Symptoms and Signs

Ten Common Symptoms and Signs That Make You First Eye Doctor of Your Child.

Dr Virender Sachdeva, Consultant, Pediatric Ophthalmology, Strabismus and Neuro-Ophthalmology, L V Prasad Eye Institute Visakhapatnam.

Children tend to suffer from a large variety of eye ailments. On an average one out of every five children gets afflicted from one or the other eye condition in early childhood and infancy.

Refractive errors (glass power), lazy eye, cataracts, squint (misalignment of the eyes), allergic conjunctivitis and bacterial conjunctivitis are some of the most common eye conditions. A few of these can have far reaching visual complications (cataracts, retinal conditions, lazy eye), or else can have serious implications such as cancers of the eye.

Even though very common, a large majority of the eye conditions often go unnoticed and are easily missed by the parents, relatives and their teachers. This is due to the fact the children may fail to express themselves and the parents/ relatives may be unaware of the condition.

However, knowledge of the symptoms and signs of the common eye conditions may help suspect a possible eye condition early in the course and hence help provide early treatment. This article suggests the symptoms and signs of common eye conditions in children.

  1. Blurring of vision, watching objects and television from close distance. These observations made by parents could signify presence of an underlying refractive error. Such children may also ignore the objects such as toys beyond a particular distance and if the child tries to make the eyeballs small while reading or making the objects. In little older children, headaches and eye strain after moderate reading work can signify the need for the glasses.
  2. Headaches and eyes strain are again one of most common complaints in children. If these symptoms occur following reading work or watching television for moderate or prolonged times, these are highly suggestive of an underlying refractive errors, imbalance of the muscles of the eye and sometimes underlying squint in the eye. A detailed eye examination by a specialist can easily detect these conditions. Proper use of glasses, special exercises for muscle weakness and sometimes surgical treatment for squint may help relieve the problems.
  3. Rubbing of the eyes, redness, watering and discharge from the eyes signify allergic eye disease, commonly referred to allergic conjunctivitis. Although it may be seasonal or present all throughout the year in some of these children, it can be easily suspected if there is a history of frequent rubbing of the eyes along with redness and watering from the eyes. Usually there is a mild swelling of the lids, redness of the eyes and a small discharge in the eyes. Sometimes there may be presence of a foamy swelling around the cornea (central black portion of the eyes). The condition usually responds well to medical treatment, although sometimes long term treatment may be needed.
  4. Swelling of the eyelids, watering, discharge, sticking of the eyelids and photophobia signify the presence of infections of the eye and eyelids. An important point to remember is that while in the ocular allergies the discharge tends to mild, it tends to copious in the infections of the eye. Sometimes infections of the eye may also be associated with development of fever.
  5. Whitish opacity in the eye could signify the presence of many conditions such as a corneal scar, cataract, retinal degenerations and an eye cancer, retinoblastoma.

    Presence of a whitish opacity on the cornea (the central transparent portion of the eye) may suggest a possible corneal scar that may result from an infection, trauma, due to other hereditary eye conditions.

    Similarly presence of a whitish opacity in the eye could signify the presence of a cataract. It may be associated with a blurred vision for distant objects in the older children and in the infants; it may lead even to lack of eye contact and response to parents. If advanced the whitish opacity can be easily recognised by the parents. In some children, if delayed it may be associated with squint and nystagmus (shaking of the eyeballs).

    A whitish opacity in one or both eyes in an infant or small child may also be due to retinal developmental problems or retinoblastoma (a life threatening cancer of the eyes). In such cases, usually the parents may complain of a catís eye reflex i.e. a bright whitish shadow seen in eye especially in dark light. Thus presence of a white reflex in the eye needs an urgent/ detailed eye evaluation.
  6. Watering, photophobia (inability to open eyes in the bright light) associated with the haziness of the central portion of the eyes, or an associated bluish discolouration of the eyeballs may suggest the development of a congenital glaucoma. If treated early in infancy it can prevent permanent visual loss due to damage to the nerve of the eyeball.
  7. Children with squint (deviation of the eyeballs), shaking of the eyeballs or tendency to keep the head to one side may have a problem with the eye movements. Such conditions may be signify an underlying eye or brain problem. As we noted above, squint may also be a late presentation of conditions like cataract, refractive error, lazy eye, etc.
  8. An exceptionally fair skin and hair along with shaking of the eyeballs may suggest albinism, a condition characterised by the absence of the pigment responsible for skin, hair and eyes. Such children also usually have a photophobia and difficulty in vision.
  9. Photophobia (inability to open the eyes) can be a symptom of the underlying glaucoma, infections of the eye, albinism and other retinal conditions. An early examination may help diagnose these conditions early and maximise the visual potential of the child.
  10. Asymmetry of the two eyes may signify the presence of a difference in the size of the eyeballs or a difference in the eyelid position. This falling of the upper eyelid (ptosis) may be by birth or may occur following an eye injury. It can usually be corrected by a small surgical procedure, however, if left untreated can lead to development of a special refractive error or lazy eye.

An early detection and prompt referral of the children with abovementioned conditions may help the children get a timely treatment. We hope that this article shall enable the parents, teachers and relatives to recognise the common eye conditions in children and help them get necessary eye examination and treatment early in the course of the disease.