Pediatric Ophthalmology

Nystagmus most often affects babies or very young children and may be present at birth (congenital) or may develop later (acquired). It’s often called jiggling eyes or dancing eyes because the child’s eyes move around rather than focus steadily. Children with nystagmus cannot control this eye movement and may not be aware of it. Usually, parents are the first to notice it. But it can affect a child’s ability to focus on an object as well as interfere with depth perception, balance and coordination. 

Nystagmus may improve on its own, or it may improve with treatment for an underlying health problem. Our children’s ophthalmology team works with other specialists to determine the cause of the condition and how best to treat it.

Strabismus refers to any condition that causes the eyes to be misaligned, so that both eyes don’t look at the same place at the same time. There are different types of strabismus. For example, the eyes may appear crossed, one eye may turn upward, downward, in toward the nose or out toward the temple. 

Most types of strabismus result from problems with the muscles that control the way the eyes move. Children with strabismus may have vision problems, such as double vision or difficulty with depth perception. 

Strabismus usually develops by age 3. Without treatment, strabismus may cause the vision in one eye to become weaker (amblyopia) because the brain stops using it. Treatments may include eyeglasses, vision therapy or surgery to correct weak eye muscles. Adults with strabismus who weren’t treated during childhood may have very good results with treatment as well.

Tears help lubricate and protect the eyes, and normally drain through tiny ducts in the inner corners of the eyes. If these ducts are partially or completely blocked, tears can’t drain properly, and the eye may become watery, irritated or infected. About 6% of babies are born with a blocked tear duct, which usually clears up on its own within four to six months. 

In children, blocked tear ducts can develop if the thin tissue that covers the tear duct doesn’t open normally, or if the nasal bone grows abnormally and puts pressure on the duct. Infection also may cause blockage. A pediatric ophthalmologist can determine the cause of a blocked tear duct and plan the appropriate treatment.

An orbital dermoid is a type of cyst that develops on the bones of the eye socket, usually near the eyebrow. It looks like a large, smooth bump under the skin and is usually filled with a yellowish substance. These cysts are not cancerous or harmful and usually don’t affect the child’s vision. But if the cyst ruptures, it may cause an inflammatory reaction. Because of this risk, pediatric ophthalmologists may recommend surgery to remove orbital dermoids.

Retinopathy of prematurity (ROP) is a type of eye disorder that affects babies who are born prematurely. ROP causes abnormal growth of the eye’s blood vessels and is one of the most common causes of vision loss in children. There are five stages of ROP, ranging from mild to severe. Most babies have very mild cases that improve without treatment, but more serious cases can cause a partially or completely detached retina. Without treatment, severe ROP causes visual impairment or blindness.

Treatment for ROP may involve surgery using laser therapy or cold therapy to slow or stop the abnormal blood vessel growth. In very advanced cases, other types of surgery may be recommended to repair the detached retina.

Cataracts occur when the lens that covers the eye becomes cloudy and causes blurry vision or loss of vision. In children, cataracts may be present at birth (congenital) or may develop later due to injury, diabetes or unknown causes. Pediatric cataracts are especially serious because a child’s vision continues to develop until age 10 or so. If a cataract affects the child’s vision, the brain may stop using the affected eye, which can lead to amblyopia (lazy eye).

In most cases, treatment for childhood cataracts involves surgery to remove the cataract, followed by vision training to teach the eyes to focus correctly. Some children may need to use contact lenses or have a lens implant placed in the eye.

Glaucoma is a disease that damages the eye’s optic nerve and can eventually cause vision loss. The optic nerve becomes damaged when too much fluid builds up in the eye and raises the pressure in the eye (intraocular pressure) above normal. Pediatric glaucoma is relatively rare. A baby may be born with glaucoma, or the disease may develop later. Most causes are unknown, but sometimes glaucoma may be inherited or be related to another condition. 

The Scripps pediatric ophthalmologist and team treat glaucoma in children by lowering the pressure in the eye, usually through surgery to drain excess fluid. Eye drops and medications taken by mouth also may be used to control pediatric glaucoma. Early treatment is most successful, and children with glaucoma need to be closely monitored following treatment.

Ptosis is a condition in which the upper eyelid droops over the eye. Ptosis is usually due to weak muscles in the eyelid. In children, ptosis can lead to vision problems if the drooping lid interferes with vision. The affected eye may become weaker, which can cause amblyopia (lazy eye) or strabismus (wandering eye). 

Treatment depends on the severity of ptosis and the child’s age, and often involves surgery to repair the eyelid muscles. If ptosis has caused the eye to weaken, the pediatric ophthalmologist will treat that problem as well.

Uveitis or inflammatory eye disease is inflammation of the eye’s uveal tract. The uveal tract includes the colored part of the eye (iris), the ciliary body and the choroid. There are different types of uveitis based on the part of the uveal tract affected. In children, uveitis may be related to an autoimmune disease (such as juvenile rheumatoid arthritis), infection or an unknown cause. 

Pediatric ophthalmologists diagnose uveitis using a painless eye test called a slit lamp exam. Treatment depends on the type of uveitis. Uveitis caused by an infection may clear up on its own or require antibiotics. Uveitis related to autoimmune disease or unknown causes may be treated with medicated eye drops or anti-inflammatory medications given by mouth or by injection.