What is Amblyopia?
Amblyopia is the decrease of vision in one eye which is otherwise a healthy eye. It occurs when a child prefers to use one eye and stops using, or “shuts off”, the other eye. There are two common types of Amblyopia. One is due to a misalignment of the eyes (turning in or turning out). The other is due to an unequal eye glass prescription between two eyes.
If Amblyopia goes undetected and as the child learns to see, the eye that is crossed, wandering, or blurred sends an unclear image to the brain. In turn, the brain ignores the unclear or double image, and soon the child unconsciously stops using the weaker eye. The result is that Amblyopia or “lazy eye” often develops in the eye that is not being used, leaving the child nearly blind for life if the condition goes untreated. The treatment which is usually successful is frequently a patch over the stronger eye to make the weaker eye work.
Goal of treatment: To achieve vision in each eye. This goal can be achieved. Reaching this goal requires a team effort with the child, the doctor, and most importantly, the parents. The best present you can give your child is the gift of good vision in both eyes.
In checking your eyes today, we find that the eyes the eyes are nice and healthy. Part of your examination involves measuring the children for nearsightedness, farsightedness, and astigmatism. This measurement is called a refraction and is very accurate, even in small babies. In measuring your child’s eyes, we have found an inequality of the refraction between the two eyes, which is called ANISOMETROPIA. Basically, this means that instead of the two eyes having the same amount of nearsightedness or farsightedness as the other, that one eye has a greater amount than the other. It is common for there to be a small difference between the two eyes, and in small amounts Anisometropia usually does not affect the way the eyes see and does not need to be corrected. Greater amounts of Anisometropia make it very difficult for the children to use their eyes together because the eyes are out of balance with each other. The children will depend on the better eye, and will tend not to want to use the other eye. When there is a larger amount of Anisometropia, we commonly prescribe glasses to balance out the two eyes.
Sometimes children with Anisometropia will develop Amblyopia, or decreased vision in one eye. Wearing the glasses helps improve the vision, but often patching of the eye with better vision is needed to help the vision improve in the other eye. With the combination of glasses and the patch, we are very successful in giving the children good vision in both eyes.
Parents frequently ask if glasses will be needed when the children get older. The answer is that it really depends on how much difference there is between the two eyes and what happens as the children grow. We do see children who “outgrow” their glasses, and we also see children who do not need the correction on a long term basis to balance out the eyes. These children are often ideal candidates for wearing contact lenses to keep the eyes balanced and the vision good.
Your child has been found to have ASTIGMATISM. Astigmatism is an unequal curve of the front surface of the eye that can cause blurry vision at a distance and at near. This is a very serious problem which may change over time, and which frequently improves.
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It is not necessary to give glasses for astigmatism unless the vision becomes significantly blurry. It is important that the children are seeing as well as possible, and this is why we give them glasses. Some children may be nearsighted or farsighted in addition to their astigmatism, and this is corrected by glasses as well.
Other children and adults with astigmatism may often choose to have their vision corrected with contact lenses. In the past, many patients with astigmatism were told that they could not wear contact lenses; however, we now have both soft and gas permeable lenses specially designed to correct astigmatism, which are successful in many cases, depending on the amount of astigmatism.
Blepharitis is a very common low-grade, recurrent inflammation of the eyelid margin. It is characterized by recurrent redness and inflammation of the edge of the eyelid coupled with crusting at the base of the eyelashes and in some instances, loss of eyelashes. A common symptom of Blepharitis is frequent burning of the eyes, which can contribute to dry eyes. Blepharitis can sometimes make contact lens wear more difficult.
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Blepharitis is a chronic problem which can usually be controlled relatively easily. Initial treatment includes lid hygiene, and may also include antibiotic drops or ointment to help control the inflammation. Blepharitis responds quite readily to this treatment, but may tend to recur. Recurrence can be kept to a minimum by on-going use of lid hygiene.
The lid margins of the upper and lower lids should be thoroughly cleaned each morning and each evening for two weeks using a lid scrub process will remove the dry skin and bacteria on the lid margins, and is usually enough to arrest the redness, swelling or irritation. Lid hygiene should be continued on an ongoing basis 2-3 times each week after the initial treatment period.
