Cataracts in Children
A cataract is a clouding of the eye's normally clear lens. The lens of the eye plays an important role in focusing images on the retina, the light-sensitive nerve cells lining the back of the eye. If the lens loses its clarity, light rays do not focus clearly and vision is blurry. Just as it is hard to see through a dirty window, it is hard to see through a cataract. Although most cataracts occur in older adults, they can appear in children, in one or both eyes, often at birth. They look like a white or gray spot in the pupil.
Cataracts in children may be inherited or develop because of an infection or a disease acquired before birth, or as a result of an injury. In most cases, no specific cause is found.
Children may lose vision permanently because of amblyopia (lazy eye) if a severe cataract is not removed quickly. The better eye may also need to be patched. Mild cataracts may not need treatment.
The focusing power of the original lens, removed during cataract surgery, must be replaced to restore vision. Intraocular lenses (IOLs), permanent plastic lenses placed inside the eye, are implanted in older children much as they are in adults. In infants, IOLs are controversial because the eyes grow and change their prescriptions during the first few years of life. Many surgeons prefer contact lenses or even glasses for younger children.
Regardless of the type of correction, children need follow-up exams to avoid possible complications, including glaucoma, scar tissue forming in the pupil, and amblyopia. Often, children will need eye muscle surgery because the eye turns or crosses.
Despite these problems, cataracts are the single most treatable cause of childhood blindness. After surgery, most children can see the blackboard in school (20/60-20/100). While some do not do as well, with appropriate correction, many children see almost normally.
<< BackChildren and Vision
People are often confused about the importance of glasses for children. Some believe that if children wear glasses when they are young, they won't need them later. Others think wearing glasses as a child makes one dependent on them later. Neither is true. Children need glasses because they are genetically nearsighted, farsighted, or astigmatic. These conditions do not go away nor do they get worse because they are not corrected. Glasses or contacts are necessary throughout life for good vision.
Nearsightedness (distant objects appear blurry) typically begins between the ages of eight and fifteen but can start earlier. Farsightedness is actually normal in young children and not a problem as long as it is mild. If a child is too farsighted, vision is blurry or the eyes cross when looking closely at things. This is usually apparent around the age of two. Almost everyone has some amount of astigmatism (oval instead of round cornea). Glasses are required only if the astigmatism is strong.
Unlike adults, children who need glasses may develop a second problem, called amblyopia or lazy eye. Amblyopia means even with the right prescription, one eye (or sometimes both eyes) does not see normally. Amblyopia is more likely to occur if the prescription needed to correct one eye is stronger than the other. Wearing glasses can prevent amblyopia from developing in the more out-of-focus eye.
Children (and adults) who do not see well with one eye because of amblyopia, or because of any other medical problem that cannot be corrected, should wear safety glasses to protect the normal eye.
<< BackBabies' Vision
Babies have poor vision at birth but can see faces at close range, even in the newborn nursery. At about six weeks a baby's eyes should follow objects and by four months should work together. Over the first year or two, vision develops rapidly. A two-year-old usually sees around 20/30, nearly the same as an adult.
Parents should be aware of signals of poor vision. If one eye turns or crosses, that eye may not see as well as the other eye. If the child is uninterested in faces or age-appropriate toys, or if the eyes rove around or jiggle (nystagmus), poor vision should be suspected. Other signs to watch for are tilting the head and squinting. Babies and toddlers compensate for poor vision rather than complain about it.
Should a baby need glasses, the prescription can be determined fairly accurately by dilating the pupil and analyzing the light reflected through the pupil from the back of the eye.
A baby's vision can also be tested in a research laboratory where brain waves are recorded as the child looks at stripes or checks on a TV screen. The test is called Visual Evoked Potential (VEP). Another test called preferential looking or Teller Acuity Cards uses simple striped cards to attract the child's attention. In both tests, as the stripes grow smaller, the child eventually does not respond (with brain waves or by looking at the stripes).
<< BackChildhood Reading Problems
When children have difficulty reading, parents often think poor vision is the problem. If a visit to an ophthalmologist rules out any medical or vision problems, it may be a learning disability.
A learning disability is a disparity between a person's ability and performance in a certain area. It has nothing to do with intelligence or IQ. A learning disability can make it difficult to succeed in school and, if untreated, gets worse, causing a child to lose self-confidence and interest in school.
Identifying the learning disability is the first step in treating it. Dyslexia, a reading disability that may involve reversing letters and words, is one of the many learning disorders that can affect reading.
