Insights from Dr Zena Lim from Thomson Surgical Centre

When you were younger, your parents would nag at you not to sit too close to the television, or to refrain from reading in the dark, so as not to get myopia in the future. You may find yourself singing the same tune to your kids now. With some 40 per cent of adult Singaporeans suffering from myopia or short-sightedness ― one of the world’s highest ― it’s an eye problem many of us are familiar with. Yet, children also suffer from less well-known eye problems.

Dr Zena Lim, a Consultant Ophthalmologist from Thomson Surgical Centre, tells us more about children’s eye problems, their symptoms as well as the treatments available.

1. Myopia

Myopia is a common vison problem in children. The rates of myopia are high in school age children in Singapore. Myopia occurs when light rays from an object entering the eye pass through and are focused in front of the back layer (retina) of the eye instead of onto the retina. The end result is visual blurring, in particular, when viewing distant objects.

Symptoms of undiagnosed myopia in a child may include difficulty seeing the white board in school, “squinting” to see and turning of the head sideways when watching TV.

Treatment:

Treatment of myopia is with glasses in young children. Options to slow the progression of myopia include low dose Atropine eye drops and myopia-control corrective lenses for spectacles. FDA has also recently approved a daily disposable soft contact lens for older children whose parents may be interested in myopia control and spectacle-free vision for their children.

2. Allergic conjunctivitis

Allergic conjunctivitis or in layman terms, “eye allergy”, is another very common eye problem. The triggers are often found in our day-to-day environment such as dust, dust mites, and less commonly, mould, grass and pets like cats and dogs.

Symptoms include frequent blinking of the eyes, rubbing, complaints of itchiness and intermittent eye redness and eye discharge.

Treatment:

It can be easily achieved with anti-histamine and mast cell stabilizer eye drops. More serious forms of eye allergies may require steroid eye drops. Adding oral anti-histamine medications and cold compresses over the eyes may further relieve symptoms. Frequent flare-ups may necessitate doing allergy tests to isolate the environmental triggers.

3. Squints (or eye misalignment)

A squint is a condition of eye misalignment whereby one eye drifts inwards, outwards and less commonly, upwards or downwards. The medical term for squints is “strabismus”. A new onset of eye misalignment in a child requires a comprehensive eye assessment.

Although eye misalignment is due to poor central brain control of eye alignment, occasionally, squints can be a sign of an underlying eye disease such as childhood cataract or retinoblastoma (a condition of eye cancer in children). Uncorrected high eye power can also predispose a child to developing a squint.

Treatment:

The treatment of squints depends on the underlying cause. If it is due to poor central brain control, eye patching may be prescribed or eye exercises can be taught to older children to improve the eye misalignment. If contributed by difficulty seeing clearly due to a high eye power, glasses may be prescribed to assist with the alignment control. Occasionally, poorly controlled eye misalignment may require eye muscle surgery.

4. Amblyopia (or lazy eye)

Lazy eye, medically termed “amblyopia”, is poor vision that results from interruption of normal visual development during early childhood. Critical visual development occurs in early childhood up to the ages of 7 to 8. If the brain receives blurry images from the lazy eye prior to this and no treatment is instituted, it would be difficult to improve vision in the lazy eye once the brain visual development is completed after the ages of 7 to 8. Therefore, lazy eye should be diagnosed and treated prior to these ages. 

Common causes of lazy eye are:

- Refractive errors: Short-sightedness (myopia), long-sightedness (hyperopia) and/or astigmatism
- Large differences in glasses power between both eyes (myopia, hyperopia or astigmatism)
- Squint (medically termed “strabismus”) or eye misalignment
- Obstruction of vision by droopy eyelids, childhood cataracts or other eye conditions
  
Often, the lazy eye may not be detected especially if the condition is unilateral, as the other eye often has good vision and the child may not complain of difficulty seeing. Do seek help if the child complains of poor vision, is unable to function well in school, fails a school vision screening test or is noticed to have eyes which are not well-aligned.