There are several good Lid Scrub products on the market, usually packaged with a mild, non-irritating cleanser and cotton pads.
An alternative to pre-packaged lid scrubs is to make a solution of one part baby shampoo to nine parts water. This is applied to the margins with a cotton pad or q-tip swab.
Your child has a Chalazion Cyst. Chalazion Cysts form in the wax glands that are in the eyelid. These glands have tiny ducts which open onto the edge of the eyelid, and sometimes, for reasons that we do not understand, one of the ducts may become blocked. When this occurs, the wax that is made by the gland becomes backed up in the duct, and a pea-sized knot, or cyst forms in the eyelid. The cyst may dissolve on its own, or may become spontaneously inflamed and get bigger, and then go down again. Frequently, over an extended period of time, they do have a tendency to go
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We recommend conservative treatment of Chalazion Cysts. When the children develop significant inflammation, we usually treat the cyst with warmth compresses and antibiotic eye drops. The drops and the warm compresses are used for five days, after which the cysts are usually much smaller and less red, and may dissolve completely. If the cyst persists for several months, or if there are multiple periods of inflammation, then we may consider surgically removing them, but we don’t like to do that unless we absolutely, positively have to.
At Thomas Eye Group, we offer specialty eye care for kids! As the largest pediatric eye care practice in the Southeast, our team of pediatric eye specialists provide comprehensive eye care for children, from the detection and treatment of eye disorders to eye surgery.
"Tricks of the Trade" and Suggestions for Toddlers
The most commonly asked question from the parent of an 18 month old is,"How do I prevent my child from taking off his glasses?" As with every situation involving a toddler, if a plan A doesn’t work, go to plan B. And, if plan B doesn’t work, go to plan C. If you get to Z and nothing has worked, go back to plan A and start again. Keep in mind that the overriding factor in determining your child’s adjustment to wearing glasses is you attitude. It is important that you succeed.
What to do?
Be sure you child’s glasses are comfortable. Check that the ear piece fits well on the child’s ears and that it does not pinch or squeeze anywhere.
Once you are assured of your child’s comfort, you have to decide that your child will wear his glasses as prescribed by his doctor. You make this decision the same way you would if your child had diabetes and required an insulin injection daily. It is necessary. If you attitude is positive, definite and unwavering, your child will understand that wearing glasses is not a matter of choice. At first you will need to enforce your decision. Each time the glasses are removed, replace them on your child’s face immediately. By the tone of your voice and your attitude, you convey to your child that there are no options. Either anger at your child’s disobedience or amusement at his antics are counterproductive. You need to remain calm, definite and unmovable. Show displeasure if the glasses are removed. Show pleasure when they are worn and maintain your unswerving conviction that the glasses remain on.
It is recommended that you start this regime at the time when you have planned to accomplish nothing else but the introduction of the glasses. This may necessitate taking some time off from work and keeping your child at home with you during this period of adjustment.
Most parents find it helpful to work together and even to enlist the help of a friend or relative. This can be a frustrating time and you may need support.
It is crucial to spend this time focused on your child. Each adult should take turns playing and interacting with the toddler while the other adults care for siblings or do the minimum of necessary household chores.
This is not a time to work on any other issues. Don’t fight about clothing, naps, toilet training, etc. It is also a time to let concerns about proper nutrition slide for a few days and indulge your child’s preferences.
Distraction is effective with most toddlers. Invite other children for short visits. Set up activities that are engrossing and possibly messy, such as water play, making edible play dough, etc.
You know your toddler better than anyone. Focus on your toddler’s favorite activities and perhaps introduce a new toy or two.
In examining your child’s eyes today, we find that your child has Ptosis, which is a drooping of the upper lid of one or both eyes. We have many children with ptosis, and have found that a conservative course of treatment is best suited to their needs. Basically, we need to ensure that they maintain good vision in each eye, and then as they grow a little older, we can consider correction of the ptosis.
It is important that we follow children with ptosis to ensure the normal development of their vision. Children with ptosis will often raise their eyebrows to raise the eyelid, and may also hold the head back to see out from under the eyelid. This allows them to see normally, despite the droopy lid.
