Watery eyes in a newborn can be due to neonatal conjunctivitis, nasolacrimal duct obstruction (NLDO) or congenital glaucoma. Sometimes watery eyes in a young child can be caused by seasonal allergies.
Tears flow out from the eye through the nose via a tear duct called the nasolacrimal duct which opens into the inferior meatus of the nasal cavity. The opening is partially covered by a mucosal fold called valve of Hasner which usually disappears several weeks after birth.
NLD obstruction is quite common, about 1 in every 20 babies born is present with this condition.
The infection results from stagnation of bacteria in the warm, moist environment of the lacrimal sac. Enlargement and abscess formation may occur in the lacrimal sac in infants with dacryocystoceles.
The majority of infants with NLDO spontaneously improve during the first several months of life.
Digital massage of the lacrimal sac (Crigler’s massage) is commonly recommended. The goal of the massage is to force fluid through the distal NLD and cause the obstruction to open. If massage is used, it is important to use proper technique, which requires direct digital pressure over the lacrimal sac. The presence of mucopurulent reflux through the puncta indicates that pressure is being applied appropriately. It is not necessary to stroke the finger in a downward motion over the lacrimal sac as commonly taught; compression of the lacrimal sac is the only requirement to proper massage. Many a time parents don’t perform the massage correctly and often get frustrated with its efficacy. A topical antibiotic is recommended if there is significant discharge.
If children do not improve with time and conservative measures fail, surgical treatment is indicated. NLD probing has a fairly high success rate if done within 9 months of birth. In an older child probing is always attempted, if unsuccessful a dacryocystorhinostomy (DCR surgery) should be performed.
Refractive errors are one of the most important causes of visual impairment in children.
Uncorrected refractive errors can lead to poor vision, quality of life, and scholastic achievement in academics and extracurriculars. It could also lead to inattentiveness and problems like amblyopia or lazy eye and strabismus or crossed eye. A successful correction of a refractive error ensures normal development of binocularity and stereopsis.
One of the most common treatment modalities in children involves the use of spectacles. However, spectacle correction though simple is not straightforward. To achieve a satisfactory correction one should consider an individualised approach.
Important factors that need to be considered while prescribing glasses are the child’s age, type and magnitude of refractive error, amount of anisometropia, and presence of amblyopia or strabismus.
An infant’s world is confined to nearby objects, as a result uncorrected hyperopia is more detrimental than myopia in infants. Very high myopia or can be associated with amblyopia. Kids often get used to these types of vision problem, and might not mention it to their parents. As a result, their amblyopia might not be diagnosed for months or even years, while parents chalk up poor grades or clumsiness to a child not being academically or athletically gifted.
Commonly known as lazy eye, it is a condition where due to many reasons the eye does not acknowledge the images seen.
During the critical period of growth (birth to 6 years old), both eyes must receive clear vision. Anything that interferes with clear vision, like an uncorrected refractive error, will result in amblyopia or anisometropic amblyopia. This is a neurologically active process and results in suppression of the image with a permanent decrease in vision that later cannot be corrected by glasses or any form of treatment.
Early detection and treatment by using glasses, drops and patching offers some of the best outcomes.
If the amblyopia is because of a squint, muscle surgery to improve the alignment of the eyes may be an option.
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