Your child's eyes
by Dr. Chin Pik Kee
I. Introduction
A child's vision undergoes a critical period of maturation
during the first eight to 10 years of life. Eye problems occurring during this time
can prevent normal visual development and result in a lifetime of irreversible visual
impairment. It is therefore very important to prevent, detect and treat childhood
eye problems as early as possible.
II. Early detection
Even a very young child can have a serious eye condition that parents
may not notice. So, all infants should have their eyes and vision checked for obvious
abnormalities during regular visits to well baby clinics.
General appearance
Many serious childhood eye diseases cause noticeable changes in the colour,
lustre, size or symmetry of the eye(s). Look at your child's eye. For infants, a
good time to do this is during feeding. If you do notice anything odd about your
child's eye, bring this to the attention of your Paediatrician or Ophthalmologist
(Eye Specialist) immediately.
Some important abnormalities and their causes are:
1. a white spot or area within the pupil – cataract or retinoblastoma (a childhood
eye cancer)
2. hazy or white cornea – many causes, including congenital glaucoma, birth injury,
developmental abnormality, etc
3. an abnormally large eye – congenital glaucoma
4. drooping upper eyelid – congenital ptosis
5. crossed eyes – squint, poor vision
Visual response
Take note of your child's visual behaviour. Does your baby seem to see? Infants
blink or close their eyes in response to bright light. Within the first two months
of life, your baby should start showing an interest in the human face and begin
to look at you as you move around the room. By three months of age, normal babies
are usually able to follow a bright toy steadily with their eyes as you move it
horizontally from one side to the other.
Are your baby's eyes steady when looking at things? Any eye jerkiness or aimless
roving movements is abnormal.
Does your baby have unusual behaviour such as eye poking? This is also abnormal,
and usually indicates very poor eyesight.
Routine vision screening
It is possible for serious eye and vision problems to pass unnoticed during childhood.
For this reason, all children should have their eyesight routinely tested starting
from three to four years of age. At this time, they should also be screened for
common conditions like refractive error (short-sightedness, far-sightedness and
astigmatism), squint (crossed eyes) and amblyopia (lazy eye), colour deficiency
or colour blindness.
III. Common eye problems in childhood
You should be aware of a few common disorders that need prompt medical attention.
Treatment for these conditions is effective only if given early.
Amblyopia (lazy eye)
If a child's visual system fails to mature fully during the developmental years,
he or she will suffer reduced eyesight. This condition is called amblyopia. Amblyopia
becomes permanent once the period of maturation has passed; after this time, amblyopia
cannot be corrected with spectacles, surgery, or other forms of treatment.
What causes amblyopia? Any disorder that prevents a child from using the eye in
a normal way can interfere with the maturation of that eye. Common causes are squint,
refractive error, and conditions that block vision such as a drooping eyelid, cataracts
and corneal abnormalities.
Can amblyopia be treated? Yes, it can, but there is a very definite window period
(a limited time period during which treatment is effective) for treating amblyopia.
Depending on the cause, this window period can vary from weeks to years of life.
The essential elements of treatment are:
(i) correcting the underlying cause(s) where possible, and
(ii) patching to increase usage of the weak eye.
If your child is at risk for amblyopia, he or she must be closely monitored by an
Ophthalmologist (Eye Specialist) until at least eight to ten years of age.
Congenital / Developmental cataracts
Cataracts refer to a loss of transparency of the natural lens inside the eye.
Although they are most commonly seen in older people, cataracts can affect any age
group, including newborn babies. Significant cataracts are usually visible as a
white dot or area in the child's pupil.
Dense congenital cataracts result in severe irreversible amblyopia unless surgery
is done within the first four months of life. The younger the child, the more urgent
the treatment. After surgery, the child will need spectacles or contact lenses,
amblyopia treatment and regular follow-up by an Eye Specialist.
Squint (crossed eyes)
There is a squint when the two eyes are not aligned, or not looking at the same
point. In other words, one eye is focused on an object while the other eye is looking
elsewhere.
A squint may result in amblyopia and, very commonly, failure to develop normal binocular
vision ('3-D' vision, depth perception).
Squints are treated with spectacles, eye patching, eye exercises and surgery, alone
or in combination. Generally, delaying surgery until after the age of about eight
years will often only improve the child's appearance, not the quality of vision.
Sometimes, childhood squints may also be a warning sign of a serious underlying
disorder such as retinal detachment or retinoblastoma (eye cancer).
