Pediatric Ophthalmology

Children who have eye conditions are often referred to a Pediatric Ophthalmologist, who is an ophthalmologist with sub-specialist training in eye disorders that commonly affect children.

Some conditions are more common in children than adults, including strabismus, nasolacrimal duct obstruction, amblyopia, and retinopathy of prematurity.  There are other conditions that can affect children more rarely, including cataract, glaucoma, uveitis, retinal dystrophies, genetic abnormalities and congenital abnormalities.

Pediatric ophthalmologists are specially trained to examine children, diagnose and treat most conditions that children may present with.  Occasionally, the condition requires further specialty care and your pediatric ophthalmologist may co-ordinate care with another ophthalmologist.

Common conditions:

1. Strabismus (see separate section)

2. Amblyopia

3. Nasolacrimal duct obstruction

WHAT IS AMBLYOPIA?

Amblyopia is decreased vision in one or both eyes due to the brain getting used to “seeing” blurred images during childhood.  Amblyopia is most commonly caused by refractive error (needing glasses to see), strabismus (an eye misalignment) or occasionally ptosis (a droopy eyelid).

Treatment first includes glasses to correct the blurred vision.  It is important that children wear the glasses at all times while awake.  If the amblyopia persists after wearing glasses for a few months, patching is then recommended.  Parents may be asked to patch the dominant (strong) eye to force the brain to use the weaker eye for 2-6 hours/day.  Ophthalmologists typically recommend patching with sticky patches as the children aren’t able to peak around the patches.  If the child refuses to patch, there are options of using atropine 1% eye drops in the dominant eye to blur the vision instead of using patches.  Patching therapy works best in children under age 5, but it can have benefits into teenage years if no previous patching has been performed.

The American Academy of Pediatric Ophthalmology and Strabismus has further details.  Please see their website for further information.

WHAT IS A NASOLACRIMAL DUCT OBSTRUCTION?

Tears that are made in the lacrimal gland flow across the surface of the eye and drain into a tear system in the eyelid, then into the nose.  When children are born, it is very common that the tear system (nasolacrimal duct) that ends in the nose is blocked by a small membrane.  Typically, the children will have clear tears from one or both eyes from birth and this is usually worse when the child has a cold.  There is often crusty discharge from the eyes in the morning, worse then the child has a cold.  If one eye is larger than the other or the cornea (front of the eye) becomes cloudy, this is worrisome for congenital glaucoma (an eye emergency).

In 95% of cases, the membrane dissolves by 1 year of age and the tearing resolves by itself.  Due to this, most ophthalmologists will wait until age 1 before recommending surgery.  Massaging the tear system, warm compresses to remove crusting and discharge can help symptoms during this time.  Antibiotic eye drops are used when there is an infection.

If the tearing continues after 1 year of age, your ophthalmologist may suggest a tear duct probing and irrigation.  This procedure is done under general anesthesia at the Alberta Children’s Hospital.  Once the child is asleep, a small thin probe is placed into the natural tear duct system to enlarge the tear duct and open the membrane at the bottom of the nose.  No cuts are made in this procedure.

Often, there is minimal pain or discomfort post-operatively.  The child may have a bloody nose for a day or two.  Occasionally, the tearing doesn’t resolve following a tear duct probing and further surgery may need to be performed.

The American Academy of Pediatric Ophthalmology and Strabismus has further details.  Please see their website for further information.