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services » eye » paediatric ophthalmology & strabismus
Know about Paediatric Ophthalmology

Paediatric Ophthalmology is a relatively newer branch of Ophthalmology, which focuses on children's eyes till the age of 16 years. The eye of a child is developing till this age. A normal ophthalmologist neither has the specialized education nor the equipment to correctly assess the visual needs of a child.

Some of the most common problems in children are Refractive Errors, Strabismus (squints), Amblyopia (lazy eye syndrome) and Astigmatism (abnormal curvature of the cornea).

In the case of children, it is very necessary for early detection and intervention. If this is not done, the entire development process may be hampered, and in extreme cases, may result in irreversible blindness. It is generally recommended that on birth, the concerned Paediatrician examines the eyes of the baby under normal torchlight and refers to a Paediatric Ophthalmologist in case of any aberration. Remember, there is no lower age limit for bringing a baby for consultation. The hospital often receives babies who are just a few days old.

It is normally advised that children up till the age of 16 years should visit a Paediatric Ophthalmologist every six months. Quite often, during these routine examinations, the doctors pick up conditions which otherwise left unattended, may adversely affect the child's eye. It is shocking but even in Delhi, 1 out of a 1000 children suffers from Childhood Blindness; Blindness brought about due to lack of detection and intervention in the childhood years.


Tips for Parents
If your child displays any of the following symptoms get in touch with a Paediatric Ophthalmologist. Your child has only one pair of eyes. Don't neglect them!
  • Regularly complains of headache or watery eyes
  • Blinks or squints excessively
  • Rubs eyes vigorously during or after short periods of reading
  • Makes frequent written mistakes even while copying
  • Repeatedly bumps into or drops things
  • Suffers from nausea, dizziness, motion sickness or double vision


Eye examination benchmarks for children
Internationally, a child's comprehensive vision examination has to include the testing of a number of visual skills, namely:
  • Distance Acuity
  • Near Acuity
  • Binocular Fusion
  • Color vision
  • Convergence and eye teaming skills
  • Eye tracking and fixation skills
  • Focusing skills
  • Streopsis
  • Visual form discrimination
  • Visual Memory
  • Visual Motor Integration.

The examination should also test for the ability to transform images from a vertical to a horizontal plane (i.e. from the blackboard to the desk surface) and for the conditions of Hypermetropia and reversal frequency.

Insist on these tests. You owe it to your child.

Know about strabismus

Strabismus or squint is a deviation of the eyes. Strabismus is a condition in which the eyes point in different directions.

An eye turn may be constant (when the eye turns all of the time) or intermittent (turning only some of the time, such as, under stressful conditions or when ill). Whether constant or intermittent, strabismus always requires appropriate evaluation and treatment preferably before seven years of age to enable proper development of binocular vision.

Children do not outgrow strabismus!

Strabismus (misaligned eyes) in adults is often the result of progressive, untreated or unsuccessfully treated strabismus from childhood. There are also many adults who develop strabismus as the result of an injury or disease, which then frequently leads to double vision. This is often hard to tolerate and prompts evaluation and treatment by a strabismus specialist. In the past, most eye doctors thought that adults with misaligned eyes could not be treated successfully, or that treatment was "only cosmetic". Advances in the management of misaligned eyes now provide benefits to most adults as well as children. Treating adults with strabismus can improve depth perception, the way the two eyes work together, and the field of vision. Many patients report improved self-esteem, communication skills, job opportunities, reading and driving.

The best way to determine whether straightening of the eyes is possible and appropriate, is to undergo an examination by a strabismus surgeon.

Having straight eyes is a valuable asset that patients deserve.

In addition to affecting eye function, misaligned eyes can get in the way of normal eye-to-eye contact, communication skills and social interaction. This can lead to reduced self-confidence and many patients will often look down or away from the person to whom they are speaking to avoid eye contact. The person being spoken to may be uncertain which eye the patient is using and may be distracted from what the patient is trying to communicate. Such impairment of communication skills can lead to limited job (or job advancement) opportunities. Straightening the eyes will lead to some binocularity (that is, the two eyes working together) in the majority of cases, even in instances where the onset of the strabismus occurred in early childhood. Strabismus repair is not a "cosmetic" procedure but should more appropriately be considered reconstructive. After eye alignment surgery, most children and many adults improve eye function and may gain social and economic benefits.

