Eye Problems

We realize that you may have questions about your child’s vision or pediatric eye problems, so we’ve provided resources and extra information below that have been medically reviewed by our Nemours experts at KidsHealth.org or approved by our Nemours ophthalmologists who consult regularly with national organizations devoted to children’s visual health.

Get More Information on Pediatric Eye Problems

Find more details on some of the pediatric eye problems treated at Nemours.

 
Amblyopia (Lazy Eye)

What is amblyopia or "lazy eye"?

Amblyopia, (am-blee-o-pee-uh) or "lazy eye” is one of the most common vision problems in children and is responsible for more vision loss in children than all other causes.

With amblyopia, vision is decreased when one or both eyes send a blurry image to the brain causing the brain to “learn” to see blurry with one eye and to “turn off” that eye in order to favor the other eye.

What are the causes of amblyopia?

Underlying causes for decreased vision in a child’s eye may include refractive errors such as astigmatism or farsightedness, strabismus (a misaligned eye) or a cataract (cloudiness of the lens).

Amblyopia can be difficult for parents, and even pediatricians, to spot. A child’s eye and eye structure may look fine, and the one “good eye” may have normal vision, so the only way to detect the amblyopia is with a vision test.  

What are treatment options for amblyopia?

Amblyopia treatment may involve prescription glasses, occlusion therapy (covering one eye with a patch) or blurring the vision in one eye with atropine drops.

Blocking or blurring the vision in the “good eye” with a patch or with eye drops (which don’t sting) helps stimulate the brain to learn to use the other the eye. It usually takes a few weeks for your child’s vision to improve and the best results may be achieved over several months depending on the child’s age and level of vision. Maintenance treatment until 9-10 years of age may also be necessary.

Surgery may be used to treat strabismus (only one cause of amblyopia), but it is often not performed before treating the amblyopia with patches, glasses, and/or atropine.

 
Blocked Tear Ducts

What are blocked tear ducts?

Blocked tear ducts, also known by the medical term nasolacrimal duct obstructions, are very common in children and infants. Children may be born with a tear-duct system that hasn’t fully developed and this can lead to blockage, excessive tearing, and infection. Many cases of blocked tear ducts clear by themselves during the first year of life.

What are symptoms of blocked tear ducts?

Symptoms of a blockage include an overflow of tears, as well as red, swollen eyelids and possibly a yellowish-green discharge from a build-up of bacteria in the tears.

How are blocked tear ducts diagnosed and treated?

Our Nemours pediatric ophthalmologists will perform certain tests in the office to confirm the diagnosis of blocked tear ducts.

If the tear duct obstruction does not resolve by itself, your Nemours physician may recommend one or more of the following treatments:

  • tear duct massage
  • topical antibiotic eye drops
  • tear duct probing 
  • balloon tear duct dilation
  • tear duct intubation
 
Pediatric Cataracts

What are pediatric cataracts?

A pediatric or childhood cataract refers to any cloudiness or opacity (whiteness) in the normally clear lens of a child’s eye. A cataract can affect a very small part of the lens or involve the entire lens. Infantile and childhood cataracts occur in about three per 10,000 children.

What causes pediatric cataracts?

Cataracts in babies may be caused by abnormal development of the lens before birth. By interfering with the light ray path to the retina (back part of the eye), cataracts in children can cause abnormal vision development and may result in permanent loss of vision. 

How are pediatric cataracts treated?

Cataracts that are small and/or off-center in the lens may not need to be removed because your child’s vision can develop normally, even with the cataract. Larger cataracts or those causing major visual loss should be removed as soon as it is safely possible to do so. 

Nemours pediatric ophthalmologists are experienced eye surgeons and are highly skilled in performing cataract procedures in infants and children. Following pediatric cataract removal surgery, our team will work to restore and improve your child’s eye focus through the use of intraocular lenses placed during the surgery, or contact lenses and glasses designed specifically to help focus light rays and correct vision in infants and young children. Eye patching is also required in many cases of children with cataracts. 

 
Pediatric Glaucoma

What is pediatric glaucoma?

Pediatric glaucoma is a rare condition characterized by damage to the optic nerve and usually caused by elevated internal eye pressure (intraocular pressure). The optic nerve is responsible for sending vision from the eye to the brain.

