age of 25 years.
iii. Progressive myopia: This type progresses rapidly and is accompanied by
degenerative changes in vitreous, choroids and retina.
Pathophysiology
When the length of eyeball in anterio-posterior axis is more due to over development of
the eye, or if the refractive index of lens is greater than normal or if the curvature of
cornea is greater than normal, it causes the light rays to focus in front of retina.

15. Clinical Features
 The clinical features of myopia are as follows:
 Dimness of vision for distant objects – The child usually complains that he/she
cannot see the writing on blackboard in school.
 If the defect is severe, apart from dimness of vision for distant objects, the child
complains of headache on reading.
 The child is seen holding books closely to eyes, while reading.
Management
The defect should be corrected by prescribing a concave lens; of appropriate strength for
the child. Photorefractive keratectomy laser surgery may be used to correctmyopia.
HYPEROPIA (FAR SIGHTEDNESS)
Definition
Hyperopia is the condition in which parallel rays from a distant object focus behin the
retina. This is the most common refractory error.

16. Pathophysiology
 When the length of eyeball in anterio-posterior axis is shorter than normal or if the
refractive index of lens is low or if the curvature of cornea is less than normal, the
light rays focus behind the retina resulting in difficulty with near vision.
Clinical Features
The Clinical features of hyperopia are as follows-
 Diminished vision, both for near and distant objects.
 In less severe hyperopia, the child complains of reading problem.
 There may be headache, transient blurring of vision (particularly while reading), pain
in eyes, heaviness of eyelids and redness of eyes.
ASTIGMATISM
Definition
Astigmatism is the refractory error in which refraction differs in different meridians of
eye. In the horizontal meridian, the eye is emmetropic while in the vertical meridian, it is
hypermetropic or myopic.

17. 
Types Irregular astigmatism: Here the rays of light are reflectedvery irregularly
due to irregular cornealcurvature, as in case ofcornealscar.
 Regularastigmatism: In this type, the meridians of greatestand leastcurvature
are at right angles to eachother. They are called principal meridians. It is of the
following types:
 Simpleastigmatism: In this type, one meridian is emmetropic (normal
refraction) while other is either myopic or hypermetropic/hyperopic.
 Compoundastigmatism: In this type, both the meridians are either myopic
or hypermetropic/hyperopic.
 Mixed astigmatism: Whenone meridian is myopic and the other is
hyperopic, it is known as mixed astigmatism.
 Pathophysiology

18. Astigmatism occurs where there is uneven curvature of the cornea or lens or
both, preventing light rays from focusing correctly on retina. It also occurs due
to dislocationof the lens.
Management
 For the correctionof regular astigmatism, cylindrical lens of proper strength is
prescribed. In case ofirregular astigmatism, correctionin eye sight can’t be
made with cylindrical lens, but use of contactlens can be helpful.
DISORDERSOF IMPAIRMENT OF EYE MUSCLES
 Eye movements are coordinatedand controlled by six small muscles, innervated
by cranial nerves III, IV and VI. If these muscles are affected, vision becomes
impaired. Disorders of eyes, relatedto impairment of muscles are – Strabismus
and Amblyopia.
 STRSBISMUS (SQUINT) Definition
 The deviation of visual axis from normal alignment is known as strabismus. The
visual line of eacheye does not simultaneously focus on the same objectdue to
lack of muscle coordinationresulting in a crossed – eye appearance.

