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Eye care for Children
 
( PAEDIATRIC EYE CLINIC )
 
 
WHY EYE CARE AT YOUNG AGE ? DEVELOPMENT OF CHILD’S VISION RECOMMENDED CHILD'S EYECARE
SYMPTOMS OF CHILDREN EYE DISEASES CHILDREN EYE DISEASES TREATMENT AMBLYOPIA  
SIGNS & SYMPTOMS CAUSES TYPES OF AMBLYOPIA DIAGNOSIS AND DETECTION  
 
 
For proper development of children , good vision and eye health are very important . Many of us may not know many truths about Eyecare for children.
   
   
 
DO YOU KNOW ?
  • 25% Children in the world have some eye problems or the other. This percentage may be much higher in     developing & underdeveloped countries.
  • Approx. 20% children in school are either near or far sighted.
  • 8% children have problems other than refraction / glasses (This may be congenital, squint, cataract, or     even cancer in eye )
  • Approx. 15% children have vitamin dificacy and/or wrong reading / writing habits.
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    WHY EYE CARE AT YOUNG AGE ?
  • A child does not know if he has a vision problem. The parents have to ensure that his vision is     satisfactory.
  • Child’s eye continues developing till 8 – 9 years of age . Many a future disease can be controlled     prevented by correcting & guiding so that the visual pathways develop properly.
  • There are several diseases which go un-noticed, not only by children as they grow up, but also by     parents.Both assume normal vision because symptoms of abnormality are not in their knowledge.
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    VISION SCREENING
      Vision screening is an overall eye check for obvious eye problems visible outside the eye.
    These are desirable at an early age. However only 25 – 30 % of eye problems or diseases can be found .
    A detailed examination should not be avoided at appropriate ages, as described further.
     
     
     
       
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    DEVELOPMENT OF CHILD’S VISION
     

    DEVELOPMENT OF CHILD’S VISION The vision system of a child is poorly developed at birth. But develops rapidly with a remarkable combination of nerve tissues, muscles and optical lenses that provide the sense of vision.

    The information processed by the eyes is sent directly to the Brain and is interpreted as vision. Awareness of location, space , depth, color, shapes provides valuable clues to help us understand our environment.

    The visual system is nearly developed but its full development & fine tunning continues till adolescence and adulthood.

    A one – month child sees clearly say, upto 2 feet and by 3 months its nearly developed . But fine tunning & development completes after 15 – 17 years.

     
     
     
       
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    RECOMMENDED AGES FOR CHILD’S EYECARE
     
    Experiance & good practice reveal that following are good ages when eyecare of child is very important :
    1. Within 3 – 6 months of birth
    2. Between 3 – 5 years or school admission.
    3. 8 – 9 years
    4. 14 – 16 years
     
    Within 3 – 6 months of birth 8 – 9 years 14 – 16 years
     
     
     
       
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    SYMPTOMS OF CHILDREN EYE DISEASES
      Eye disease of children can be first identified by their parents only. The parents need to watch if any of the following symptoms are visible :
     
     
    1.
    Redness or Swelling
    Redness or Swelling
    Redness
    Ex. Tears
    Ex. Tears
    Rubbing Eye
    Rubbing Eye
    Drooping Eye
    Drooping Eye
    Eyes Turned In
    Eyes Turned In
    White Colour
    White Colour
    2.
    Excessive Tears
    3.
    Discharge
    4.
    Tendency of rubbing eye
    5.
    Jerky eye movement
    6.
    Drooping eyelids
    7.
    One eye turns in or out
    8.
    Involuntary to & fro movements
    9.
    Child tills head or his eyes appears to constantly or
    intermittently turn in / out / up / down
    10.
    White colour in the dark area of eye
    11.
    Part of the iris ( the coloured circle of eye ) is missing
    12.
    The eyes seen to jiggle or rotate
    13.
    One pupil ( black centre of eye ) is larger than the other
    14.
    Child always tilts his head to look at things
    15.
    The baby does not focus or follow objects nor do they
    make eye contact by 3 months
    16.
    Eyes are oversensitive to light
    Also if the child is school going then following symptoms are also indicative eye problems :
    17.
    The child complains of headache or tiredness after reading
    18.
    Child holds his book vary close to face
    19.
    Any other symptoms associated with eye and appears abnormal
     
     
     
       
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    CHILDREN EYE DISEASES
      It requires skills to diagnosis eye disease of children. Various symptoms need to be correlated with the stage of development of eye. The disease could be functional or physiological. Broadly the following are the disease in children’s eyes.

