Pediatric Eye Care
Development of the visual system occurs from birth through the first ten years of life. Ideally, children should have their first eye exam when they’re around 3 ½ years old, and an exam at any age if a problem is suspected. Having a complete eye exam will help diagnose vision problems without any symptoms, and vision problems in infants and toddlers who are not able to verbalize their frustrations. At the Eye Center of Northern Colorado, your child’s complete examination will help detect and treat any potential problems with their vision, including amblyopia (lazy eye), strabismus (misalignment of the eyes), significant refractive errors, or congenital cataracts. Early detection is vital to correcting these problems and others before they result in permanent damage.
Dr. Patrick Arnold is the Eye Center of Northern Colorado’s fellowship-trained ophthalmologist. Dr. Arnold is the only full-time specialist in pediatric ophthalmology and strabismus in Northern Colorado. He and his excellent pediatric team are the best choice for your family and your child’s eye care needs.
Amblyopia (Lazy Eye)
Amblyopia is a condition where one eye does not reach visual acuity as fast as the other eye, causing vision problems. It can be caused by eye misalignment (strabismus), refractive error, or deprivation (something blocking the vision, like a cataract or a droopy eyelid). This condition can be hard for parents to diagnose because it may not be outwardly visible.
When caught early, amblyopia is usually treatable with glasses or contact lenses. Placing an eye patch on the strong eye or using a dilating eye drop (atropine treatment) to blur the vision in one eye are also effective in forcing the “lazy eye” to develop normally.
Congenital Cataracts
Cataracts typically affect older adults; however, there are cases of cataracts affecting people at birth.
Congenital cataracts are formed when naturally occurring proteins in the eye lens become clumped. The result is cloudy vision that may affect the entire lens or just portions of the lens. Congenital cataracts can lead to amblyopia or strabismus because the child will try to overcompensate for the blurred vision.
Not all congenital cataracts must be removed immediately. When they begin to affect the child’s vision and daily life, cataract surgery may be recommended. Cataract surgery involves removing the affected lens and replacing it with a new, clear Intraocular Lens.
Nasolacrimal Duct Obstruction
Tears normally drain from our tear duct through the nasolacrimal duct. In babies, this nasolacrimal duct can often be blocked by a membrane, which does not allow tears to pass through. A nasolacrimal duct obstruction, often referred to as a “clogged tear duct,” can be addressed and opened surgically if needed, although 90% of the time the duct opens spontaneously on its own by the age of 12 months.
Nystagmus
Nystagmus is a constant shaking or movement of the eyes and should always be evaluated by a pediatric ophthalmologist. Nystagmus can be a horizontal, vertical, or torsional (rotational) movement. There may be large and obvious movements or smaller, less noticeable movements. Nystagmus may be congenital and present from very early on in infancy or may be acquired and come on at any point later in life.
Some patients with nystagmus have a large head turn or tilt in order to see their best. This may require an eye muscle surgery to minimize their head position. There are also some medications that may be helpful in later onset acquired nystagmus (called oscillopsia) that interferes with vision.
Ptosis
Ptosis, or a droopy upper lid, can affect one or both eyelids. It can be congenital or acquired and may or may not have a genetic component. Vision can be affected when the upper lid blocks light coming into the pupil, causing a child to adopt a chin-up head posture that helps them to compensate.
A complete eye exam is required to assess the child’s vision, head posture, refractive error, and eyelid position. If your pediatric ophthalmologist determines the ptosis is causing a decrease in visual development, surgical intervention may be required.
Retinopathy of Prematurity
When babies are born prematurely, their retinas (the layer at the back of the eye that helps us see) is not always fully developed. These babies are at risk for retinopathy of prematurity (ROP), which can cause abnormal blood vessel growth in the retina and lead to blindness.
ROP exams are frequently done when babies are in the NICU and shortly after release from the hospital until blood vessel growth reaches a certain stage. The timing of these exams is crucial to ensuring the best sight for premature babies. If treatment is required, ROP may be treated with injections or with laser treatment.
Strabismus
Strabismus results when your two eyes cannot keep proper alignment with each other, causing the eyes to look in different directions; it’s a misalignment of one eye compared to the other. There are several forms of strabismus:
- Crossed (esotropia), one eye crosses in, relative to the other
- One straight/one down (hypotropia)
- One straight/one out (exotropia)
- One straight/one up (hypertropia)
- Pseudostrabismus is a false appearance of misalignment, sometimes diagnosed in infants and toddlers
This can be a constant or frequently occurring vision problem that most children do not outgrow. The brain often begins to ignore the visual images from the misaligned eye, which can lead to amblyopia. Strabismus can be treated through eye muscle surgery, with glasses, or sometimes both.