Healthy eyes and vision are a critical part of child development. Signs that a child may have vision problems include constant eye rubbing, extreme light sensitivity, poor focusing, poor visual tracking (following an object) abnormal alignment or movement of the eyes (after 6 months of age) chronic redness of the eyes, chronic tearing of the eyes, a white pupil instead of black. Regular eye exams can detect and correct this and other vision problems.
CONGENITAL CATARACT: cataract present at birth.
A 7 months old female child was seen by us in the month of August 2018; the baby was under treatment for Down’s syndrome and congenital heart disease. Down syndrome is a chromosomal condition that is associated with intellectual disability, a characteristic facial appearance, and weak muscle tone (hypotonia) in infancy. Children with Down syndrome have an increased risk of developing several medical conditions and have an increased risk of hearing and vision problems. On examination the baby was able to follow light well in all directions. The baby was diagnosed to have calcified cataract with Nystagmus. Nystagmus is a vision condition in which the eyes make repetitive, uncontrolled movements. The child was advised for BOTH EYES CATARACT EXTRACTION + ANTERIOR VITRECTOMY + PARSPLANA CAPSULOTOMY UNDER GENERAL ANAESTHESIA. The child underwent the surgery on 21.12.2018.
CORNEAL SCAR: Injury to cornea - The cornea is the eye’s outermost layer. It is the clear, domeshaped surface that covers the front of the eye. It plays an important role in focusing our vision. The cornea and lens of the eye are built to focus light on the retina, which is the light-sensitive tissue at the back of the eye. When light strikes the cornea, it bends—or refracts—the incoming light onto the lens. The lens refocuses that light onto the retina, which starts the translation of light into vision. Minor injuries or scratches, the cornea usually heals on its own. Deeper injuries can cause corneal scarring, resulting in a haze on the cornea that impairs vision.
An 11 yrs old boy was presented to us with the above condition He came to us with diminution of vision in left eye; his visual acuity in left eye was counting fingers at ½ mtr distance. Anterior segment examination showed corneal scar which necessitated surgical intervention of LEFT EYE KERATOPLASTY UNDER GENERAL ANAESTHESIA. The child underwent the surgery on 07.01.2019. As on 07.02.2019; the child is doing well, his visual acuity in left eye is counting fingers at 2 mtr distance.
CONGENITAL GLAUCOMA: Congenital glaucoma is a developmental glaucoma that results from the abnormal development of the aqueous drainage structure, characterized by an elevated intra-ocular pressure, enlargement of globe (buphthalmos), corneal edema and optic nerve cupping.
A 14 yr old boy has been under our care and management for congenital glaucoma since 2011. The child has undergone multiple surgical interventions to retain the vision in the only Seeing Eye – right eye. On follow-up on 07.01.2019; the intraocular pressure (IOP) in right eye was 34 mmHg which is a sight threatening condition. The child was advised to undergo RIGHT EYE AADI (AUROLAB AQUEOUS DRAINAGE IMPLANT) UNDER GENERAL ANAESTHESIA. The child underwent the same on 31.01.2019. As on 07.02.2019; IOP is well controlled and his visual acuity is counting fingers at 2.5 mtr.
Preventing childhood blindness requires access to prenatal care, primary health care, and good nutrition, which is not often available in especially rural areas. Taking care of children eyes and learning about its health is a first step to preventing vision loss from common eye problems and the eye diseases that affect people in childhood and as age progresses which, if left untreated, result in blindness or severe visual impairment that are likely to be untreatable later in life.
1. A 6 months old female baby was seen at our hospital for retinal evaluation and management. The baby’s mother informed of attack of hip & knee septic arthritis at birth. (Septic arthritis is also known as infectious arthritis, and is usually caused by bacteria. Common bacteria that cause acute septic arthritis include staphylococcus and streptococcus. These foreign invaders enter the bloodstream and infect the joint, causing inflammation and pain. If the infection is not treated early, permanent joint damage may result. The baby was in the hospital for 1 month for the above treatment. She also informed of noticing white reflex in right eye. The baby was a suspected case of Leukocoria - white pupillary reflex which is an abnormal white reflection from the retina of the eye / retinoblastoma. The baby was advised for BOTH EYES EXAMINATION UNDER ANAESTHESIA TO RULE OUT THE ABOVE CONDITION. The child underwent the above on 22.08.2018 under the guidance of ocular oncologist. The examination was inferred as a presence of cystic membrane in right eye and the baby is advised to review after 6 months.
