Pediatric ophthalmology

Pediatric ophthalmology refers to eye medicine for children and involves early recognition of possible eye conditions. Especially regular preventative examinations of children’s eyes carried out by eye doctors are an important aspect of general pediatric prophylaxis. As children tend to dislike having their eyes examined, ophthalmological tests are a challenge which need to be tackled with methods appropriate for children.

What is pediatric ophthalmology?

Pediatric ophthalmology is the field of eye care for children that aims to detect potential eye diseases as early as possible. Above all, periodic preventive eye checkups in early childhood, conducted by an ophthalmologist, play an important role in general preventive eye care for children. For example, this entails testing the eyesight, evaluating the position and the mobility of the eyes. Early diagnosis of visual defects is extremely important, because the corresponding nerve pathways in the brain are already being formed in childhood, and correcting a lacking or defective nerve formation in later life is problematic. As a result, permanent functional restrictions of the visual capacity can arise.

Which eye problems occur in children?

The typical eye disorders in childhood include strabismus and defective vision in one of the eyes, also known as amblyopia. A defective vision of both eyes, requiring eyeglasses, is also diagnosed and treated by pediatric ophthalmology.

Besides the above-mentioned visual impairments, sometimes more severe eye problems may attract the attention when examining children. An obstruction of the lacrimal duct may occur in babies and toddlers, which is corrected by flushing the lacrimal duct or in some cases by surgery.

In contrast, urgent treatment should be provided if the intraocular pressure increases (referred to as glaucoma) and in cases of infantile detachment of the retina. Prompt action in these cases is necessary to preserve vision. Also congenital cataract, characterized by a clouding of the lens and therefore a reduction of vision, needs to be treated by cataract surgery at an experienced center. Among the malignant diseases of pediatric ophthalmology is retinoblastoma, a rare tumor of the eye that arises from the cells of the retina.

What is vision school and how is it done?

Vision school provides preventive eye examinations for children of infant and preschool age. Nowadays, the term "vision school" is seen as rather outdated and frequently replaced by orthoptics, which means "correct" or "straight" vision.

Vision school investigates the interaction of the two eyes and focuses on discrepancies such as strabismus, eye tremor or visual impairment.  

Vision can be checked by means of different examination methods. Trained orthoptists make use of charts with letters and numbers of different sizes, but also rings and symbols of different sizes or child-appropriate designs such as animals. Near and distance visual acuity, three-dimensional vision, color vision and pupillary response are tested.

For a more detailed examination of a cross-eyed child, the so-called cover test is performed, which involves covering one eye and observing the second eye more precisely. Later on, a more specific test can be performed to establish the angle of the strabismus.

During the fixation test, an illuminated star is projected onto the retina to detect potential abnormalities in the shape of the symbol. Regarding the glasses, the shadow test can be done to find the right strength. The direction of the light on the retina can be interpreted as an indication of the strength of the glasses. Children are given eye drops to dilate and relax the pupil so that the examination can be performed.

Which eye diseases in children need surgery?

In cases of amblyopia, occlusion therapy of the healthy eye can be used to exercise the weaker eye and prevent long-term damage. But in children with very marked strabismus, surgery to correct the problem may be performed by moving or shortening the eye muscles responsible for the problem. Infantile cataract usually requires surgical therapy to preserve the child's vision. This involves suctioning out the lens and replacing it with a contact lens or inserting a special artificial lens, based on the age of the child.

Childhood glaucoma requires immediate surgical treatment and can be corrected by trabeculotomy. During this procedure, the outflow of aqueous humor is eased by the an incision made within the trabecular meshwork. Retinal detachment also demands urgent treatment, as it often progresses rapidly in children and can lead to blindness. Operative treatment may include suturing on a silicone patch, which works like a band-aid. Moreover, the tears of the retina can be sealed by a laser, but this usually requires the previous removal of the vitreous body.

On the other hand, childhood eye cancer requires more radical approaches, based on the stage of the disease. If retinoblastoma is present on only one side, typically the affected eye is removed. In addition, radiation therapy or chemotherapy may be administered. In the case of tumors in both eyes, doctors generally try to preserve at least one eye, although this is only possible if the tumor is diagnosed at an early stage.

What are prognosis and chances of cure like in pediatric ophthalmology?

A child's prognosis strongly depends on the nature of the disease. For many eye diseases, early diagnosis and initiation of treatment can lead to a long-term satisfying outcome. This is why preventive examinations in childhood are extremely important.

Which doctors and clinics are specialists?

Ophthalmologists and specially trained orthoptists carry out the necessary tests, the treating ophthalmologists develop a therapy concept and perform necessary control examinations. Surgical interventions on the eyes are carried out by specialized eye clinics.

Let us help you to find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in pediatric ophthalmology and are looking forward to your inquiry or wish for treatment.