Treatment Options

Strabismus can be treated in various ways. Depending on the individual case, treatment options include:
  • Glasses
  • Prisms
  • Patch
  • Botox injection
  • Surgery


1. How can vision and eye check up be done for a baby ?
Ans: Babies begin to fix on faces and colourful objects from 3-4 months of age. Babies also prefer to fix on patterned surfaces. Special tests to assess a childs vision are available based on these principles. An experienced clinician can determine a childs visual potential based on observation of visual behavior and these tests. Drops are used to dilate a childs eyes to check for any glass power and to do a detailed retina check up.

2. How will a baby wear glasses?
Ans: Glasses are prescribed in babies to correct a high glass power, for correction of squint or after cataract surgery. These glasses are necessary for development of normal vision and binocularity in children. Children are smarter than you think! They realize that vision is clearer with glasses and adapt very rapidly to them. Special lightweight lenses, colourful frames with reseducation bands are available especially for children.

3. How long will my child need to wear these glasses? When will they be removed?
Ans: Glasses are prescribed for development of normal vision and binocularity in children. Usually the requirement of glasses is lifelong and they cannot be removed. If the glasses are not worn regularly, it can even lead to permanent loss of vision and development of "lazy eye"

4. Can't squint surgery be delayed till a child is older?
Ans. The visual system of a child develops rapidly in the first two years and continues to develop till a child is eight years of age. A child learns to use both the eyes together and develops binocular or 3 D vision. Squint surgery has to be done early in order to restore the normal position of the eyes during this period of development. Squint surgery done at older age groups is only for cosmetic purpose, not for functional gain.

5. Can glasses be removed after squint surgery?
Ans: No. Squint surgery is done only to correct the deviation of the eyes. Glasses will have to be continued after surgery.

6. How can I know if my child has a vision problem?
Ans: Common symptoms are: if a baby has a problem focusing on objects or faces, has a squint, shaking movement of the eyes, goes close to the T.V. or blackboard, squeezes his eyes, rubs eyes continuously, has redness or sticky discharge from the eyes etc. One indicator of a serious problem can be a white reflex in the black part of the eye (pupil).
It is strongly recommended that all children have a routine eye examination by a paediatric ophthalmologist at 2-3 years of age before starting school.

7. If a child is wearing glasses, then will watching T.V. or computer games make the eyes weaker?
Ans: Watching T.V./ playing video games or reading in dim light does not harm your eyes or lead to glasses or an increase in glass power. A child with glasses can engage in all indoor and outdoor activities. However, children can develop blurred vision, headaches and other problems due to excessive T.V. watching, hence this should be restricted.

8. What is lazy eye?
Lazy eye, technically called amblyopia, means that one or both eyes have blurred vision even with the correct glasses. Amblyopia is a disorder of the brain which blocks vision from one eye because both eyes cannot be used together. Because the brain suppresses the vision in one eye early in life, normal sharpness of vision does not have a chance to develop.

Common causes:
1.Refractive amblyopia - Develops when one eye is more farsighted or near sighted than the other and appropriate glasses have not been worn. The brain cannot process a clear image from one eye with a blurred image from the other eye; hence it blocks the image from the eye with blurred vision.
2.Strabismic amblyopia - When a child has squinting of the eyes, the two eyes point in different directions. Therefore two different images are sent to the brain which causes double vision. In order to avoid this double vision the brain blocks the image from the squinting eye leading to a decrease in vision in that eye.

Treatment - Lazy eye can be treated by a combination of glasses, patching and surgery when required. Lazy eye is best treated if detected at an early age.

Paediatric Ophthalmology & Strabismus(squint) Specialists at SCEH