The Pediatric Eye Diseases and Adult Strabismus Service of the Asian Eye Institute offers comprehensive diagnoses, treatment and management of the various types of pediatric eye diseases, as well as problems related to alignment and movement of the eyes for children and adults. Our service is geared towards providing total eye care using a team approach to address the special needs of children’s eyes and those with eye deviation.

What are the more common children’s eye diseases? Infants and children can suffer from the same eye diseases as adults. However, the causes of these diseases in children, as well as the treatment approach, recovery period, and prognosis may be different from that in adults.

Some children’s eye diseases are caused by problems in the muscles that move the eyeball up and down, and from side to side. Strabismus is a misalignment of the eyes and is characterized by a squint (eyes appear to look at an object obliquely-in Tagalog, banlag), or “cross-eye,” (in Tagalog, duling). An abnormal head turn or tilt may also be a sign of strabismus. While glasses may often help this condition, there are cases where they are insufficient and surgery is needed to realign the eyes.

Lazy eye or amblyopia is characterized by poor vision in the absence of a physical disease. Lazy eye is usually caused by a refractive error (nearsightedness, farsightedness or astigmatism) in the affected eye and can be prevented or even reversed with timely and proper use of glasses or contact lenses. Usually, this condition may be reversed until around seven years of age and the earlier the intervention, the higher the possibility that the vision will improve. Sometimes it is necessary to cover the better eye in order to allow the child to use the “lazy eye”. This treatment should be supervised closely.

Other common diseases that may occur in children include congenital cataract, which is treated surgically. When a child has cataract, the central part of his eye appears white, and his vision is blurred. Cataracts in children should be treated as soon as possible because the danger of developing amblyopia. Some other common eye diseases would be stye (in Tagalog, kuliti), tearing, which can be secondary to a blocked nasolacrimal duct and nystagmus (jittery movement of eyes).

What is retinoblastoma?

Retinoblastoma is a form of malignant tumor inside the eye which occurs in children. It can appear as early as few months of age. The condition can be detected through ophthalmoscopy. The pupils are dilated with some eye drops and an ophthalmoscope is used to view the inside of the eye. Tests that are used to confirm the diagnosis include ultrasonography and CT scan.

Clinical signs of retinoblastoma include strabismus, white papillary reflex known as”cat’s eye reflex”, glaucoma, bulging of the eyeball, eye inflammation and nystagmus.

Retinoblastoma can be treated using cryotherapy, chemotherapy, radiotherapy, laser photocoagulation, or enucleation (removal of the eyeball). The choice of treatment depends on the size and location of the tumor, and the possibility of having useful vision in the affected eye.

Is it true that premature babies have a higher chance of visual impairment?

Premature babies weighing less than three pounds at birth may be affected by a condition called retinopathy of prematurity (ROP). In ROP, abnormal blood vessels and scar tissue grow over the retina, which is the part of the eye that captures visual images and sends them to the brain.

If ROP is not addressed immediately, the baby can develop permanent visual loss. When ROP is still in the early stages and treatment is applied, there is a good chance that the baby will develop functional vision. If the ROP is quite advanced already, abnormal vessels and scar tissue will pull the retina leading to retinal detachment. This can lead to severe visual loss.

The baby’s ophthalmologist can detect ROP during an examination of the baby’s eyes in the nursery. The examination involves shining a bright light with a special instrument into the eye. It may be necessary to examine the baby’s eyes several times to check the severity and progression of the disease before appropriate treatment can be determined. Early detection and treatment is very important. Treatment may be in the form of laser therapy, cryotherapy, or operative surgery.

Even after treatment, there is still a risk of developing visual impairment. Premature babies are prone to develop errors of refraction and strabismus therefore regular examinations by an ophthalmologist will be needed as the baby grows, to ensure that his vision is developing as normally as possible.

What is Adult Strabismus?

Adult strabismus is the presence of misalignment of the eyes in adults. The eyes can appear crossed or it may drift out, up or down. Usually, it is secondary to persistent childhood strabismus, but can also be caused by medical conditions such as thyroid disease, diabetes, strokes, or neurologic diseases. It may also occur after trauma.

Adults with strabismus may experience double vision, eyestrain and difficulty in reading or focusing. They may also have an abnormal head turn. Adult strabismus can usually be corrected by surgery on the eye muscles. Use of a special surgical technique called adjustable suture technique significantly increases the chances of success in treatment.

What can I do to protect my child's vision?

It is very important to see an ophthalmologist once you notice any external symptoms in your child, or if he complains of blurred or abnormal vision. Very young children, however, cannot be relied upon to complain of abnormal vision. For babies, you can do a simple test like putting your finger or a toy about one foot away from the eyes and slowly moving it from left to right to check whether he follows the movement with his eyes. For toddlers or preschoolers, inattentiveness in class or when looking at picture books or other images may indicate that he cannot see very well.

The best way to protect your child’s vision if you suspect an abnormal condition is to bring him to a specialist in children’s eye diseases. Even if the child appears to have no visual problems, it is important to bring the child for an eye check-up at around 3 years of age to detect possible visual problems. Young children usually would not complain even if they are not seeing well. There are conditions which may not be reversible anymore when detected late. Early intervention is very important in minimizing the chances of permanent visual impairment. As children’s eyes are still developing, it is also important to have regular eye examinations even after a condition has been corrected or treated.