Exercises have been used to improve the coordination or focusing of the eyes. Since poor reading is not usually an eye problem, these exercises rarely prove helpful. Colored lenses, special diets or vitamins, jumping on trampolines, or walking on balance beams have also been prescribed without much success. Over time, these methods have tended to fall out of favor.
Children with learning disabilities benefit from various educational programs, in or out of school. Parents also play a vital role. They can support their children by reading with them at home. Children with learning disabilities need to be encouraged to develop strengths and interests so they can fully develop their unique talents and abilities.
<< BackChildren's Eye Safety
Accidents resulting in serious eye injuries can happen to anyone, but are particularly common in children and young adults. More than 90% of all eye injuries can be prevented with appropriate supervision and protective eyewear.
Goggles and face protection can prevent injuries in sports like baseball, basketball, racket sports, and hockey. It is more difficult to protect against injuries in boxing, though thumbless gloves help.
People who must rely on only one good eye should wear polycarbonate safety glasses all the time and should wear safety goggles for sports and other dangerous activities. Choose frames and lenses that meet the American National Standards Institute standard for safety (Z87.1).
Appropriate adult supervision is key in preventing all eye injuries. Children should never be allowed to play with fireworks or BB guns. Sharp and fast-moving objects, such as darts, arrows, scissors, knives, and even pencils or pens can be dangerous. Special care should be taken when working around lawn mowers, which can throw rocks and debris, and when banging two pieces of metal together, which can dislodge small shards of metal. Chemicals such as toilet cleaners and drain openers are especially hazardous.
A primary care physician or an emergency room can treat minor injuries, such as a foreign body or an abrasion (scratch) on the cornea. Any foreign material must be removed from the eye. An antibiotic drop or ointment may be applied, perhaps with an eye patch for comfort.
More serious injuries, like blood inside the eye (hyphema), a laceration (cut), or rupture of the eye, require examination by an ophthalmologist. Both surgery and hospitalization may be necessary.
Chemicals that burn should be rinsed from the eye immediately. The ultimate outcome depends on the severity of the injury, which cannot always be identified in the initial examination.
<< BackColor Vision
Color blindness (color vision deficiency) is a condition in which certain colors cannot be detected. There are two types of color vision difficulties: inherited (congenital) problems that you have at birth, and problems that develop later in life.
People born with color vision problems are unaware what they see is different from what others see unless it is pointed out to them. People with acquired color vision problems are aware that something has gone wrong with their color perception.
Congenital color vision defects usually pass from mother to son. These defects are due to partial or complete lack of the light-sensitive photoreceptors (cones) in the retina, the layer of light-sensitive nerve cells lining the back of the eye. Cones distinguish the colors red, green and blue through visual pigment present in the normal human eye. Problems with color vision occur when the amount of pigment per cone is reduced or one or more of the three cone systems are absent. This limits the ability to distinguish between greens and reds, and occasionally blues. It involves both eyes equally and remains stable throughout life.
There are different degrees of color blindness. Some people with mild color deficiencies can see colors normally in good light but have difficulty in dim light. Others can't distinguish certain colors in any light. In the most severe form of color blindness everything is seen in shades of gray.
Except in the most severe form, color blindness does not affect the sharpness of vision at all. It does not correlate with low intelligence or learning disabilities.
Most color vision problems that occur later in life are a result of disease, trauma, toxic effects from drugs, metabolic disease, or vascular disease. Color vision defects from disease are less understood than congenital color vision problems. There is often uneven involvement of the eyes and the color vision defect will usually be progressive. Acquired color vision loss can be the result of damage to the retina or optic nerve.
There is no treatment for color blindness. It usually does not cause any significant disability. It can, however, prevent employment in an increasing number of occupations.
Change in color vision can signify a more serious condition. Anyone who experiences a significant change in color perception should see an ophthalmologist.
<< BackEyeglasses for Infants and Children
Prescriptions for glasses can be measured in even the youngest and most uncooperative children by using a special instrument called a retinoscope to analyze light reflected through the pupil from the back of the eye.
Most lenses today, especially for children, are made of plastic, which is stronger and lighter than glass. It is a good idea to get a scratch-resistant coating on plastic lenses. Children can be rough with glasses and plastic lenses scratch easily.
Color tints or tints that respond to changes in light can be incorporated into lenses. For children, the tint should not be so dark that the child has trouble seeing indoors.
