Common Paediatric Eye Conditions
Common eye conditions in children include strabismus (squint), amblyopia (a lazy eye), allergic conjunctivitis, blepharitis (inflammation/infection of the eyelids), chalazion (‘stye’).
Retinopathy of Prematurity
Retinopathy of prematurity (ROP) is an eye disease which effects very premature babies (less than 32 weeks and/or less than 1500g birthweight). ROP may be mild and may resolve spontaneously. If untreated, severe cases can result in loss of vision and blindness due to retinal scarring and retinal detachment. Treatment for ROP is usually carried out using laser, or injections into the eye in the most severe cases.
A cataract occurs when the lens of the eye is cloudy or opaque. Cataracts in childhood are rare (occurring in approximately 3 in 10,000 children) but may be present from birth or can develop during childhood. They are often genetic and can be associated with other medical problems. They do not always effect have a significant effect on vision, and in some cases can be managed with spectacles and patching. However, cataract surgery is often needed. Infants and young children may need to wear contact lenses following cataract surgery.
Glaucoma occurs when the pressure within the eye builds up (the intraocular pressure, IOP) and damages the optic nerve. It is very rare in children but can occur from birth or later on in childhood. Surgery is usually needed for childhood glaucoma, although some cases in older children may be treated with eye drops.
Strabismus (squint) occurs when the eyes are not aligned. It can be present from infancy or develop later in childhood. In many cases, spectacle wear improves or get rid of the strabismus. Strabismus is often associated with amblyopia (a lazy eye) which can usually be treated with patching of the good eye (or atropine drops). In some cases, surgery is needed to improve the alignment of the eyes.
Uveitis in children
Uveitis occurs due to inflammation of the ocular structures; it can affect the anterior part of the eye (anterior uveitis, iritis), the middle part of the eye (intermediate uveitis), or back of the eye (posterior uveitis, retinitis, vasculitis). Uveitis can occur in children with arthritis (juvenile idiopathic arthritis, JIA). Uveitis may not cause any symptoms in young children; in view of this, children with JIA should have regular eye screening appointments to detect any uveitis at an early stage. Uveitis in children can lead to loss of vision due to cataract, glaucoma and swelling at the back of the eye (macule oedema). New treatments have significantly reduced the incidence of visual loss in children with uveitis.
Neurometabolic disorders are a group of rare genetic diseases that often present in infancy and childhood. They are associated in many cases with eye disorders such as atrophy of the optic nerve, retinal degeneration, and corneal clouding, which may result in loss of vision, and also eye movement disorders.
Genetic disorders effecting the eyes include retinal dystrophies (degeneration of the retina causing, in many cases, night blindness and loss of peripheral vision), albinism (caused by the complete or partial absence of pigment in the eyes and/or skin and hair), and aniridia (partial absence of the iris with nystagmus and reduced vision).
Corneal disease in childhood
Corneal conditions in childhood can lead to visual loss due to scarring and corneal clouding. Common corneal conditions in childhood include infections (viral or bacterial), or involvement in allergic eye disease. Corneal dystrophies in childhood may cause recurrent episodes of painful erosions or progressive visual loss from corneal clouding. Keratoconus occurs when the cornea curvature becomes irregular, sometimes due to excessive rubbing of the eye.
Cranial nerve palsies occur in children due to a variety of causes, and result in abnormalities of eye movement, squints and double vision in older children. Optic nerve problems in children may be found by the optician and include optic nerve drusen (which is a common optic nerve variant which requires no treatment) and, rarely, swollen optic nerves due to intracranial pressure (papilledema) which may require urgent treatment.