2. An 11 yrs old boy was seen by us with complaints of sudden diminution of vision. On examination the child was diagnosed to have Retinal detachment. It occurs when the retina separates from the back of your eye. This causes loss of vision that can be partial or total. When the retina becomes detached, its cells may be seriously deprived of oxygen.. The retina is a layer of tissue on the inside of the eye. It transmits visual information from the optic nerve to your brain. A detached retina shifts from its normal position. If left untreated, retinal detachment can cause permanent loss of vision. Retinal detachment is a medical emergency. The boy was treated with surgical intervention of Scleral buckling on 05.09.2018. It is a surgical procedure used to repair a retinal detachment. The sclera, or the white of the eye, is the outer supporting layer of the eyeball. In this surgery, a surgeon attaches a piece of silicone or a sponge onto the white of the eye at the spot of a retinal tear. The buckle is designed to repair retinal detachment by pushing the sclera toward the retinal tear or break. The vision is restored post surgery and the child is doing well.
3. A 15 yrs old girl with history of gross developmental delays + epilepsy was diagnosed with mature cataract in both eyes. The child was able to appreciate the light at ½ mtr distance in both eyes. She was surgically managed with intervention of BOTH EYES PHACOEMULSIFICATION + FOLDABLE HYDROPHOBIC IOL IMPLANTATION UNDER GENERAL ANAESTHESIA in single sitting on 11.10.2018. Post surgery the child is able to appreciate light at 3 mtr distance.
The control of blindness in children is a VISION 2020 priority: the right to sight. Because the number of ‘blind person years’ resulting from blindness starting in childhood is second only to cataract. Blindness may be due to genetic mutations, birth defects, premature birth, nutritional deficiencies, infections, injuries, and other causes. Severe retinopathy of prematurity (ROP), cataracts and refractive error are also causes.
1. A 8 months male child was referred to us with complaints of premature birth with birth weight of 1.5 kgs + gross developmental delays + left inguinal hernia which requires surgery after eye management (A hernia occurs when a part of the intestine pushes through a weakness in the belly (abdominal) muscles. A soft bulge shows up under the skin where the hernia is. A hernia in the groin area is called an inguinal hernia. A hernia can develop in the first few months after a baby is born. It happens because of a weakness in the abdomen muscles). During visual acuity examination the child was able to follow light in both eyes. Anterior segment examination showed congenital total cataract in both eyes. The child was managed with surgical intervention of BOTH EYES LENSECTOMY UNDER GENERAL ANAESTHESIA on 22.06.2018.
2. A 4 yrs old male child was recognized in one of the eye screening camps with a rare eye condition. The child was referred to us for the possible surgical intervention. The parents informed of growth on the medial side of both eye + c/o both eyes watering with whitish discharge on and off. The child was able to fix and follow light in both eyes. The child was diagnosed to have 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.
The child underwent 1st stage of correction on 27.06.2018.
3. A 13 yr old boy was evaluated in one of our school screening camps and was referred for squint surgery to base hospital. On examination the parents informed of squinting since 3 yrs of age and were unaware of requirement of surgical intervention for correction of the same. His visual acuity in both eyes was 6/6p. The child was diagnosed to have bilateral alternating exotropia (SQUINT) - Squint (also known as strabismus) is a condition that arises because of an incorrect balance of the muscles that move the eye, faulty nerve signals to the eye muscles and focusing faults (usually long sight). If these are out of balance, the eye may turn in (converge), turn out (diverge) or sometimes turn up or down, preventing the eyes from working properly together. If left untreated, it can lead to a permanent visual defect in the squinting eye.. The child was managed with surgical intervention of bilateral squint correction surgery (2 muscles) under General Anaesthesia. The operation involves moving the muscles that control eye movement so that the eyes line up better. If a squint or amblyopia is not picked up before the age of 7/8 years old then it can have a permanent effect on the vision in one eye.
Childhood blindness is an important cause contributing to the burden of blindness. Preventing childhood blindness requires access to prenatal care, primary health care, and good nutrition. Children’s eyes are very sensitive and are easily affected by infection and nutritional deficiencies. Childhood blindness is caused by a number of diseases and conditions. Vitamin-A deficiencies, cataracts from rubella, corneal scarring from measles, strabismus, and retinopathy of prematurity from premature birth. Prevention and treatment depends on the cause of blindness
Squint
A 6 yr old male boy was operated for squint. The child was diagnosed to have bilateral alternating exotropia (SQUINT) - A squint is a condition where one eye is out of alignment, Squints can affect the eyesight in childhood, as the brain will begin to ignore a squinting eye causing the sight in it to be worse that in the other eye. The child was advised to undergo bilateral squint correction surgery (2 muscles) under General Anaesthesia. The benefits of squint surgery are an improvement in the appearance of the squint, reduction in the severity or frequency of double vision, an improvement in the control over the squint. In young children a benefit may be allowing the eyes to work together as a pair.
