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PAEDIATRIC OPHTHALMOLOGY, AMBLYOPIA THERAPY, SQUINT SURGERY

What is Paediatric Ophthalmology ?

Paediatric ophthalmology is unique amongst the sub-specialties of ophthalmology in that its boundaries are defined primarily by the age of the patient rather than by groups of clinical conditions that it treats.
The separation of the care of children and young people from that of adults helps to ensure that they are treated by appropriately experienced doctors in an environment which is child and family-friendly. The separation of paediatric and adult care may take place either in space (separate paediatric departments or hospitals) or time (dedicated operating lists or clinics within a department that also treats adults).
The practice of ophthalmologists who have a sub-specialty interest in paediatric ophthalmology varies widely. Many (particularly in smaller eye departments) will not undertake paediatric ophthalmology exclusively, but will also have an adult general ophthalmology commitment and a general ophthalmology on-call commitment. It is particularly common for ophthalmologists with an interest in strabismus to have a practice which treats both adults and children. Ophthalmologists whose work consists entirely of paediatric ophthalmology are likely to be found in tertiary referral centres. Within the largest paediatric ophthalmology services, there may be some further sub-specialisation, and such departments may also use the services of ophthalmologists from other sub-specialties (eg vitreoretinal surgery, glaucoma, orbital surgery) for the treatment of conditions that occur very rarely in children.
In some situations, there are tensions between the desirability of separating adult and paediatric care, and the need to provide a clinical service which is safe and accessible for children and their families. This may for instance be the case in rural areas or in services which treat very rare conditions, or in emergency situations, where it may not always be possible to segregate the care of children and adults entirely.
Many children with eye problems have other health problems or developmental issues which may be related or incidental. Paediatric ophthalmologists may be called upon to examine a child to confirm or exclude ocular signs of a multi-system disorder, or to look for signs of eye disease in a sibling of an affected child. It is therefore important that the paediatric ophthalmologist is in close communication with paediatricians and a range of colleagues from other disciplines who treat children. Paediatric ophthalmologists may contribute to multi-disciplinary teams for the care of children with multi-system disorders, and will need to maintain close liaison with specialist sensory disability teams for the care of children with visual impairment.

What is Amblyopia ?

Amblyopia means that vision in one eye does not develop fully during early childhood. Usually, amblyopia is a correctable problem if it is treated early. Late treatment can mean that the sight problem remains permanent. A squint is one of the most common causes of amblyopia. Treatment involves making the amblyopic (lazy) eye work harder to see. This is usually done by blocking the vision in the good eye with a patch or making the eyesight in the good eye blurry by using atropine eye drops.

What is amblyopia?
Amblyopia is a condition where the vision in an eye is poor because of lack of use of the eye in early childhood. In most cases, only one eye is affected, but it sometimes affects both eyes. Amblyopia is often called a lazy eye. In some cases of amblyopia caused by anisometropia (see below), the problem can sometimes be corrected by glasses. In most cases, however, glasses do not help.

Understanding the development of vision
Newborn babies can see. However, as they grow, the visual pathways continue to develop from the eye to the brain, and within the brain. The brain learns how to interpret the vision signals that come from an eye. This visual development continues until about age 7-8 years. After this time, the visual pathways and the parts of the brain involved with vision are fully formed and cannot change.
If, for any reason, a young child cannot use one or both eyes normally, then vision is not learnt properly. This results in poor sight (poor visual acuity) called amblyopia. The amblyopia develops in addition to whatever else is affecting the eye. In effect, amblyopia is a developmental problem of the brain rather than a problem within the eye itself. Even if the other eye problem is treated, the visual impairment from amblyopia usually remains permanent unless it is treated before the age of about seven years.

What is Squint ?

Strabismus or Cross-eyes or Squint is a vision problem in which both eyes are not in alignment with each other. Though it is common in infants and children, it can occur at any age. Adults may also develop the condition. Strabismus can be intermittent or constant.
Intermittent strabismus may worsen when the eye muscles are tired — late in the day, for example, or during the course of an illness. Parents may notice their infant’s eyes wandering from time to time during the first few months of life, especially when the infant is tired. This occurs because the infants are still learning to focus their eyes and to move them in a coordinated fashion. Most babies outgrow this intermittent strabismus by the age of 3 months
Causes

Heredity

  1. Due to weak eye muscles or abnormal nerve impulses to the eye muscles
  2. Strabismus can accompany some systemic illnesses like diabetes, high blood pressure, multiple sclerosis, myasthenia gravis or thyroid disorders
  3. Blurred or poor vision due to cataract, corneal scars, glaucoma, refractive errors, optic nerve disease, retinal disease, tumors of the eye etc.
  4. Brought about by injuries
  5. Can accompany some systemic illnesses like diabetes, high blood pressure, multiple sclerosis, myasthenia gravis or thyroid disorders.

Symptoms

  • Eyes that look misaligned
  • Eyes that do not appear to move together
  • Frequent blinking or squinting, especially in bright sunlight
  • Tilting head to look at things
  • Faulty depth perception
  • Double vision
  • Poor vision in one or both eyes

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