Frames come in all shapes and sizes. Choose one that fits comfortably but securely. There are devices available to keep glasses in place, a good idea for active children and young children with flat nasal bridges. Cable temples, which wrap around the back of the ears, are good for toddlers. Infants may require a strap across the top and back of the head instead of earpieces. Flexible hinges hold glasses in position, allow the glasses to "grow" with the child, and prevent the side arms from being broken.
Children often do not like their glasses although the prescription is correct. Distraction, positive reinforcement, and bribery help children get in the habit of wearing glasses. If all else fails, your ophthalmologist can prescribe an eye drop that blurs vision when the glasses are not in place. This often overcomes the child's initial resistance to wearing glasses.
<< BackGlaucoma-The Basics
What is glaucoma?
Glaucoma is a disease of the optic nerve, which is the part of the eye that carries the images we see from the eye to the brain. The optic nerve is made up of many nerve fibers (like an electric cable containing numerous wires). Glaucoma damages nerve fibers, which can cause blind spots in our vision and vision loss to develop.
Glaucoma has to do with the pressure inside the eye, or intraocular pressure (IOP). When the clear liquid called the aqueous humor--which normally flows in and out of the eye--cannot drain properly, pressure builds up in the eye. The resulting increase in IOP can damage the optic nerve.
The most common form of glaucoma is primary open-angle glaucoma, where the aqueous fluid that normally circulates in the front portion of the eye is blocked from flowing back out of the eye through a tiny drainage system. This causes the pressure inside your eye to increase, which can damage the optic nerve and lead to vision loss. Most people who develop primary open-angle glaucoma notice no symptoms until their vision is impaired.
In angle-closure glaucoma, the iris (the colored part of the eye) may drop over and completely close off the drainage angle, abruptly blocking the flow of aqueous fluid and leading to increased IOP or optic nerve damage. In acute angle-closure glaucoma there is a sudden increase in IOP due to the buildup of aqueous fluid. This condition is considered an emergency because optic nerve damage and vision loss can occur within hours of the problem. Symptoms can include nausea, vomiting, seeing haloes around light, and eye pain.
Even people with "normal" IOP can experience vision loss from glaucoma. This condition is called normal tension glaucoma. In this type of glaucoma, the optic nerve is damaged even though the IOP is considered normal. Normal tension glaucoma is not well understood, but we do know that lowering IOP has been shown to slow progression of this form of glaucoma.
Childhood glaucoma is rare, and starts in infancy, childhood or adolescence. Like primary open-angle glaucoma, there are few, if any, symptoms in the early stage. Blindness can result if it is left untreated. Like most types of glaucoma, this type of glaucoma may run in families.
Your ophthalmologist may tell you that you are at risk for glaucoma if you have one or more risk factors, including elevated IOP, a family history of glaucoma, a particular ethnic background, advanced age, or certain optic nerve conditions. Regular examinations with your ophthalmologist are important if you are at risk for this condition.
<< BackCoats' Disease
Coats' disease is a chronic, progressive disorder that affects the retina, the light-sensitive nerve layer at the back of the eye. Coats' disease is an abnormal growth spurt of the small blood vessels (capillaries) that nourish the retina. The fragile abnormal vessels break and leak the clear serum part of the blood into the retina, causing the retina to swell.
Coats' disease usually affects children (especially boys) in the first ten years of life, but it can also affect young adults. The condition affects central vision, typically in only one eye. Severity can range from mild vision loss to total retinal detachment and blindness. No cause has yet been identified for Coats' disease.
The leaking blood vessels can be treated with laser surgery or cryotherapy (freezing). If the retina is detached, a vitrectomy to replace the vitreous (the clear gel-like substance inside the eye) with a gas bubble may be necessary to restore vision.
<< BackRetinitis Pigmentosa (RP)
Retinitis pigmentosa (RP) describes a group of related diseases that tend to run in families and cause a slow but progressive loss of vision. RP affects the rods and cones of the retina, the light-sensitive nerve layer at the back of the eye, and results in a decline in vision in both eyes. RP usually affects both eyes equally with severity ranging from no visual problems in some families to blindness at birth in others. RP gets its name from the fact that one of the symptoms is a clumping of the retinal pigment that can be seen during an eye exam.
