Children’s eyes and their physio-pathology are a whole specialty within ophthalmology, simplifying enormously we can comment some of them.
Although we cannot consider them as pathology but as variations of normality, refractive defects (hyperopia, myopia and astigmatism), deserve a great number of consultations. Among these, the most frequent in childhood is hyperopia, only sometimes they are or cause a real pathology.
These alterations must be treated not only to improve the child’s vision, but also his school performance and prevent the appearance of amblyopia, also called lazy eye, and strabismus.
Strabismus is one of the most common and well-known pathologies, which we also see in adults. Also very frequent are ocular surface problems, atopic or allergic or infectious conjunctivitis, which disturb the normal life of the child without being in general serious pathologies.
In infants it is common to see tearing due to tear duct stenosis (closed tear duct).
Lazy eye – Amblyopia
The amblyopic eye or lazy eye is an eye that has not developed or has lost its ability to see, there is an atrophy and regression of the neurons that encode the image. Erroneously we speak of lazy eye when there is a difference of graduation between the two eyes, but if one eye sees well with glasses, it is not a lazy eye.
There are many degrees and types of amblyopia.
Causes of lazy eye
The factors that cause lazy eye are: strabismus, eyes that are not optically equal (anisometropia), eyelid ptosis, cataracts, corneal scars and, in general, any obstacle in the reception of the image. There can also be several causes that manifest themselves at the same time because they favor each other, for example an eye with a higher prescription can also deviate and the causes add up.
Lack of stimuli or defective stimuli in one eye cause unused neurons to atrophy and only the most useful neurons are retained. Thus, if later one wants to rehabilitate the vision of an eye, it will not be possible depending on the age, placing the limit between 8 or 9 years of age.
Treatment of lazy eye
After a good diagnosis of the cause and usually the appropriate glasses. The most classic and also the most effective treatment, although not the only one, are occlusions. This involves covering the other eye with a patch over the skin to ensure that the child uses the eye to be treated for at least a certain period of time.
The duration and intensity of the treatment varies from case to case, depending on the severity of the case and the age of the child. But it has to be prolonged until the maximum possible vision is achieved and then “maintenance” up to 8 or even 9 years of age.
Vision problems in children vs. adults
The child is a developing organism, this makes a big difference in terms of treatment and adult diseases, it is not more or less easy, it is different. Vision is also developed in early childhood, we learn to see, we must therefore prevent amblyopia. If the pediatrician and the ophthalmologist fight for it, it could be prevented on many occasions.
All children with a history of strabismus, hyperopia or amblyopia in their direct family should be checked.
At the other extreme, cataract in adults is currently treated with agility, even its surgery has been excessively trivialized, but the treatment of congenital cataract in a child can present great problems, not so much because of the surgery and optical correction, but because of the subsequent treatment of visual rehabilitation and the profound amblyopia that can result.