As our children grow from newborns to crawlers to walkers and beyond, it's easy to take for granted the important role their eyes play in all they do. "Vision is fundamental for so many aspects of learning, from recognizing faces and shapes to reading, and from birth until 7 to 10 years old is a critical time for developing vision," says Laura K. Green, M.D., a cornea specialist and comprehensive ophthalmologist at the Krieger Eye Institute and director of the ophthalmology residency program at Sinai Hospital of Baltimore. "Just like children have to learn to pick up a spoon and get it to their mouth, through early childhood they are building connections between the eyes and the brain and the brain is learning how to see." For that reason, recognizing and treating eye problems promptly is a key part of keeping your child thriving. Read on to learn about some common eye problems in children and what you can do to keep your little one's baby blues--or browns, hazels, or greens--in top shape.
"The most common reason to go to the eye doctor is the need for glasses," says David L. Rogers, M.D., clinical assistant professor of ophthalmology at The Ohio State University, director of research in the department of ophthalmology at Nationwide Children's Hospital in Columbus, Ohio, and a member of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Glasses help to correct refractive errors, which are vision problems that occur when the shape of the eye prevents you from focusing well, according to the National Institutes of Health's National Eye Institute (NEI). Refractive errors in children include myopia (also called nearsightedness), which is difficulty seeing things that are far away, hyperopia (farsightedness), or trouble seeing things close by, and astigmatism, distorted vision caused by an irregularly shaped cornea. The most common symptom of these conditions is blurred vision, says the NEI. Other red flags: double vision, haziness, glare or halos around bright lights, squinting, headaches, or eye strain. Talk to your child's pediatrician if you have any concerns.
Amblyopia, also known as "lazy eye," is a condition in which the vision in one eye is compromised because the eye and the brain are not working together properly. The brain doesn't want to see double, explains Dr. Green, so if one eye doesn't see well, the brain will block the blurrier image. "Over time, if not treated before the age of 7 to 10 years, one eye's images will be blocked out permanently," she says. Amblyopia can be caused by strabismus (misaligned eyes), different prescriptions in each eye (for example, one eye might be more nearsighted than the other), or issues such as cataracts or a droopy eyelid. Some of the causes of amblyopia are visible--misaligned eyes, for example--but others aren't, which means you might not realize anything is wrong with your child's eyes. Routine vision screenings at your child's well visits can pick up problems. Treatment for amblyopia typically involves addressing the issue that's causing poor vision in one eye as well as forcing your child to use that weaker eye. This is often done by patching or blurring the stronger eye with eye drops or the prescription in glasses. The earlier treatment begins, the better.
Strabismus is a condition in which the eyes are misaligned--one may turn in, out, up or down--and therefore don't focus on the same point at the same time. You may hear the terms "crossed eyes" or "wandering eye" used to describe this condition. According to the American Academy of Ophthalmology (AAO), strabismus affects approximately 4 percent of children in this country. Strabismus can be a precursor to amblyopia because when the eyes are focused in different directions, the brain may "turn off" the misaligned eye. Over time, the ignored eye can lose vision. The treatment for strabismus can include glasses, eye exercises, and/or eye surgery.
Commonly referred to as "pinkeye," conjunctivitis is the inflammation of the thin lining of tissue inside the eyelid and over the white part of the eye. It is caused by viruses, bacteria, allergens (say, mold or pet dander), or irritants such as swimming pool chlorine or smog, says the American Academy of Pediatrics (AAP). Symptoms include redness or swelling of the white part of the eye or inside the eyelid, tearing, eye discharge (which can be white, yellow, or green), itchy or burning sensations, increased sensitivity to light, a gritty feeling in the eye, and crust on the eyelids or lashes. Pinkeye caused by bacteria is usually treated with antibiotic eye drops or eye ointment. If the pinkeye is viral, it just has to run its course, which typically takes seven to 14 days. Both viral and bacterial conjunctivitis are contagious so make sure your child doesn't share towels, sheets or pillows with anyone else in the family, and encourage everyone to be extra careful about hand washing.
A stye is a tender, red bump that pops up when an oil gland on the eyelid becomes blocked. While the bump is usually the most obvious symptom, your child may also feel that his eye is more sensitive to light than normal, tears more than usual, is sore, or feels like there's something in it. Styes can usually be treated at home by applying a warm, wet compress to the area for ten minutes several times a day. This can help coax the gland to open and release the fluid (usually excess oil) that's clogging it. Never try to pop or burst a stye. You should call the doctor if the stye gets progressively larger or doesn't show signs of improvement within a few days, says Dr. Rogers.
One in ten babies is born with a blocked tear duct, according to the AAP. "We commonly see blocked tear ducts in children under 1 year old. Often, a parent will notice that one eye is always tearing and so she'll bring the child in," says Lauren S. Blieden, M.D., an ophthalmologist at the Robert Cizik Eye Clinic and assistant clinical professor at The University of Texas Health Science Center at Houston. "We usually just watch it, because the vast majority of times a blocked tear duct opens on its own as the child's face grows and his anatomy matures." In the meantime, your child's doctor may recommend that you gently massage the inner corner of the eye twice a day to encourage the duct to open if a mild infection occurs. If the blocked duct doesn't resolve itself by the time your child is 12 months old, an ophthalmologist can perform a relatively simple procedure to unblock it.
"Parents are the first line of defense against developmental eye issues," says Dr. Green. "If you notice something unusual, bring your child in for an eye exam, ideally with a pediatric ophthalmologist." Some red flags to look out for include:
- An eye (or eyes) that turns in or out. (The exception: If a child is under 4 months old it's normal for the eyes to sometimes turn in or out, says Dr. Blieden.) You might notice this in person or only in pictures. "A mild crossing of the eyes might only be apparent in photos and not when your child is in front of you moving and looking around," says Dr. Green.
- Pupils that appear different from each other. Both pupils should be the same size.
- A child who always holds her head in a certain position so she can see better.
- Uneven red reflex. When looking at the latest photos of your kids, check out their eyes. "The red eyes that you see in photos should both look the same," says Dr. Blieden. "If one eye looks different in more than just one photo then that's a reason to see an ophthalmologist more urgently."
While it's important to be alert to any abnormalities, not all eye problems are visible to parents. For that reason, regular vision screenings are essential. The American Academy of Ophthalmology recommends eye exams for newborns, infants between six months and one year, preschoolers and school age children. "Your child's pediatrician can do the exam and if she finds something worrisome then your child should see an ophthalmologist," says Dr. Blieden.
A final word of eye advice: Have your child wear safety glasses when participating in sports like baseball and basketball, says Dr. Blieden. It's an underused but important way to protect your child's precious peepers.
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