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Pediatric Ophthalmology

Pediatric Ophthalmology

The most commonly treated conditions include crossed eyes (strabismus) or lazy eye (amblyopia), glaucoma, and inherited eye disease. We also treat problems that result from injury to the eye and eye conditions that may occur as a result of medical problems. Routine eye care for children is also available.

An eye that does not see to its full potential due to not having been used when a child is young is said to be amblyopic. There are many causes of amblyopia. Basically anything that gives the young child's brain a reason to "select one eye over the other" can result in amblyopia of the unselected eye. Examples include conditions that physically block the sight such as a droopy lid, ones that blur the vision such as the need for glasses and ones that result in two different images such as misaligned eyes.

Treatment

Treatment of amblyopia involves encouraging the child to use the "weaker eye." This can be done by patching or blurring the vision in the "good eye." Treatment must be done while the child is young, since it is only the young child's brain that can be "taught how to see." Treatment at times also involves glasses to ensure that the image on the retina is optically clear (i.e. to help ensure that the child's brain is not being asked to see an image that is not in focus.)

Misalignment of the eyes is referred to as strabismus. The deviation can be constant or intermittent. The most common types of strabismus are inward crossing (esotropia) and outward drifting (exotropia) of the eyes. In the young child with strabismus, the brain simply ignores one image. While this does solve the problem of double vision (that an adult might experience in a similar situation), it can result in amblyopia.

Treatment

Treatment of strabismus often involves glasses and/or surgery but is dependent upon the type of strabismus, examination findings, etc.

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A lid that droops is referred to as a ptotic lid, and a patient with a droopy lid is said to have ptosis.

Treatment

Treatment of ptosis involves not only treating the lid (often surgically) but also addressing related problems that can occur such as astigmatism (see refractive error) and amblyopia.

Timing of ptosis surgery depends upon the severity of the ptosis as well as the severity of associated conditions and the child's age.

Any cloudiness of the natural (crystalline) lens of the eye is technically a cataract. While most cataracts form over many years and do not require treatment until our more senior years, some are present from birth or form during early childhood and can require early treatment.

Treatment

A childhood cataract severe enough to significantly interfere with vision is typically surgically removed early to allow the child to develop vision to the full potential (see amblyopia). Also, in contrast to adult cataract management, many children wear a contact lens or thick spectacle (glasses) to focus images on the retina in the way that our natural lens or an intraocular lens implant would. Once a focused image is possible, amblyopia issues must be addressed. This can mean years of patching therapy.

The nasolacrimal duct system can be thought of as the "drain of the eye." The lacrimal gland (the "faucet of the eye") produces tears to keep the eye surface moist. These tears then drain into small openings in the eyelid ("at the corner of the eye"). From there, the tears travel through a small channel to eventually drain into the nose. One of the more common causes of frequent tearing in young children is blockage of this passageway. The blockage most often is due to thin layer tissue within the drainage system inside the nose.

Treatment

Some nasolacrimal duct obstructions resolve spontaneously or with conservative treatment such as massage (over the area of the nasolacrimal duct). Others however require surgical management.

An eye in which images come to optical focus at a location other than the retina is said to have a refractive error.

Refraction is the "bending of light rays that occurs as those rays go a substance." When light rays enter the eye, they go through the cornea (clear tissue in the front of they eye), then through the lens (focusing structure inside the eye) and then travel to the retina.

Ideally those light rays should meet on the retina in one location.

In a myopic (nearsighted) eye the light rays meet before reaching the retina and therefore are already spreading out again when they get to the retina. This means that they will contact the retina in different locations resulting in an image that is less than optimally focused.

In a hyperopic (farsighted) eye (assuming no additional focusing patient focusing effort), the light rays contact the retina at different locations prior to coming together. The result is an image that is less than optimally focused.

Astigmatism can be thought of as a mixture of these two conditions. Some light rays meet too early, and some reach the retina before having "had the opportunity" to meet. Once again, the result is an image that is less than optimally focused.

Treatment

Treatment varies depending upon the severity of refractive error, the symmetry of the measurements (right eye versus left eye) and the patient's age. Most commonly, refractive error significant enough to require treatment in a child is treated with the use of glasses. The glasses do not cure the refractive error but rather help to bend those light rays such that the point of focus is located at the child's retina. As children get older and more responsible, contact lenses are sometimes considered. Adults with refractive error could have other options depending upon their own clinical situations.

There are many common childhood eye problems such as infections/injuries, amblyopia, or "Lazy Eye", or vision problems like nearsightedness or farsightedness. Observing your child's eyes and paying attention to how your child behaves is very important.

Anything unusual in appearance, like eyes that cross or one eye that looks different, could be a sign of a problem. Unusual behavior such as closing one eye or tilting the head to see things can be a warning sign. School-age children may complain of things looking blurry or not being able to see the chalkboard. Fortunately, most childhood eye problems can be corrected if detected early. To help protect your child's sight, watch for warning signs and take your child to a doctor at the first sign of a problem.