COMMON EYE PROBLEMS IN CHILDREN

CONGENITAL CATARACTS
marked opacity of the lens. may occur from steroid use or radiation exposure when the opacity is on the anterior surface of the lens, the cause is thought to be birth injury or possibly contact between the lens and the cornea during intrauterine life when the opacity is located at the edge of the lens, it may be the result of nutritional deficiency during intrauterine life, such as rickets or hypocalcemia.

ASSESSMENT the pupil opening appears to be white (leukocoria) the red reflex elicited by shining light into the pupil appears white older children report blurred vision from the cataract formation in the infant, detected by a lack of response to a smile or inability to reach and grasp a nearby object

THERAPEUTIC MANAGEMENT Surgical removal of the cloudy lens followed by insertion of an internal intraocular lens. If total lens is involved, removal is as early as 3 months If it is not done within 6 months, amblyopia may result Incision is small that it does not need eye patching Infants are given sedatives to help them rest for 24 hours introduce fluids cautiously after surgery so nausea and vomiting do not occur. Vomiting increases IOP which could injure the suture line encourage parents to stay with the infant, helping with care so the infant does not cry after surgery because this would also increase IOP should not have pain after surgery if restless, fussy or crying and seem to be in pain, notify the physician immediately. These may be a sign of IOP from hemorrhage or from occlusion of the canal of Schlemm causing a developing glaucoma. children are given mydriatics to dilate the pupil and steroids to prevent post-operative development of pupillary adhesions

AMBLYOPIA
lazy eye subnormal vision in one eye or children are using only one eye for vision while resting the other eye.

ASSESSMENT All school children should be screened for amblyopia by vision testing with a preschool E chart. The child with amblyopia will have 20/50 vision (normal for preschool age) in one eye. The other eye will show lessened vision (perhaps 20/100). THERAPEUTIC MANAGEMENT Amblyopia is correctible if treated during the preschool period. The good eye is covered with patch held firmly in place. This forces the child to use the poor eye to develop vision in that eye. Generally, the child has some difficulty initially adjusting to the patch and being unable to see well from the unpatched eye, possibly develops headaches and dizziness. The patch is removed for 1 hour/day to prevent amblyopia from developing in the non-amblyopic eye. Administration of levodopa Atropine to produce pupil dilatation

STRABISMUS
unequally aligned eyes (cross-eye) normally, the resting position of the eye is straight in strabismus, the resting position may be divergent (turned out) or convergent (turned in). One pupil may be higher than the other (vertical strabismus). May be monocular, in which the same eye deviates constantly. Or may be alternating

strabismus, in which one eye deviates first, then the other. ASSESSMENT infants eyes may cross occasionally until 6 weeks of age constant strabismus before 6 weeks of age need referral right away Deviations could be: o Exotropia eye turning out o Esotropia eye turning in o Hypertropia eye turning up THERAPEUTIC MANAGEMENT depends on the cause of the problem if the fusion mechanism is weak, eye exercises (orthoptics) may be necessary If eyes are diverging problem with convergence because of the nearsightedness or farsightedness, the child needs glasses to correct the basic visual defect if the misalignment is caused by unequal muscle strength, eye-muscle surgery is necessary eye patches are not necessary after eye surgery antibiotic ointment is applied 2-3 days post operatively

RETINOBLASTOMA
malignant tumor of the retina of the eye ASSESSMENT occurs from 6 weeks of age through the preschool period located on the retina or in the vitreous fluid or extend backward into the choroids, the optic nerve and the subarachnoid space pupil appears white the child will develop strabismus as the eye becomes non-functional this tumor metastasizes along the course the optic nerve to the subarachnoid space to the brain; it quickly involves the second eye. metastasis to distant body sites occurs because of the rich blood supply to the brain DIAGNOSIS CT scan and sonography to detect intraocular calcification or the presence of tumor lumbar puncture to evaluate distant metastasis liver and skeletal survey bone marrow biopsy THERAPEUTIC MANAGEMENT Cryosurgery freezing the tumor to destroy the local cells photo coagulation through laser surgery to destroy the blood vessels supplying the tumor

of

radiation chemotherapy nitrogen mustard, vincristine, and cyclophosphamide if the tumor is large, enucleation is necessary. observe for bleeding on the dressing and monitor vital signs frequently. restrain the child to keep him from tugging at the dressing and removing it dressing is removed after 48 hours and small patch is applied irrigation with NSS or application of antibiotic ointment eye prosthesis is fitted 3 weeks after surgery

DACRYOCYSTITIS
Is an inflammation of the lacrimal sac. Can be caused by bacteria or obstruction. In acute dacryocystitis, bacteria are usually the cause. The most common organisms are staphylococcus aureus and B-hemolytic streptococci. Chronic dacryocystitis results from chronic infection of the lacrimal sac. This is usually a result of a congenital obstruction in children or trauma causing obstruction in an adult.

SIGNS AND SYMPTOMS Acute dacryocystitis is characterized by: redness at medial aspect of the eye pain edema tenderness Pus may be present from the sac TREATMENT Warm compresses should be applied locally to the area, as should local antibiotic ointment such as neosporin 1% opthalmic ointment plus systemic penicillin antibiotics. Massaging the duct area toward the puncta is the initial treatment. However, surgery is most likely required to correct the obstruction.

HEALTH TEACHING Reassure the parents that the duct often will open up with consistent massaging. Good hygiene is important, including hand-washing by the parent and keeping the discharge cleared from the infants face

PTOSIS
drooping of the upper lids. can be genetic or traumatic in origin.

due to an abnormality in innervation or musculature of the levator muscle to lift the lid on the side of the ptosis

SIGNS AND SYMPTOMS problems seeing if the lid covers enough of the pupil. lids are covering their eyes unequally.

TREATMENT Surgery is usually indicated when the child is 3 to 4 years of age. It may be done sooner if the condition might lead to amblyopia *Note Although myasthenia gravis dos not usually occur in children, it does cause ptosis. Myasthenia gravis should be ruled out as a potential cause.

RED EYE(CONJUNCTIVITIS)
more commonly known as red eye inflammation of the conjunctiva.

SIGNS AND SYMPTOMS Bacterial conjunctivitis is characterized by: o purulent discharge that causes the eyelids to stick together in the morning o Injected conjunctiva o minimal pain and short duration (1 to 3 days o Vision may be slightly blurred due to exudate Viral conjunctivitis is characterized by: o longer duration (14 to 21 days) o excessive tearing and minimal discharge TREATMENT The bacterial infection responds to local antibiotic ointment sucha s Sodium Sulamyd or antibiotic eyedrops such as sulfisoxasole (Gastrisin). Viral conjunctivitis is resistant to antibiotic therapy. Palliative comfort measures should be used to keep the eye clean and dry. HEALTH TEACHING Bacterial conjunctivitis is very contagious. Instruct patients to wash their hands frequently, especially after applying eye medication. Instruct patient to keep the hands away from the eyes. Keep the child home from school for 2 to 3 days after starting medication.

STY
Also known as hordeolum staphylococcal infection of the sebaceous glands of the eyelids

SIGNS AND SYMPTOMS area of infection is usually red and tender TREATMENT Application of hot soaks to the eye at least 4 times a day is indicated. If no relief occurs in 48 to 72 hours, incision and drainage may be necessary. HEALTH TEACHING Instruct patients to keep their hands away from their eyes. Keep the eye area clean. Hot soaks are a very effective treatment if done 4 times a day.