OPEN YOUR EYES…
TO EYE & VISION
PROBLEMS
Early diagnosis and treatment of infant eye conditions enables the best chance of visual development
We know eye problems run in the family. Knowing your family history of vision or eye problems in childhood will alert your doctors to know what to look out for.
Some eye problems that occur during childhood can interfere with vision development. This is called ‘amblyopia’. The need for glasses (refractive error) or a turned eye (strabismus/squint) can cause amblyopia. With early detection, amblyopia can be treated very successfully.
Sometimes vision problems are hard to see…
Poor vision in one eye is difficult for a parent or caregiver to detect as a child’s vision will always be as good as the better-seeing eye.
This is why community vision screening at a young age is really important.
Eye health professionals can check an infants’ vision even before they learn how to talk!
Here are important signs of eye or vision problems:
Asymmetry of the eyes or eyelids
- Frequent misalignment of an eye can prevent the eye from sending accurate visual messages to the brain.
- Early diagnosis and treatment is vital to ensure that the misaligned eye is provided with the best opportunity to develop properly.
- A droopy eyelid is called a “ptosis”.
- If a droopy eyelid is present at birth or within the first year of life, the condition is called congenital ptosis.
- Any ptosis that develops over a period of days or weeks can signal a serious medical problem and needs further evaluation from a medical professional[1].
- Congenital ptosis occurs equally among different races and equally between males and females[2][3].
The appearance of a white pupil or cloudy eye
- When looking into your baby’s eyes, you should see a dark pupil in the centre of both eyes.
- With flash photography, the pupils will appear a bright red colour due to the reflection from the retina at the back of the eye.
- If one or both eyes appear white, cloudy, or asymmetric in a photograph this is a crucial sign to have investigated further. The eyes may be normal, but the only way to know is to have an examination by an eye health professional.
Congenital Cataract
- A cataract is any opacity within the lens of the eye. The lens is one of the structures that focus light to the back of the eye.
- It is estimated that congenital cataracts are responsible for 5% to 20% of blindness in children worldwide [4].
Retinoblastoma
- Retinoblastoma is rare, but is the most common eye cancer in children[5].
- The estimated incidence varies by country from 3.4 to 42.6 cases per million live births[6].
- Retinoblastoma typically affects young children. The average age of the child when diagnosed is 2[7].
- It occurs equally in males and females[8].
Extreme light sensitivity and excessive watery or teary eyes
- Observe how your baby responds to light.
- If they have an extreme sensitivity to bright lights, together with an appearance of an enlarged eye, opaque (whitish-grey) cornea, and excessive tearing, this could be a sign of “congenital glaucoma”.
- This is a condition where the pressure inside the eye is too high.
- In Australia, it is estimated that there is 1 diagnosis of congenital glaucoma for every 30,000 births[9].
Red eyes and discharge
- It is common for babies to have small amounts of eye discharge and it is rarely a cause for concern.
- A blocked tear duct is a common cause of persistent eye discharge. This is due to the tear duct not fully opening when the baby is born. It can affect one or both of the infant’s eyes.
- A blocked tear duct, or “nasolacrimal obstruction”, usually spontaneously resolves within the first year of life[10].
- Although less common, it is more concerning if there are signs of watery and crusty discharge together with redness, swelling and tenderness. This may indicate a sign of an infection and will require further investigation by an eye health professional.
- Red eyes, watering and yellow/green sticky discharge with eyelid swelling during the first weeks of life after natural delivery could be a serious form of conjunctivitis. Neonatal conjunctivitis will require a swab of the discharge to determine the cause and decide the best treatment[11][12].
[1] Pavone, P. PhDa; Cho, Sung Yoon PhDc; Praticò, A.D. PhDb; Falsaperla, R. PhDa; Ruggieri, M. PhDb; Jin, Dong-Kyu PhDc,* Ptosis in childhood, Medicine: September 2018 – Volume 97 – Issue 36 – p e12124 doi: 10.1097/MD.0000000000012124
[2] Eyewiki, Ptosis, Congenital, https://eyewiki.aao.org/Ptosis,_Congenital
[3] Griepentrog GJ, Diehl NN, Mohney BG. Incidence and demographics of childhood ptosis. Ophthalmology. 2011;118(6):1180-1183. doi:10.1016/j.ophtha.2010.10.026
[4] Gilbert C, Foster A. Childhood blindness in the context of VISION 2020–the right to sight. Bull World Health Organ. 2001;79(3):227-32. Epub 2003 Jul 7. PMID: 11285667; PMCID: PMC2566382.
[5] Rodriguez-Galindo C, Orbach DB, VanderVeen D. Retinoblastoma. Pediatr Clin North Am. 2015 Feb;62(1):201-23. doi: 10.1016/j.pcl.2014.09.014. PMID: 25435120.
[6] Review of Retinoblastoma. (2021). Retrieved 19 March 2021, from https://www.aao.org/disease-review/review-of-retinoblastoma
[7] American Academy of Pediatrics, Section on Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology, American Association of Certified Orthoptists. Red reflex examination in neonates, infants, and children. Pediatrics. 2008;122(6):1401-1404.
[8] Cancer.Net, Retinoblastoma – Childhood : Statistics, https://www.cancer.net/cancer-types/retinoblastoma-childhood/statistics
[9] MacKinnon JR, Giubilato A, Elder JE, Craig JE, Mackey DA. Primary infantile glaucoma in an Australian population. Clin Exp Ophthalmol. 2004 Feb;32(1):14-8. doi: 10.1046/j.1442-9071.2004.00750.x. PMID: 14746584.
[10] Vagge A, Ferro Desideri L, Nucci P, et al. Congenital Nasolacrimal Duct Obstruction (CNLDO): A Review. Diseases. 2018;6(4):96. Published 2018 Oct 22. doi:10.3390/diseases6040096
[11] Makker K, Nassar GN, Kaufman EJ. Neonatal Conjunctivitis. [Updated 2020 Dec 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441840/
[12] Antonio R. de Toledo, John W. Chandler, Conjunctivitis of the newborn, Infectious Disease Clinics of North America,
Volume 6, Issue 4, 1992, Pages 807-813, ISSN 0891-5520, https://doi.org/10.1016/S0891-5520(20)30483-9.