19. Types
 Strabismus is of two types:
 i. Paralytic or non-concomitant type
 ii. Non paralytic or concomitant type
 Paralytic or non-concomitant type
 This type occurs due to weakness or paralysis of one or more extra ocular muscles.
There is limitation in movement of eye and diplopia occurs. Congenital paralytic
strabismus occurs due to neuromuscular anomalies or birth trauma. Acquired
strabismus results due to intracranial tumors, myasthenia gravis, CNS infections,
polio, encephalitis, diphtheria toxin, lead toxicity, botulism, thiamine deficiency and
fracture of base of skull.
 Non paralytic or concomitant type

20.  This is the commonest type. The movements of individual ocular muscles are present,
but coordination is lacking. Diplopia does not occur in this type.
 According to another classification, strabismus is of three types-
 i. Esotropia
 ii. Exotropia
 iii. Hypertropia
 Another Classification of strabismus classifies it into three types-
 i. Esotropia (convergent): In this type, the eyes turn towaaards the midline.
 ii. Exotropia (Divergent): In this type, the eyes turn away from the midline.
 iii. Hypertropia: In this type, the eyes are out of vertical alignment. One pupil
appears higher than the other.
 Diagnostic Evaluations Hirschberg test
 A pen light is held such that the light is facing straight aheadand is
approximately 12 inches from the child’s head. Using one hand the
ophthalmologistturns the child’s head so that the light is in midline position
towards child’s eyes. The ophthalmologistthan observes the light reflection
from cornea. The reflectedlight should be seensymmetrically in the centerof
both corneas.
 In esotropia, light reflection is displacedto the outer margin of cornea as the eye
deviates inward. In exotropia, light reflectionis displaced to the inner margin of
cornea, as the eye deviates outward.
 Cover-Uncover/test
 This test is performed on infants greater than 6 months of age through schoolage.
Place the child in a seated position on the examining table or caregiver’s lap. The
physician stands 2 feet away, in front of the child. The child is asked to focus
attention on penlight in the hands of the physician. A cover card or hand is placed
over one eye. Wait until the uncovered eye focuses, then remove the cover card or
hand and evaluate the eye just uncovered for focusing movement.
 The normal finding is that neither eye moves when cover card or hand is being
removed. It is abnormal for one or both eyes to move to focus on pen light during

21. assessment. Strabismus after 6 months of age is abnormal and indicates eye muscle
weakness.
 Management Early diagnosis and treatment is desirable, as failure to do so
results in permanent Amblyopia. The goalof treatment is to attain the best
possible vision in eacheye while also attaining binocular vision.
 Treatment canbe medical or surgical. To develop best possible and equal or
near equal vision in both eyes, it is essentialthat all refractoryerrors be
correctedafteraccurate assessmentof visual acuity. Also other associated
conditions such as cataractshould be treated.
 MedicalManagement
 The medical approach may utilize occlusion therapy and orthoptic training for
correction of strabismus.
 a. Occlusion therapy
 Occlusion therapy is recommended, if the squinting eye is amblyopic. Vision
improves in squinting eye by continuous exercise. Forthis purpose, the normal eye
has to be absolutely occluded for 1-2 weeks or longer (at a time for 6-8 weeks).
 b. Orthoptic training
 Specially designed visual exercises are taken in order to encourage the productionof
simultaneous and binocular vision, elimination of false projection and production of
stereoscopic apparition.
 c. Pharmacologic therapy
 Use of miotic drugs makes accommodation easier.
 SurgicalManagement
 Surgery involves shortening; lengthening or repositioning of extra ocular muscles
should be under taken at earliest if other modalities fail.
Nursing management: Nursing assessment
It includes the following:-
 Assess forred light reflex, especiallyin newborns. Absence or asymmetry of red
light reflex may indicate congenitalcataractoran intraocular tumor.

