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How Can I Keep My Child's Eyes Healthy?

From: “The Eye of A Surgeon”, by Dr Cynthia J MacKay

Up to 10% of pre-school children, and up to 25% of school age children, have some form of eye problem. If your child is not seeing well, he will not complain to you because he will not know that anything is wrong. Parents will sometimes take their children to a dentist, but neglect to take them to an eye doctor. Your child’s eyes are more important than his teeth.

What is the most common cause of blindness in children?

An enormous amount of vision development takes place very early in your child’s life, especially in the first 6 weeks to 3 months. During that critical time, nerve fibers grow up his optic nerve to the visual cortex of his brain, where they make multiple connections that will let him see normally. If one, or both, of his eyes is not seeing clearly, for example, because it is out of focus or has a cataract, these connections will never be made, and his eye will be permanently “lazy” (AMBLYOPIA). If this problem is detected and corrected early, and the lazy eye is strengthened by patching the other eye, his eye can be saved.

How will I know if my baby can see normally?

Your baby will normally see as soon as he is born. His eyes may roam around, and even briefly cross in and out, but he should look at a human face longer and more intently than at anything else. By three months, his eyes should be straight, and he should be able to fix on an object and follow it when it moves. Take him to an ophthalmologist right away if he does not fix and follow by 3 months of age, or if his eyes cross in, out or up.

How will I know if my child can see normally?

While you are driving in a car, ask him about far-away objects, such as animals in fields, or road signs. If he is a boy, ask him the color of passing red and green cars. If he squints when he looks at objects in the distance, he may be nearsighted. If he complains of difficulty reading, he may have convergence insufficiency, or be farsighted, or have astigmatism.

When should my child’s eyes be examined?

A doctor should check your baby’s eyes before he is 6 months old, to make sure they are fixing and moving normally, and that they are aligned well. Usually, your pediatrician will do this.
When he is three years old, and again when he is five to six years old (i. e. before he enters kindergarten) he should be examined by an eye doctor. If his eyes are normal, bring him back every two years. Bring him back once a year if he wears glasses, if he was premature, if he is diabetic, or if eye problems run in your family, such as amblyopia, crossed eyes, childhood glaucoma or cataracts, or hereditary eye cancer.

What danger signals will tell me that my child needs to see an ophthalmologist right away?

• One of his eyes starts to turn in, or out, or up.
  If his eyes are not aligned normally, the eye that is turning may have a vision problem, for example, near- or far-sightedness or astigmatism, or even a cataract or an abnormality in the retina.
• His eyes begin to wiggle back and forth.
  This condition, called “NYSTAGMUS”, can be a relatively harmless condition that runs in families, but it can also mean that your child is not seeing properly, or that he has a neurological condition.
• One, or both, of his eyes are constantly tearing, with a chronic discharge.
  This probably means that the little duct that drains his tears into his nose has failed to open properly. If this is the case, your doctor will give you antibiotic drops, and tell you to massage that duct. Usually, that duct will open by itself by the time he is age one. If it does not, a minor procedure called a lacrimal probing may need to be done.
   Less commonly, this may be a sign that the eye has an infection, an allergy, or even a form of childhood glaucoma.
• The pupil of his eye looks white instead of black.
  There are many different eye problems that can cause a white pupil. They include cataracts, various developmental abnormalities, and a variety of retinal problems such as infections, abnormal blood vessels, and, extremely rarely, retinal detachments or eye tumors. It is important that you find out what the problem is. It could possibly save his life.
• He squints, holds books close while reading, rubs his eyes frequently, tilts his head to see, or complains that he cannot see the board at school, or gets headaches when he reads.
• One, or both, of his lids begin to droop.Even if this lid does not cover the center of his eye, the pressure from the lid may cause astigmatism, and decrease his sight.
  Rarely, a drooping lid can be a sign that he has developed a neurological problem.
• He seems to bump into things, and he always has bruises.
  This might be a sign that his peripheral vision is not normal.

What will happen during my child’s eye exam?

• Your child’s vision will be checked during every eye exam. If he does not know his letters, he will be asked to identify pictures, or taught to play the “E” game, where he will be asked to hold his fingers to indicate the direction an “E” is pointing.
• Both eyes will be checked for nearsightedness, farsightedness, and/or astigmatism by having him look into a special machine, or by studying the reflexes from the back of his eye with a RETINOSCOPE.
• If your child is a boy, his color vision will be checked (10% of males have red-green color-blindness or color-weakness).
• His pupils will be checked. They should be round, and equal (to within one millimeter), and they should both react briskly to light.
• His eye muscle balance will be checked, by having him look first at distance and then at near, covering his eyes alternately. He will be asked to look in 6 different positions. His convergence will be checked by asking him to follow an object that is brought from reading distance up to his nose.
• His eyes will be dilated with drops. These will burn briefly, but they are harmless. After dilation, his eyes will be sensitive to light, so you should bring dark glasses for him to wear home. Warn him that his sight will be blurry at near for a short time. He should not play sports that afternoon.
• He will be asked to put his head in a SLIT LAMP, which is a microscope on its side, so the doctor can check his lids, lashes, cornea, and anterior chamber under magnification.
• The doctor will look at his retina using an INDIRECT OPHTHALMOSCOPE, a special light strapped onto his head.

How can I protect my child’s eyes from injury?

It is estimated that up to 90% of all eye injuries in children can be prevented by proper eye protection. If your child is playing competitive tennis or squash, or boxing, he should wear three-millimeter-central-thickness polycarbonate eye protection glasses. Give him neutral gray, polarized sunglasses if he is sailing or skiing. Never let him stare into a laser pointer, or look directly at the sun. Do not let him play around working lawn equipment. Leave fireworks to professionals.

Can eye exercises help my child’s eyes?

Eye exercises with not get rid of nearsightedness, farsightedness, or astigmatism. They can not treat learning disabilities, or improve eye-hand coordination, or correct misaligned eyes. They are, however, effective in treating CONVERGENCE INSUFFICIENCY, where a child has difficulty pulling his eyes together while he reads.