Emergency Department Pediatrician Tamara Katy MD, provides parents with an overview of common childhood eye conditions. Photo by Larry S. Glenn
Don’t run with scissors!” For generations, parents have echoed this cautionary warning to their children. But “pointy things” are just one hazard that can threaten your child’s 20/20 vision. Yearly, millions of children suffer from eye injury—and millions more have eye infections or allergic irritations. With some simple precautions, most eye traumas can be prevented and serious complications from infections avoided.
Sticks and Stones Can Hurt Me
Eye injury knows no season. Any time of the year, children may suffer from corneal abrasions, which commonly occur when the clear surface of the cornea is scratched by anything from tree branches to fingernails. Tearing, pain, sensitivity to light and rubbing of the affected eye are telltale signs. Children may complain that it feels as if there is something in their eyes.
Be sure to keep sharp objects, such as scissors, locked away from small children.
Sometimes foreign bodies, such as rust from toys, dirt, dust and even eyelashes, do end up in children’s eyes. Left untreated, abrasions and foreign objects in the eye may lead to serious infection. If an at home saline rinse doesn’t help, go to an emergency department. Physicians will use a special lamp to look at the eye and often prescribe an antibiotic ointment to prevent infection.
In terms of prevention, remember these rules of thumb:
- check all toys for points, rust or loose paint
- don’t buy toys that fly or shoot
- use safety gates around beds and at stairs to prevent falls
- keep sharp objects, such as cooking utensils, gardening tools and scissors, locked away from small children
- lock up harmful materials like paints and cleansers; chemical burns of the eye always constitute an emergency. If your child complains of severe pain or burning, go to the nearest emergency department immediately.
Protective sports gear with face masks are important when small objects, such as baseballs, hockey pucks and lacrosse balls, are flying fast.
Keep Your Eye on the Ball
Sports injuries to the eye always need to be evaluated by a physician. These are most often caused by blunt trauma, when an object, such as a ball, hits the eye. This can cause bleeding and sometimes an orbital fracture—a break in the delicate bone that surrounds the eye and supports the eye muscles. A CT scan may be required to diagnose this fracture.
Penetrating injury occurs when an object punctures the eye and, like blunt trauma, may cause blindness. Make sure your children wear protective eye gear—especially when playing sports in which hard flying objects are moving at top speed.
Swim goggles will protect eyes
from the irritation caused by
chlorine that many young
swimmers experience.
Itchy, Oozing Infections
Few kids reach adolescence without at least one bout of conjunctivitis, or pink eye. The most common types are viral, bacterial and allergic— all can cause red eyes, itchiness and discharge. Everything from a blocked tear duct to the common cold can cause pink eye. And because it’s often hard to distinguish a viral from a bacterial infection, most people will be treated with an antibiotic ointment or drop.
Allergic conjunctivitis can be determined by the season, medical history and an eye exam. Oral medications and some eyedrops may be helpful. Whatever the cause, pink eye means an appointment with the pediatrician or ophthalmologist.
Another common eye infection in children is cellulitis, which has two types: periorbital and orbital. Periorbital cellulitis may be caused by trauma, such as an insect bite, a scratch on the skin of the eyelid, a sinus infection or bacteria in the bloodstream. Periorbital cellulitis may lead to orbital cellulitis, which is much more serious and affects the actual eye socket. Both types can cause fever, redness and swelling, and both require a trip to the pediatrician or ophthalmologist.
Kids Who Wear Glasses
Between five and 10 percent of all children will have some type of refractive vision problem—astigmatism, farsightedness or nearsightedness. In astigmatism, the cornea of the eye is shaped like a football rather than being round. This altered shape distorts images. In farsightedness, the eyeball is too small or the focusing power is not strong, which causes close-up objects to appear blurred. The opposite is true in nearsightedness.
The good news is that as children develop, so do their eyes. They can outgrow farsightedness. Nearsightedness, in contrast, can develop rapidly as kids grow. They will need frequent changes in their lenses and regular visits to a pediatric ophthalmologist. All kids should have annual vision screenings during their regular check-ups.
Amblyopia, called lazy eye, affects a smaller number of children but also requires a physician examination to diagnose and treat. In children with amblyopia, the brain hasn’t learned to use both eyes together to form a single image. If your child is exhibiting the common symptoms of lazy eye, such as having one eye that appears to wander or poor depth perception, talk to your pediatrician. Normal vision can be restored with early treatment.
Eye exams should be a part of every child’s annual check-up.
Knowing What to Look For
Remember, children may not tell you they are having trouble seeing. But if they are squinting a lot, sitting close to the television or having difficulty with their schoolwork, schedule an eye exam. If that initial exam indicates a problem, your doctor will refer you to a pediatric ophthalmologist.
And if your child frowns at the notion of wearing glasses, contacts might be an alternative. Ask yourself, “Is my child responsible enough to clean and care for contacts?” If not, glasses are the better choice. Let children select their own frames. If your child is 3 years old or younger, make sure the frames are plastic.
As for the use of refractive eye surgery (LASIK) to correct near- and farsightedness or astigmatism in kids, the jury is still out. There hasn’t yet been enough research conducted to prove that it is a good approach for children younger than 18.