Infantile or congenital glaucoma may be present from birth and is caused by problems in the development of the eye’s drainage system. The elevation in intraocular pressure that results can damage the optic nerve and cause severe vision loss. Juvenile glaucoma occurs in children older than age three  and is caused by other problems that can lead to increased eye pressure.

What are the symptoms of pediatric glaucoma?

Some of the most common symptoms of childhood glaucoma that our Nemours pediatric ophthalmologists look for are:

  • excessive tearing
  • sensitivity to light
  • a dull-looking iris caused by clouding of the cornea 

How is pediatric glaucoma diagnosed and treated?

Although parts of the examination for glaucoma can be done in our office, diagnosing babies with glaucoma usually requires an examination under anesthesia in order to evaluate the intraocular pressure and other aspects of the condition. For older children with glaucoma, the complete examination may be done in our office.

Taking care of pediatric glaucoma may require both surgical and medical treatment. As with most childhood eye conditions, the earlier the diagnosis and treatment, the more promising the outcome.

 
Ptosis (Droopy Eyelid)

What is ptosis or "droopy eyelid"?

Ptosis ("toe-sis") or droopy eyelid may involve one or both upper eyelids. Sometimes an eyelid can be so droopy that it blocks vision or causes a child to hold his or her head in an abnormal position in order to see well. Ptosis may be present at birth (congenital) or show up later in life (acquired).

What are some of the causes of ptosis?

One of the most common causes of droopy eyelids is poor development of the muscle in the upper eyelid, but ptosis of the eyelid can also be caused by neurological conditions that affect the nerves and/or muscles of the eyelid, or rarely by an eyelid mass.

How is ptosis treated?

Depending upon how the drooping eyelid is affecting your child’s vision and learning, Nemours ophthalmologists may recommend treatment for ptosis, possibly including prescription glasses or surgery. The American Association of Pediatric Ophthalmology and Strabismus (AAPOS)  has excellent information about ptosis.

 
Retinoblastoma (Eye Tumor)

What is retinoblastoma?

Retinoblastoma is a cancerous tumor that grows in the retina, the light-sensing part of the eye that sends the images we see to the brain. This childhood cancer, which occurs most often in children under five, can be present in one or both eyes. 

How is retinoblastoma diagnosed?

In diagnosing retinoblastoma, our pediatric ophthalmologist will examine the retina by dilating the eye, and also order imaging tests, like an ultrasound of the eye, a computerized tomography (CT) scan, or magnetic resonance imaging (MRI), as well as blood tests.

How is retinoblastoma treated?

If tests reveal that a retinoblastoma might be present, our doctors will work together with Nemours pediatric oncologists (cancer doctors) to look for any other signs of the cancer in the body, and determine the disease stage and best course of treatment.

At Nemours, we know that the discovery of a childhood cancer like retinoblastoma is overwhelming. We promise to give you and your child the resources you need to make informed decisions, to answer all your questions, and to help you cope every step of the way. 

You should also know that majority of children treated for retinoblastoma go on to lead normal lives ― and more than 80% of them will retain 20/20 vision.

 
Retinopathy of Prematurity

What is retinopathy of prematurity?

Premature babies can face a number of health problems and one of the more common is called retinopathy of prematurity (ROP). ROP causes abnormal blood vessels to grow in the retina, the layer of nerve tissue in the eye that enables us to see.

How is retinopathy of prematurity diagnosed?

Generally, the earlier a baby is born, the greater the risk of ROP. Because ROP has no signs or symptoms, the only way to detect it is through an eye examination by a pediatric ophthalmologist.

Nemours Advances the Screening and Treatment of ROP

In Florida, eye doctors at Nemours Children's Specialty Care, Jacksonville, have developed a single-use sterile exam kit for performing retinopathy exams. This kit, now used in 31 state and 60 Neonatal Intensive Care Units across the country, makes ROP testing safer and lessens the chance of infection.

And in Delaware, team members in the Division of Ophthalmology at Nemours/Alfred I. duPont Hospital for Children have published medical journal articles reviewing new guidelines on ROP screening and treatment, recent advances in therapies, and effective laser treatment options.

How is retinopathy of prematurity treated?

The results of your baby’s first eye exam will determine the need for and frequency of follow-up examinations. ROP is usually diagnosed according to stages that describe how far the blood vessels have grown into the retina.

