Children with vision problems often do not complain about trouble with their eyes, and many exhibit no outward signs of impairment. Pediatric Ophthalmologist Amy Wexler, M.D. specializes in the diagnosis & the treatment of routine and complex children’s eye problems, including crossed eyes (strabismus), lazy eyes (amblyopia), blocked tear ducts, eye infections, as well as regular eye care and eyeglass prescriptions.
Strabismus & Crossed Eyes
Strabismus is a misalignment of the eyes. It includes in-turned eyes, called Esotropia, out-turned eyes, called Exotropia and other eye muscle disorders. Sometimes children are successfully treated for strabismus only to redevelop strabismus later in life. This may be secondary to the inability of a person to use both eyes together, called binocular vision, or other unknown causes. People who have one eye that does not see well when fully corrected with glasses, called Amblyopia, may develop strabismus with time. Most often, the poorer seeing eye will drift outward. In adults who suddenly develop strabismus we must be concerned about vascular insults to a nerve that controls the movement of one or more eye muscles. This is most often seen in adults with a history of diabetes or high blood pressure.
Amblyopia & Lazy Eye
Amblyopia is the medical term for poor vision in one, or sometimes both eyes. Children are born with poor vision. As they develop the eyes send the message of what they see to the brain and the visual brain cells “learn” how to interpret these images. Over time the brain learns how to fine-tune the images it is receiving and the vision improves. If the image that is being sent to the brain is blurry then the brain will never learn how to see clearly from that eye. The important piece in this problem is that the brain cannot “learn” how to see clearly after a certain age (that age is not known for certain). We do know that the younger the patient is when he/she is treated the better the outcome will be. So, Amblyopia should be treated as early as possible.
-Treatment of Amblyopia
In most cases Amblyopia is treatable. However, the success of treatment is dependent upon the initial level of vision, the amount of time the vision has been poor and the age of the child. The most important factor in treating Amblyopia is compliance with the treatment protocol. Treatment requires “forcing” the brain to use the non-preferred eye. In most cases this means patching the better seeing eye for some part of the day. Glasses may also be required to “balance” an unequal refractive power between the two eyes. For some patients an eye drop can be used to blur the vision in the better seeing eye. If a cataract is present, this may need to be removed before Amblyopia treatment can be started. The initial treatment period may be difficult for the child, as he/she is being made to use their poorer seeing eye. This usually lasts a short period of time, as their vision usually improves rapidly.
Nasolacrimal Duct Disorders
Tearing in children is a common finding. There are many different causes of tearing and it is important to have your doctor check your child for some of the more serious problems. Most often tearing is caused by a blockage of the nasolacrimal duct (NLD) passageway. This is a common finding in infants-studies have shown that about 6% of infants are born with an NLD obstruction. The most common cause of an obstruction is from a mucous membrane of the nose, which fails to regress during development. Other causes of NLD obstructions include irregular development of the lacrimal drainage passageway, infections, trauma, growths and medications. Treatment initially involves massaging the lacrimal system, warm compresses and sometimes antibiotic drops. If these interventions are unsuccessful, a nasolacrimal duct probing may be necessary. Some children require the placement of a silicone tube in the nasolacrimal duct system to keep the passageway open. Most obstructions will resolve on their own by one year of age.