     
    1. Vision problem : Near vision or Far vision


    2. Vision development problem
      This may have following symptoms :-
      1. Blurred vision
      2. Erratic eye movements
      3. The ability to focus from far to near and far to near in a short amount of time
      4. The ability to remember what is seen
      5. The ability to correctly visualize a figure or picture
      6. The ability to scan words or pictures

    3. Squinting :
      1. In normal lighting: There is often is an attempt to see more clearly, or a neurological problem with eyelid muscle control.
      2. A greater than expected reaction to light: This can be a sign of an injury to the exposed parts of the eye or internal infection.

    4. Eye Turning
      1. Turned-in (crossed) or turned-out (wall) eyes. Improper position or incorrect muscle length can result in one or both eyes being misaligned or unable to track.This is called strabismus. This type of problem can cause poor spatial perception, clumsiness, and reading disabilities.
      2. Eyes that roam in rhythmic, sometimes rapid movements is a condition called nystagmus. This can be a sign of neurological disorders of the eye or brain.

    5. Blinking
    6. - Excessive or Insufficient Eyelid blink problems can result in or be caused by dry eyes, irritation, infection or neurological dysfunction.

    7. Neurological Development Problem :
    8. Symptoms are often similar to the problems outlined above. Lack of development of good visual acuity from misalignment or from a neurological anomaly, is called amblyopia. Also, there may be fixation problems, attention deficits, and binocular vision (3-D, stereopsis) defects.

    9. Pupil Abnormalities :
      1. Reflexes. The black-appearing pupils should be of equal size at any light level, clearly smaller when a penlight is shined onto the eye and larger when it is removed.
      2. A white or cloudy looking pupil is a sign of potentially serious illness.

    10. Swelling and Redness of Eye :
    11. Many things can cause this, including insect bites, allergies and minor infections.These may resolve without treatment. If the swelling is painful and it is warm to the touch, rapidly worsens and/or is accompanied by fever, seek immediate medical attention. This could be a rare, but serious, potentially vision -threatening condition in children.

    12. Redness of the
    13. "white of the eye"(sclera) and inside of lids.

    14. Pink Eye or Red Eye :
    15. Conjunctivitis is inflammation of the thin, normally transparent membrane which lines the outside of the eye and inside of the eyelids. This can be caused by chemical or particle irritation, bacteria, virus or allergies.
      1. Bacteria-caused conjunctivitis often have mucous discharge which is yellowish, sometimes tinged with green.

      2. Virus-caused conjunctivitis may cause the eye to appear very red, often with tearing but little or no pain. The eye often looks much worse than it feels. Sometimes the child is hardly aware of the problem, but is spreading the infection

      3. Allergy-caused conjunctivitis: The eyes are red , often tearing and always itching, often Intensely. Doctor may advise washing out the irritant and lubricating, non-medicated eye drops are used to limit the reaction and help with the symptoms.

    16. Excessive Tearing ( without infection ) : Some children are born with narrow or closed puncta (the small openings in the eyelids through which tears drain into a ductwork called nasal - lacrimal system. Others develop the condition as a result of infection or injury.

    17. Other Vision Problem : Glasses can not correct every vision problem. Below is a list of other types of vision problems that children can have. In children with these problems, the eye itself may be fine, but the brain and the eye may not be working well together. Just as children need to learn hand-eye coordination to catch a ball, their eyes and brain need to learn to work together to properly visualize and understand words and numbers. These problems may not be obvious by looking at the child's eye. An eye exam is needed to determine if they have any vision problems. Eyeglasses do not correct such problems.
      1. Accommodation disorder - inability to focus for clarity with changes in position, distance or posture . The child may have trouble copying from chalkboard to paper.

      2. Binocular dysfunction - inability of both eyes to act as a team; vision is blurred

      3. Directionality disorder - lack of understanding an object's position in space in relationship to ourselves; may lead to letter or number reversals.

      4. Eye tracking disorder - the inability of the eyes to look at, and accurately follow an object. It results in skipped letters, words or lines when reading.

      5. Strabismus - eyes are misaligned or crossed; can lead to vision loss.

    18. Amblyopia - poor vision in an eye that did not develop normal sight during early childhood, sometimes called "lazy eye.This is one of the more common eye problems of children.