Congenital Glaucoma
A 7 months old baby was seen by us. The baby is under treatment for coronary heart disease (CHD) + PDA (CHD means a child is born with an abnormally structured heart and/or large vessels & Patent ductus arteriosus (PDA) is a persistent opening between two major blood vessels leading from the heart). On examination the child was able to fix and follow light in both eyes. Anterior segment examination showed Megalocornea (Megalocornea is an extremely rare non-progressive condition in which the cornea has an enlarged diameter, reaching and exceeding 13 mm). Fundus examination showed pigmentary changes in both eyes. The child was advised for EXAMINATION UNDER GENERAL ANAESTHESIA. Impression – both eyes congenital glaucoma with irido/ trabecular dysgenesis will need to plan both eyes trabeculotomy under GA.
Superomedial Dermoid
A 4 yrs old female child was operated for dermoid. The mass is a firm one, non mobile, non tender, fixed to bone. Dermoid cysts grow slowly and contain mature tissue; this type of cystic teratoma is nearly always benign. In rare cases the dermoid cyst is malignant. The child was advised forLEFT EYE – Superomedial Orbitotomy & biopsy under General Anaesthesia.
ORBITAL CELLULITIS
A 9 ½ yr old female child was operated for ORBITAL CELLULITIS. Orbital cellulitis is an inflammation of the soft tissues of the eye socket behind the orbital septum, a thin tissue which divides the eyelid from the eye socket. Orbital cellulitis most commonly refers to an acute spread of infection into the eye socket from either the adjacent sinuses, skin or from spread through the blood. The child was advised for ORBITOTOMY UNDER GENERAL ANAESTHESIA. The complications of orbital cellulitis are meningitis and death. As the fungal infection had spread to brain; we were unable to save the life of the child.
LIMBAL DERMOID.
A 3 yrs old male child operated for Limbal dermoid. Limbal dermoids are benign congenital tumors that contain choristomatous tissue (tissue not found normally at that site). They appear most frequently at the inferior temporal quadrant of the corneal limbus. The child was advised for LIMBAL DERMOID EXCISION WITH AMNIOTIC MEMBRANE GRAFT UNDER GENERAL ANAESTHESIA.
Childhood blindness remains a significant problem globally, especially in developing countries. When eye diseases and conditions that occur in early childhood are left untreated, they can result in visual impairment or blindness. The major causes vary and are largely determined by socioeconomic status and access to primary health care and eye care services. Regular eye examination helps to protect the child’s vision and provide useful information about the child’s eye health.
1. Keratoconus – Keratoconus is a degenerative disorder of the eye in which structural changes within the cornea cause it to thin and change to a more conical shape than the more normal gradual curve. Keratoconus can cause substantial distortion of vision, with multiple images, streaking and sensitivity to light. It is typically diagnosed in the patient's adolescent years. A 17yrs old female was treated for Keratoconus with surgical intervention of C3R surgery. This helps to arrest progression of keratoconus thereby avoiding the need for Keratoplasty.
2. Chemical Injury
Chemical injuries to the eye can produce extensive damage to the ocular surface and anterior segment leading to visual impairment and disfigurement. Chemical Injury of the conjunctiva and cornea is a serious ocular emergency and requires immediate intervention. A 10 yr old girl was presented to us with alkali injury to left eye. The child’s visual acuity in left eye was presence of perception of light and projection of rays. The child was diagnosed to have grade 4 chemical injury. The child was managed with surgical intervention of MUCOUS MEMBRANE GRAFT UNDER GENERAL ANAESTHESIA.
3.NLD Obstruction
A 2.5 year old boy with developmental delays was treated for NLD blockage with purulent discharge (Naso Lacrimal Duct Obstruction). The child underwent DACRYOCYSTOTHINOSTOMY WITH INTUBATION UNDER GENERAL ANAESTHESIA (Dacryocystorhinostomy (DCR) surgery is a procedure that aims to eliminate fluid and mucus retention within the lacrimal sac. A DCR procedure involves removal of bone adjacent to the nasolacrimal sac and incorporating the lacrimal sac with the lateral nasal mucosa in order to bypass the nasolacrimal duct obstruction. This allows tears to drain directly into the nasal cavity from the canaliculi via a new low-resistance pathway).
4. Congenital Cataract
A 7 months old baby treated for congenital cataract. The baby is under treatment for gross developmental delays + spastic quadeiparesis with microcephaly. (spastic quadeiparesis is an autosomal recessive inheritence. It affects the entire body. Spastic refers to the muscle stiffness of all four quadrants of the body Spastic quadriplegia is caused by extensive brain damage or by congenital malformations in the brain. patients with spastic quadriplegia cannot walk and their speech may also be profoundly affected. Seizures are common in spastic quadriplegia. This type of CP can significantly affect the intelligence. People with spastic quadriplegia may have mental retardation, ranging from moderate-to-severe). The child underwent BOTH EYES LENSECTOMY UNDER GENERAL ANAESTHESIA (Removal of the lens of the eye)
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