Pediatric Ophthalmology

Cataracts can be seen in new born babies or small children and require urgent attention. Various reasons are known as causative agents for childhood cataracts

1. Heredity child born to parents with known Childhood cataracts.
2. Infections, drugs, deficiencies during pregnancy like rubella, CMV infections
3. Prematurity Trauma with sharp objects can cause cataracts.

TREATMENT OPTIONS

1. Child less than 6-7 months simple removal of cataract with lensectomy and correction with glasses or contact lenses is the treatment of choice.
2. However, in children older than 7 months a personalized decision to implant intra ocular lens is taken based on size of eyeball & associated defects like coloboma, microcornea etc.
3. In children older than 18-24 months intraocular lenses are implanted with good results. A meticulous follow up and careful change in glasses along with patching of eye is needed for an excellent outcome.

Raised intra ocular pressure causing damage to the nerve of eye causing permanent loss of vision is known in adults and is one of the major blinding diseases. This disease can affect a new born or a child. Commonly it is diagnosed with following symptoms.

1. Large size of eyeball.
2. Hazy cornea (front part of eyeball).
3. Watering of eye.
4. Photophobia (inability to tolerate light).
5. Although a smaller number of these children have family history of glaucoma most of them do not have such history.
6. Causes are not really known which cause congenital glaucoma.

TREATMENT OPTIONS

Medical treatment: - In form of drops to control pressure temporarily till the child is fit for surgery

Surgical treatment: -Operations like trabeculotomy + trabeculectomy offer success to the time of 85%. but requires multiple surgeries sometimes and use of drops after surgery in many occasions. For non-responding cases. other options like valve implants, laser cyclophotocoagulation are used.

Child with childhood glaucoma needs early and continued treatment and may bring failures also sometimes.

A new born even if cries does not have tearing of the eyes. And any child with tearing of eyes needs an eye checkup. Most children with tearing of eyes have the duct carrying. Tears from eye to nose blocked. This can be opened by simple massage learned from an expert till 6 - 9 month of age.

However, children who continue to have watering beyond 9 months of age need to undergo a small surgery called Probing to open this block in the duct. Children beyond 1.1/2 yrs. to 2 yrs. have less success rate of this operation and need an additional procedure of silicon intubation where in a silicon tube is connected from eye to nose and kept for 3 months in place. This operation offers 95% success rate. Dr. Killedar has done pioneering efforts in India to start and propagate this operation and bring down the cost with indigenous tools.

This rare cancer of eye occurs in 1 in 14000 new born babies. It commonly appears before 1 yr. of age in both eyes or little older children (2 - 4 yrs.) in one eye. Child most commonly develops a white reflex. In eye which should not be neglected.

sometimes It is familial i.e. occurring in those whose mother /father either have it or carry it although saving of life is most of the times possible the newer modalities of treatment like chemo reduction, EBRT, laser therapy have potential to save the eye and save the vision also.

In India children (1-12 yrs. of age) in preschool and school going group have 5% occurrence of need to wear glasses. Where as in countries like Singapore, Hongkong, Japan this percentage is 60%.

A child holding things too close, watching TV from very close distance should be taken to eye specialist for eye checkup. Ideally every child’s vision should be checked before 4th birthday to avoid many eye problems. Myopia (-minus number) in children tend to grow with age and usually stops growing by 19yrs in girls and21-23 yrs. in boys. Till then they need yearly checkups and use of glasses.

Recently use of atropine 0.01% eye drop is found to reduce progress of myopia. After stability, operation like LASIK give excellent results and freedom of glasses. If used in 6 to 12 years, Hyperopia (+plus number) in children tends to reduce with age and stabilizes by 19-23 yrs. Numbers up to 6 D can also be successfully treated by LASIK often this age.