What we do to correct the ptosis is that we surgically raise the lid that is drooping, to make it the same level as the other eyelid. In addition, we pay close attention so that we carefully match the curve of the same eyelid with the curve of the other eye. If both eyes have ptosis, then we correct both eyes. This is done as an outpatient, under general anesthesia, and the children to go home the same day as the surgery is done. We usually consider correcting the ptosis when the children have reached the age of 3 1/2 to 5 years old. By this age, the children have grown, and their eyelid structures are more developed, which gives us a much better result.
Your child will be having eye muscle surgery in the near future. You may have many questions at this point as to what will happen before and after the surgery. Please review the following information, which should answer many of your questions. If you have other questions which are not answered here, please take the time to write them down so that we may answer them for you during your pre-operative appointment.
Eye muscle surgery is done as an outpatient at the hospital, most often under general anesthesia. Before the surgery, we take careful measurements of the eye position which enables us to determine which muscles to operate on, whether we will operate on one or both eyes, and how much need to move the muscles to achieve good eye position after the surgery. Taking these measurements may involve several appointments. We are very careful because the success rate of eye muscle surgery is not 100 percent. The success rate of eye muscle surgery is 60-80 percent. This means that on the average, 7 out of 10 persons who undergo eye muscle surgery will achieve a good result with only one procedure. The remaining three persons may, at some point, be benefited by additional surgery for good eye position. The success rate of each surgery is always the same, 60-80 percent.
Starbismus surgery to correct the eye position is a commonly done procedure. It does not involve cutting into the eyeball, nor does it require that the eye be “taken out” in order to reach the muscle. A small incision into the transparent covering of the eye (the conjunctiva) is made to reach the muscle. The muscle is then repositioned and rattached with tiny sutures, and the conjunctiva is also closed with tiny sutures, which willdissolve by themselves over the next 1-2 weeks. Once the surgery is completed, your child mauy go home after awakening. Most patients spend several hours in the outpatient surgery area, and go home in the mid-afternoon if the surgery was done in the morning. IN most cases, there are no patches or bandages over the eyes following the surgery. Glasses, if worn, may be re-started after the surgery. Please do remember to bring them with iyou on your postoperative visit. If your child is wearing a patch, e will discuss this with you at the time of the first postoperative visit.
After the surgery, the eyes will be quite red in the areas where the surgery was done, and may have a jelly-like swelling. This is normal and will clear over the next few weeks. Sometimes, the redness spreads before clearing, but do not be alarmed. Antibiotic eye drops will be prescribed for use after the surgery, and will be used for 5-7 days, according to the doctor’s instructions. The discomfort following eye muscle surgery is usually minimal with a foreign body sensation in the eyes or some discomfort on movement of the eyes for a day or two. Pain medicine is usually not necessary; however, you may use Tylenol as needed. Some people may experience transient double vision after the surgery. This is a normal part of healing as the brain must “get used” to the new position of the eyes. The double vision is usually completely gone within a few days of the surgery, but in some instances may last longer.
It is important that children who have had eye surgery stick to “light physical activity” for ten days following the surgery. Basically, this means no exercising, PE, running or jumping, or heavy lifting during the ten days. After the ten days, it is fine to swim, preferably using goggles until the redness has gone away. E usually see children who have had eye muscle surgery within the first few days postoperatively, then the next week, and then six weeks postoperatively. The healing process is gradual, and will take six weeks to complete.
Your confidence in allowing us to care for your child is highly valued. We are always available to answer your questions, and hope you will feel free to let us know if there is anything we can do to make this time easier for you.
In checking your child’s eyes today we find that the eyes themselves are nice and healthy, and that the vision is good. Part of our examination involves checking the children for nearsightedness and farsightedness, and we have found that your child is farsighted. Farsightedness in small amounts is actually normal for children, and does not interfere with their vision. The reason for this is that the children have a special ability to “auto-focus” the eyes by themselves to clear their vision, and thus we usually do not need to give them glasses.
Some children have greater amount of farsightedness than usual, which may sometimes cause them to develop crossing of the eyes. The reason for this is that children try to “auto-focus” to see clearly, they may not be able to keep the eyes straight at the same time. This is a focusing type of crossing, and is easily treated by giving the children glasses. Children who have greater amounts of farsightedness may develop the crossing anywhere from age 1 to around age 5, and it is important that we follow them carefully and watch for crossing of their eyes.
