PAEDIATRIC

OPHTHALMOLOGY

Dr Shuaibah Ab.Ghani
Paediatric Ophthalmologist
Hospital Queen Elizabeth
Kota Kinabalu

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INTRODUCTION
Children are the most precious resource
of families
Children represent the families future
and their hope
A blind child is a tragedy to the families
A child whose blindness could have
been prevented or cured is an EVEN a
greater disaster

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EPIDEMIOLOGY

Definitions
Child individual aged <16
(UNICEF)
Blindness best corrected VA <3/60
in the better eye
Severe Visual Impairment (SVI)
Best corrected VA <6/60 in the better
eye.

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Screening

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Pediatric Eye
Screening

History
- Listen to what the mother says. They
are usually correct especially if they have
older children.
- risk factors for eye and vision
abnormalities
- ex ; family history of Cong. Cataract
Cong. Glaucoma
Retinoblastoma

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Snellen equivalent
AGE

DEVELOPMENT

Birth
20/400
2 month 20/200
4 month 20/200
6 month 20/150

1 year
5 year

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20/50
20/20

VISUAL ASSESSMENT
OF THE CHILDREN

Newborn to 3
months
Inspection :
- structural
abnormality
- Size and clarity of
cornea

3 to 6 months
able to follow an
object / light

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6 to 12 months
Inspection
Corneal light reflex
Fix and follow with
each eye

3 years and
aboved
Visual acuity
(monocular)

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Guidelines for Screening

Preterm

Retinopathy
of
prematurity
(ROP)

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Perinatal /
infantile
period
Cong.Cataract
Glaucoma
Anterior
segment
disorder

Preschool

Elementary
school

Strabismus
Refractive error
Refractive error
Anisometropia

Retinopathy of
Prematurity (ROP)

Untreated will cause

blindness

Premature babies
< 32 weeks or
< 1500g

Needs screening by
ophthalmologists

Patho-physio

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Normal fundus

Zone III

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Zone II

Zone I

Stage 2

Stage 1

Stage 3

Stage 4

Plus disease

Rubeosis iridis

Laser therapy

Leukocoria
White red reflex
Leukocoria- white pupil
All must be referred to doctors as soon
as possible
Possible diagnosis:

Retinoblastoma - eye cancer

Cataract
Infection

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Leukocoria - Cataract
Developmental at birth
or in the first yr. of life
- usually harmless
Congenital
uni- or bi-lateral at birth
- symptoms
white pupil
squint

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Leukocoria retinoblastoma

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SQUINT
synonym: cross-eye,
strabismus
may be:
convergent
divergent
vertical

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Refractive error myopia

Cannot focus on
distance object

Very common

Needs glasses /
contact lens correction

Needs regular visits to

the optometrist

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Refractive error hypermetropia

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Cannot focus on near

object
School children may
complain of headaches
when doing close work

Refractive errorastigmatism

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Common
Surface of the eye like rugby ball rather than
a football
Usually mild but if significant will need glasses

Common eye problems

Red eyes
Watering eyes
Other

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RED EYES

Conjunctivitis
gonococcal conjunctivitis
ophthalmia neonatorum

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RED EYES
Conjunctivitis
special type:

allergic conjunctivitis
dust, pollen or
animals
seasonal
Mx: avoidance of
allergenicsubstance

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allergic to drug

WATERING EYES

most common
among babies
soon after birth
D/T incomplete
dev. of tear
passage
Settles during 1st
year

WATERING EYES

May became
infected

Tx:
See ophthalmologist
eyedrop &/or
ointment

OTHERS

Congenital ptosis

Unilateral or bilateral
May have other

neurological problems
May cause amblyopia
Cosmetically poor

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Glaucoma

i. Congenital ( at birth)
ii. Infantile ( 1-2 years)
iii. Juvenile ( 2-16 years)

Clinical triad

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Epiphora +
Blepharospasm +
Photophobia

Gross Congenital Abnormalities

Refer all gross abnormality to the

paediatrician / ophthalmologist
Some examples

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Sturge-Weber
Syndrome

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Facial cleft

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Down Syndrome

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Craniosynostosis

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Microcephalysmall head

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Albinism

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Blepharophimosissmall lids

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Anophthalmiano eye

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Massages!
Refer all gross abnormality to the
paediatricians.
Listen to what the mother says. They
are usually correct especially if they
have older children.
If the mother thinks that the child
cannot see, refer.

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Thank You

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