The earliest symptom of retinitis pigmentosa, usually noticed in childhood, is night blindness or difficulty with night vision. People with normal vision adjust to the dark quickly, but people with night blindness adjust very slowly or not at all. A loss of side vision, or tunnel vision, is also common as RP progresses. Unfortunately, the combination of night blindness and the loss of peripheral vision can be severe and lead to legal blindness in many people.
While there is a pattern of inheritance for RP, 40% of RP patients have no known previous family history. Learning more about RP in your family can help you and your ophthalmologist predict how RP will affect you.
Usher's syndrome, in which a person is both deaf and blind, can be associated with RP. The incidence of Usher's syndrome is difficult to determine but surveys of patients suggest up to 10% of RP patients are deaf. The incidence of Usher's syndrome is three cases per 100,000. It is the most frequent cause of combined deaf-blindness in adults.
Considerable research is being done to find the hereditary cause of RP. As hereditary defects are discovered it may be possible to develop treatments to prevent progression of the disease. While developments are on the horizon, particularly in the area of genetic research, there is currently no cure for retinitis pigmentosa.
Nutritional supplements may have an effect on RP. It has been reported that Vitamin A can slow the progression of RP. Large doses of Vitamin A are harmful to the body and supplements of Vitamin E alone may make RP worse. Vitamin E is not harmful if taken with Vitamin A or in the presence of a normal diet. Your ophthalmologist can advise you about the risks and benefits of Vitamin A and how much you can safely take.
Despite visual impairment, people with RP can maintain active and rewarding lives through the wide variety of rehabilitative services that are available today. Until there is a cure, periodic examinations by your ophthalmologist will keep you informed of legitimate scientific discoveries as they develop.
<< BackRetinoblastoma
Retinoblastoma, a malignant tumor that grows in the retina, the layer of light-sensing cells in the back of the eye, can destroy a child's vision and be fatal. Affecting children of all races, boys and girls equally, retinoblastoma occurs in one or both eyes, usually in the first year or two of life.
The most common sign is a change in the color of the pupil, which can appear white in reflected light. This phenomenon is referred to as a cat's eye reflex. Sometimes the affected eye will cross or turn outward. Retinoblastoma can be hereditary and is more likely to develop in children with a family history of the disease.
With early diagnosis, retinoblastoma treatment is remarkably effective. More than 90% of children survive and many eyes are saved with a combination of medications, radiation therapy, and heat, freezing, or laser treatments. In severe cases, the affected eye is removed.
If a child has had retinoblastoma there is an increased chance for a second cancer to develop. Children with retinoblastoma should have regular examinations by an ophthalmologist and a pediatric oncologist.
<< BackRetinopathy of Prematurity (ROP)
Retinopathy of Prematurity (ROP) damages premature babies' retinas, the layer of light-sensitive cells lining the back of the eye. ROP usually occurs in both eyes, though one may be more severely affected.
The last 12 weeks of a full-term pregnancy are an especially active time for the growth of the eye. When a baby is born prematurely, blood vessels are not ready to supply blood to the retina. At birth, abnormal new blood vessels form and cause scarring or detachment of the retina. The condition is especially common in very small babies. It is more likely to occur at one or two pounds than at three pounds.
Despite improved medical care, the disease is becoming more common because smaller and sicker infants are surviving. Supplemental oxygen given to premature babies may be part of the cause of ROP, but not the only factor, as once thought.
In severe cases, the retina may be extremely scarred and detached. Many cases get better without treatment and only a small number of children go blind. Freezing (cryotherapy) or laser treatments can prevent progression of the disease.
Children with ROP are more likely to develop nearsightedness and amblyopia (lazy eye). Glasses, patching, and eye muscle surgery can help these associated problems. Follow-up exams of severely affected children should continue periodically.
<< BackRetinoschisis
Retinoschisis is a genetic eye disease that splits the retina, the light-sensitive layer of cells lining the back of the eye. It occurs in two forms, one affecting young children, the other older adults. Both forms usually affect both eyes, though one eye may be worse than the other.
Because the disease is inherited on the X chromosome, childhood retinoschisis occurs in boys more than girls. It is usually detected because of poor vision.
If the split retina involves the peripheral or side retina, peripheral vision is lost. One is also at risk for a retinal detachment. But more commonly, retinoschisis affects the macula, the area of the retina responsible for central vision. In this location, one loses central vision.
Peripheral retinoschisis, more common in adults, is usually caused by aging and does not affect vision, but it can cause a retinal detachment. If detected early, a retinal detachment can be treated with surgery or laser therapy.