Your child is being evaluated for Iritis. Iritis is a low-grade inflammation or irritation inside the eyes. It is frequently, although not always, associated with other inflammatory conditions in the body, including arthritis. The reason for our examination is related to the fact that in many instances, Iritis may provide minimal symptoms. As such, it is not always possible for the parent to be aware of the problem. In view of this, we usually see children between three and six months, depending on the type of problem that they have.
We do ask the parents to assist us in monitoring the children for this condition. The key in evaluating these children at home is to watch for persistent problems. The symptoms of Iritis can include PERSISTENT PAIN, PERSISTENT REDNESS, or PERSISTENT LIGHT SENSITIVITY. The importance of diagnosing the Iritis is that it allows us to institute appropriate treatment usually using some eye drops, which in most instances, can decrease or suppress the inflammation completely.
We look forward to seeing your child in the future.
Amblyopia (Lazy Eye)
Vision develops during the first two years of life and continues more slowly until about age nine. Since each eye sends a slightly different image to the brain, our eyes and brain have to learn how to work together so the stereo images are processed correctly into one clear image.
If there is a problem with vision in one eye (for example, severe nearsightedness, farsightedness or astigmatism), this learning process is disrupted. The brain stops developing normal vision for that eye and concentrates only on the images coming from the unaffected eye. A defect in the lens, such as a cataract, or a defect in the cornea can also cause amblyopia.
A child with amblyopia may not even realize that he or she is using only one eye. Ignoring the image from the weak eye is the brain's unconscious response, not the child's decision. Despite the nickname of "lazy eye", an eye with amblyopia is not actually lazy but is being ignored by the brain.
Amblyopia affects one child in forty. Treatment during early childhood (up to about age seven to nine years) can usually reverse amblyopia. Treatment after childhood is usually less helpful but may improve vision in some cases. A child with amblyopia who does not get treatment may have poor vision for the rest of his life.
How Is Amblyopia Treated?
Early treatment for amblyopia is vital. Without it, the child may never develop normal vision in the affected eye.
Glasses can be used to correct vision in the impaired eye. Eye patches and eye drops are also effective.
An eye patch is the most common way to treat children with amblyopia. Most children dislike having to cover the "good eye", but the ultimate goal should be kept in mind: good vision that can last a lifetime.
Parents can help the child deal with patching by taking it gradually, showing understanding and not making it a punishment. Any visually stimulating activity that your child enjoys will help to improve his eyesight. Video games wearing a patch yield the most visual improvement in the least amount of time.
Some children can wear a patch for only a few weeks and gain permanent improvement; others may need to use the patch for longer periods, up to months or even years.
Sometimes eye drops are used alone or in combination with patching to blur vision in the ‘good eye’ so that vision in the amblyopic eye can improve.
Symptoms of Amblyopia
There are three signs that your child may be amblyopic:
If you suspect that your child may be amblyopic, please call us for an appointment.
Your child has nearsightedness (myopia). Children who are nearsighted usually have no difficulty seeing up close; however, their vision is blurred in the distance. Children with nearsightedness require glasses or contacts to help them see in the distance.
Parents are frequently concerned that their child will become dependent on the glasses if they are worn too much. This is, in reality, not correct. The glasses themselves do not have any effect on the nearsightedness. Thus, if your child is going to become more nearsighted or less nearsighted, this will happen whether or not the child wears glasses. The only thing that the glasses do is allow the child to see clearly in the distance. In general, children have a tendency to become more nearsighted as they grow toward their mid-teenage years. This is the reason that people have gotten the impression that children can become dependent on glasses. In reality, just as a child grows, the eyes have a tendency to change usually in the direction of nearsightedness. In view of this, it is important that a child be check at yearly intervals. Should, however, you notice your child to be squinting or if they complain of difficulty seeing off in the distance, they should b re-evaluation sooner than one year.
Parents frequently are concerned about the amount of time a child should wear the glasses. At a bare minimum, a child who has nearsightedness should use the glasses to help see the blackboard in school. If the child prefers to sit at home and watch television or go to movies and not see quite as well as he might with his glasses, this is not cause for concern as it will in no way injure the eyes. As the nearsightedness increases, children recognize how well they see with their glasses and will frequently place their glasses on first thing in the morning and wear them throughout the day. This will in no way injure the eyes, but will rather provide them with good, clear vision throughout the day.