    19. “This is described at the end of this section”


    20. Cataract : One may wonder and ask “Do Children get Cataract” Children can get cataracts, clouding of the lens of the eye, from a variety of causes. About 50 percent of cases are inherited from one parent who might have no symptoms or who might have had surgery for a similar problem in infancy, childhood, or early adulthood. Trauma is the next most common cause of cataracts. Both blunt and penetrating injuries to the eyes can disrupt the integrity of the lens and lead to its clouding. A large number of systemic (whole-body) metabolic, inflammatory, and infectious diseases can also lead to cataracts. And finally, the chronic use of some medicines — such as steroids — might also produce clouding of the lens.
     
     
     
       
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    TREATMENT
      The eye develops continually as the child grows to 8 – 10 years & then adulthood. But may development
    takes place by the age of 8 – 10 years.
    The sooner an eye disease is treated, the better. Early treatment can prevent vision loss. In some cases,
    if the disease is not treated, the child could lose his or her ability to see.
    Treatment for eye diseases could include one or more of the following:
  • Medications
  • Surgery
  • Eye patches or exercises
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    AMBLYOPIA
    (LAZY EYE)
     
  • Amblyopia, commonly referred as “Lazy Eye”, is a condition in which vision of the eye does not improve     more than 6/12 by glasses or contact lenses.

  • A child’s visual system is fully developed between the ages 9-11 approx. if eye is not fully developed the     child adapts to visual problems by suppressing or blocking out the image. If this is detected early, the     vision can be corrected and preserved. However after approx 10-11 years, it is very difficult, if not     impossible, to train the brain to use the eye normally.

  • This less visual acuity is not because of any eye anatomy or physiology. i.e.it is not due to any eye     diseases.

  • Amblyopia is always congenital (by birth) in nature, but its very difficult to self notice it. Regular detailed     eye examinations will help us to rule out Amblyopia.

  • Amblyopia can be unilateral as well as bilateral.


  • AMBLYOPIA Cataract
     
     
     
       
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    SIGNS & SYMPTOMS
      SIGNS & SYMPTOMSChildren early complain of poor vision as they are able to adapt to most of the visual requirements very easily.
    Parents must be very careful and observant of young children & should have a routine eye exam performed before their admission in school, say 2-3 years of age.
    Some of the Symptoms are:
  • Poor vision in one or both the eyes
  • Crossed or turned eye
  • Squinting or closing one eye while watching TV or reading
  • Turning or tilting head while looking at an object
  • Amblyopic patients lack binocular vision- i.e. the ability to bound
  • images of both eyes together. This hinders in perception of depth and distance.
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    CAUSES
      CAUSESThere can be one or more of the following causes
  • Unequal vision (No body tends to see with one eye closed.)
  • Uncorrected distance vision
  • Cloudy cornea
  • Squinting eye or crossed aye
  • Droopy eyelid
  • Congenital cataract
  • Improper nutrition
  • Lack of necessary stimulus to the eyes
  • Psychological status of the individual
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    TYPES OF AMBLYOPIA
     
    Amblyopia is of 10 different types but most commonly found types are as follows.
  • Refractive Amblyopia (due to Myopia or Hypermetropia)
  • Strabismic Amblyopia (due to squint)
  • Nutritional Amblyopia (due to nutritional deficiency)
  • Stimulus Deprivation Amblyopia (due to lack of proper stimulus to the eye)
  • Psychogenic Amblyoipa (it’s psychological)
  • TYPES OF AMBLYOPIA
    Nutritional Amblyopia
     
     
     
       
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    DIAGNOSIS AND DETECTION
      The eye doctor diagnoses amblyopia after examination and evaluation of :
  • Vision
  • Eye alignment
  • Eye movement
  • Fusion of images made by two eyes
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    TREAMENT
      Treatment of the Amblyopia depends upon the underlying problem. Some of the modes could be :
    TREAMENT
  • Glasses or contact lenses to correct refractive error
  • Patching of the one of the two eyes which is strong is temporarily
  • Droopy eyelids may often require surgery
  • If there is vision impairment due to cataract, it will require surgery
  • Eye exercises
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    MOST IMPORTANT
     

    It is extremely important to eye examination and treatment  are undertaken as early as possible before the child’s brain learns to permanently suppress or ignore the poor eye, or continues to have the eye disease for childhood.

       
       
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