<< BackStargardt's Disease
Stargardt's is an inherited disease that affects the retina, the layer of light-sensitive cells lining the back of the eye. It usually becomes apparent between the ages of 8 and 14. Boys and girls are equally susceptible and more than one child in a family may have it.
Stargardt's disease begins with slightly blurry vision that gradually gets worse. By the late 20s, vision is typically about 20/200, the level labeled legally blind. Remaining vision is good enough for most people to live fairly normal lives, though they won't drive, or read without using magnification devices.
A build-up of lipofuscin (fatty substance) in retinal cells is thought to cause Stargardt's disease. The buildup typically happens in the central retina, or macula, where it resembles beaten bronze. Or, it can occur in the side retina where it causes small white flecks. This form is called fundus flavimaculatus. Angiography, a special photograph of the retina, may aid in the diagnosis. Although no specific medical or surgical treatment is available, glasses and magnification help affected people adapt to the disease.
<< BackToxoplasmosis
Toxoplasmosis is a common parasitic infection. When contracted by a pregnant woman, toxoplasmosis can pose serious risks to the unborn baby. Simple precautions can reduce the chance of infection.
Pregnant women should avoid handling litter boxes and eating raw meat because the parasite may originate in cat feces or undercooked meat. If acquired during the first trimester of pregnancy, the infection can be devastating to an infant.
Toxoplasmosis affects the retina, the light-sensitive cells lining the back of the eye. Both eyes are usually involved. If the infection settles in the macula, the area of the retina responsible for central vision, good vision is lost forever.
When toxoplasmosis heals, it leaves a scar. The infection may recur years later, sometimes near the previously infected area. Swelling that fights the infection may cause floating spots in one's vision, red, painful eyes, and poor vision.
Treating toxoplasmosis with oral medications can be very effective. Pyrimethamine and sulfa drugs are the classic antibiotics although some doctors add or substitute clindamycin. Occasionally steroids, laser, or freezing (cryotherapy) treatments are prescribed.
Screening tests can identify women of childbearing age who are at risk of passing the infection to an unborn child.
<< BackRefractive Errors
To see clearly, light rays must be bent or refracted to focus on the retina, the light- sensitive nerve layer that lines the back of the eye. The cornea and lens of the eye work together to bend or refract light rays and bring them together on the retina. If a refractive error is present, the light is not focused directly on the retina, so images appear blurry.
Myopia (nearsightedness): Distance vision is impaired when the eye is too long in relation to the curvature of the cornea. This causes light to focus before it reaches the retina. Close objects look clear but distant objects appear blurry.
Hyperopia (farsightedness): Close vision is impaired, with some impairment of distance vision, as well. The eye is too short in relation to the curvature of the cornea. Light rays are not yet in focus when they reach the retina, so images appear blurry.
Astigmatism (the cornea is oval shaped instead of round): The irregular curvature of the cornea causes light to focus on more than one point on the retina. Uncorrected astigmatism impairs both distance and near vision.
<< BackStrabismus
Strabismus refers to misaligned eyes. If the eyes turn inward (crossed), it is called esotropia. If the eyes turn outward (wall-eyed), it is called exotropia. Or, one eye can be higher than the other which is called hypertropia (for the higher eye) or hypotropia (for the lower eye). Strabismus can be subtle or obvious, intermittent (occurring occasionally), or constant. It can affect one eye only or shift between the eyes.
Strabismus usually begins in infancy or childhood. Some toddlers have accommodative esotropia. Their eyes cross because they need glasses for farsightedness. But most cases of strabismus do not have a well-understood cause. It seems to develop because the eye muscles are uncoordinated and do not move the eyes together. Acquired strabismus can occasionally occur because of a problem in the brain, an injury to the eye socket, or thyroid eye disease.
When young children develop strabismus, they typically have mild symptoms. They may hold their heads to one side if they can use their eyes together in that position. Or, they may close or cover one eye when it deviates, especially at first. Adults, on the other hand, have more symptoms when they develop strabismus. They have double vision (see a second image) and may lose depth perception. At all ages, strabismus is disturbing. Studies show school children with significant strabismus have self-image problems.
Amblyopia, or lazy eye, is closely related to strabismus. Children learn to suppress double vision so effectively that the deviating eye gradually loses vision. It may be necessary to patch the good eye and wear glasses before treating the strabismus. Amblyopia does not occur when alternate eyes deviate, and adults do not develop amblyopia.
