I think it’s very important for children to be examined by somebody who is specialized in their care. This is because a lot of children are nonverbal so you need to use special tests to evaluate division. Also the condition they suffer from are very unique to children and really need somebody who sees a lot of children to be able to diagnose and treat them adequately.
A baby’s eye colour is determined by the eye colour of the parents, generally, the babies will revert to having the eye colour of the parent with the darker eye. A lot of babies start life as blue eyed, but can end up with a darker eye colour. The first indication you have of what their eye colour will be is at about six to nine months of age. However, this can keep changing up to three years of age. This is when you really know what their eye colour will end up being.
So watery eyes can be caused by two groups of conditions. It can be because of overproduction of tears or by a reduction in the tears draining away. So tears can reproduce excessively in allergy, when you’re out on a cold and windy day or because of irritation in the eyes. The tears may not drain away effectively because of problems with the lids of the draining apparatus. This will need to be corrected to treat a watery eye.
A lot of this is down to genetics as well as your environment. It has been shown that if both your parents wear glasses they’ve got a 60 percent chance that you may also need glasses if you don’t spend a lot of time outdoors. However if you spend up to 14 hours a week outdoors the chances of needing glasses drops to 20 percent. So whether you need glasses or not depends on your genetics but also on how you conduct your life.
Paediatric ophthalmology is a science that’s related to the development of vision and eye health in children. The definition of children differs from place to place, but on the whole, we would consider anybody under the age of 16 as a child. This specialty is quite different because children are not young adults, so the conditions they develop ,and that we look for, are very different to what we see in adults. For example, children don’t usually develop conditions like cataracts or glaucoma or dry eye; that is very common in adults. However, there are conditions like a strabismus or a squint, a lazy eye or refractive error that are much more common in children than in adults.
This is very interesting because a lot of children actually don’t complain of an eye problem. They may have blurred vision, but for them that might be normal. So a lot of times the signs that something is wrong are indirect. They can be picked up on a school eye screening test or they might be made evident by the fact that the child is struggling at school. They ask to sit closer to the board, they hold things up quite close to see, cover one eye at a time while looking at the television, or they complain of headaches or sore eyes.
What we aim to do in this clinic is carry out a comprehensive examination of your eyes when you come to see us. This includes the evaluation of the function as well as the structure of the eye. If you have issues with double vision or have noticed a squint or if you’re a child, we will usually carry out an orthoptic assessment prior to the ophthalmic assessment. This includes an assessment of your vision; colour vision; the balance of your eyes to see how well your eyes work together. Whether you have a deviation or a squint and how good your 3D vision is. We also carry out a comprehensive history to ensure that we can capture what presenting symptoms you have and what brings you to the clinic. Following this, I usually carry out a structural assessment of the eye, which includes a bio microscopic assessment of the front and the back of the eyes. We also like to assess your refractive status to see whether you do need to wear glasses or if you are wearing glasses, whether they are the correct prescription for you.
Vision in children develops very differently to what we would imagine. For example, a young newborn baby can hardly see beyond the first meter, but that’s where they need to see because that’s what their parents face is. As they develop, so do the eyes. By about six weeks, children should develop a social smile and with increasing age by about six months, they should develop hand-eye contact, and as they get older, these facilities develop. Most of the development is complete within the first two years of life. However, the three divisions continue to develop and it can take up to seven years for the vision to be completely normal as an adult.
Unfortunately, a lazy eye may be something that is completely asymptomatic, or there may be no signs of a problem. If a child has blurred vision in one eye, they may carry on very well without noticing it because the other eye is completely normal. This is detected many times on a school test or by a routine visit to the optometrist. We recommend that all children have an eye test by four years of age to detect any possibility of lazy eye, especially if there is a family history of this.
The advice is very simple: get your child tested. If you suspect that your child sees better out of one eye than the other, the first port of call would be either to see your optometrist or a paediatric ophthalmologist. What we do this situation is assess the vision in either eye to see if there is any evidence of reduced vision.
The different types of lazy eye depend on what causes the lazy eye. You can have the refractive or and isometropic kind. This is a condition in which there’s a difference in the refractive status of the two eyes. So the eye with the higher refractive error is ignored by the brain and develops a lazy eye. You can have a sensory deprivation type of lazy eye in which, for whatever reason, the vision is obscured temporarily in one eye. This could be by a droopy eyelid or by a cataract or even just sometimes just having a bandage over one eye for a short time, and that can cause a reduction in the vision. You can also have a strabismic variety of lazy eye in which one of the items inwards or outwards. As a result, the immediate sense of the brain is not quite right, and the brain tends to ignore that. Very rarely, you have an amyotrophic or meridional type of lazy eye in which both eyes have reduced vision because of very high refractive error or very high astigmatism.
So most people with conjunctivitis will have a red eye. That is how it is usually diagnosed. The symptoms also depend on the agent that causes the conjunctivitis. For example, in allergic conjunctivitis there is associated itching, soreness and discomfort. It tends to be in response to an allergen like pollen or at a specific time of the year. If conjunctivitis is infective, associated with discharge or watering, viral conjunctivitis – which is far more common – has a watery discharge. Whereas if the conjunctivitis is due to a bacterial infection, you get a thick ropy discharge.
The treatment of squints can be divided into two primary types: surgical and non-surgical. All patients with squint should have a full ophthalmic assessment, including an assessment of the refractive status, because in some cases, just giving them the appropriate glasses or contact lenses can control the squint. Once that is done, we can look at various treatment options. This might be the use of prisms in adults to help align the eyes without needing any surgery. Botox or toxin treatment can also be used to treat squint, because this weakens muscles selectively. For example, if the eyes are pointing inwards, we can use Botox to weaken the muscle that pulls the eye in, leading to better alignment of the eyes. For long term correction of squint, surgery can be very effective and is something that we can discuss with every patient. The most important thing is that squints are very individual, and everybody needs a different, tailored plan for their squint.
Squints can be classified in various ways. A squint may be the eye deviating inwards, outwards, upwards or downwards. A squint may be constant, when it’s present through out the day, or intermittent when it comes and goes. A squint may be present when you are born, which is congenital, or it may come back later in life – where it is then an acquired squint.
The causes of squint differ with the ages of onset. We think that children develop squints because fusion mechanisms in the brain are not well developed. The brain just cannot hold the eyes together. But the consequence of the eyes drift in or outwards and cannot work in unison. Squints in adults will differ in their causation because they usually occur due to problems with the mechanism once it has been formed. This can be seen after trauma, after a stroke, or rarely by decompensation of a childhood squint.
Botulinum toxin is used extensively to weaken muscles, and this is how it helps in the treatment of squints. For example, if your eyes are drifting inwards, we can use Botox in the muscle that pulls your eye in to relax it temporarily and to improve the alignment of the eyes. This can be carried out very safely and effectively on the day and doesn’t require any surgical treatment.
If a watery eyes persistent or is causing associated changes such as redness or soreness of the eyes or surrounding skin, and we should seek treatment for it.
So watery eyes can be caused by two groups of conditions. It can be because of overproduction of tears or by a reduction in the tears draining away. So tears can reproduce excessively in allergy, when you’re out on a cold and windy day or because of irritation in the eyes. The tears may not drain away effectively because of problems with the lids of the draining apparatus. This will need to be corrected to treat a watery eye.
When assessing watery eye, the red flags are associated symptoms. If there is excessive watering from one or both eyes, the associated redness or blurred vision, if there is redness or excoriation of the surrounding skin, these are all important signs and should be taken seriously.
