Child Eye Care and Squint: What
we all should know?
Dr Hemant D Anaspure
Assistant Professor
Dept of Ophthalmology
Childhood
Blindness
Childhood blindness
• Globally approx 1.4 million children who are
blind1
• 2/3rd live in developing countries
• The prevalence of blindness approx 0.3 – 1.2
/1,000 children2
• 40%of the blindness in children is avoidable
1. World Health Organization, Geneva. Global Initiative for the Elimination of
Avoidable Blindness. Geneva WHO/PBL/97.61
2. Gilbert C E, Foster A. Childhood blindness in the context of VISION 2020 Ð The
Right to Sight. Bull WHO 2001; 79: 227-232.
What we can do?
The Eyes Don't See
What the Mind Don't Know
The Eyes See
What the Mind Know
Amblyopia
(Lazy
Eyes)
Amblyopia
• Amblyopia or "lazy eye" is weak vision or
vision loss in one or both apparently normal
eyes that cannot be fully corrected with lenses
• Causes: Anisometropia, Squint, High refractive
error in both eyes, Visual deprivation due to
congenital cataract, glaucoma,corneal opacity
What we should know?
 Amblyopia is one of the most common causes
of visual impairment in both children and
adults
Prevalence 0.2% - 12% (average 2-3%)
Failure to develop binocular vision and
prevent the individual from pursuing certain
occupations
Amblyopia increases the chances of blindness
in the healthy eye, mostly from trauma
Fortunately , completely treatable cause of
blindness
Timely diagnosis and treatment is
key for successful treatment
Using glasses at early age can
prevent amblyopia in many cases
Best age for treatment is < 8 years
(Max 16 years)
Refractive
Errors in
Children
Refractive Errors in Children
• Refractive errors occur when the shape of the
eye prevents light from focusing directly on
the retina
• Types
- Myopia
- Hypermetropia
• Factors:
 Length of the eyeball (Axial
Myopia/Hypermetropia)
 Shape of the cornea (Astigmatism)
 Refractive power of lens (Index)
What we should know?
 Wandering eye moments, no response to
mother’s face or attractive colourful objects,
shaking of the eyes by 3 months
Watching TV from too close distance, frequent
eye rubbing, holding books close to face,
squinting, poor academic performance Think
of glasses
All children should have one vision screening
between 3 to 5 years
What we should know?
Myths about glasses
• If your child wear glasses all the time, the
number will reduce
• Your child watches too much T. V. and hence
has glasses
• With Plenty of vegetables and drinking carrot
juice his number should go away
• Vitamin A tablets help increase eye power
• Using glasses will make him habituate
Squint
Squint
• While one eye looks straight ahead, the other
eye is turned either inwards or outwards. This
is called a squint.
• Major types
 Esotropia
 Exotropia
What we should know?
• Effects:
Children can lose stereopsis / binocularity
 Loss of vision in the crossing eye (amblyopia)
 Loss of confidence and self esteem
• Depending on cause, treatment varies from
glasses to surgery
• In infantile cases, best time for surgery is less
then 2 years of age to restore binocularity
What we should know?
• Keep in Mind : Retinoblastoma can present as
squint at early age ….
Retinopathy of Prematurity (ROP)
Retinopathy of Prematurity
Retinopathy of Prematurity
• The incidence of ROP in India 38 – 51.9 % in
low birth weight infants
• Annual live births in India approx 26 million
• In India 8.7% of newborns birth weight < 2000
grams
• Almost 2 million newborns are at risk for
developing ROP
What we should know?
• Birth weight have an inverse relationship with
development of ROP
• NNF Criterias
 In whom: . < 34 weeks / Birth wt < 1750gms
. 34 – 36 weeks / Birth wt 1750 –
2000 gms with risk factors
 When : Born > 28 wks : 4 weeks
Born < 28 wk/ < 1200gms : 2 – 3 wks
What we should know?
• The children have more chances of refractive
errors and squint
• Recommended follow up 6 months, one year,
3 years and 7 years
Retinoblastoma
Bruchner’s Test
What we should know?
• Retinoblastoma is the most common
malignant tumour of the eye occuring in
childhood
• White pupillary reflex is most common
presentation
• 5 year Survival rate is > 95%
• Early diagnosis helps not only to save life but
to save eye and vision
Paediatric Cataract
Paediatric Cataract
• A cataract is any cloudiness or opacity of the
lens of the eye
• White opacity seen in a child’s eye may be due
to several reasons. The most common of all is
cataract
• Causes
- Heredity
- German measles
- Injury to the eye
- Steroids use
What we should know?
• Preventable and Treatable cause of blindness
• Amblyopia sets in very early if not treated on
time
• Ideal time for congenital cataract
Unilateral < 1.5 months
Bilateral < 3 months
• Requires long term follow up and treatment
Summary
• Amblyopia : Timely intervention is key
• Refractive error : One check up bet 3 to 5 yrs
• Squint: Needs early treatment to restore
binocularity
• ROP : Screen any child < 2 kg birth weight
• Retinoblastoma: White pupillary reflex is
dangerous sign
• Pediatric cataract: Don’t waste time
• Child's future success depend on ability to see
well
• While most children have good vision, any
vision problem needs to be caught early
• Rarely will a child complain about his/her
vision
• Young children think that everyone sees the
way they do
Thank You …..