Some cases of ROP are mild and correct themselves, but others require surgery to prevent vision reduction or blindness. Surgery involves using a laser or other means to stop the growth of the abnormal blood vessels,  the goal being to prevent the vessels from pulling on and detaching the retina.

Because there are varying degrees of ROP, the surgical approach used can differ for each case. We will discuss your baby’s condition with you and which method we recommend. The most frequently used method of ROP surgery is:

  • laser surgery, in which small laser beams are used to scar the peripheral retina (also called laser therapy or photocoagulation). This procedure lasts about 30 to 45 minutes for each eye.

For more-advanced cases of ROP where retinal detachment has occurred, these methods are used:

  • scleral buckling, which involves placing a flexible band, usually made of silicone, around the circumference of the eye.
  • vitrectomy, a complex surgery that involves replacing the vitreous, or the clear gel in the center of the eye, with a saline (salt) solution.

Babies who’ve required any kind of treatment for ROP will need regular, long-term follow-up care. You can count on us to be with you every step of the way, and, if necessary, to provide recommendations for any vision-related services your child may need in the years to come. 

 
Strabismus (Crossed Eye)

Strabismus ("struh-BIZ-mus") is a misalignment of the eyes in which both eyes are oriented in different directions.

What causes strabismus?

Sometimes called “crossed-eyes” or “walleye,” strabismus often begins when a child is very young and is usually the result of a problem with neuromuscular, including brain, control of eye movement, or less often, the actual eye muscle itself.

How is strabismus treated?

If your child has strabismus, your Nemours pediatric ophthalmologist may recommend glasses, patching (wearing an eye patch over the good eye in order to strengthen the weaker eye), or in some cases, surgery to straighten the eyes. The important thing is to begin treatment as soon as possible to help improve your child’s vision.

Tear-Duct Obstruction and Surgery

Many babies are born with an underdeveloped tear-duct system, a problem that can lead to tear-duct blockage, excess tearing, and infection.

Blocked tear ducts are common in infants; as many as one third may be born with this condition. Fortunately, more than 90% of all cases clear up by the time children are 1 year old with little or no treatment.

About Tear Ducts

Our eyes are continually exposed to dust, bacteria, viruses, and other things that could cause damage, and the eyelids and eyelashes play a key role in preventing that.

Besides being protective barriers, the lids and lashes also help the eyes stay moist. Without moisture, the corneas would dry out and could become cloudy or injured.

Working with the lids and lashes, the protective system of glands and ducts (called the lacrimal system) keeps eyes from drying out. Small glands at the edge of the eyelid produce an oily film that mixes with the liquid part of tears and keeps them from evaporating.

Lacrimal (or tear-producing) glands secrete the watery part of tears. These glands are located under the browbone behind the upper eyelid, at the edge of the eye socket, and in the lids.

Eyelids move tears across the eyes. Tears keep the eyes lubricated and clean and contain antibodies that protect against infection. They drain out of the eyes through two openings (puncta, or lacrimal ducts), one on each of the upper and lower lids.

From these puncta, tears enter small tubes called canaliculi or ducts, located at the inner corner of the eyelids, then pass into the lacrimal sac, which is next to the inner corner of the eyes (between the eyes and the nose).

From the lacrimal sacs, tears move down through the nasolacrimal duct and drain into the back of the nose. (That's why you usually get a runny nose when you cry — your eyes are producing excess tears, and your nose can't handle the additional flow.) When you blink, the motion forces the lacrimal sacs to compress, squeezing tears out of them, away from the eyes, and into the nasolacrimal duct.

The nasolacrimal duct and the lacrimal ducts are also known as tear ducts. It's the nasolacrimal duct that's usually involved in tear-duct blockage in babies.

TearDuctObstruction.gif

Causes of Blocked Tear Ducts

Many babies are born without a fully developed nasolacrimal duct. This is called congenital nasolacrimal duct obstruction or dacryostenosis. Most commonly, an infant is born with a duct that is too narrow or has a web of tissue blocking the duct, so it doesn't drain properly or becomes blocked easily. Most kids outgrow this by the first birthday.

Other causes of blockage, especially in older kids, are rare. Some kids have nasal polyps, which are cysts or growths of extra tissue in the nose at the end of the tear duct. A blockage also can be caused by a cyst or tumor in the nose, but again, this is very unusual in children.

