Common Childhood Eye Disorders

This month, our Ask The Expert topic is all about paediatric ophthalmology and the signs to look out for that suggest your child may have an eye disorder or need glasses. Here, Dr Syed Masad Ali from Moorfields Eye Hospital Centre tells us about the common eye disorders in children, what symptoms to be aware of, and why you should be limiting the amount of time your child spends looking at a screen or even reading a book

Eye disorders aren’t uncommon in children, and the vast majority of them are treatable. Aside from prevention, the most important thing is to detect symptoms early, before they impact on your child’s quality of life and performance at school.

This condition occurs when one or both eyes are misaligned and the eyes do not point in the same direction. The eyes may turn inwards (crossed eyes), outwards (wall eyed), up and down, or a combination of these. Squint effects around 2% of children, can be present at birth or early infancy, and may be caused by a muscle imbalance or a need for glasses. Treatment may involve the use of glasses, orthoptic therapy, or eye muscle surgery.

This is blockage of the tear passages preventing tears from running. It is relatively common; fortunately it tends to disappear in almost all cases within the first year. Typically as the child grows the problem resolves on its own. We usually recommend massaging the inner corner of the eyelid regularly as this might help in opening the tear passage. The eye may tend to turn red and need to be treated with antibiotics but only for short periods of time. It is very helpful to keep the eye clean of discharge. If this persists we would consider opening the tear passage with a quick and effective procedure but only if the child is over one year of age.

Refractive errors cause decreased vision, visual discomfort (“eye strain”), and/or amblyopia. The most common form, short-sightedness (poor distance vision) is usually seen in school-age children and is treated effectively, in most cases, with glasses. Uncorrected refractive errors can cause amblyopia particularly if they are severe or are different between the two eyes.

It may sound like a good thing but actually it isn’t. It happens when the eye is a little too short so light is focused behind the eye rather than on the retina. The eye has to work hard all the time to keep things in focus and when it tires the vision goes blurry. It is often associated with crossed eyes and can be a barrier to normal visual development.

Here the eye is a little too long so light is focused in front of the retina. Objects close to the eye are in focus but things in the distance are not. This is not usually a barrier to normal visual development because a child is mostly interested in the things close by anyway.

This is a condition in which an abnormal curvature of the cornea occurs, resulting in decreased vision. This can start in childhood or as an adult and can be easily corrected if it is causing problems. Some signs and symptoms of astigmatism may include headache, eye-strain, difficulty reading, and fatigue.

This is a cyst on the eyelid, and happens when one of the glands gets blocked and leads to swelling, and it can be of variable size. For the first few days the cyst is inflamed and you might see a small white head on the top of it which then tends to shrink, but might take months to disappear completely. This is not a serious condition and no action is required in most cases. Initially hot compresses with massaging of the area in addition to an antibiotic ointment are all that is required. If the cyst is very big to start with and doesn’t drain or if it tends to persist for months and is bothersome, it is best removed surgically.

This is redness of the thin skin covering the white of the eye. It is a very common condition but there are differences between conjunctivitis with sticky discharge and the allergic type. The former is contagious and can be spread in small communities such as kindergarten and schools. It is not serious but it is important to take preventive measures to avoid further spreading. The conjunctivitis tends to disappear within a couple of weeks in most cases. Allergic conjunctivitis on the other hand is an on-going problem, with symptom- free periods and new outbursts in other periods of the year and occasionally persistent, and requires specific treatment and sometimes anti-inflammatory drops.

Lazy eye, as it is commonly known, affects around 3-5% of children. It occurs when an eye that is otherwise normal, has not received proper stimulation during early childhood and therefore suffers reduced vision. It may result from the presence of a squint or one eye focusing better than the other. If the condition is not recognised and treated during childhood the lazy eye will never improve and the vision loss will be permanent. Treatment typically consists of correcting any focusing problems with glasses and then covering the good eye (patching) to force the lazy eye to work. Improvement of vision after the child is 8 or 9 years of age is rarely achieved.

The most common eye conditions that affect children are strabismus (squint), amblyopia (lazy eye), and refractive error (long/short sight or astigmatism).