Common Eye Problems in
Children
 |
healthprobleminformation.blogspot.com |
Summary
The
following article describes four conditions commonly seen in pediatric
ophthalmology in primary care. Describe a simple approach to assessing children
using these presentations.
The Infant with Delayed Vision
Normal
visual development are born with Although these methods are not as reliable as
measuring visual acuity in adults using the Snellen letter chart, visual acuity
in neonates has been shown to be approximately 2/60. Visual acuity in infants
develops rapidly, reaching approximately 6/12 vision six months after birth.
Their color vision, sensitivity to contrast, and ability to focus on nearby
objects (adaptation) are also poorly developed at birth and improve quickly.
Parents
expect their children to achieve visual performance milestones of facial gaze
and tracking of faces and other large objects in about 8 weeks, and these
milestones are usually If it doesn't arrive in time, it's usually time to see a
doctor.
Evaluation of Infants with Potential Visual Delay
Use an
ophthalmoscope or flashlight to check for corneal flare. This is a small
pinpoint her flare, usually located nasally toward the center of the pupil when
the infant is looking toward the light source. Strabismus can occur when light
reflection in each cornea is not symmetrical. Are your eyes shaking? When
nystagmus is observed, it can be due to either sensory problems (such as
retinal dystrophy) or motor problems (such as brainstem lesions).
The black
numbered lens of the ophthalmoscope allows a closer examination of the eye. Try
setting it to +6 or 7 (black). This brings the eye into focus from
approximately 15 cm (note: in North American ophthalmoscopes, sometimes sold in
the UK, the positive lens is red instead of black). Then set the red reflex
back to 0 with the ophthalmoscope unless you need to correct for not wearing
your own glasses. For nearsightedness (myopia), for farsightedness
(hyperopia/farsightedness), a red lens must be passed (with a British standard
ophthalmoscope) to see the red reflection from a distance. Go through it
through the black lens.
Cyclopentolate
0.5% can safely dilate the pupil if the red reflex is not well characterized in
infants under 1 year of age. Over the age of 1 he should use 1%. There is no
risk of causing acute glaucoma in children. Warn parents that the drops will
sting and the baby will be tormented within a minute.
Babies'
ability to stick to and follow colorful targets is most easily assessed when
they have both eyes open. Make sure the target has no auditory cues. Then cover
each eye with your hand or your parent's hand directly in front of your face.
If the child objects to covering both eyes evenly, at least moderate visual acuity
exists in each eye. Older children happily close their eyes, fixate, and follow
each goal in turn. Quantitative assessment is performed by an orthoptist
trained in assessing visual acuity and measuring strabismus in children using
Cardiff-Her maps or the more discriminating Kay images, depending on child
development. increase.
Significant Causes of Visual Delay
Congenital
cataracts can be missed on postnatal examination, appear in late infancy, and
are usually accompanied by abnormal retinal reflexes, decreased vision, or
strabismus on photography. If examination reveals a dull red or white reflex
(vitiligo), the infant should be seen by an ophthalmologist within a week to
rule out an intraocular tumor (eg, retinoblastoma). Cataract surgery is best
done as early as possible to avoid developing amblyopia.
Optic nerve
hypoplasia is a unilateral or bilateral condition that can occur with
left-right asymmetry. The optic nerve is of variable (sometimes near-normal)
size on ophthalmoscopic examination, and this condition is associated with
various visual impairments. Optic nerve hypoplasia may be associated with
midline intracranial abnormalities, and children with this condition should
undergo imaging and pediatric endocrinological evaluations.
Retinal
dystrophy can occur early in life and is usually accompanied by visual
disturbances and nystagmus. An ophthalmoscopic examination may be normal in the
early stages. Pure ocular albinism in infants presents with nystagmus and
various visual disturbances. The iris may appear normal with an ophthalmoscope.
The retina is usually brighter than average.
Cerebral
visual impairment is the term for visual impairment due to congenital or
acquired neurological deficits. Although often associated with hypoxic-ischemic
encephalopathy, cerebral visual impairment can be prenatal, perinatal, or
postnatal in the primary visual pathway (retina to occipital cortex) or
secondary visual in the cerebral cortex. It may be caused by area damage. It is
often a component of a more global developmental delay. Children may have
problems with vision, field of vision, or object recognition, especially in
crowded visual environments.
