PO and S What We All Should Know By Dr Anaspure Asstt
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Transcript PO and S What We All Should Know By Dr Anaspure Asstt
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 …..