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Children’s eye conditions

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.

  • A chalazion is a harmless cyst caused by a blocked meibomian gland in the eyelid. Meibomian glands in the eyelid produce an oil which helps to keep the eye moist. If the gland becomes blocked, the oil builds up into a cyst which looks like a small lump in the eyelid. The lump can become irritated and red and, occasionally, infected.

    Lid cysts are common, especially in children. If children develop cysts repeatedly, they could have blepharitis, a long-term mild irritation of the edge of the eyelids, which is usually harmless but occasionally affects the eye.

    Most cysts disappear with time but can take weeks and sometimes many months, to go away. They are normally harmless and can be safely left to get better with time in most cases.

    Warm compresses might speed up the disappearance of the cyst. Boil some water and let it cool a little, or use water from the hot tap. Water should be hot but not hot enough to burn. Soak cotton wool or a clean flannel in the water and gently press onto your child’s closed eyelids for two to three minutes at a time, twice daily.

    For further advice on how to clean the eyelids of children and babies, please watch our instructional video here: www.youtube.com/watch?v=eJmWNlMziXM

    Occasionally, the doctor will prescribe a short course of antibiotic ointment or drops to help any irritation and, if there is infection spreading from the cyst, antibiotics by mouth. However, medication does not cause the cysts to disappear.

    If there is a large cyst which remains for a long time, it is possible to perform surgery to remove it. In most cases, surgery is not medically necessary but can be done to speed up healing of the cyst. However, surgery is often not recommended because:

    • The cyst is harmless and will disappear with time
    • Surgery does not prevent another cyst from developing
    • There is a one in five chance the cyst will regrow
    • There are rare but serious risks of surgery such as infection or scarring
    • For many children, it requires a general anaesthetic which carries a small risk to the general health
  • A corneal abrasion is a scratch on the clear window on the front of the eye (the cornea). Abrasions are very painful because there are many nerves in this part of the eye. The eye is often watery, red and sensitive to light; it may be puffy and the vision may be blurry too.

    The abrasion will heal itself over 24 to 48 hours but it can take up to one week, and occasionally a little longer, for your child’s eye to feel and look completely better. It is important to prevent any infection whilst it is healing by using antibiotic drops or ointment for several days, which your eye doctor or nurse will prescribe.

    Occasionally with big abrasions, other drops and an eyepad are also needed. Painkillers suitable for children, such as paracetamol or ibuprofen, can be taken if needed.

  • Conjunctivitis is an infection in the membrane lining the eye and inside the eyelids, called the conjunctiva. The eye becomes red, sticky or watery, and can be itchy, sore and uncomfortable. The infection can affect one eye or both eyes.

    Infection can be caused by a virus (such as the common cold virus, the flu virus and many others) or, less often, by bacteria. Conjunctivitis is not normally serious and in many cases gets better on its own. Some people notice that they have a cold, sore throat or feel unwell at the same time.

    Most infections will clear up on their own. Viral infections do not respond to antibiotics and the infection may last two to three weeks before the body’s natural immunity is able to clear the virus – just like when we have the flu. Clean any discharge/crusting away with a cotton pad and water. Antibiotic drops and/or lubricating drops may be prescribed for a short course. In a very small number of cases, in which there is a severe virus infection, anti-inflammatory steroid drops may be needed.

    Virus infections are very contagious (catching) and spread by contact with infected tissues, towels, pillowcases and even door handles and also by droplet spread through sneezing and coughing. Washing hands frequently and not sharing towels/pillows is important to reduce the spread. Nurseries and schools may not allow children to attend whilst they have an infection.

  • 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.

    Medical Term Direction of turn Common Term
    Esotropia (convergent squint) Eye turned in Cross eyed / Boss eyed
    Exotropia (divergent squint) Eye turned out Wall eyes
    Hypertropia (vertical) Eye turned up
    Hypotropia (vertical) 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
    • Injury
    • 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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Children’s eye conditions consultants

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Mr Ashwin Reddy

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Professor Mandeep Sagoo

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Professor Michel Michaelides

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Mr Chien Wong

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Mr Himanshu Patel

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A picture of Mr Frank Larkin

Mr Frank Larkin

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Ms Pari Shams

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A picture of Mr Yassir Abou–Rayyah

Mr Yassir Abou–Rayyah

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A picture of Mr Jimmy Uddin

Mr Jimmy Uddin

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A picture of Mr John Brookes

Mr John Brookes

Consultant Ophthalmic Surgeon

A picture of Mr Daniel Ezra

Mr Daniel Ezra

Consultant Ophthalmic Surgeon

A picture of  Maria Theodorou

Maria Theodorou

Consultant Ophthalmologist

A picture of Professor Richard Collin

Professor Richard Collin

Consultant Ophthalmic Surgeon

A picture of Mr Robert Henderson

Mr Robert Henderson

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Miss Annegret Dahlmann-Noor

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