All children, even those with no signs of trouble, should have their eyes checked at regular intervals. Any child who experiences vision problems or shows symptoms of eye trouble should receive a comprehensive eye exam by an eye doctor. Eye care professionals use many different treatments to correct a child’s eye problems. These treatments may be used alone or in combination. Poor vision in early ages of childhood affects performance in school, at work or in a social circle. Overall, it has a negative influence on the growth and development of the child. Being able to see clearly is important for a child’s overall development and helps them to discover and learn about their world.
Neurotuberculosis with complicated cataract
A 4 year old male child was seen at our hospital in the month of May 2020. On examination parents informed of noticing vision problem since 1 month & gave a history of on treatment for tuberculosis. It is a known case of neurotuberculosis. Neurotuberculosis, which affects mainly young patients, is considered the most dangerous complication as it often leads to severe neurological sequel.
The child was diagnosed with panuveitis with complicated cataract. Panuveitis is a serious inflammation of the uveal tract of the eye. The uveal tract includes the iris, the ciliary body, and the choroid. Panuveitis also typically involves the retina and the vitreous humor. Panuveitis can be caused by infections, chronic inflammatory diseases, or its cause may be unknown. Uveitis is a major cause of blindness worldwide.
The child was suggested for surgical / medical management to both eyes under general anaesthesia.LEFT EYE – Lensectomy (removal of lens) + Vitrectomy + intravitreal antibiotic and antifungal injection; RIGHT EYE: intravitreal antibiotic and antifungal injection.The vitreous sample was sent for microbiology/cytology to rule out endophthalmitis.
The child underwent the above suggested management on 20.05.2020. The surgery lasted for 2hrs 15 min and was uneventful.
Most of the children in their school going age are unaware of their visual needs or vision related problems. The proverb “an ounce of prevention is worth a pound of cure” is true with children’s eye care. As children progress throughout their education, they face increasing demands on their visual abilities. When certain visual skills have not developed, or are poorly developed, learning is difficult and stressful. Children will typically attempt to do the work, but with a lowered level of comprehension or efficiency. Eye exams by an eye doctor are an important way to identify problems with your child's vision. Problems that are found early have a better chance of being treated successfully
CONGENITAL GLAUCOMA:
A 7 months old male baby was seen by us on 31.10.2019 in Glaucoma Department. The baby has the systemic condition called sturge weber syndrome with seizure. It is a congenial disorder and a rare neurological condition that affects the development of certain blood vessels causing abnormalities in the brain, skin and eyes from birth. It is characterized by a port-wine birthmark on the child’s face. On examination parents informed of treatment at Indira Gandhi Institute of Child Health care for epilepsy since 1 month. During visual acuity examination the child was able to follow and fix light in both eyes. Anterior segment examination showed megalo cornea in both eyes. An intraocular pressure in right eye was 24 mmHg and in left eye was 28 mmHg. The child was advised to undergo BOTH EYES EXAMINATION UNDER ANAESTHESIA + TRABECULECOTMY + TRABECULOTOMY UNDER GENERAL ANAESTHESIA. The child was advised to start perioperatively oral propranalol 1 week prior to surgery (to treat high blood pressure and circulatory conditions after pediatrician opinion)
After undergoing all preliminary investigations (paediatrician fitness) the baby was posted for surgery on 30.12.2019. The surgery lasted for 1 hr 45min and was uneventful.
As on 21.01.2020; the baby is doing well and examination under anaesthesia has been advised.
DEVELOPMENTAL CATARACT
A 7 year old female child was seen at our hospital in the month of September 2019. On examination parents gave a history of undergoing cataract surgery to left eye 2 yrs back elsewhere. The child complained of diminution of vision in right eye. Her visual acuity in right eye was counting fingers at 1 mtr distance and in left eye was 6/60. Anterior segment examination showed presence of cataract with diffuse lenticular opacities. The child is suffering from chronic disease known as nephritic syndrome. (Nephritic syndrome is the name given to a collection of different signs and symptoms that occur as a result of inflammation in the kidneys. This inflammation causes the kidneys to works less effectively. It also causes protein and red blood cells to leak from the blood stream into the urine. There are many conditions that may cause nephritic syndrome and it can occur in people of all ages. Common causes are infections, immune system disorders and inflammation of the blood vessels. The main symptoms are passing less urine than normal, leading to a fluid buildup in the body, and having blood in the urine. People with nephritic syndrome also often develop high blood pressure). The child is under treatment for the above condition. The child was advised to undergo RIGHT EYE CATARACT EXTRACTION + ANTERIOR VITRECTOMY + IOL IMPLANTATION + POSTERIOR CAPSULOTOMY UNDER GENERAL ANAESTHESIA. Post surgery close monitoring on child’s BP fluctuations was advised by the paediatrician and was monitored round the clock.