Contact lenses can be worn by most children. I usually prefer to wait until the children are a minimum of 9 years old so that eh child is mature enough to properly care for the lenses and motivated enough to wear them. One major concern relating to contact lenses that parents often have is the cost of replacing contact lenses if the child needs a stronger prescription. Fortunately, the fee for replacing contact lenses runs about the same as the cost of a new pair of glasses. The original fee for contacts is understandably higher to cover the cost for the initial fitting and initial follow up visits. Although some people may tell you that nearsightedness can be prevented or delayed by wearing contact lenses, there is unfortunately no scientific evidence to support this, although on occasion, I do see children whose nearsightedness seems to “slowdown” after being fit with contact lenses.
The use of glasses in sports activities should be encouraged as this will provide your child with normal vision during the activity. Since nearsighted children have difficulty seeing objects off in the distance, the use of glasses or contacts in sports played at a distance with small object such as baseball or tennis, may very well improve their performance. The one sport where the use of glasses is not quite as critical would be an activity such as soccer where the ball is large and, in addition, the children frequently use their head to make contact with the ball.
Glasses are purchase at an optician. If you do not have one, I recommend our opticians at Thomas Eye Wear. They specialize in children’s glasses and will help guide you to the proper spectacles for your child. Contact lenses are fitted here in the office. If you have any questions in this regard, further information is available.
There is almost never any difficulty getting children, even young children, to wear glasses, if a positive attitude is taken by the people around the child. Should you have any questions or concerns, I hope you will communicate them to me.
Our pediatric locations are.....
At Thomas Eye Group, our board-certified doctors and orthoptists have years of experience in providing eye care to children. We work as a team to give your child state-of-the-art care from caring specialists. Click on the links below to read about each of our doctors and orthoptists.
Eye-muscle surgery is often performed on children with strabismus (crossed or misaligned eyes) and other visual conditions.
Strabismus is sometimes called cross-eyes, walleye, or squint. Infants whose eyes are not aligned in the first two months of life should be closely monitored by their primary-care doctors, as strabismus does not always require surgery. Any child older than three months whose eyes are not properly aligned all of the time should be examined by an ophthalmologist.
Eye-muscle surgery is performed on an outpatient basis at the hospital, most often under general anesthesia.
The Surgical Procedure
Surgery to correct the eye's position is a common procedure. A small incision is made into the transparent covering of the eye (the conjunctiva) to reach the muscle. The muscle is then repositioned and reattached with tiny sutures which dissolve within one to two weeks. Most of our patients have surgery in the morning and then go home in the afternoon.
The healing process is gradual and lasts about six weeks. Antibiotic eye drops will be prescribed for five to seven days after surgery. Discomfort following eye-muscle surgery is usually minimal, but the eyes will be quite red and may display a jelly-like swelling. This is normal and will clear over the next few weeks. Sometimes the redness spreads before clearing; some children may experience temporary double vision after the surgery as the brain gets used to the new position of the eyes; again, this is normal and is no cause for alarm.
Ptosis, or drooping of the upper eyelid, is a condition that may affect one or both eyes. It can be mild, where the lid partially covers the pupil, or severe where the lid completely covers the pupil.
In children, ptosis is usually congenital. The most common reason is improper development of the levator muscle, the major muscle responsible for lifting the upper eyelid.
How Is Ptosis Treated?
Congenital ptosis is treated surgically, generally when the child is between three and five years of age. However, if the ptosis interferes with the child's vision, surgery may be performed earlier to allow for proper visual development.
A short incision is made in the natural skin crease and the eyelid raising muscle is shortened to lift the eyelid. Dissolving sutures are used inside the lid and on the skin.
After surgery an eye pad is usually used for 24 to 48 hours and an ointment or antibiotic drops are prescribed for one to three weeks. The upper eyelid will usually appear swollen for the first 7 to 10 days.
What are the risks of ptosis surgery?
Treatment of Cataracts in Children
The treatment of pediatric cataracts has advanced tremendously in recent years.