Treatment:

It depends on the underlying cause of the lazy eye. Glasses, patching, penalization of the good eye with eye drops, and even squint surgery may be required.

FAQs on eye conditions in children

#1 What causes poor eyesight in toddlers?

Undiagnosed eye power issues such as long-sightedness (hyperopia), short-sightedness (myopia) and astigmatism can lead to poor eyesight in toddlers.

Lazy eye due to eye misalignment, or obstruction of the child’s central vision due to a droopy eyelid can also lead to poor development of vision. Less commonly, other serious eye conditions such as congenital cataracts, retinoblastoma and other congenital retinal abnormalities can cause poor vision.

#2 How do I know if my child has eye problems?

Your child should undergo a vision examination from age 4 onwards. This can be carried out by your child’s family doctor or paediatrician. The school health service often carries out annual routine vision screening in pre-school from the ages of 4. 

If your child displays symptoms such as frequent blinking, tilting or turning of the head when watching TV, “squinting” to see when focusing on distance objects, and if feedback is given by your child’s teachers about potential vision issues in school, a comprehensive eye assessment is required.

Even before age 4, if your child displays any of the above symptoms, an eye examination is warranted.

Other symptoms of childhood eye conditions include:

- Excessive tearing - May indicate blocked tear duct
- Red or encrusted eyelids - Could be a sign of an eye infection
- Eye misalignment - Indicates eye muscle control issues
- Extreme sensitivity to light - May indicate an elevated pressure in the eye
- The appearance of a white pupil may indicate the presence of eye cancer or childhood cataract

#3 How can I test my child’s eyes at home?

A picture or alphabet vision chart can be downloaded from the internet, and placed at a specified distance from your child. This distance can vary depending on the size of the printed pictures or alphabets, which will often be specified for you.

Another easy way is to compare what you can see (assuming your vision is properly corrected) and what your child can see. Most toddlers from the ages of 3 to 4 should see as well as adults.

#4 How can I prevent my child’s eyesight from deteriorating? 

Too much near work or screen time has been shown to accelerate the onset and progress of myopia (i.e. short-sightedness). The American Academy of Paediatrics discourages media use for children younger than 18 months of age, and has guidelines for screen time allowance for older children.  

- Between 18 and 24 months, screen time should be limited to watching educational programming with a caregiver.
- For children ages 2 to 5, limit non-educational screen time to about 1 hour per day
- For ages 6 and older, encourage healthy habits and limit activities that include screens.

Other good habits include turning off all screens during family meals and outings, using parental controls and avoiding using screen time as pacifiers, babysitters, or to stop tantrums.

Toddler vision development 

Birth to 4 months

Babies have not yet developed the ability to see fine details of objects, although they may be interested in high contrast objects. They often are able to make out objects held 8-10 inches from their face, and are interested in their parents’ faces. There is occasional tracking of objects and faces and they respond well to light stimuli. 

Prior to 3 months, they may exhibit occasional eye misalignment and their eyes may appear to wander or be crossed but after the ages of 3 to 4 months, the eye coordination should be normal. Tracking and reaching out for objects should happen readily from 3 months onwards.

5 to 8 months

Control of eye movements and depth perception (the ability to judge if objects are nearer or farther away) improve and they can pick up a toy that is dropped, and able to make out small objects. Colour vision is also well developed around the ages of 6-8 months.

9 to 12 months

Babies can now judge distances fairly well and can see objects in the distance, as well as fast-moving objects. 

Age 1 and above

Vision continues to improve from age 1 year onwards and by age 3 years, vision is nearing Snellen 6/6 or 20/20.

Identify eye conditions and seek treatment early at Thomson Surgical Centre

Thomson Surgical Centre
Address: 339 Thomson Rd, #03-01, Singapore 307677
WhatsApp: 8666 1646
Email: surgicalcentre@thomsonmedical.com

Photos: iStock

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