Pediatric Ophthalmology

What is Pediatric Ophthalmology

Pediatric ophthalmology is the branch of ophthalmology specialising in eye and vision conditions in infants, children and teenagers. As part of a comprehensive eye examination, children need different techniques, equipment and approach from those used for adult patients.

The visual system develops from birth until around 7–9 years of age. Within this critical window, any pathology — a refractive error, strabismus or amblyopia — if not treated, can permanently affect the development of vision.

Conditions detected and treated early have a significantly better prognosis. In contrast, a delay in diagnosis — even of a few months — can reduce the effectiveness of treatment or make certain options ineffective.

When should the first examination take place

Most parents wait until their child complains about their vision — but this often does not happen, because the child does not know what "normal" vision looks like. For this reason, preventive examinations are necessary regardless of symptoms.

• At 6–12 months: screening for congenital conditions, nystagmus, strabismus and clouding of the ocular media (cataract, infant glaucoma)
• Around 3 years: assessment of visual acuity, screening for amblyopia and strabismus — a key age for starting treatment if a problem exists
• Before starting school (5–6 years): complete eye examination, detection of refractive errors affecting reading and learning
• During school age: annual monitoring, especially if there is myopia or a family history

Regardless of age, an immediate examination is indicated if you notice eye misalignment, unusual eye movements, light sensitivity, closing one eye, a white or abnormal reflex in a photograph, or if the child gets unusually close to the screen or a book.

Common conditions in children

The most common conditions treated in pediatric ophthalmology are:

• Amblyopia ("lazy eye"): reduced visual acuity in one eye with no structural damage — early treatment (glasses, patching, atropine) restores vision if started before development of the visual cortex is complete
• Strabismus: misalignment of the eyes — inward (esotropia), outward (exotropia) or vertical deviation. Treated with glasses, exercises or surgery
• Myopia: increasingly common in school-age children — corrected with glasses or contact lenses, assessed through refraction and eyeglasses prescription, with monitoring of progression
• Hyperopia: often without symptoms in young children, may lead to amblyopia or strabismus if uncorrected
• Astigmatism: blurred vision at all distances — corrected with cylindrical lenses
• Nystagmus: involuntary rhythmic eye movements — assessment of cause and management of the impact on vision
• Infant epiphora (watering): often due to a blocked tear duct — usually resolves on its own, rarely requires intervention

Each child is examined individually. Management depends on age, severity and the cooperation of the young patient and family.

The examination at the practice

The pediatric eye examination is adapted to the child's age and cooperation. For younger children, pictures and symbols are used instead of letters, while in infants assessment is made by observing the response to visual stimuli.

• Measurement of visual acuity with children's optotypes (pictures, shapes or letters depending on age)
• Cover test to assess eye alignment and detect strabismus
• Retinoscopy or automated refraction under cycloplegia (special eye drops that inactivate accommodation) for accurate refraction measurement
• Slit-lamp biomicroscopy to examine the anterior segment
• Fundus examination and assessment of the optic nerve, retina and macula
• Tonometry (intraocular pressure measurement) where deemed necessary

The use of cycloplegic eye drops (dilation) is often necessary for accurate measurement of refraction in children. After the examination, near vision may be temporarily blurred for several hours — make sure someone else can drive if needed.

Parents are encouraged to bring information about any family history of eye conditions, as well as previous glasses prescriptions if available. For all services at our practice, see the relevant page.