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What are the most common problems that children have with their eyes?

glasses

As a parent, I tend to divide the ‘care of child’ world into what is really scary, what is worrisome and what is normal. Retinoblastoma is a primary cancer of the eye that can occur in children. It is uncommon and is usually noticed by an unusual appearance to the pupil in which you see a white or amber glint instead of the usual black. Infantile glaucoma is also unusual and may cause a child to be extremely sensitive to light. Their eyes also often have an unusual bulging appearance as the internal pressure of the eye causes it to protrude. The reality is that the above conditions, though serious, are very unusual. Eye injuries are a much more common reason why children lose vision. This can occur while playing sports or trauma. A take home lesson I learned in a recent course of eye trauma, was that children will often not tell their parents the whole story if there is an accident, because they don’t want to get in trouble. For example, a young child said a tree branch hit his eye rather than admit he was playing a BB gun (true story!) and only when he was being wheeled in to have a CAT scan admitted that he was shot in the eye. As a parent, have a degree of suspicion if you did not witness the accident and observe if the extent of the injury jives with the story you are told. More commonly, children eyes are injured while playing sports. If a ball hits an eye directly, the force of the impact has to go somewhere. The bones below the eyeball and on the nasal (nose) side are quite thin and make break as they absorb the impact. A less treatable problem is if the eyeball and the nerve that connects it to the brain absorbs the blow. The take home lesson is to have children playing sports particularly with smaller balls (lacrosse, racquetball, baseball, softball) wear eye protection (see Liberty Sport under featured eyewear). Amblyopia (lazy eye) is a condition that occurs if a child isn’t using one of her eyes to see. This can occur if one eye’s vision is much better than the other, for example if one eye has perfect vision and the other eye is nearsighted, or if the eyes don’t align (happens about 3% of the time) so the child can’t use them together. A good way a parent can screen for this at an early age is to play ‘pirate’ and patch one eye and then the other. If your child’s behavior is quite different depending on which eye is covered it raises suspicion that she can’t see well in one eye. I’ve touched on scary and worrisome. Normal problems include allergies, eye infections and vision changes that can be corrected with glasses. Itchy eyes are the hallmark of eye allergies; so if your child is rubbing his eyes a lot, suspect an allergy. Cold compresses and eye drops (artificial tears that have been kept in the refrigerator) are good home cures. There are several effective prescription drops, like Pantanol, that can be used. ‘Pink eye’ is quite common in children and are spread just like colds or flu so encouraging frequent hand washing helps limit the spread of infections. Generally, the ‘bug’ is viral and will go away in a few days (cold also helps the symptoms of ‘pink eye’, but if the lids are swollen or really stuck together, the infection may be bacterial and need a dual antibiotic like Polytrim. In the United States, fifteen percent of children by eighth grade are myopic (nearsighted) and will have trouble seeing the board at school. A large study in Orinda that has spanned many years showed no evidence that environmental factors like excessive reading or computer work caused children to become nearsighted. The only significant risk factors were having nearsighted parents and having a physically long eyeball. An Austrailian study though suggests that children who play outside an hour a day are less at risk for developing myopia. Why people become myopic is an active area of research with at this point, lots of contradictory findings.