The VIIO Child Eye Care Project

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.