After undergoing all preliminary investigations (paediatrician fitness) the child was posted for surgery on 05.10.2019
To prevent blindness children's vision screenings are an accurate, cost-effective way to find vision problems in children. Children rarely understand if something is wrong with them. Unless they are hurt or ill, most of the times they tend to be reckless and disregard any safety measures to keep themselves out of trouble. Eyes are extremely delicate and any damage to them could not be treated as easily as you think. Children eye care is an essential thing. Rather than reactive, taking proactive measures is essential to prevent vision problems and ensuring a trouble-free childhood. Eyes are our window to the world and children gain a lot of information by just observing and seeing everything around them.
1. DEVELOPMENTAL CATARACT:
A 5 month old male baby was evaluated at our hospital on 20.08.2019 by Dr.Bhargavi Murali (vitreo-retinal consultant) and Dr.Seema A V (paediatric Ophthalmology consultant). During visual acuity examination the baby was unable to fix and follow light in both eyes. Anterior segment examination showed white reflex in pupillary area in both eyes. The child was diagnosed to have developmental total cataract in both eyes. A cataract is any light scattering opacity of the lens. The majority of bilateral congenital or infantile cataracts not associated with a syndrome have no identifiable cause. Genetic mutation is likely the most common cause. If the cataract is felt to be visually significant, surgical intervention is the only option. The timing of surgery is critical for visual development. The child was advised to undergo BOTH EYES LENSECTOMY + ANTRIOR VITRECTOMY + POSTERIOR CAPSULOTOMY UNDER GENERAL ANAESTHESIA. The child underwent right eye surgery on 06.09.2019 and left eye on 17.10.2019. As on 04.11.2019 the child is doing well and is able to fix and follow light in both eyes. The child has been advised for glasses checkup.
2. STRABISMUS - Misalignment of eyes: It is a disorder in which the eyes don't look in exactly the same direction at the same time. Causes of strabismus can include nerve injury or dysfunction of the muscles controlling the eye. Crossed eyes can usually be corrected with early treatment. Several treatment options exist to align the eyes. They include special eye wear, use of an eye patch and surgery.
A 4 year old male child was seen at our hospital on 22.08.2019 by paediatric Ophthalmologist. On examination the child’s parents informed of noticing squinting since 10 months of age. The child was diagnosed to have alternating esotropia. Alternating esotropia is a lazy eye condition which allows fixating with either eye, but not at the same time. A surgery will help to fuse the image of both eyes. The child was advised to undergo BOTH EYES SQUINT CORRECTION SURGERY UNDER GENERAL ANAESTHESIA. The child underwent the suggested surgery on 11.10.2019. As on 04.11.2019 the child is doing well and glasses has been suggested.
The human eye is an organ that reacts to light and allows vision. Healthy eyes and vision are a critical part of child's development. Their eyes should be examined regularly, as many vision problems and eye diseases can be detected and treated early. Childhood blindness has an adverse effect on growth, development, social, and economic opportunities. A child's brain learns how to use eyes to see, just like it learns how to use legs to walk or a mouth to form words. The longer a vision problem goes undiagnosed and untreated, the more a child's brain learns to accommodate the vision problem. A comprehensive eye examination is very important for children.
CHILDHOOD GLAUCOMA
An 11 year old male child has been under our care and management for congenital glaucoma management since 2018. Childhood glaucoma is a rare condition that may be inherited, caused by incorrect development of the eye’s drainage system before birth. This leads to increased intraocular pressure, which in turn damages the optic nerve. Symptoms of childhood glaucoma include enlarged eyes, cloudiness of the cornea, and photosensitivity (sensitivity to light). Pediatric glaucoma is treated differently than adult glaucoma. The aim of pediatric glaucoma surgery is to reduce IOP either by increasing the outflow of fluid from the eye or decrease the production of fluid within the eye.
The child’s visual acuity in right eye was counting fingers at 1 mtr distance and in left eye was 6/60. The intraocular pressure in right eye was 8 mmHg and in left eye was 17 mmHg. The child was advised to undergo LEFT EYE TRABECULECTOMY WITH MITOMYCIN C UNDER GENERAL ANAESTHESIA. The child underwent the surgery on 25.04.2019.
STRABISMUS - Misalignment of eyes Crossed or misaligned eyes (strabismus) can have different causes, such as problems with muscle control in the affected eye or eyes. Strabismus is a common cause of amblyopia and should be treated early in childhood so vision and eye teaming skills can develop normally.
