Pediatrics

Amblyopia

Amblyopia is decreased vision in one or both eyes due to abnormal development of vision in infancy or childhood. In amblyopia, there may not be an obvious problem of the eye. Vision loss occurs because nerve pathways between the brain and the eye aren’t properly stimulated. The brain “learns” to see only blurry images with the amblyopic eye even when glasses are used. As a result, the brain favors one eye, usually due to poor vision in the other eye. Another word for amblyopia is often “lazy eye.” It is the leading cause of vision loss amongst children.

Strabismus

Strabismus is any misalignment of the eyes. It is estimated that 4% of the U.S. population has strabismus.

What causes strabismus?

Most strabismus is the result of an abnormality of the neuromuscular (including brain) control of eye movement. Our understanding of these control centers in the brain remains incomplete. Less commonly, a problem with the actual eye muscle may cause strabismus.

How is strabismus treated?

The goal of strabismus treatment is to improve eye alignment which allows for the eyes to better work together (binocular vision). Treatment may involve eyeglasses, eye exercises, prism, and/ or eye muscle surgery. Problems associated with strabismus (including amblyopia, ptosis, and cataract) are usually treated prior to eye muscle surgery.

Chalazion

A chalazion is a localized bump in the eyelid of varying sizes. {See Figure 1]. More than one chalazion can occur in an eyelid at the same time, and both upper and lower eyelids may be affected. A chalazion can occur on one or both eyes

What causes a chalazion?

Small glands lining the edge of the eyelids produce oil that helps to lubricate the surface of the eye (meibomian glands). When one of these glands becomes blocked, oil backs up inside the gland and forms a bump in the eyelid. If the gland ruptures, the oily materials can irritate the surrounding eyelid skin causing it to become red, swollen and painful.

Nasal Lacrimal Duct Obstructions

What causes nasolacrimal duct obstruction in children?

The most common cause is the failure of a membrane at the end of the tear duct (valve of Hasner) to open normally at or near the time of birth. Other causes of blocked tear ducts in children include:

  • Absent puncta (upper and/or lower eyelids)
  • Narrow tear duct system
  • Infection
  • Nasal bone that blocks the tear duct entering the nose.

How common is nasolacrimal duct obstruction?

Over 5% of infants have symptoms of nasolacrimal duct obstruction affecting one or both eyes. Most (approximately 90%) clear spontaneously during the first year of life. What are the signs/symptoms of tear duct obstruction? Blockage of the drainage system causes tears to well up on the surface of the eye and overflow onto the eyelashes, eyelids, and down the cheek. This usually occurs within the first days or weeks of life. The eyelids can become red and swollen (sometimes stuck together) with yellowish-green discharge when normal eyelid bacteria are not properly “flushed” down the obstructed system. Severe cases result in a serious infection of the tear duct system (dacryocystitis).