22.  Inspect eyes for redness of conjunctiva, cloudiness of cornea, excessive tearing,
ptosis or misalignments, which provide clue to congenitaleye problems.
 Assess the visual acuity routinely in infants and children.
Nursing interventions: Minimizing effects ofvision loss.
 Encourage and assistparents in obtaining corrective lenses for child.
 Assistparents in locating and finding resourses suchas financial
assistance, specialeducationin braille or parental support groups.
Minimize bodyimage disturbance.
 Encourage parents to focus on normalization rather than begin over protective
towards the child.
 Allow the child to play with peers and make his life as normal as possible.
 Encourage parental acceptance towards appearance of the child.
Prevent injury:
 Encourage the family to take care of child’s safety at home, schooland in
community.
 Advise the family to maintain a consistent and uncluttered furniture arrangement.
Notify the child of changes done in home setting.
Instruct the child to use a cane or other walking assistance device Promote normal growth
and development:
 Encourage the parents to provide many sensoryopportunities to the child such as
manipulating objects, hearing various sounds, noting the smells in environment etc.
Parental education:
 Parents must be taught about instillation of medications and use of eye shield to
prevent injury to the eye after surgery.
 Bed rest may be required immediately postoperatively.
 Older children should be advised to avoid engaging in strenuous activities or contact
sports for at least 2 week.
 Avoid over feeding the child to prevent vomiting that may cause straining.

23.  Do not let the child cry.
 Encourage and teach parents to do eye care to remove eye discharge or crusts on
lashes by washing the eyes with warm water. Eye care can also be done by wiping off
the eyes with moist cotton balls.
 AMBLYOPIA: Definition:
 Amblyopia means poor vision in one eye that has not developed normal
sight. It is unrelated to an organic cause. The condition is sometimes called“lazy
eye”. It occurs whenvisual acuity is better in one eye that the other.
Incidence and Etiology
 Amblyopia occurs in approximately 2-3% of the population in preschoolage.
 The most common cause ofAmblyopia is strabismus, where the brain
suppresses visionin deviated eye to avoid double image that is receiving.
Eventually the eye sight of deviated eye is lost.
 Other causes ofAmblyopia are cataract, cornealopacityor prolonged patching
of eye to correctstrabismus and refractive Amblyopia, which occurs whenthere
is asymmetric refractive error in eacheye.
Clinical Features
 Infants and children with Amblyopia often do not display any symptoms. They
may occasionallyoverreachfor an object
 Diagnostic Evaluation
Amblyopia is usually asymptomatic because the goodeye assumes the burden of
vision and the child is unaware that there is a problem. It is therefore essential,
that child’s eyes are examined periodically before the age of 7 years. If any
difference in the visual acuity of two eyes is detectedthe child should be referred
to an ophthalmologistfor treatment.
Management
 If the cause ofAmblyopia is strabismus, surgery may be required. If the cause is
a cataract, then cataractremovalsurgeryis done. Refractive Amblyopia is
treated by correcting refractive error with corrective lenses.

24.  The main managementof Amblyopia is occlusionofthe goodeye to force vision
in the “lazy eye”.
LESS COMMON EYE DISEASES IN CHILDREN
 While the above eye disorders are common and easyto correct, if detectedand
treated early, eye diseasescanbe much more serious. Some of them can be
treated cured, others are incurable. Fortunately, these diseasesare rare
 RETINOPATHYOF PREMATURITY(ROP)
 Babies born with a very low birth weight have an increasedrisk of developing
abnormal peripheral retinal blood vessels thatcan cause the retina to become
loose (detachedretina), which can lead to blindness. Those babies who do not
develop this problem in childhood still have an increasedrisk of retinal
detachment later in life, and should be seenregularly by an eye doctorto check
for retinal detachments.
 FAMILIAL (CONGENITAL)BLINDNESS
 If there is a history of blindness in the family of either the father or mother,
parents need to seek genetic counselling to help determine the risk of blindness
in their children.
 RETINITIS PIGMENTOSA
 In this inherited disease, the retina in eye degenerates more and more over time
(progressively). Children are unable to see at night (develop night blindness)
and then lose their side (peripheral) vision. Tunnel vision (no side vision at all,
as if in a tunnel) develops, followedby complete blindness.
 LEBER’S CONGENITALAMAUROSIS
 Blindness or near-blindness occurs in children with this disease becauseofloss
of nerve function in the retina of both eyes. A jerky movement of the eyes
(nystagmus) may occuralong with hypersensitivity to light and sunken eyes.
 CONGENITALGLAUCOMA
 In this disease, highpressure of the fluid within the eye, togetherwith an
enlargedcornea cancause nerve damage in newborns and infants. A common

