Common Eye Problems In Children

A Parent's Guide

There are a number of eye problems that are more common in children than adults. These eye problems vary in severity and nature, from infectious to allergic, and traumatic (due to injury). As parents, it is a terrible feeling to have your child come up to you with an eye problem, and regardless of the benign nature of some of the eye problems, all parents should bring their child in to see the eye doctor as soon as possible. It is important at this time to note that adults can develop these eye problems also; however, they are most common in children.

Conjunctivitis (Pink Eye)

Conjunctivitis, commonly known as “pink eye,” is an infection of the eye – usually due to either bacteria or a virus. With a bacterial infection, antibiotics are required. Children with bacterial conjunctivitis will have a red eye, with a thick, mucous discharge. Common complaints involve difficulty opening the eyes upon awakening, and slight discomfort (usually no pain). Children with viral conjunctivitis will also have a red eye, but the discharge will generally be watery. Often, an upper respiratory tract infection will accompany viral conjunctivitis – either at the same time, or before the eye infection. Treatment for viral conjunctivitis is strictly supportive – what this means is that there is no treatment other than providing a patient with artificial tears, which will improve comfort while the child heals. For both cases of pink eye, the child must be brought to an optometrist's office, as it is certainly possible that a bacterial infection can mimic that of a viral infection. Early treatment with antibiotics in the case of a bacterial infection is crucial.

Allergic Conjunctivitis

While this type of conjunctivitis is not caused by an infection, children will have a red eye, and often the tissues surrounding the eye may be swollen, watery, and itchy. Children with allergic conjunctivitis often also have pre-existing allergic conditions such as asthma. There are many different types of allergic conjunctivitis, and by visiting an optometrist, each patient can be classified properly, with provision of the best possible treatment – often this involves the use of antihistamine eye drops. Alternative (or concomitant) treatment medications involve the use of mast cell stabilizers (this is for long-term control of allergic symptoms), and corticosteroids.

Blepharitis

Blepharitis is the medical term for inflammation of the eyelids. Children with blepharitis will tend to have red, swollen eyelids at the lid margin (along the line of the eyelashes). The base of the eyelashes will typically show crusting or flaking. This becomes irritating and itchy for the child. Treatment for blepharitis consists of the implementation of daily lid hygiene. Ether a Q-tip or a soft cloth can be used with baby shampoo (or Lid Care towelettes) and rubbed along the lid margin each day. Untreated, blepharitis can lead to the formation of a stye, or a hordeolum.

Subconjunctival Hemorrhage

Subconjunctival hemorrhages occur often as a result of increased pressure within the blood vessel walls of the eye, leading to rupture and subsequent leakage of that blood vessel. Trauma (such as a hard fall in the playground), forcible vomiting, constipation, or excessive lifting (ie. trying to lift an object that was too heavy) can cause this type of eye problem. A subconjunctival hemorrhage can look very serious, but generally they will resolve within a couple weeks without treatment. Learn more about subconjunctival hemorrhages.

Corneal Abrasion

Corneal abrasions occur as a result of trauma to the eye. Somehow, some object either scratched the eye, or perhaps a fingernail scraped the eye. This will cause a tremendous amount of pain, with a red, watery eye, and sensitivity to light (photophobia). Treatment for corneal abrasions involves the use of antibiotics as a preventative measure to ensure no infections occur while the cornea is healing. It is important that optometrists are provided with as much information about the nature of the trauma to the eye in order to best treat the child. For instance, if the corneal abrasion resulted from being hit in the eye with a tree branch, there is increased risk that a fungal infection may occur. This will simply require closer monitoring by the eye doctor while the child heals. Typically, healing from a corneal abrasion is rapid – within 24 hours, the child should be much more comfortable and (depending on the severity of the abrasion) may even be healed completely.

Preseptal Cellulitis

Figure: Preseptal Cellulitis. Courtesy of EyeAtlas.com.

This is a serious infection of the tissue surrounding the eye that can lead to fever and may even require hospitalization. With preseptal cellulitis, the eyelids are red and extremely swollen (may be swollen shut). Seek medical attention immediately if your child is exhibiting these signs.

Strabismus

Figure: Accommodative Esotropia, correctable with glasses. Courtesy of EyeAtlas.com.

Strabismus is the medical term for an eye turn (commonly referred to either as crossed eyes, or wall-eyes). When one eye is turned in, this is called esotropia, and when one eye is turned out, this is called exotropia. Strabismus often presents in childhood and requires immediate attention in order to improve the visual prognosis for the child. When one eye turns in or out, the brain essentially ignores the visual information from that eye. This is detrimental to the development of vision in that eye. By taking your child to visit an optometrist, he or she will be able to train the eye to see better – this often requires the implementation of a rigorous patching schedule, where the straight eye is patched for a few hours each day, allowing the turned eye to be used. Depending on the nature of the strabismus, different treatment options are available – eyeglasses can help tremendously to straighten the eyes in some children, but they are not always successful. Surgery is usually considered as a last resort, and is an additional treatment to patching (not an alternative). Children with an eye turn must be brought to visit their optometrist as soon as possible – this is the time in a person's life when vision in a turned eye can be improved. Once a child reaches the age of 7 or so, the vision in an eye generally cannot be improved much.

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