A 2½ year old girl child was seen at our hospital on 05.03.2019. On examination the baby’s mother informed of head injury due to fall from bed 1 yr back. The child was under treatment for lateral rectus palsy (traumatic plasy). (Head injuries can cause a lateral rectus palsy this is due to raised intracranial pressure.Typical features of lateral rectus palsy include sudden onset of horizontal double vision, which is worse when the patient looks to the affected side). The child was diagnosed to have esotropia (one or both eyes turns inward) in left eye and was advised to undergo LEFT EYE SQUINT CORRECTION SURGERY (2 MUSCLES) UNDER GENERAL ANAESTHESIA. The child underwent the suggested surgery on 31.05.2019.
In order to prevent Blindness a continuum of eye care for children that can include both vision screening and comprehensive eye exams are recommended. All children, even those with no signs of trouble, should have their eyes checked at regular intervals. Any child who experiences vision problems or shows symptoms of eye trouble should receive a comprehensive eye exam.There are different treatments to correct a child's eye problems. These treatments may be used alone or in combination. Glasses compensate for refractive error, eye drops or ointments are used to treat infections, Patching one eye is common in treating amblyopia, and surgery may be needed to remove the lens if the child has a cataract. Eye exercises (orthoptics) can improve focusing and help the eyes move better and work together.
PENETRATING KERATOPLASTY
A 16 year old boy was reviewed by us in the month of March 2019. The boy was treated with penetrating keratoplasty for Keratoconus grade 4 in left eye in 2016, when he was reviewed in March 2019 graft scarring was noticed, his visual acuity dropped to counting fingers at 1 mtr distance. The child was suggested to undergo LEFT EYE PENETRATING KERATOPLASTY (re-graft) UNDER GENERAL ANAESTHESIA. The child underwent the suggested surgery on 28.03.2019.
(A cornea transplant (keratoplasty) is a surgical procedure to replace part of the cornea with corneal tissue from a donor. Cornea is the transparent, dome-shaped surface of the eye that accounts for a large part of eye's focusing power. A cornea transplant can restore vision, reduce pain and improve the appearance of a damaged or diseased cornea.)
LAMELLAR CATARACT
A 7 months old male baby was seen at our hospital in the month of March 2019 by our Paediatric Ophthalmologist. The baby is under treatment for gross developmental delays and milestones. (Gross developmental delay is an umbrella term used when children are significantly delayed in their cognitive and physical development. It can be diagnosed when a child is delayed in one or more milestones, categorized into motor skills, speech, cognitive skills, and social and emotional development).
The baby was diagnosed to have both eyes lamellar cataract. (This type of cataract is bilateral. It can be congenital or it can be acquired. The cataract is always large enough to occlude the pupil. Its effect on vision depends primarily on the density of its components - especially the nucleus). The baby was advised to undergo BOTH EYES CATARACT EXTRACTION + ANTERIOR VITRECTOMY + PARSPLANA CAPSULOTOMY UNDER GENERAL ANAESTHESIA. The baby underwent the suggested surgery on 28.04.2019.
ZONULAR CATARACT
A 5 year old child was seen by us in the month of Feb 2019. The child’s visual acuity was 6/60 in both eyes. He was diagnosed to have zonular cataract in both eyes. (Zonular Cataract is a rare inherited disorder, and is characterized by zonal opacification of lenses, the disease is progressive. It may result in vision impairment if left untreated). The child was advised to undergo BOTH EYES PHACOEMULSIFICATION + FOLDABLE HYDROPHOBIC IOL IMPLANTATION UNDER GENERAL ANAESTHESIA. The child underwent the suggested surgery for left eye on 07.03.2019.
COLOBOMA CORRECTION
A 4 yrs old male child who was operated for a rare eye condition with diagnosis of Midline facial dysmorphism with upper lid coloboma + medial canthal dystopia (Eyelid Coloboma is an uncommon, unilateral or bilateral, partial or full-thickness eyelid defect. It is caused by failure of fusion of the mesodermal lid folds. It may be isolated or associated with other ocular or systemic anomalies. Immediate attention at an early age through corneal protection, surgical repair of the eyelid defect, and monitoring of the visual development are essential to prevent complications: corneal leukoma, symblepharon, and amblyopia). The child was suggested to undergo surgical management in 2 stages.
Stage – 1 - Coloboma correction
Stage - 2 - Debulking, medial canthal reconstruction with transnasal wiring.
The child underwent 1st stage of correction on 27.06.2018.
2nd stage correction was done on 30.04.2019
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