25. cause is malformation of some parts of the eye. Too much tearing (excessive
watering)can be a warming sign of congenitalglaucoma but may also indicate
less serious conditions, such as a blockedtear duct.
 DERMOID CYSTS
 These are bumps usually found on the side of the head near the eyebrow. They
are not cancer, but are actually capsules containing skintissue, hair, fat, or
other body tissue. Dermoid cysts should be removed before the child begins to
walk because they can break open during a fall and cause painful inflammation.
Warning Signs
 An eye doctor-either an optometrist or an ophthalmologistmust be consulted, if
any of the following signs are presentin the child:
 Eyes flutter quickly from side to side (nystagmus).
 Eyes are wateryall the time.
 Eyes are always sensitive to light.
 Eyes change in any way from their usual appearance.
 White or yellow material appears in the pupil.
 Redness in either eye persists for severaldays.
 Pus or crust appears in either eye.
 Eyes look crossedor“wall-eyed”.
 The child constantly rubs his or her eyes.
 The child often squints.
 The child’s head is always tilted.
 Eyelids tend to droop.
 One or both eyes seemto bulge.
 One pupil is larger or smaller than the other (asymmetric pupil size).
 Baby does not make eye contactby 3 months of age.
 Baby does not focus on and follow objects by 3 months of age.

26.  Baby does not reachfor objects by 6 months of age.
 Baby covers or closes one eye.
 One eye constantly or sometimes (intermittently) turns in, out, up or down.
BLINDNESS:
 Definition:
 According to W.H.O. “The inability to count fingers in day light from a
distance of 3 meters is defined as blindness”
Prevalence and etiology:
 It is estimated that there are 16-18 million blind people in the world. In
India, their number is about 9 million. The main causes ofblindness in children
are:
 Vitamin A Deficiency
 Malnutrition
 Eye infections
 Injuries
 Congenitaleye disorders like cataract
 Tumors
Problems of blind child:
 Problems of attachment:
 When a mother discovers that her child is blind, the initial reactionis
often of depressionand grief followedby rejection of the child. Due to blindness,
the vital interactionbetweeninfant and mother is hampered.
 Inability to use hands as organof perception:
 In normal sighted infants, hand coordination and reaching for objects is
developed until 9 months to one year. Those infants who do not receive early
intervention, the hand may not develop as an autonomus organof perception
and they may developas an autonomus organof perceptionand they not make
sensitive discrimination and are incapable of Braille reading.

27.  Problem in locomotion:
 The blind children show marked delay in locomotion. While a normal
sighted child starts walking by one year, blind children start waking
independently by two years. There are constantdifficulties in travelling from
one place to another.
 Dependence:
 The most capable blind child even if given an optimum environment, is
more dependent on parents or care takers than normal child. Routine self care
skills such as dressing, eating, toilet training, personalhygiene etc. Present
practicalproblem. They require specialeducation(Braille system) and can be
trained in specialschools.Integrationinto the societyis also a specialproblem.
 Behaviouralproblems:
 Certain common behavioural problems are seenin blind children like
body swaying, head knocking, eye rubbing, head rotating or repetitive hand
motions. The child may develop severe ‘blind deviant child syndrome’ in which
the child demonstrates stereotypedhand behaviour, rocking, swaying and
mutism or copying spokenwords.
Management
 Early intervention can greatly alleviate the problems of blind children.
 Blind children can be helped in following ways:
 The blind child should be trained to recognize tactile and auditory stimuli which
will be helpful in locomotion.
 Help the child in speechdevelopment by providing speechtherapy.
 Occupationaltherapy or vocationaltraining should be provided to these
children so that they can earn their living
 These children should be trained to recognize and use common household
things.
 They should be trained to travel independently using various tools and
techniques like long cane, guide dog, GPS systemetc.