Refractive error
Shortsightedness, far-sightedness and astigmatism are classified together as refractive
errors. High degrees of refractive error ('power'), and/or a significant disparity
between the two eyes are a common cause of amblyopia (see above). Fortunately, amblyopia
can be prevented if the affected child is given suitable spectacles early.
Does every child with a refractive error need to wear spectacles? Not always. It
depends on several factors, such as the child's visual acuity, the degree ('power')of
the refractive error, the difference between the two eyes and the presence (or absence)
of amblyopia.
IV. Prevention of eye injuries
Injuries are a major cause of vision loss in children.
You may not suspect it, but ordinary household items can be a danger to the eyes.
For instance, children frequently stab themselves in the eye when they trip and
fall while holding pointed objects in their hand. Do not allow your children to
play at fighting with objects like rulers, forks, spoons or sticks - it is common
even for plastic objects to cut the eye, especially when they snap. See the list
below for common dangerous items.
At home and school
1. Toys with sharp or protruding parts
2. Pencils, pens, colour pencils
3. Hooks for hanging infant rockers
4. Furniture corners and protruding household fittings
5. Scissors
6. Lidi sticks (a type of skewer for satay)
7. Plastic spoons and forks
8. Rulers (plastic or metal)
9. Elastic straps
10. Firecrackers
In Malaysia, the most common sports injury by far is from badminton. When a shuttlecock
hits the eye, bleeding often occurs inside the eye. The child may end up with serious
long-term eye damage. It is best to use appropriate protective sports goggles.
Sports injuries in Malaysia
1. Badminton (shuttlecock, racquet)
2. Squash
3. Basketball
4. Netball
5. Any contact sport
6. Fishing hooks
V. Miscellaneous concerns
Watching television and computer games
You may be concerned that your child likes to spend time at the computer, watching
television or playing on small digital game sets. While VDUs (video display units)
cause eye tiredness and eyestrain symptoms, research has not been able to show that
they do any actual harm to the eyes. However, sustained near work has been associated
with the development of shortsightedness.
A sensible and reasonable approach is to allow your child to do these things in
moderation, with periods of rest for the eyes at regular intervals. Reading and
computer work should be balanced with a healthy amount of physical exercise and
outdoor activities.
Vitamins and food supplements
If your child is taking a healthy, balanced diet, there is no need
at all to take special vitamins or supplements to improve eyesight. Not only are
they an added cost, there is no scientific evidence that they benefit the eyes.
There is also insufficient information about their safety, both in the short term
and long term.
Eye exercises and special gadgets to improve eyesight
You may have seen advertisements claiming that your child's eyesight can be improved
or his shortsightedness cured by various methods such as pinhole spectacles, eye
exercises, eye massage and certain devices.
Unfortunately, these claims are largely based on anecdotal reports and lack of sound
scientific backing. It is best that you to speak with an Eye Specialist before starting
your child on any treatment of this nature.
VI. Miscellaneous concerns
It is very important to give proper attention to your child's eyes during the growing
years. When problems arise, appropriate and prompt intervention can help prevent,
or at least minimise, lasting damage to the child's vision.
© Copyright 2004 Dr. Chin Pik Kee. May not be reprinted without permission.
what you want, but control what you do.
Here are some ways that can help you decide if your child is doing all right:
• Is your child working on emotional tasks that are appropriate for her age and
ability? For example, if she's two and a half, is she asserting herself from time
to time?
• Is your child able to separate from you without undue stress and form an attachment
with at least one other adult?
• Is your child learning to conform to routines at school without too much trouble?
• Is your child able to involve himself deeply in play?
• Can your child settle down and concentrate?
Is your child aware of all her feelings and can she express them without
In summary, parents who desire to produce emotionally healthy children would do
well to focus on making their child's world physically and emotionally safe, to
learn who their child is and then do all they can to help that unique child BE that
person and thrive doing so, to allow children their feelings and perceptions, and
to create situations in which the child can develop a sense of competency and mastery
over different things. Doing these things is not easy for the parents, but the results
of an emotionally healthy child will make all the parents' efforts worthwhile. Later
on, these emotionally healthy children will go on to function as emotionally healthy
adults. What happens in the developmental years spent in the home is of VITAL importance.
© Copyright 2004 Francis Xavior M Dimalanta. May not be reprinted without permission.