Dr. Greene`s Answer:

Strabismus is quite common in children, affecting about 1 in 25 kids. Convergent strabismus or esotropia is a condition where the eyes turn slightly in. Often convergent strabismus is caused by farsightedness. When it is, glasses to correct the farsightedness are usually the best treatment for the short run. These kids usually love their glasses, both because they can see better, but even more because eye muscles can relax. They will usually not need the glasses once they have outgrown their farsightedness.

If farsightedness is not the cause, then patching is usually the best treatment. If patching is not successful, then surgery on the eye muscles is sometimes done.

Amblyopia, or lazy eye, is often the result of strabismus–one eye stops seeing as well as the other. For amblyopia, eye drops can take the place of patching. There was a great study published in March 2002, where half the kids wore patches for six hours a day for six months and half had one eye drop per day. The two groups improved about the same.

There is another situation called pseudostrabismus where it looks like the eyes turn in but they are really straight. It’s just that the bridge of the nose is wide and this situation gets better on its own as kids grow into their faces. When there is a question, kids should get tested by a pediatric ophthalmologist. If there is real strabismus, even if mild, the results are much better if treated early.

Related concepts:

Hordeolum

Introduction to stye:

A stye looks like nothing more than an irritating bump on the eyelid. And this is usually true. But untreated styes occasionally spread and become serious infections.

What is a stye?

A stye is a bacterial infection of the glands at the edge of the eyelid. The bacteria involved are usually Staphylococcus aureus, the bacteria that can also cause impetigo.

Who gets a stye?

Styes are common in children. Once a child has had one, there is an increased risk of having another.

What are the symptoms of a stye?

Styes look like bumps at the edge of the eyelid. They may be tender, swollen, red, and/or warm to the touch.

Is a stye contagious?

The bacteria in a stye could cause a stye or another infection (such as impetigo) if they enter a break in the skin or an eyelid gland.

How long does a stye last?

A stye usually lasts several days, whether or not it is treated. Most often, the body will eliminate the infections with no outside help.

How is a stye diagnosed?

It is diagnosed from the location and physical appearance.

How is a stye treated?

The initial treatment for styes is usually warm compresses to the eyelid at least three or four times a day. These compresses increase the blood supply to the area, aiding the body’s attack against the bacteria.
Sometimes antibiotic ointment or drops are prescribed.
If untreated, the infection occasionally spreads and requires systemic antibiotics, or even surgical drainage, to treat.

How can a stye be prevented?

In children who are susceptible to styes, gently cleaning the eyelid with a clean, warm washcloth can help prevent the pores from becoming clogged.
Avoiding touching or rubbing the eyes, especially with unwashed hands, can also prevent styes.

Related A-to-Z Information:

Blocked Tear Duct, Cold Sores (Herpes simplex), Conjunctivitis (Pink eye), Contact Transmission, Eczema, Impetigo, Staph (Staphylococcus aureus)

Eye patches have long been a standard treatment for amblyopia, or lazy eye. But children and parents alike have a tough time following through. Even if the child is initially enthusiastic about looking like a pirate, the patch ordeal can soon get old. It did in my house.

I was pleased to see a study published in the March 2002 issue of Archives of Ophthalmology that tested children with amblyopia at 47 different clinical sites. Half received patching (6 hours a day for 6 months); the other half were treated with eye drops (one drop of atropine a day for 6 months).

Treatment was successful (at least 3 lines of vision improvement, or vision brought to at least 20/30) in 79% of the patched kids and 74% of those receiving drops. Atropine drops appear to be a great treatment choice for some families.

Cover one eye, and read these letters…  Testing the vision of babies, toddlers, and children with developmental delays can be difficult and inaccurate. It’s also important! Strabismus (eyes that don’t line up properly) and amblyopia (a normal eye that doesn’t see well — lazy eye) are common in children, but most young children go untested and unidentified.

A March 2002 policy statement by the American Academy of Pediatrics (AAP) recommends that all babies should have vision screening (including screening for strabismus and amblyopia) at the earliest possible age, and at regular intervals throughout childhood.

Rather than relying on informal or subjective assessments of vision, the policy discusses photoscreening, a new test that can make checking vision easier and more accurate for even very young babies. A specially equipped camera takes their picture and a computer or a person analyzes the eye data obtained.

Ask your pediatrician about having your baby screened.

Dr.Greene’s Answer:

Conjunctivitis is a broad term that means inflammation of the conjunctiva of the eye. Bacteria, viruses, allergens, irritants, or toxins can cause it.

Viral conjunctivitis is common in children and does not require antibiotics either orally or topically.

Bacterial conjunctivitis is usually treated with antibiotic eye drops, but if a child is taking oral antibiotics anyway, that is usually sufficient (though a bit slower). Bacterial conjunctivitis that accompanies an ear infection is most commonly caused by H. flu — an organism that is sensitive to Augmentin.

If you elect to continue with the eye drops to speed the resolution, here is a tip:

Her eyes do not need to be open to put the drops in! I have children lie on their backs and close their eyes. I put a few drops in the corners nearest the nose. It will pool there until they blink. Then it slips in without that annoying ‘plunk’ of a falling drop hitting the eyeball.

When bacterial conjunctivitis is in only one eye, both eyes should still be treated so that it doesn’t ‘jump’ to the other eye. If the child is taking oral antibiotics, this counts as treating the other eye, so the drops can be placed only in the affected eye to make the treatment easier.

One of the great wonders of the human body is the ability of damaged cells to be repaired or replaced. Red blood cells, for instance, live for about 120 days. Each day, about 1% of your red blood cells retire to be replaced by a fresh generation. The lens of the eye is a notable exception. The cells of the lens of the eye are never replaced; the proteins of the lens are never replenished. The lens cannot repair itself; damage accumulates over a lifetime.

Cataracts are the result of gradually accumulating damage to the proteins of the lens. The most important source of this damage is exposure to ultraviolet (UV) radiation, especially while one is young.

Behind the lens lies the retina, the thin lining of the back of the eye. The retina is the eye’s miracle. This patch of tissue, about the size and thickness of a postage stamp, is able to dissolve and create a new image every tenth of a second.

Today in the United States, retinal diseases are the leading cause of blindness. Macular degeneration, the accumulation of damage in the retina, is the leading cause of blindness from retinal disease. Slowly, over the years, the macula is irreversibly damaged by exposure to UV radiation. About one third of adults over age 65 experience this steady decline of central vision, not correctable by glasses.

Excessive exposure to sunlight during early childhood is harmful to the eyes. Sunlight contains harmful UV radiation.

The risk for retinal damage from the sun’s rays is greatest in children less than 10 years old, although the consequences usually do not become apparent until well after they are adults.

All children should be taught to wear sunglasses, especially between 10 AM and 2 PM, when ultraviolet exposure is the most dangerous. This is true even for children with darker eye colors, even though their darker pigments afford partial protection. Of course, children with light-colored eyes need sunglasses all the more.

Ultraviolet exposure is at its peak when children are at high altitudes, snow-covered landscapes, bright sandy beaches, or near reflective bodies of water.

All sunglasses are not the same. Effective sunglasses should block both UVA and UVB radiation. The sunglasses must be measured to block 99% to 100% of UVA or UV400 (400 nm is the wavelength of UVA radiation). Thankfully, all sunglasses block UVB radiation.

Large lenses that fit close to the eyes are best. Those that block visible blue light are even safer.

Expensive brand names and polarizing lenses are no guarantee.

Ordinary sunglasses make the situation WORSE! The dark lenses cause the pupils to dilate, allowing more of the dangerous UVA radiation to damage the lens and the retina.