Delayed
visual maturation is a diagnosis reserved for visual impairment in the presence
of slow improvement in normal visual function or decreased visual acuity in the
presence of cerebral visual impairment or eye disease. In the absence of other
visual impairments, three-quarters of children have significant improvement in
visual function at six months of age. In most cases, no cause of delay is
found, but it may be associated with more widespread developmental delay, and
all such children should be referred for childhood developmental evaluation.
Watery eyes and/or or sticky children
Although
most cases of neonatal conjunctivitis (formerly known as neonatal ophthalmia)
are due to Gram-positive bacteria, serious complications with conjunctivitis
secondary to Neisseria within the first 2 weeks of life disease may occur. Or
chlamydia. All newborns with conjunctivitis should be referred to an
ophthalmologist within 24 hours. The first step in diagnosing conjunctivitis is
looking for signs of inflammation. Are there any signs of eyelid swelling or
erythema, conjunctival swelling or redness (vasodilatation)? In this case, a
swab should be taken and a Gram stain should be requested in addition to the
culture. Then topical broad-spectrum antibiotics such as chloramphenicol and
fusidic acid should be started.
Ocular
stickiness does not distinguish between infectious conjunctivitis and
congenital narrowing of the lacrimal glands. If none of the above signs of
inflammation are present, infection is unlikely and caregivers should keep
eyelids clean and discourage the use of topical antibiotics. It should be noted
that lacrimation (lacrimation) and stickiness may increase or decrease. This is
especially aggravated by upper respiratory tract infections. Congenital
lacrimal duct stenosis resolves in 95% of children within the first year of
life. After this, if the situation does not change, you can be referred to an
ophthalmologist who can operate under general anesthesia. Parents should be
made aware that problems may resolve on their own after the first year of life
and that referrals should be deferred if problems begin to improve.
In rare
cases of potions with photophobia without eyelid signs or stickiness, infantile
glaucoma should be suspected. This can only happen in asymmetric cases.
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healthprobleminformation.blogspot.com |
In infants
or older children, subacute and chronic conjunctivitis are usually caused by
blepharitis (inflammation of the eyelids) or an allergic eye disease. Allergic
eye disease in children can be exacerbated during hay fever season, but it is
often a problem year-round. In both conditions, signs of inflammation may be
minimal, and symptoms may also vary.In some cases, photophobia may be evident,
while in other cases only excessive blinking may be noticed by parents.
There may be
evidence that blepharitis is a contributing factor. B. History of recurrent
cysts (chalazion) or signs of visible scaling on the eyelashes or erythema at
the base of the eyelashes. If your child complains of atopy or itching, it may
be caused by an allergy (spring) disease.
If your
child has symptoms that last for days or cannot open one or both eyelids, they
may have corneal disease in addition to conjunctivitis (keratoconjunctivitis).
This can have a permanent effect on your child's vision and should be evaluated
by an ophthalmologist within 48 hours.
Topical
antibiotics are usually the best initial treatment for suspected acute
bacterial conjunctivitis. Antiallergic medications can be started if allergy
signs and symptoms develop. An ophthalmologist can use steroid eye drops for
moderate to severe keratoconjunctivitis, but steroid eye drops should never be
initiated by anyone other than an ophthalmologist. Oral erythromycin can be
given long-term to control blepharitis.
Children who appear to squint
Check the
red reflex of all children suspected of squinting. If you suspect that your
squint is due to an eye problem, you should be evaluated by an ophthalmologist
within a week.
Temporary
eye movements (squinting) are normal during the first 6 months of life. By the
age of 12 months, infants may have inward-facing (converging) eyes due to a
wide nasal bridge. Examine the corneal flare using an ophthalmoscope or
flashlight. This is usually a small pinpoint her flare located nasally towards
the center of the pupil when the child is facing the light source. Clinking a
key is an impromptu goal that often works well. If the light reflex is
positioned differently for each pupil (when the child is looking at you),
strabismus may be present and the child should be introduced regularly unless
there is a problem with the child's red reflex or vision. need to do it.
