Common Vision and Eye Problems
Falsely Misaligned Eyes (pseudostrabismus)
Sometimes infants appear to have crossed eyes, yet the eyes are truly straight. The cause for pseudostrabismus is presence of a wide nasal bridge or extra folds of skin between the nose and the inside of the eye that make the child have a cross-eyed appearance. Most children outgrow this problem, but you should contact your doctor for an examination. Your pediatrician can tell whether a child has misaligned eyes or just pseudostrabismus, but in some instances, a visit to an ophthalmologist is necessary for further tests.
Misaligned Eyes (strabismus)
With strabismus, the eyes are not aligned. Strabismus is quite common and occurs in about 4% of children. One eye may gaze straight ahead while the other eye turns inward, upward, downward, or outward. When an eye turns inward, the child has "crossed" eyes (esotropia). There are two common causes for esotropia. Some children are born with crossed eyes (or develop it shortly after birth), and in this situation the muscles are too tight. Treatment for this most commonly involves surgery on the eye muscles, generally performed prior to the age of 2.
The second most common cause for esotropia is excessive farsightedness. This problem can be present at birth, but most commonly occurs between the age of 2 and 6 years. This type of esotropia is corrected with glasses.
When an eye turns outward, the child has exotropia. Exotropia may be present from birth, but most commonly is seen in children 2 to 7 years of age. Generally the eyes turn out on rare occasions at first but with time more frequent outward turning of the eyes is noted. Children with exotropia occasionally squint one eye when exposed to bright sunlight. The treatment for large amounts of exotropia is usually eye muscle surgery.
Children with misaligned eyes will generally turn off the vision in the turned eye so that they are not plagued with double vision. Children with strabismus should have a careful examination by an ophthalmologist because untreated strabismus may lead to a lazy eye (amblyopia) or loss of depth perception. Rarely, strabismus may indicate a more serious condition, such as cataract or eye tumor (retinoblastoma).
Lazy Eye (amblyopia)
Lazy eye is reduced vision from lack of use in an otherwise normal eye. It usually happens only in one eye. Any condition that prevents a clear image can interfere with the development of vision and result in amblyopia.
Amblyopia is common, affecting about 2% of children. Some causes of amblyopia include strabismus, droopy eyelids (ptosis), cataracts, or refractive errors. Because early treatment offers the best results, your pediatrician will refer you to an ophthalmologist.
Children who are "nearsighted" see objects that are close to them clearly, but objects that are far away are unclear. Nearsightedness is very rare in infants and toddlers, but becomes more common in school-age children. Eyeglasses will help clear the vision but will not "cure" the problem. Despite using glasses, near-sightedness will generally increase in amount until the mid-teenage years so that periodic follow-up examinations by an ophthalmologist are indicated.
A small degree of farsightedness is normal in infants and children. It does not interfere with vision and requires no correction. It is only when the farsightedness becomes excessive, or causes the eyes to cross, that glasses are required.
Astigmatism is the result of an eye that has an irregular corneal shape. Astigmatism may result in blurred vision. Children with astigmatism may need glasses if the amount of astigmatism is large.
Learning disabilities are quite common in childhood years and have many causes. The eyes are often suspected but are almost never the cause of learning problems. Your pediatrician may refer you for an evaluation by an ed
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