Objective: To describe the most common visual disorders in children and their functional implications
Visual disorders in children are closely related to economic conditions. Corneal opacities and uncorrected refractive errors are more common in poorer regions of the world, while retinopathy of prematurity is more common in relatively richer regions of the world.
Most visual disorders are not easily detected; the child’s behavior – missing steps, redness in the eyes, bumping into objects, pressing the eyes, inability to locate dropped objects – is the best indicator that something is wrong. But if any part of the eye is red, immediate action must be taken to obtain treatment, such as ointment, antibiotics, or eye drops to prevent further damage.
A Cataract is clouding of the lens of the eye that prevents clear vision. Children can be born with the condition, or a cataract may develop after eye injuries, inflammation, or some other eye diseases. Cataracts in children should be removed. Removing cataracts will create the need for spectacles. See http://www.who.int/blindness/causes/priority/en/index1.html.
Cerebral Visual Impairment is a disorder of the brain that can affect the visual pathways or the visual cortex, and may occur with or without additional disability. In many cases the eyes appear healthy. It is more common in developed countries. See also http://www.who.int/mediacentre/factsheets/fs382/en/.
Corneal visual impairment encompasses a wide variety of infectious and inflammatory eye diseases (including trachoma, newborn conjunctivitis, xerophthalmia, herpes, keratoconjunctivitis) that cause scarring of the cornea and ultimately leads to vision loss. The cornea is the clear membrane that covers the front of the eye. See also http://www.who.int/blindness/causes/priority/en/index8.html.
Keratoconjunctivitis is an inflammation of the conjunctivia (the mucus membrane that covers the front of the eye and lines the eyelids) and cornea.
Ophthalmia neonatorum or neonatal conjunctivitis, is caused by an infection acquired during passage through the birth canal of a mother who has venereal disease. (See a general discussion of conjunctivitis at https://nei.nih.gov/health/pinkeye/pink_facts.)
River Blindness or Onchocerciasis is caused by an insect parasite carried by certain species of blackflies that abound in riverside areas. It causes inflammation of the eye, bleeding, and other complications that ultimately lead to blindness. Onchocerciasis also causes disfiguring skin lesions and disabling intense itching. See http://www.who.int/blindness/causes/priority/en/index2.html.
Trachoma is the leading cause of infectious blindness, caused by a bacterium which is spread through personal contact with the infected person (via towels, fingers, bedding, etc.) and through flies that have been in contact with discharge from the eyes or nose of an infected person. It is highly contagious and causes considerable eye pain with itching and irritation of the eyelids, sometimes with a discharge. The eyelids can swell, and photophobia (light sensitivity) is common. Active disease is mainly found in pre-school children. Trachoma control programs promote the World Health Organization- (WHO) recommended SAFE strategy, which is a combination of Surgery (S), Antibiotics (A), Facial cleanliness (F) and Environmental improvement (E). See also http://www.who.int/mediacentre/factsheets/fs382/en/.
Xerophthalmia is excessive dryness of the cornea and conjunctiva, caused by a vitamin A deficiency.
Glaucoma is increased pressure in the fluids of the eye, which can lead to damage to the optic nerve. Symptoms hardly ever include pain and often progress with no change in vision, but headaches, and/or a change in eye color are sometimes reported. Treatment can control and prevent blindness, but not reverse the condition. Without treatment, peripheral vision will gradually be lost as pressure increases. See http://www.who.int/blindness/causes/priority/en/index6.html.
Retinopathy of Prematurity was once a disease of richer countries, but as neonatal intensive care is becoming more common in many cities of Latin America, Eastern Europe, and Asia this disease is increasing. Once thought to be the result of excessive oxygen, it is now associated more with low birthweight and preterm birth. It is characterized by a proliferation of blood vessels in the retina of the eye that leads to varying degrees of retinal detachment. More information: https://www.aao.org/eye-health/diseases/what-is-retinopathy-prematurity.
Amblyopia is commonly known as “lazy eye,” where one eye is misaligned, and the child risks not being able to use the eye altogether. See https://nei.nih.gov/health/amblyopia.
Myopia is near-sightedness, meaning that the child needs to be close to objects to see them clearly. See https://nei.nih.gov/health/myopia
Astigmatism is an irregularly shaped cornea that distorts rays of light such that they cannot come to a focus. See https://nei.nih.gov/health/astigmatism.
Refractive errors include myopia and hyperopia, with or without astigmatism (an imperfection in the curvature of the cornea). Most refractive errors can be corrected with eye examinations and a resulting prescription for spectacles. Uncorrected refractive errors are believed to be the leading cause of visual impairment worldwide. See http://www.who.int/blindness/causes/priority/en/index4.html.
A number of eye conditions are unknown, or cannot be determined, or are due to congenital abnormalities, such as anophthalmia (absence of the eye), microphthalmia (small eye) (see also https://nei.nih.gov/health/anoph/anophthalmia), or some other condition originating during the first trimester of pregnancy, when the eye is being formed.
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Common Visual Disorders in Children