Children will be seen by a Moorfields Private consultant paediatric ophthalmologist. Initial appointments for children can take 60-90 minutes. Common problems affecting children include Lazy Eye (Amblyopia), squints (Strabismus), and Watery Eye (Nasolacrimal Duct Obstruction).
Amblyopia, often known as ‘lazy eye’, is an early childhood condition where the child’s vision does not develop properly. It usually occurs in one eye, but it can occur in both eyes. Amblyopia affects approximately 2% of children.
Most commonly amblyopia occurs as the result of a squint (strabismic amblyopia) or because the two have have different refractive errors (anisometropic amblyopia). The latter can lead to poor vision in the absence of a noticeable squint and may not be detected unless vision is specifically tested.
A baby is able to see as soon as it is born, and vision continues to develop until around seven or eight years of age. Treatment to improve the vision in an eye, which is lazy or amblyopic is usually effective until about 7 years of age and is a combination of glasses, patching or Atropine. A patch will cover the good or straight eye and will ensure that the child uses their poor eye and will allow the vision to improve. The patch is usually used with any glasses, which have been prescribed.
The consultant will advise how many hours a day you will need to use the patch for your child. For the best results when using the patch would be when the child is carrying out detailed work such as reading, writing, drawing, jigsaws, computer games etc.
Wearing a patch is most effective at a young age. By the age of approximately 8, the eyes are fully developed and it becomes difficult to improve the vision
Atropine drops are used to blur the sight in the better eye to encourage the weaker eye to work.
Squint is the common name for ‘strabismus’ which is the medical term used to describe eyes that are not pointing in the same direction. You may have heard it called ‘lazy eye’ or ‘cast’ or according to the direction of the turn of the eye.
Direction of turn
Esotropia (convergent squint)
Eye turned in
Cross eyed / Boss eyed
Exotropia (divergent squint)
Eye turned out
Eye turned up
Eye turned down
The squint may be present all or only part of the time, in only one eye or alternating between the two eyes.
Why do squints develop?
There are a number of reasons. The main ones are:
Refractive (focusing abnormality)
Eye muscle imbalance
These separately or together cause squint.
It can run in families
Illness – can make it obvious
Rarely, it can be due to other diseases or illness
Some babies may appear to have a squint that is not a true squint. It is called ‘epicanthus’ and is caused by folds of skin on a wide nose. Epicanthus does not exclude the possibility of a squint being present and so you should always seek an expert opinion.
The common cause of watery eye in a small child is where the passage that carries the tears away from the eye into the nose (nasolacrimal duct) has not developed normally.
The symptoms usually are constant watering of one of both eyes and stickiness or discharge. Normally 9 out of 10 children’s symptoms clear up by themselves by the age of 12 months. However, if a child has significant problems at the age of 12 months, then an operation to clear the blocked duct may be considered.
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