1. Child Eye Care and Squint: What we all should know?
Dr Hemant D Anaspure
Assistant Professor
Dept of Ophthalmology

2. Childhood Blindness

3. Childhood blindness
Globally approx 1.4 million children who are blind1
2/3rd live in developing countries
The prevalence of blindness approx 0.3 – 1.2 /1,000 children2
40%of the blindness in children is avoidable
1. World Health Organization, Geneva. Global Initiative for the Elimination of Avoidable Blindness. Geneva WHO/PBL/97.61
2. Gilbert C E, Foster A. Childhood blindness in the context of VISION 2020 Ð The Right to Sight. Bull WHO 2001; 79:

4. What we can do?

5. The Eyes Don't See
What the Mind Don't Know
The Eyes See
What the Mind Know

6. Amblyopia
(Lazy
Eyes)

7. Amblyopia
Amblyopia or "lazy eye" is weak vision or vision loss in one or both apparently normal eyes that cannot be fully corrected with lenses
Causes: Anisometropia, Squint, High refractive error in both eyes, Visual deprivation due to congenital cataract, glaucoma,corneal opacity

9. What we should know?
Amblyopia is one of the most common causes of visual impairment in both children and adults 
Prevalence 0.2% - 12% (average 2-3%)
Failure to develop binocular vision and prevent the individual from pursuing certain occupations
Amblyopia increases the chances of blindness in the healthy eye, mostly from trauma

10. Fortunately , completely treatable cause of blindness
Timely diagnosis and treatment is
key for successful treatment
Using glasses at early age can
prevent amblyopia in many cases
Best age for treatment is < 8 years
(Max 16 years)

11. Refractive Errors in Children

12. Refractive Errors in Children
Refractive errors occur when the shape of the eye prevents light from focusing directly on the retina
Types
- Myopia
- Hypermetropia

13. Factors:
Length of the eyeball (Axial Myopia/Hypermetropia)
Shape of the cornea (Astigmatism)
Refractive power of lens (Index)

14. What we should know?
Wandering eye moments, no response to mother’s face or attractive colourful objects, shaking of the eyes by 3 months
Watching TV from too close distance, frequent eye rubbing, holding books close to face, squinting, poor academic performance Think of glasses
All children should have one vision screening between 3 to 5 years

15. What we should know? Myths about glasses
If your child wear glasses all the time, the number will reduce
Your child watches too much T. V. and hence has glasses
With Plenty of vegetables and drinking carrot juice his number should go away
Vitamin A tablets help increase eye power
Using glasses will make him habituate

16. Squint

17. Squint
While one eye looks straight ahead, the other eye is turned either inwards or outwards. This is called a squint.
Major types
Esotropia
Exotropia

18. What we should know? Effects:
Children can lose stereopsis / binocularity
Loss of vision in the crossing eye (amblyopia)
Loss of confidence and self esteem
Depending on cause, treatment varies from glasses to surgery
In infantile cases, best time for surgery is less then 2 years of age to restore binocularity

19. What we should know?
Keep in Mind : Retinoblastoma can present as squint at early age ….

20. Retinopathy of Prematurity (ROP)

21. Retinopathy of Prematurity

22. Retinopathy of Prematurity
The incidence of ROP in India 38 – 51.9 % in low birth weight infants
Annual live births in India approx 26 million
In India 8.7% of newborns birth weight < 2000 grams
Almost 2 million newborns are at risk for developing ROP

23. What we should know?
Birth weight have an inverse relationship with development of ROP
NNF Criterias
In whom: . < 34 weeks / Birth wt < 1750gms
. 34 – 36 weeks / Birth wt 1750 – gms with risk factors
When : Born > 28 wks : 4 weeks
Born < 28 wk/ < 1200gms : 2 – 3 wks

24. What we should know?
The children have more chances of refractive errors and squint
Recommended follow up 6 months, one year, 3 years and 7 years

27. Retinoblastoma

28. Bruchner’s Test

29. What we should know?
Retinoblastoma is the most common malignant tumour of the eye occuring in childhood
White pupillary reflex is most common presentation
5 year Survival rate is > 95%
Early diagnosis helps not only to save life but to save eye and vision

30. Paediatric Cataract

31. Paediatric Cataract
A cataract is any cloudiness or opacity of the lens of the eye
White opacity seen in a child’s eye may be due to several reasons. The most common of all is cataract
Causes
- Heredity
- German measles
- Injury to the eye
- Steroids use

32. What we should know? Preventable and Treatable cause of blindness
Amblyopia sets in very early if not treated on time
Ideal time for congenital cataract
Unilateral < 1.5 months
Bilateral < 3 months
Requires long term follow up and treatment

33. Summary Amblyopia : Timely intervention is key
Refractive error : One check up bet 3 to 5 yrs
Squint: Needs early treatment to restore binocularity
ROP : Screen any child < 2 kg birth weight
Retinoblastoma: White pupillary reflex is dangerous sign
Pediatric cataract: Don’t waste time

34. Child's future success depend on ability to see well
While most children have good vision, any vision problem needs to be caught early
Rarely will a child complain about his/her vision
Young children think that everyone sees the way they do

35. Thank You …..