This document provides information about common eye disorders in children. It discusses signs of eye problems, possible eye conditions like amblyopia and strabismus, refractive errors, and ophthalmia neonatorum. Vision problems are common in young children and can affect learning if not addressed. Early diagnosis and treatment of conditions like amblyopia are important to prevent long-term vision loss.

1. EYE
D
ISO
R
D
ER
S

2. INTRODUCTION
• Without good vision, a child's ability to learn about the world
becomes more difficult.
• Vision problems affect one in 20 preschoolers and one in four
school-age children.
• Since many vision problems begin at an early age, it is very
important that children receive proper eye care.
• Untreated eye problems can worsen and lead to other serious
problems as well as affect learning ability, personality and
adjustment in school.

3. SIGNS OF EYE PROBLEMS
• What do child's eyes look like?
– eyes don't line up, one eye appears crossed or looks out!
– eyelids are red-rimmed, crusted or swollen
– eyes are watery or red (inflamed)
• How does child act?
– rubs eyes a lot
– closes or covers one eye
– tilts head or thrusts head forward
– has trouble reading or doing other close-up work, or holds objects close to eyes to see
– blinks more than usual or seems cranky when doing close-up work
– things are blurry or hard to see
– squints eyes or frowns
• What does child say?
– "My eyes are itchy," "my eyes are burning" or "my eyes feel scratchy.""I can't see very well."
– After doing close-up work, child says "I feel dizzy," "I have a headache" or "I feel sick/nauseous."
– "Everything looks blurry," or "I see double."
• Remember, the child may still have an eye problem even if he or she does not
complain or has not shown any unusual signs.

4. POSSIBLE EYE PROBLEMS
Amblyopia (Lazy Eye)
 Lazy eye, or amblyopia, is a loss of vision in an eye that is not corrected by glasses
alone.
 Crossed eyes, eyes that don't line up, or one eye that focuses better than the other
can cause amblyopia.

5. Strabismus (Crossed Eyes)
 Strabismus is a word for eyes that are not straight or do not line up with each other.
 If the problem is not treated, it can cause amblyopia.

6. Color Deficiency (Color Blindness)
 Children with color blindness are not really blind to color.
 Instead, they have trouble identifying some colors.

7. Retinopathy of Prematurity
 Soon after birth, some premature infants develop changes in the blood vessels of
the eye's retina that can permanently impair vision.

8. Refractive Errors
• Refractive error refers to the optical state of the eye .
• It is a physical characteristic like height or weight and can be quantitated.
• Not all refractive errors require correction, but severe errors can cause
amblyopia (reduced vision with or without an organic lesion).
• Can usually be corrected with glasses.
• Less often, contact lenses are required, usually for very high or
asymmetrical refractive errors, or for adolescents who do not want to wear
spectacles.

9. • Laser refractive surgery is not currently indicated for most children.
• There are three common refractive errors: myopia, hyperopia, and
astigmatism.
• Inequality of the refractive state between the two eyes (anisometropia) can
cause amblyopia.
• Children at particular risk for refractive errors requiring correction with
spectacles include those who were born prematurely, those with Down
syndrome, those who are offspring of parents with refractive errors.

10. 1. Myopia (Nearsightedness)
– For the myopic or nearsighted individual, objects nearby are in focus; those at a distance
are blurred.
– This is because the plane of focus is anterior to the retina.
– The onset is typically at about age 8 years and may progress throughout adolescence and
young adulthood.
– Divergent lenses provide clear distance vision.
– Many studies have been done attempting to slow or stop myopic progression.
– Atropine eye drops have shown some effect, but produce many side effects. A newer drug,
pirenzepine, has shown promise in animal studies, and human studies are underway.

11. 2. Hyperopia (Farsightedness)
 Saying that the hyperopic child is sighted for far (not near) is somewhat misleading,
because the child can focus on near objects if the hyperopia is not excessive.
 Large amounts of uncorrected hyperopia can cause esotropia(inward deviation, or crossing,
of the eyes)and amblyopia.
 Most infants have a hyperopic refraction that begins to diminish during the toddler years
and does not require correction.

12. 3. Astigmatism
– Astigmatism results primarily from an irregular shape of the front surface of the cornea, the
transparent "window" at the front of the eye. When either the cornea or the crystalline lens
is not perfectly spherical, an image will not be sharply focused in one plane.
– Schematically, there will be two planes of focus.
– Both of the planes can be either in front of or behind the retina, or one of the planes can be
in front of the retina and the other behind it.
– Persons with astigmatism typically see vertical lines more clearly than horizontal ones, and
sometimes the reverse.
– This refractive state is described as astigmatism. Large amounts of astigmatism not
corrected at an early age can cause decreased vision from amblyopia, but proper refractive
correction can prevent this.

13. A: Emmetropia. B: Myopia.
C: Hyperopia. D: Astigmatism, myopic type.
E: Astigmatism, hyperopic type. F: Astigmatism, mixed type

14. AMBLYOPIA
Definition:
• Amblyopia is reduced vision in an eye that has not received adequate use
during early childhood.
– It is estimated that two to three percent of the general population suffers from this form of
visual impairment.
Causes:
• Amblyopia, also known as "lazy eye," has many causes.
• Most often it results from either a misalignment of a child's eyes, such as
crossed eyes, or a difference in image quality between the two eyes (one
eye focusing better than the other.)
• In both cases, one eye becomes stronger, suppressing the image of the
other eye. If this condition persists, the weaker eye may becomes useless.

15. Treatment:
• With early diagnosis and treatment, the sight in the "lazy eye" can be
restored.
• The earlier the treatment, the better the opportunity to reverse the vision
loss.
• Before treating amblyopia, it may be necessary to first treat the underlying
cause.
• Glasses are commonly prescribed to improve focusing or misalignment of
the eyes.
• Surgery may be performed on the eye muscles to straighten the eyes if non-
surgical means are unsuccessful.
• Surgery can help in the treatment of amblyopia by allowing the eyes to work
together better.
• Eye exercises may be recommended either before or after surgery to
correct faulty visual habits associated with strabismus and to teach
comfortable use of the eyes.

16. • The correction may be followed by:
– Patching or covering one eye may be required for a period of time ranging from a few
weeks to as long as a year. The better-seeing eye is patched, forcing the "lazy" one to work,
thereby strengthening its vision.
– Medication—in the form of eye drops or ointment—may be used to blur the vision of the
good eye in order to force the weaker one to work. This is generally a less successful
approach.
Complications:
• If not treated early enough, an amblyopic eye may never develop good
vision and may even become functionally blind.

17. OPHTHALMIA NEONATORUM
Ophthalmia neonatorum (conjunctivitis in the newborn) occurs during the first
month of life.
It is characterized by redness and swelling of the lids and conjunctiva and by
discharge .
Ophthalmia neonatorum may be due to inflammation resulting from silver
nitrate prophylaxis given at birth, bacterial infection (gonococcal,
staphylococcal, pneumococcal, or chlamydial), or viral infection.

18. • In developed countries, Chlamydia is the most common cause.
• Neonatal conjunctivitis may threaten vision if caused by Neisseria
gonorrhoeae.
• Herpes simplex is a rare but serious cause of neonatal conjunctivitis, since
it may indicate systemic herpes simplex infection.
• Gram staining, Giemsa staining for elementary bodies, enzyme
immunoassay for Chlamydia, and bacterial and viral cultures aid in making
an etiologic diagnosis.