Childhood Eye Disorders and Amblyopia Detection

Examination of children with eye disorder Visual acuity screening, preferably performed before four years of age, is essential for diagnosing amblyopia. Cover testing may disclose small angle or intermittent strabismus. Leukocoria, which is detected with an ophthalmoscope, may indicate retinoblastoma or cataract. Children with glaucoma may have light sensitivity and enlargement of the cornea, and Conjunctivitis that does not respond quickly to treatment may reflect more serious ocular inflammation. Children with serious eye injuries often present to the primary care physician. Nystagmus and many systemic conditions are associated with specific eye finding

global initiative against avoidable visual impairment. Since the causes of visual loss vary, diverse country-specific programmes are being implemented, . A key global challenge is the promotion of early detection of ophthalmic disorders in children, so that specific treatment can be started within the critical periods of visual maturation, together with the provision of appropriate developmental and educational interventions, genetic counselling, and advice and support to families of affected children but the focus of debate is pre-school screening for amblyopia.

The involvement of pediatric ophthalmologists with specialized training, expertise and examination equipment is often required. all children should have their monocular visual acuity tested before four years of age

Amblyopia Amblyopia (lazy eye) is defined as a reduction in best- corrected visual acuity that is not directly attributable to any structural abnormality of the eye or visual pathway. With a prevalence of 2 percent,6 it is the most common cause of uncorrectable loss of vision in children. The visual outcome can range from 20/25, or nearly normal, to worse than 20/200, or legally blind. With effective detection and early treatment, most vision loss associated with this condition can be avoided. Most cases of amblyopia affect only one eye, but some cases are bilateral. Ophthalmologists refer to anisometropic amblyopia when one eye is involved and isometropic amblyopia when the condition is bilateral amblyopia may occur in children as old as four to six years. There are three major categories of amblyopia

Strabismic amblyopia is the most common type of amblyopia. The deviating eye which may turn in (esotropia), out (exotropia), up (hypertropia) or down (hypotropia), is suppressed in order to prevent double vision Refractive amblyopia is the most difficult type of amblyopia to detect. If the two eyes have significantly different refractive states, the young child may rely on the sight of the more focused eye, causing the other eye to lose its visual potential. The child will appear to see normally at home and in the primary care office because the normal eye is being used for visual tasks. If both eyes are out of focus, both may become amblyopic. Deprivation amblyopia is the most severe type in terms of loss of vision. It typically affects children with unilateral or bilateral congenital cataracts but also may occur in those with corneal or vitreous opacity, severe ptosis (droopy eyelid) or excessive patching.develope because the retina does not receive a clear image. In some cases, the cataract may not be apparent on casual penlight inspection but is detected by the absence or distortion of red reflex on ophthalmoscopic examination.

Small-Angle Strabismus Accommodative esotropia, which usually begins in toddlers who are farsighted, is an example small-angle esotropia is at least as likely as more significant deviations to be associated with amblyopia

Leukocoria Alteration in the pupillary light reflexes (called leukocoria if the pupil appears white) may indicate a disorder anywhere within the eye. Disorders include corneal opacity, blood (hyphema) or other material in the anterior chamber, cataract, vitreous opacity or retinal disease. The most urgent diagnosis is retinoblastoma

TESTING FOR THE RED REFLEX Children who do not have a bright or symmetric red reflex using anophthalmoscope from a distance of 1 to 2 ft) should be referred to an ophthalmologist for urgent evaluation performed in a well-darkened room. If the reflex is still poor, it may be helpful to dilate the pupils with a drop of 1 percent tropicamide (Mydriacyl) or 2.5 percent phenylephrine (Neo-synephrine).

Glaucoma Children, however, may develop discomfort, light sensitivity, tearing and gradual enlargement or eventually, opacification of the cornea. Children who have had cataract surgery are especially at risk for glaucoma even in the absence of symptoms, Pertinent features of congenital glaucoma (which differentiate it from the tearing seen in obstruction of the nasolacrimal duct) include light sensitivity, increased corneal diameter, corneal cloudiness and, occasionally, conjunctival injection. Glaucoma is likely to be bilateral.

Ocular Inflammation Conjunctivitis is easily treated in most cases. Some children, however, do not respond to topical antibiotics, and may have persistent redness, discharge and discomfort . The most likely cause is probably viral conjunctivitis or keratoconjunctivitis (if the cornea is involved). abrasion of the cornea due to misdirected lashes, may cause chronic redness and tearing. Uveitis, or inflammation of the iris, ciliary body or choroid, may also cause light sensitivity, pain and loss of vision.

Eye Trauma Children, especially boys, are at high risk of eye injuries compared with the adult population Corneal abrasions and foreign bodies cause intense conjunctival redness and sensitivity to light. Children with chemical injuries of the eye may present to the primary care office. Whether the offending agent is acid or alkali

Nystagmus Children with nystagmus may have disorders of the eye or the central nervous system

proposals for screening and surveillance for vision and ophthalmic disorders in childhood6 Target population Recommendation Specialist ophthalmic examination to detect retinopathy of prematurity Newborn and 6 8 week examination to detect media opacities (particularly congenital cataract) and eye anomalies Neonatal period and early infancy Very low birthweight and premature babies All newborns and 6 8-week-old infants Discontinue routine screening examinations for strabismus and amblyopia by orthoptists or health visitors Infancy to primary school age (4 years and under) Introduce primary screening by orthoptists for strabismus and amblyopia Primary-school age (all 4 5 year olds) Insufficient evidence to recommend either discontinuation of existing, or introduction of new, vision-screening programmes for refractive errors Secondary-school age (11 years and above)