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.
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.
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
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.
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.
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.
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.
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 ("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.
From Nemours' KidsHealth
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Retinopathy of Prematurity
About Retinopathy of Prematurity
Retinopathy of prematurity (ROP) is a disease that occurs in premature babies. It causes abnormal blood vessels to grow in the retina, the layer of nerve tissue in the eye that enables us to see. This growth can cause the retina to detach from the back of the eye, leading to blindness.
Some cases of ROP are mild and correct themselves, but others require surgery to prevent vision loss or blindness. Surgery involves using a laser or other means to stop the growth of the abnormal blood vessels, making sure they don't pull on the retina.
Because there are varying degrees of ROP, the surgical approach used can differ for each case. The more you know about retinopathy of prematurity and your baby's surgery, the easier the experience is likely to be for you.
Causes of ROP
Retinopathy of prematurity causes blood vessels to grow abnormally and randomly in the eye. These abnormal vessels tend to leak or bleed, which leads to scarring of the retina. When the scars shrink, they pull on the retina, causing it to detach from the back of the eye.
Since the retina is a vital part of vision, its detachment will cause blindness.
Blood vessels grow from the center of a developing baby's retina 16 weeks into the mother's pregnancy, and then branch outward and reach the edges of the retina 8 months into the pregnancy. In babies born prematurely, normal retinal vessel growth may be disrupted and abnormal vessels can develop, which can cause leaking and bleeding in the eye.
ROP can stop or reverse itself at any point, so it often resolves as the baby grows. Sometimes, though, the disease may progress to cause scarring, which pulls the retina away from the rest of the eye.
ROP has no signs or symptoms. The only way to detect it is through an eye examination by an ophthalmologist.
ROP surgery is used to stop the growth of abnormal blood vessels by focusing treatment on the peripheral retina (the sides of the retina) to preserve the central retina (the most important part of the retina). ROP surgery involves scarring areas on the peripheral retina to stop the abnormal growth and eliminate pulling on the retina.
Since surgery focuses treatment on the peripheral retina, these areas will be scarred and some amount of peripheral vision may be lost. However, by preserving the central retina, the eye will still be able to perform vital functions like seeing straight ahead, distinguishing colors, reading, etc.
The most frequently used methods of ROP surgery are:
- laser surgery, the most common type of ROP surgery, in which small laser beams are used to scar the peripheral retina (also called laser therapy or photocoagulation). This procedure lasts about 30-45 minutes for each eye.
- cryotherapy, where freezing temperatures are used to scar the peripheral retina to stop abnormal blood vessel growth. For many years, cryotherapy (also called cryosurgery) was the accepted method of ROP surgery, but it has been all but replaced by laser therapy.
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. The band is placed around the sclera, or the white of the eye, causing it to push in, or "buckle." This, in turn, causes the torn retina to push closer to and remain against the outer wall of the eye. This surgery takes 1-2 hours.
- vitrectomy, a complex surgery that involves replacing the vitreous, or the clear gel in the center of the eye, with a saline (salt) solution. Removing the vitreous allows for the removal of scar tissue and eases tugging on the retina, which stops it from pulling away. Vitrectomy can take several hours.
Your baby's ophthalmologist will determine and discuss with you which ROP surgery method is best.
Your baby's pediatric ophthalmologist will describe the procedure and answer your questions. This is a good time to ask questions about anything that you don't understand.
ROP surgery is usually performed with a patient under either general anesthesia (medication that induces a deep sleep-like state) or deep sedation (medication that makes the patient unaware of the procedure but not as deeply sedated as with general anesthesia).
Although there is no cutting or stitching involved in laser surgery or cryotherapy, all surgical procedures for retinopathy of prematurity require that the baby be given sedation and pain medication or general anesthesia.
Laser surgery and cryotherapy are usually done at the child's bedside with sedation and pain medication. Because scleral buckle and vitrectomy surgeries require general anesthesia, they are done in an operating room. For all procedures, your baby's breathing and heart rate will be closely watched during the surgery.
Your child will receive eye drops to dilate the pupil(s) before each procedure. During the surgery, a tool called an eyelid speculum will be gently inserted under the eyelids to keep them from closing.
The eye will be covered with a patch after scleral buckling and vitrectomy, but not after laser or cryotherapy. Whether a hospital stay is required will depend on the child's medical condition and age at the time of surgery.
Caring for Your Child
If admission to the hospital isn't necessary, you'll be able to take your child home about an hour after the procedure. Follow-up care for ROP surgery includes giving your child eye drops (to prevent infection) for at least a week.
To make sure the eyes are healing properly and that ROP hasn't returned, eye exams should be scheduled based on instructions from the ophthalmologist. This is usually every 1-2 weeks. For scleral buckling, the ophthalmologist must examine the buckle every 6 months to account for your child's growing eye.
The goal of surgery for retinopathy of prematurity is to stop the progression of the disease and prevent blindness. Although ROP surgery has a good success rate, not all babies respond to treatment. Up to 25% of babies who have ROP surgery might still lose some or all vision.
Keep in mind that for all types of ROP surgery, a degree of your child's peripheral (side) vision will be lost. And even if the ROP has stopped progressing, vision still can be affected.
Since some vision loss and complications can occur, any child who has had ROP surgery should have regular, yearly eye exams well into adulthood.
Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: April 28, 2017