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Paediatric ophthalmology

Milestones of eye examinations in children
Signs and behaviour requiring an eye examination
How to prepare the child for the visit

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Paediatric ophthalmology

What you need to know

Milestones of eye examinations in children
  • In the days following the birth for infants whose screening examination by the paediatrician at the day-care centre reveals a suspicion of a major eye disease such as congenital cataract, retinoblastoma, congenital glaucoma or elevated refractory defects.
  • Within the first year for the evaluation of more serious diseases such as congenital cataracts, congenital glaucoma and retinoblastoma, a tumour that affects children in the first two years of life.
  • between 24-36 months of life to assess whether amblyopia, the so-called lazy eye, is present (2-3% of children under 5 years of age suffer from it) and intervene early to allow proper development of visual acuity.
  • between 5-6 yearsof fundamental importance, before or during the first year of primary school
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Signs and behaviour requiring an eye examination
    • reddened eye;
    • profuse lacrimation, mucous or purulent discharge;
    • suspected strabismus;
    • abnormality of eyelid position (eyelid ptosis);
    • large or small eyes;
    • pupils of different shapes or diameters;
    • white pupil reflection;
    • Tendency to bring objects closer to the face and to get closer to the television set with a feeling of difficulty in seeing distant objects;
    • abnormal position of the head;
    • closing one eye in the light or during observation;
    • discomfort in the light;
    • frequent blinking associated with itching;
    • nystagmus (irregular shaking of the eyes);
    • absent gaze;
    • lack of reaction to light stimulus;
    • difficulty following moving objects after the age of 3 months;
    • frequent headache;
    • difficulty recognising colours (after the age of 5);
    • difficulty in colouring while respecting the edges of the figures.

 

Before school
The psycho-physical effort that the child puts into school is considerable and visual efficiency is crucial to optimise this high energy consumption.
Parents must be able to pick up on certain signals that may come directly from the child or indirectly from teachers and classmates. For example, the abnormal position of the head, which is bent slightly to one side, or the tendency to carry the head backwards by raising the chin or conversely downwards, or holding the pencil with excessive force and putting the paper at an angle; indirect signals are reported by teachers to whom the child often asks what is written on the blackboard. Children with learning difficulties should have an eye examination before embarking on courses that highlight more complex problems such as dyslexia or attention deficits.

 

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How to prepare the child for the visit

I recommend psychologically preparing the child before the eye examination so that he does not experience it as a stressful moment, explaining to him that the doctors will play games with him with drawings and lights, that it will be fun and not painful, and that at the end of the examination they will put drops in his eyes (cycloplegia to assess visual defects by dilating the pupil and releasing accommodation).
A positive attitude helps to create a relationship of trust between the child, the parents and the ophthalmologist and his staff for future check-ups. It is advisable to maintain an annual frequency even in the case of normal eyesight as the child's eye is constantly changing like the rest of the body.
If glasses or contact lenses are prescribed, it is important that they are used constantly.
The lenses of the spectacles must be made of polycarbonate to withstand the very frequent shocks at this age.
In special cases such as unilateral high myopia that cannot be corrected with contact lenses, it may be resolvable from the age of 7 onwards with laser refractive surgery.

Myopia, astigmatism, hypermetropia associated with possible strabismus should be followed up by the ophthalmologist frequently to optimise visual and learning development at school.

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