Small pediatric cataracts that do not significantly reduce the vision may only require careful observation to ensure that the eye continues to develop well. Occasionally, glasses, contact lenses or an eye patch are used to aid the affected eye's development.
Pediatric cataracts that significantly obstruct a child’s vision require surgery. Congenital cataract surgery may occur as early as a few months after birth.
How Is Surgery Performed?
Cataract surgery in children is performed under general anesthesia in the operating room. In some cases, a lens may be implanted inside the eye. This plastic lens implant is held in place by a natural membrane. Make sure to discuss the surgery in detail with your child's doctor.
After cataract surgery, treatment usually involves glasses, bifocals, contact lenses, and/or eye-patching therapy.
If you suspect your child might have cataracts, please call us for an appointment.
What to expect before surgery:
You will meet with your child's surgery scheduler who will have you complete paperwork including a history and physical and any additional health information. You will be given prescriptions for an antibiotic eye drop with instructions to begin giving the drop 3-4 days before your child's scheduled procedure.
You will receive a phone call from TESC’s pre-op nurse the day before your child's surgery. At this time, she will obtain your child's health information from you for our anesthesia department. Some of this may be seem a bit repetitive, but keep in mind TESC is committed to providing you with the safest, most effective ophthalmic care possible.
At this time, the nurse will give you some brief instructions including when to arrive for surgery, when and what your child may eat or drink, and what to bring for your child's procedure the next day.
Please be aware that the child's legal guardian must be present the day of surgery to sign medical consent forms and remain in the waiting room for the duration of the procedure. **Please bring your insurance cards, and a picture ID to your procedure the next day. Please leave all jewelry, extra money, and personal items at home.**
What to expect the day of surgery:
You will arrive 1 hour before your child's scheduled surgery time. During the check-in process, you will be asked to present your insurance cards for verification. Your identity, as well as the identity of your child, will be verified. Matching bracelets will be placed on both yours and your child’s wrist to ensure patient safety. Once your check-in paperwork is complete, a pre-op nurse will call you when a bed is available for your child. Parents and guardians are welcome to accompany their child to the pre-op area and remain with them until it is time to take them to the operating room. We do ask that if it is not possible to leave siblings at home, that another adult wait with the sibling in the waiting room. We ask your cooperation with this policy to ensure privacy of other patients, decrease the spread of cold and flu germs, and to maintain the safety and comfort of both patient and their siblings.
Once you and your child arrive in the pre-op area, the nurse will begin preparing your child for surgery. Preparation includes using the restroom/diaper changes and verifying your child’s surgical site and procedure, medical history and allergies. You will be asked to change your child into a gown. Your child’s operative eye will be marked for surgery either by the nurse or surgeon before they go back to the operating room.
In most cases, if an IV is required, it will be placed in the operating room after the child is "asleep". The Anesthesiologist will speak to you about what to expect regarding anesthesia before the procedure. This will give you an opportunity to ask any questions you may have. When it is time for your child’s procedure, the OR nurse will verify your child's name, surgical procedure scheduled, date of birth, and allergies.
The nurse and anesthesia personnel will take your child to the operating room and you can wait in one of our waiting rooms. Your child’s surgeon will speak with you after the surgery to update you on the procedure and answer any questions you may have.
What to expect after surgery:
After the procedure, your child will be returned to the recovery room and you will be able to sit with your child for the recovery process. When children wake up from surgery, they may seem distraught and disoriented. This is perfectly normal and will pass. Additional pain medication is available if your child’s anesthesiologist determines that it is needed.
When your child is awake, he/she will be offered clear liquids to drink. It is common after anesthesia for patients to experience some nausea and/or vomiting. Your recovery room nurse will give you instructions on how to manage your child’s diet for the rest of the day. She will discuss the prescription eye drops that your child had started before surgery, as well as what you can expect for your child for the next few days. You will be given a written copy of any post operative instructions. Once it has been determined that your child is stable, you may dress your child, the IV will be removed and you may take your child home.
Your child is being seen as part of the routine follow-up care for premature infants. We are specifically checking your child for retinopathy of prematurity.
As you may know, in the back of the eye there is a thin film called the rtina. This actually functions like the film in a camera and is responsible for taking a"picture." In some premature infants, particularly in those children who had breathing problems during the newborn period, they can develop some"wrinkling" or scarring of the rtina. This is retinopathy of prematurity.
