Paediatric eye diseases

Children absorb a lot of important information through their eyes, especially during the first years of life, which is why two healthy eyes are essential for their development. 

However, children perceive their environment differently to adults. Blurred vision, a lack of spatial vision or similar visual disturbances are perceived by children as ‘normal’ because they are unable to compare it with correct vision. In addition, younger children are usually unable to provide any information about their actual vision.

This is why it is extremely important, especially for younger children, to detect and treat any eye diseases and changes in vision as early as possible. 

Symptoms

Children who may suffer from an eye disease unnoticed may experienced the following accompanying symptoms: 

  • Visual disturbance 
  • Squint 
  • Headache 
  • Conspicuous uncertain motor movements 
  • Learning difficulties or problems in school lessons 

In the case of squint, the eyes do not look in the exact same direction, which makes perceived double vision possible. There are several forms of squint: 

  • inward or outward 
  • alternating (sometimes the right eye, sometimes the left eye)   
  • one-sided (the same eye is always squinting)  
  • Manifest squint, 
  • i.e. always present, or intermittent squint (= the alternation between phases of squinting and phases of normal vision)  
  • Microsquint (the squint angle is small and inconspicuous, making it virtually invisible to the layperson)  

The earlier squint is diagnosed and treated, the better the chances of normal childhood vision development. At just three years of age, however, the success of treatment decreases considerably and, despite the treatment of a visual disturbance caused by squint, no improvement can be achieved upon entering school. As a result, vision in the affected eye remains weak. 

Causes

The following eye diseases are possible in childhood: 

  • Refractive errors such as far-sightedness (also known as hyperopia), near-sightedness (known as myopia) or astigmatism 
  • Squint (known as strabismus)  
  • Eye movement disorders 
  • Eye shaking (known as nystagmus)  
  • Lazy eye (known as amblyopia), caused by refractive error or squint 
  • A wide range of organic eye diseases 

If severe refractive error remains undetected in children (for too long), this can result in permanent weakness of vision. 

Significant refractive errors in both eyes are apparent when the affected child is no longer able to recognise a wide range of objects. In addition, uncertain motor movements or impaired concentration may occur, which result from problems with vision. 

Sometimes this high refractive error occurs only in one eye, accompanied by what is known as microsquint. This condition of the eye can rarely be detected by parents. Children make no complaints and do not complain of any other negative symptoms. If this eye condition remains undetected in the child, this results in permanent weak vision in the affected eye. 

Diagnosis

The earlier visual defects are detected by a paediatrician or ophthalmologist, the better the success of a treatment – especially in childhood. Since one-sided visual defects in children in particular are sometimes detected too late, it is advisable for them to have a routine (i.e. without the presence of specific symptoms) ophthalmological examination, so that this type of eye condition can also be detected and treated at an early stage in the case of any doubt. 

During diagnosis, the doctor can use retinoscopy (also known as cycloplegia), which provides information on whether or not there is any defect in vision requiring treatment. It is completely painless and only requires simple optical aids and an experienced examiner. 

Retinoscopy is used to determine what is known as objective refraction (the patient’s visual acuity is determined by a device) and is mainly used on children. Retinoscopy essentially uses a translucent mirror that casts an image onto the back of the eye. Before the retinoscopy, the ciliary muscle (which regulates the near- and far-accommodation of the eye) is ‘paralysed’ with a drug (the tension of the inner eye muscles is released to allow an exact measurement of the refractive error). 

As the child grows older, the examination options in the ophthalmologist’s practice also become more differentiated for children. However, if there are concerns that the child’s eyes may not be healthy, or if squint or aversion to light occurs, an examination by an ophthalmologist should be carried out promptly, regardless of age. 

Treatments

The sooner a refractive error is corrected in children, the better their vision will be. After all, what was neglected in childhood can no longer be corrected or made up for later – in adulthood. 

Most refractive errors in children therefore need to be corrected with glasses between the ages of two and three in order to avoid permanent weak vision.  

Refractive errors (when a sharp image on the retina cannot be created without a suitable lens, as the incoming light rays essentially undergo refraction as they pass through the cornea and lens) are often the reason for correction by means of glasses.  

There are various treatment options for squint: 

  • Correction of refractive errors by wearing glasses 
  • Treatment of an existing visual weakness (known as amblyopia) by covering the healthy eye (= occlusion) while training the affected eye at the same time 
  • In some (rare) cases: Surgical correction of squint by rearranging the eye muscles 

Aftercare

As refractive error can change as a result of growth, it must be checked regularly by an ophthalmologist after diagnosis.

In principle, however, children’s eyes should be examined by an ophthalmologist at regular intervals, even if there are no obvious symptoms. 

FAQs

For which children is ophthalmological prevention particularly important?

Preventative care is particularly advisable for children, 

  • whose parents themselves suffer from refractive errors 
  • who are affected by hereditary eye diseases. 
  • who suffer from general diseases that may also affect the eye, such as diabetes. 
  • in whom learning and developmental problems are noticeable. 

From what age should children visit an ophthalmologist?

  • Immediately: in the case of visible abnormalities such as corneal clouding, grey-white pupils, large light-averse eyes or eye tremors 
  • At six to twelve months: with apparently normal findings, but with family history (i.e. the parents or siblings have squint or suffer from severe refractive error)  
  • At 30 to 42 months: in children with no grounds for suspicion to rule out a refractive error or a microsquint 

What key indicators are there for undetected visual defects in everyday school life?

  • Poor reading and writing, lack of interest in reading 
  • Headache 
  • Clumsiness 
  • Anxiety 
  • Occasional squinting of the eyes, complaints of double vision 
  • Rubbing the eye 
  • Lack of interest in painting or handicrafts 
  • Rapid fatigue in concentration tasks, frequent lack of concentration 
  • Approaching objects close-up and crooked head position when viewing close-up 
  • Frequent blinking, winking, squinting of an eye, sensitivity to light 

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