Strabismus is often treated by surgically adjusting the tension on the eye muscles. The goal of surgery is to get the eyes close enough to perfectly straight that it is hard to see any residual deviation. Surgery usually improves the conditions though the results are rarely perfect. Results are usuallybetter in young children. Surgery can be done with local anesthesia in some adults, but requires general anesthesia in children, usually as an outpatient. Prisms and Botox injections of the eye muscles are alternatives to surgery in some cases. However, before resorting to surgery or injections, etc., we first try to see if exercises can be effective. Exercises require a significant commitment by the patient and family, and sometimes the services of an orthoptist and/or vision training expert are necessary.
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Conjunctivitis (Pink Eye)
Pink eye, the common name for conjunctivitis, is an inflammation or infection of the conjunctiva, the outer, normally clear covering of the sclera, the white part of the eye. The eye appears pink in conjunctivitis because the blood vessels are dilated. Pink eye is often accompanied by a discharge, but vision is usually normal, and discomfort is mild.
Either a bacterial or a viral infection may cause conjunctivitis. Viruses, which are more common and last several weeks, may cause an upper respiratory infection (or cold) at the same time. Unlike viruses, bacterial conjunctivitis is treated with a variety of antibiotic eye drops or ointments, which usually cure the infection in a day or two.
Conjunctivitis can be very contagious. People who have it should not share towels or pillowcases and should wash their hands frequently. They may need to stay home from school or work and should stay out of swimming pools.
Not everyone with conjunctivitis has an infection. Allergies can cause conjunctivitis too. Typically, people with allergic conjunctivitis have itchy eyes, especially in spring and fall. Eyedrops to control itching are used to treat allergic conjunctivitis. It is important not to use medications that contain steroids (they usually end in "-one" or "-dex") unless prescribed by an ophthalmologist.
Finally, not everyone with pink eye has conjunctivitis. Sometimes more serious diseases, such as infections, damage to the cornea, very severe glaucoma, or inflammation on the inside of the eye cause the conjunctiva to become inflamed and pink. Vision is usually normal if the pink eye is really conjunctivitis. If vision is affected, or if the problem does not get better in a few days, see an ophthalmologist.
<< BackTearing in Infants
Many children are born with an underdeveloped tear-duct system, a problem that can lead to tear-duct blockage, excess tearing, and infection.
Blocked tear ducts are a fairly common problem in infants; as many as one third may be born with this condition. Fortunately, more than 90% of all cases resolve by the time children are 1 year old with little or no treatment. The earlier that blocked tear ducts are discovered, the less likely it is that infection will result or that surgery will be necessary.
What Are Tear Ducts?
Our eyes are continually exposed to dust, bacteria, viruses, and other objects that could cause damage. The eyelids and eyelashes play a key role in preventing these objects from entering our eyes and hurting them. But besides serving as barriers, the lids and lashes also help our eyes stay moist. Without moisture, our corneas, which serve as protective domes for the front of the eyes, would dry out and could become cloudy or injured.
Working with our lids and lashes, the protective system of glands and ducts called the lacrimal system keeps our eyes from drying out. Small glands at the edge of the eyelid produce an oily film that mixes with the liquid part of our tears and keeps them from evaporating. Lacrimal (or tear-producing) glands secrete the watery part of tears. These glands are located under the brow bone behind the upper eyelid, at the edge of the eye socket, and in the lids.
Eyelids move tears across the eyes. Tears keep the eyes lubricated and clean and contain antibodies that protect the eyes from infection. They drain out of the eyes through two ducts called punctum or lacrimal ducts, one on each of the upper and lower lids. From these ducts, tears enter small tubes called canaliculi, which are located at the inner corner of the eyelids. They pass from the eyes into the lacrimal sac, a small sac that's located next to the inner corner of the eyes (between the eyes and the nose).
From the lacrimal sacs, tears move down through the nasolacrimal duct and drain into the back of the nose. (That's why you usually get a runny nose when you cry - your eyes are producing excess tears, and your nose can't handle the additional flow.) When you blink, the motion forces the lacrimal sacs to compress, squeezing tears out of them, away from the eyes, and into the nasolacrimal duct.
The nasolacrimal duct and the lacrimal ducts are also known as tear ducts. However, it's the nasolacrimal duct that's involved in tear-duct blockage.
What Causes a Blocked Tear Duct?