Trauma to the eye area or an eye injury that lacerates (cuts through) the tear ducts also could block a duct, but reconstructive surgery right after the accident or injury may prevent this.

Signs of Blocked Tear Ducts

Babies with blocked tear ducts usually develop symptoms between birth and 12 weeks of age, although the problem might not be apparent until an eye becomes infected. The most common signs are excessive tearing, even when a baby is not crying (this is called epiphora). You also may notice pus in the corner of the eye, or that your child wakes up with a crust over the eyelid or in the eyelashes.

Babies with blocked tear ducts can develop an infection in the lacrimal sac called dacryocystitis. Signs include redness at the inner corner of the eye and a slight tenderness and swelling or bump at the side of the nose.

Some infants are born with a cyst in the lacrimal sac, causing a swollen blue bump called a dacryocystocele to appear next to the inside corner of the eye.

Although this condition should be watched closely by a doctor, it doesn't always lead to infection and can be treated at home with firm massage and observation. If it becomes infected, topical (applied to the skin) antibiotics might be needed.

However, with some infections, a baby may need to be treated in a hospital with IV (intravenous, given into a vein) antibiotics, followed by surgical probing of the duct.

When to Call the Doctor

If your baby's eyes tear excessively but show no sign of infection, call your doctor or a pediatric ophthalmologist (eye specialist). Early treatment of a blocked duct may prevent the need for surgery.

If there are signs of infection (such as redness, pus, or swelling) or if a mass or bump is felt on the inside corner of the eye, call your doctor immediately because the infection can spread to other parts of the face and the blockage can lead to an abscess if not treated.

Treating Blocked Tear Ducts

Kids with blocked tear ducts often can be treated at home. Your doctor or pediatric ophthalmologist may recommend that you massage the eye several times daily for a couple of months.

Before massaging the tear duct, wash your hands. Place your index finger on the side of your child's nose and firmly massage down toward the corner of the nose. You may also want to apply warm compresses to the eye to help promote drainage and ease discomfort.

If your baby develops an infection as a result of the tear-duct blockage, the doctor will prescribe antibiotic eye drops or ointment to treat the infection. It's important to remember that antibiotics will not get rid of the obstruction. Once the infection has cleared, you can continue massaging the tear duct as the doctor recommends.

Surgical Treatments

If your baby still has excess tearing after 6 to 8 months, develops a serious infection, or has repeated infections, the doctor may recommend that the tear duct be opened surgically. This has an 85% to 95% success rate for babies who are 1 year old or younger; the success rate drops as children get older. Surgical probing may be repeated if it's not successful right away.

The probe should be done by an ophthalmologist. Probes are done on an outpatient surgery basis (unless a baby has a severe infection and has already been admitted to the hospital) under general anesthesia.

The ophthalmologist first will do a complete eye exam to rule out other eye problems or types of inflammation that could cause similar symptoms. A dye disappearance test may help determine the cause of the problem. This involves placing fluorescein dye in the eye (a harmless orange colored dye)and then examining the tear film (the amount of tear in the eye) to see if it's greater than it should be. The doctor may wait to see if dye has drained properly by having the child blow his or her nose and then checking to see if any of the dye exited through the nose.

A surgical probe takes about 10 minutes. A thin, blunt metal wire is gently passed through the tear duct to open any obstruction. Sterile saline is then irrigated through the duct into the nose to make sure that there is now an open path. There's very little discomfort after the probing.

If the initial surgical probing is unsuccessful or if a child is older or has a particularly difficult blockage, the doctor may recommend another surgical treatment. One option is called silicone tube intubation, in which silicone tubes are placed in tear ducts to stretch them. The tubes are left in place for as long as 6 months and then removed in another short surgical procedure or in the doctor's office, depending on the type of stent used.

Another treatment is balloon catheter dilation (DCP). In DCP, a balloon is inserted through an opening in the corner of the eye and into the tear duct, then inflated with a sterile solution to expand the tear duct. The balloon is then deflated and removed.

Both of these procedures are fairly short but require that a child be put under anesthesia. Both are generally successful, with an 80% to 90% success rate in younger kids.

It may take up to a week after surgery before symptoms improve. Your doctor will give you antibiotic ointment or drops along with specific instructions on how to care for your child.

Reviewed by: Jonathan H. Salvin, MD
Date reviewed: September 26, 2016