How to detect if my child does not see well?

In children’s ocular pathologies, it is necessary to differentiate between refractive or binocularity defects and ocular pathologies. Thus, this would be the difference between them and the most appropriate treatment in each case:

Refractive or binocularity defects:

• Amblyopia (commonly known as lazy eye), is caused by a bad development of vision in one of the eyes, causing different visual acuity between one eye and the other. It may be due to a difference in the graduation between both eyes, a deviation of one of them or an ocular pathology. It is very important to detect it in early stages for the good ocular and learning development of our children. It is usually treated with prescription glasses, occlusion and/or exercises.
• Strabismus: This previously named amblyopia may be the result of strabismus, which is the misalignment or parallelism of the eyes. Both eyes do not look at the same object at the same time and the signals from these misaligned eyes are activated and deactivated by the brain. To avoid double vision, the brain may override the vision of one of these eyes, causing the child to use only the eye with better vision, resulting in amblyopia or lazy eye. Treatment is usually with occlusion, glasses, exercises and, sometimes, surgery.
• Refractive defects: infantile hyperopia (incorrect near vision), myopia (poor distance vision) and astigmatism (corneal curvature defect) are the most frequent visual problems in childhood. In fact, physiological farsightedness is considered normal during visual development (or emmetropization process) up to about 9 years of age (+/- 1 year). They are solved with the prescription of glasses.
• Other binocularity or accommodation disorders. The eyes must work together, both in alignment and focusing. If this does not occur, the visual system does not work well, so children have problems in reading, writing and learning. It is important to detect them in order not to influence their schooling. They are solved with the prescription of glasses and/or visual exercises.

Most common pathologies and conditions:

• Color blindness: alteration in the way of distinguishing colors, usually presented as confusion between a pair of color shades, in which green and red are the most frequent. Color blindness cannot be prevented, as it is a congenital defect. It has no treatment.
• Conjunctivitis: may refer to a viral or bacterial infection (both highly contagious) or to an allergic reaction, which is not contagious. They are usually treated with local instillation of eye drops.
• Chalazion: looks like a small lump on the eyelid and is usually produced when a Meibomian gland, which is an oil-producing gland in the eyelid, becomes plugged. It is not due to any infection and is usually treated with local eye drops.
• Stye: Unlike a chalazion, a stye is a painful lump that appears near the edge of the eyelid and is due to infection of an eyelash follicle. They are usually treated with local eye drops, but sometimes, if they become encysted, it is necessary to remove them by a simple surgery.
• Lacrimal duct obstruction: This is a partial or total obstruction. It is usually very frequent in the first months of life and, by simple development, it disappears on its own. Not being able to evacuate the tears causes the eye to weep and become irritated. It is recommended to massage the lacrimal point area and, in case of recurrent infections, to see an ophthalmology specialist. Sometimes surgical intervention is necessary.
• Ptosis: implies the drooping of an upper eyelid that, when covering the eye, either partially or totally, blocks vision. The treatment is evolutionary control but, if it prevents the vision of the eye involved, it may end up in surgery.
• Childhood cataract: it is the loss of transparency of the crystalline lens (natural lens of the eye), causing blurred or null vision. In children it can cause long-term vision problems. For this reason, early detection and treatment can prevent permanent vision loss in children with cataracts. It is treated surgically, depending on the type of cataract and vision impairment in each case.
• Fundus pathologies: At retinal level there are infantile pathologies, generally of genetic nature. Such as infantile macular degeneration, optic nerve deformities or myelinated nerve fibers. Their treatment is usually evolutionary control, in most cases.

How to detect that our child does not see well or that he/she suffers from some visual disease

The observation of our children when they play, when they draw, when they write, when they read or even when they look out of the car window is important to realize that something may be wrong. In case of any of these symptoms, a check-up with the ophthalmologist is recommended:

• Poor school performance
• Lack of attention and concentration
• The child avoids activities such as reading, painting, drawing or games that require close focusing.
• Unnatural head positions (tilts head to focus), or closes one eye.
• Difficulty distinguishing colors
• Recurrent frontal headache
• Redness of the eyes
• Whitish spots in the pupil area

How are children’s eye diseases diagnosed?

The aforementioned pathologies are diagnosed with an exhaustive visit to the ophthalmologist. The following tests will be performed:

• Monocular and binocular visual acuity (to detect amblyopia).
• Subjective refraction and refraction under cycloplegic (to detect if the child needs correction with glasses).
• Ocular motility (to detect deviations)
• Accommodation (to detect focusing problems)
• Eye health examination (to detect conjunctivitis, chalazion, stye, ptosis, cataract, lacrimal obstruction).
• Fundus examination (to detect problems in the choroid and retina) Sometimes it is necessary to perform complementary tests.

Why is it important to treat children’s ocular pathologies as soon as possible? What problems can be avoided?

Good vision is essential for the physical and cognitive development of our children, both in their learning process during the long school years and in their social relationships. That is why early diagnosis and treatment are essential to manage our children’s eye health.

The maximum development of the visual system occurs until approximately 9 years of age, therefore, many of the aforementioned conditions, once these years have passed, are complicated or impossible to solve successfully.

Routine check-ups are recommended from the age of 3 or 4 until adolescence. Although, in case of presenting some of the above symptoms, it is necessary to go earlier.