Many children are born without a fully developed nasolacrimal duct. This is called congenital nasolacrimal duct obstruction or dacryostenosis. Most commonly, an infant is born with a duct that is more narrow than usual and therefore does not drain properly or becomes blocked easily. The majority of children outgrow this condition by the time they are 1 year old.
Less often, a child has a web of tissue over the end of the duct that didn't dissolve during fetal development. This condition is more likely to require surgical probing.
Other causes of blockage in children (especially older children) are rare. Some children have nasal polyps, which are cysts or growths of extra tissue in the nose at the end of the tear duct. A blockage also can be caused by a tumor in the nose, but again, this is unusual in children.
Trauma to the eye area or an eye injury that lacerates (cuts through) the tear ducts could also cause this condition, but reconstructive surgery at the time of the accident or injury may prevent blockage from happening.
Signs of Blocked Tear Ducts
Children with blocked tear ducts usually develop symptoms of the condition between birth and 12 weeks of age, although you may not realize your child has this problem until his or her eyes become infected. The most common signs of blocked tear ducts are excessive tearing, even when a child is not crying (this is called epiphora). You also may notice pus in the corner of your child's eye, or that your child wakes up with a crust over the eyelid or in the eyelashes.
Children with blocked tear ducts can develop an infection in their lacrimal sac called dacryocystitis. Signs of this infection include redness at the inner corner of the eye and a slight tenderness and swelling or bump at the side of the nose.
Another sign that the tear ducts may be blocked can be present at birth or soon after. Some infants are born with a swollen lacrimal sac, causing a blue bump called a dacryocystocele to appear next to the inside corner of the eye. Although this condition should be monitored closely by your child's doctor, it doesn't always lead to infection and can be treated at home with firm massage and topical antibiotics. However, if it becomes infected, the child is usually admitted to the hospital for intravenous antibiotics, followed by surgical probing of the duct.
When to Call Your Child's Doctor
If your child's eyes tear excessively but show no sign of infection, consult with your child's doctor or a pediatric ophthalmologist (eye specialist) to see if your child has a blocked tear duct. Early treatment can prevent the need for surgery. If your child shows signs of infection (such as redness, pus, or swelling), call your child's doctor immediately because the infection can spread to other parts of the face and the blockage can lead to an abscess if not treated.
<< BackTreating Blocked Tear Ducts
Children with blocked tear ducts often can be treated at home. Your child's doctor or pediatric ophthalmologist may recommend that you massage the eye several times daily for a couple of months. Before massaging the tear duct, wash your hands. Place your index finger on the side of your child's nose and firmly massage down toward the corner of the nose. You may also want to apply warm compresses to the eye to help promote drainage and ease any discomfort your child may have.
If your child develops an infection as a result of the tear-duct blockage, your child's doctor will prescribe antibiotic eye drops or ointment to treat the infection. It's important to remember that antibiotics will not get rid of the obstruction. Once the infection has cleared, you can continue massaging the tear duct as your child's doctor recommends.
If your child still has excess tearing after 6 to 8 months, develops a serious infection, or has repeated infections, the doctor may recommend that your child's tear duct be surgically probed. This procedure has an 85% to 95% success rate for children who are 1 year old or younger; the success rate drops as children age.
Surgical probing may be repeated if it's not initially successful. If your child continues to experience blockage, your child's doctor may recommend surgery to widen the tear ducts using tubes that are implanted in your child's tear ducts for 6 months, or a balloon that stretches the tear duct. Both of these surgical procedures have high success rates.
What Happens Before and During Surgery?
Surgery should be performed by a ophthalmologist who is familiar with the procedure - your child's doctor should be able to refer you to such a specialist. These surgical procedures are done on an outpatient basis (unless your child is suffering from a severe infection and has already been admitted to the hospital) under general anesthesia.
When a child is referred for a blocked tear duct because of an infection or excessive tearing, a pediatric ophthalmologist will do a complete eye exam to rule out any other eye problems or types of inflammation that might be causing similar symptoms.
A dye disappearance test also may help determine the cause of the problem. This involves placing fluorescein dye in the eye and then examining the tear film (the amount of tear in the eye) to see if it's greater than it should be. Or the doctor will wait to see if dye has drained properly by having the child blow his nose and then checking to see if any of the dye exited through the nose.
A surgical probe takes about 10 minutes. A thin, blunt metal wire is gently passed through the tear duct to open any obstruction. Sterile saline is then irrigated through the duct into the nose to make sure that there is now an open path. Infants experience no pain after the probing.
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