Strabismus,
which can be treated early, is most common between 1 and 3 years of age. Inward
(convergent) or outward (divergent) strabismus may begin as an intermittent
phenomenon, and in these early stages, appropriate eyeglass prescriptions may
prevent the strabismus from becoming permanent. You can Surgery is also more
likely to return the eye to its normal position if it is done as soon as
possible after the eye has been squinted. A large strabismus may be obvious,
but a minor strabismus can only be seen with a cover test. To maintain visual
fixation, choose interesting targets such as toys or pictures that you can ask
questions about. Cover each eye with a hand or plastic occluder. Squint to lock
onto your target.
All children
under 6 years of age who may have strabismus should receive cyclopentolate eye
drops prior to eye exams. Children who develop convergent strabismus after 1
year are usually hyperopic. Without eye drops, the degree of hyperopia may be
underestimated and parents should be advised to see an optometrist who uses
cyclopentolate eye drops. Depending on how quickly you can reach hospital eye
services, an outside optometrist may be the quickest way to get children's
glasses that can fully correct your strabismus.
Amblyopia
(lazy eye) is vision loss in the absence of structural ocular or neurological
impairment. Blurry eyes due to squinting or lack of proper prescription for
glasses can develop amblyopia. Vision development stops after he is seven years
old, so it is important to treat amblyopia by this time. Patch treatments are
applied to the good eyes for several hours a day.
Children with Lumps Around the Eyes
Acute
periocular skin redness and swelling should be assumed secondary to orbital
sputum unless proven otherwise. Orbital cellulitis is a vision-damaging and
sometimes life-threatening condition. Affected children should be hospitalized
for intravenous antibiotics unless the erythema is confined to a small area
around the skin lesion or is very mild. If the eyelids are swollen and the
eyeballs cannot be seen, or if the child has a fever, hospitalization is
definitely required.
Eyelid
swelling with minimal erythema occurring simultaneously in both eyes within 30
minutes is more commonly due to an acute allergic reaction and should be given
priority for oral antihistamines.
Rhabdomyosarcoma
is the most common malignant orbital tumor of childhood and presents as a
noninflammatory mass that progresses rapidly over several weeks. Children with
rapidly progressing blepharoptosis or eyelid swelling and erythema should be
evaluated by an ophthalmologist within a week.
Chalazion is
a discrete round lump that develops on the eyelid over several weeks, with or
without erythema, and is usually caused by blockage of one of the eyelid's
lipid glands. Parents should be advised to warm and massage the affected area
to squeeze out accumulated lipids from the gland openings at the base of the
eyelashes. Secondary cellulitis can occur, but chalazion is usually not an
infectious phenomenon. Erythromycin oral solution can be used long-term to
prevent further development of chalazion, but this is achieved by altering the
bacterial profile of the gland and thus the physical properties of the lipids
produced. Chronic conjunctivitis in children with a history of chalazion should
prompt referral to an ophthalmologist to rule out secondary corneal problems.
Hemangioma
is a hamartomatous malformation that develops most rapidly in the first three
months of life, but can grow until about one year of age. Most then resolve
spontaneously, with 75% recovering by age 7. A more superficial hemangioma is
sometimes called a "strawberry nevus." Deeper lesions may encroach on
the retroorbit. Children with periocular hemangioma are at risk for amblyopia
due to induced astigmatism or ptosis. Rarely, a more extensive hemangioma can
compress the optic nerve or cause proptosis or corneal exposure. Treatment to
shrink vision-threatening lesions is with systemic propranolol or intralesional
steroid injections.
Dermoid
cysts are cystic trophoblasts, usually located above the cranial sutures,
especially the zygomatic frontal sutures. They can spread intracranially
through the bone, requiring computed tomography unless the cyst is mobile and
palpable all around. Excision is best done between the ages of 3 and her 5
years, depending on when the child tolerates imaging. These cysts rarely have
serious consequences.
Conclusions
There are a
few common reports of pediatric eye problems in primary care physicians. In
some cases, these symptoms can be so severe that it may be necessary to
introduce the child less frequently during the week or day. A child's targeted
medical history and ophthalmoscopic examination will allow us to distinguish
the most serious causes, and better communication with the ophthalmology team
will allow for timely referrals.
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