Care of a child's eye
As a practicing pediatric ophthalmologist – I have noticed the high level of ignorance among parents about the eyes of their child, and also the queries of concerned parents. That experience gave me the idea of putting down the facts on paper. It would cover the common and also answer the common doubts that parents have.
Let’s start the most common of all –
- Is it necessary to wear spectacles?
- he/she is so small to use spectacles!
- will the spectacles power decrease with constant use of spectacles?
- he will get injured with spectacles on while playing!
- exercises being offered to get rid of spectacles?
Probably these are the most common questions and misconceptions that parents have. Let’s clear them one by one. If the child is having a significant refractive error, it is must for him to use the spectacles as soon as it is prescribed.
Duration of spectacle use in children – definitely full waking hours. Children have to accumulate knowledge from their surroundings apart from their books. So they need to have good vision throughout the day – which will come only with spectacles if they have refractive error. Secondly – if error is high, they will end with permanent visual impairment due to lazy eye if they don't use spectacles.
He is so small to use spectacles – how will he? Your doctor is trained to decide which power is significant at what age. Not all refractive errors are prescribed in infants and very small children. Only when the refractive error is high enough to carry the risk of amblyopia, it is prescribed. The doctor is aware of the difficulties parents would face in trying to make their children use spectacles. They keep this factor in mind when taking the decision. So if spectacles is prescribed for children, it has to be used always. One simple technique which can be used to improve compliance with spectacles in small children is immobilization of elbow joints when the child tries to remove the spectacles. Slowly the child will get trained with this exercise.
If he uses spectacles always then the power would go! No – he is not using the spectacles to get rid of it in future. He is using it to have good vision with spectacles. Using spectacles has no correlation with how the power will progress or decrease in future.
Getting injured with spectacles on while playing outdoor games! That’s another misconception. All spectacles of children have to be of plastic or polycarbonate, thus it is unbreakable. A blessing in disguise for spectacles users is that it provides an extra layer of protection overto the eyes. That’s the reason why plastic protective spectacles are prescribed for one eyed patients even if they don't have refractive error. So children should always use their plastic spectacles while playing. I had one child who always used plastic frame and lens earlier but never got injured. Once the optical people advised his mother that glass lens would have less scratches and she went for it. Within few days he got injured, the glass lens broke pierced his eyeball and ruptured it. Luckily he did well after surgery, but many are not that lucky. So please don't take any chances – go for plastic or polycarbonate lenses for your child even if it is a bit costly, and he has to definitely use it while playing outdoor games.
Exercises offered to get rid of spectacles! There have been so many instances where children are being subjected to exercises for prolonged duration to get rid of spectacles. I have no objection to trying these therapies which have no proven efficacy – but the problem is that most of these therapies advise them not to use spectacles during the therapy period. In the process children lose very valuable months with subnormal vision. Its only when parents get frustrated after few months, they come to us and realize that the child was not seeing clearly all these months. PLEASE search the loads of information available on internet before subjecting your child to such experiments. Even if you have to try, please don't discontinue the spectacles during this period.
Myth – squint is only a cosmetic problem and can be corrected at any age.
This statement is totally false. Squint is not just a cosmetic problem – it can lead to lazy eye. Even when the vision is good, presence of squint may lead to loss of depth perception and three dimensional vision. Just to assess how your child may be seeing in the presence of squint, close one of your eyes and see your surroundings. Then open both your eyes and see – you will notice the difference. This difference can be restored only when squint is corrected at appropriate time. That appropriate time may be as early as one year of age depending on the type of squint.
Squint can be corrected either by surgery or spectacles – has to be done at a proper time when benefit would be maximum. Eyes can be aligned later on also, but the benefit would be only cosmetic alignment, not functional improvement.
3. Injury – we have to be very careful to make home and school environment child friendly to avoid injury in children. Maximum injuries in urban society occurs at home or school. In rural areas, it is more during unmonitored outdoor games and playing with dangerous items like needle or stick.
4. Amblyopia – commonly known as lazy eye. Common causes are squint, refractive error and unequal power in the two eyes. The most common form of treatment is spectacle power AND patching of the better eye. Any one of the two components of treatment missing would not help. Another important point here is that the benefit from patching is faster if done at a younger age. So once amblyopia is diagnosed, then patching has to be started immediately as advised, and cannot be missed even for a day.
5. Cataract in children – is an emergency. Adults would regain the same vision even if operated late, but children would lose the chances of visual recovery if surgery is delayed. And it has to be done by surgeons having training in Pediatric Cataract surgery. The surgery is technically more difficult than adult cataract surgery. If not done properly it may cause more harm than good.
6. Premature children – who are born on or before 32 weeks of gestation or with birth weight of less than 2.5 kg have the risk of developing a condition called retinopathy of prematurity. The risk increases if the infant experienced a stormy neonatal period with admission to NICU and exposure to oxygen therapy. These children MUST have a detailed retina checkup and treated early with laser if required. Again this has to be done by trained pediatric ophthalmologist or a retina surgeon, as this checkup also requiressome extra skill.
7. Watering in infants – many children experience watering and discharge from one or both eyes during infancy. It is generally due to incomplete canalization of what is called nasolacrimal duct. This is a tube which connects the conjunctival sac to the nose and drains the tear from eyes to nose. In some infants the nasal end of the tube remains blocked and causes watering and discharge. The solution is simple – massage over lacrimal sac area with pressure being transmitted downwards. With proper technique and frequency there is a very high chance of it getting resolved without any surgical intervention like probing under general anesthesia.
8. Eye allergy in children – it is another very common problem in children. It occurs in children due to exposure to external allergens, and not by any food. Many times steroid eye drops are required to control the allergy. Since it is a recurrent, parents do get tempted to use these drops without advice of the doctors. We have to understand that steroid eye drops are like double edged sword – can cause severe side effects if used unmonitored. So please don't self-medicate with steroid eye drops for allergy. Information about allergy which would be useful for parents – it would tend to recur in children prone to it up to about 15-16 years of age. Till then it has to be with combination of drops in dose which would minimize the side effects.
THE MOST IMPORTANT POINT OF ALL – Every child's eye has to be examined latest by 3 years of age, even if there are no complaints regarding vision. This is because children are not expected to complain about eye problems. Various eye conditions can be picked up at appropriate time – leading to treatment and restoration of better vision.