Our examination is being made to make certain that the retina is developing normally. If everything is coming along fine at this time, we usually do like to check the children again in six months. At that time, in addition to checking once again for retinopathy of prematurity, we are able to start to evaluate the development of the vision.
What is Accommodative Esotropia?
Accommodative Esotropia is a focusing type of crossing of the eyes that happens when children have more farsightedness than usual. Farsightedness is normal in children, and does not bother their vision, because they have special automatic focusing ability, like a"zoom" lens on a camera, that allows them to see clearly for reading and for seeing far away. Children with extra farsightedness can also focus to see clearly, but they have to focus an extra amount and in doing so they often get crossing of they eyes.
How is Accommodative Esotropia treated?
Accommodative Esotropia does not require surgery, but rather is nicely correctable with glasses to compensate for the farsightedness. When the children wear the glasses, the lenses do the extra focusing for them, and they can see clearly and maintain straight eyes.
How do glasses keep my child’s eyes from crossing?
In a farsighted child with crossed eyes, glasses are not prescribed to improve vision since eyesight is usually normal. Instead, they are given to relieve the eyes of the need to accommodate. The focusing is now done by the glasses rather than by the eye muscles, and the eyes are allowed to straighten.
Will my child’s eyes always be crossed?
The onset of Accommodative Esotropia can occur from age one to age up until the age of five. What happens after the crossing begins is somewhat like a trip up and over a mountain. The bottom of the mountain is the start of the crossing. As the children grow, they typically will become more farsighted up until the age of six or seven. As this happens, we frequently need to increase the strength of the glasses to help keep the eyes straight. This is the climb UP the mountain. When the children are seven or so, the farsightedness levels off, and, as they grow even more, from the age eight until twelve, the farsightedness usually decreases. This means we can usually decrease the strength of the glasses are not needed, usually when they are ten to twelve years old. Some children may continue to require correction throughout their life, and may easily wear contacts lenses to control the crossing.
My child is wearing glasses, and his eyes still cross when he takes them off, why?
When your child is wearing the glasses, his eyes will be nice and straight, because the glasses are doing all of the"extra" focusing that he needs to see clearly. When your child takes the glasses off, or looks over the top of the glasses, he must do the extra focusing himself, and so the eyes will cross any time he is not looking through the glasses.
Your doctor has recommended a procedure called “Lacricath balloon dilation”. This procedure is an addition to our treatment for tear duct obstructions that do not clear with probing and irrigation and for older children with tear duct blockage. During this procedure, a probe is first passed into the system to clear the obstruction. The balloon is then deflated and the catheter is removed. Often, the area where the tear duct opens into the nose is enlarged by a procedure called infracture of the turbinate. Near the end of the procedure, fluid is irrigated through the tear duct. This shows us that the tear duct is draining properly.
Our usual routine is for your child to see their pediatrician or family doctor within 2 days before surgery to make sure that your child is nice and healthy for anesthesia. You will also come to our office for a preop visit within a few days so that we can check your child and answer any questions that you may have. In some cases, you may also be asked to go by the surgery center for a blood test. When you speak to our surgery coordinator to schedule your child’s surgery, she will review your child’s preop instructions with you and give you written instructions. The morning of surgery you will go to the surgery center to have the procedure. Lacricath is preformed under general anesthesia and takes approximately 1/2 hour. Your child will be ready to go home within a few hours after the procedure. There are no bandages and there is no pain. There may be a small amount of blood in the tears or from the nose following the procedure, but this is usually minor. It will not be necessary to limit your child’s activities following the procedure.
There will be eye drops to use for three days before the procedure. After the procedure the drops will be used for 5 days. We will give you an information sheet at the hospital with instructions on what care your child will need following surgery.
If you have any additional questions, please call us, or you may want to jot them down so that we can review them with you at the time of your preop visit. We look forward to taking care of your child.
Tear Duct Obstruction
We find in checking your child today that the eyes are nice, normal, healthy seeing eyes, with a blocked up tear duct. This is a very common problem, and frequently within the first five or six months of life it clears up on its own.
The tear system in our eyes is like a shower system. We have a tear gland that is always making tears, even when we are not crying, and we have a drain pipe (or tear duct) that drains our tears directly out of our eyes into our nose, which is why when we cry we get a runny nose. Some little children are born with a blockage in the bottom of the tear duct, and what we see then is similar to what happens when a shower drain is blocked up. The first thing you would see is a bunch of water in the bottom of the shower, when you look at these children, we see a thin rim of water in the eye. The next thing that would happen with a blocked up shower drain is that it would overflow onto the floor. In these children, what you will see are tears running down their cheek even when they are not crying. The third thing that happens, because the tears do not flush properly, is the children get recurrent infections, and you will see yellow or green discharge in the corner of the eye.
As we have mentioned, this is very common and frequently clears by the time the children get to be five or six months of age. If the children do not clear by then, we usually unplug the system because with recurring infections there is a risk of developing scars within the drain pipe itself. If the children are 7-8 months old, and have not cleared, we recommend that they have a relatively simple operation called a probing and irrigation of the tear duct system. What we do is take a fine probe, pass it down through the system and break through the obstruction. Then we irrigate through the system and flush out any pus or discharge. This is done in the hospital, as an out patient, under what we call light general anesthesia.
The success rate of a tear duct probe is over 90 percent, but is not 100%. Occasionally, children will require a second tear duct procedure.
Crawford Tubes Information Sheet
Nasolacrimal duct obstruction in children means that the draining system responsible for removing tears from the surface of the eye is clogged. Many children have this problem successfully treated with a procedure called nasolacrimal duct probe and irrigation. A few children continue to have tearing after a nasolacrimal duct probe and irrigation. A time-tested alternative for these children is called nasolacrimal duct probe and intubation, otherwise known as a Crawford tube. It is performed under general anesthesia and takes approximately 30 minutes. A probe is used to open up the clogged area in the tear duct. After the opening is made in the tear duct, then a thin tube is placed through the opening and remains there for approximately 6 months. This allows the duct to remain open and not seal shut. Occasionally the tube can become displaced and require repositioning. Nasolacrimal duct probe with intubation (Crawford tube) is usually combined with infracture of the inferior turbinate. The inferior turbinate is a cartilaginous structure made of cartilage inside the nose that can sometimes block the opening of the tear duct. This is gently moved away from the tear duct system so that it does not block the normal flow of tears. Following surgery, the children have little or no discomfort from this procedure and resume their normal activities within 1 or 2 days. The Crawford tube is not a drain tube. Children can have tearing when the tube is in place and may get occasional mucous to be gone when the tube is removed. The tube is visible at the corner of the eyelid. It is removed six months later in the operating room.
This is a highly effective method to treat young children who continue to tear following a nasolcrimal duct probe and irrigation and in older children who have had no previous tear duct procedures. Crawford tube placement is one of several procedures that are available and its success rate is approximately 90%.
You can feel comfortable that after your child has had the tube removed there is a high likelihood of permanent resolution of tearing is extremely high.
The available services at Thomas Eye Group range from comprehensive eye exams to specialty services in LASIK, retinal and corneal disorders, glaucoma, and plastic surgery. To correct vision problems, our doctors are trained in the most current refractive surgery techniques. We also offer contact lenses and glasses to those who prefer a traditional solution.Learn More
At Thomas Eye Group, we offer comprehensive eye care to children—specialty care especially for kids! As the largest pediatric eye care practice in the Southeast; we offer a complete scope of preventive and corrective eye care for children. From the detection and treatment of eye disorders to eye surgery, we also treat disorders of eye alignment in adults including double vision..Learn More
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At Thomas Eye Group Atlanta, our board-certified ophthalmologists and optometrists have decades of combined experience in eye care. We work together as a team to bring you specialized, state-of-the-art care from caring professionals.
Our team of doctors is comprised of ophthalmologists, optometrists, and skilled support staff. Within our group of ophthalmologists, we have several sub-specialists, including LASIK, glaucoma, retina, and plastic surgery or Oculoplastics. At six locations throughout the greater Atlanta area, our group provides services ranging from comprehensive eye examinations and contact lens care to sophisticated microsurgery for cataracts, cornea and retinal disease, and refractive surgery, including LASIK.Learn More