Q&A: Kids' Eye Infections, Conditions & Allergies

We asked two local pediatric ophthalmologists – Jennifer P. Mullon, M.D., president of Lexington Eye Associates, and Melanie Kazlas, M.D., medical director of Boston Children's Hospital Ophthalmology at Massachusetts Eye and Ear Infirmary – to share their best eye-related information and advice on eye infection, conditions and allergies.


What are some serious eye symptoms parents should be concerned about?  

Mullon: Conditions for which prompt attention should be sought include any serious injury to the eye or eyelid, Herpes Simplex lesions of the eyelid, conjunctivitis associated with significant pain, a tense swollen red eyelid suggestive of cellulitis, or pain and redness associated with contact lens use. The sudden onset of vision loss in a child old enough to recognize this or the sudden onset of crossing of an eye or double vision also merit prompt attention. Conditions which present with findings, but not necessarily symptoms, include loss of the normal red reflex of the eye, or a white pupil. This may signify opacity within the normally clear tissues of the eye, such as a congenital cataract, a structural anomaly or, rarely, a tumor in the eye. Small amounts of pupil asymmetry are very common, but a significant pupil asymmetry (anisocoria), especially associated with a lid droop (ptosis) should be evaluated, as should abnormal rhythmic eye movements (nystagmus) during infancy. Light sensitivity, tearing and an unusually large eye can be signs of infantile glaucoma.


What are some common acute eye problems in kids?

Mullon: Conjunctivitis (pink eye) can be caused by infection, allergy, chemical agents, mechanical problems (such as in-turned lashes rubbing the eye) – basically any irritant to the ocular surface. The most common form of conjunctivitis is viral, which is usually self-limited and does not require treatment, although it can be quite contagious and does warrant frequent hand washing and attention to hygiene. It usually does not affect vision and causes no long-term issues. Children with viral conjunctivitis should remain out of school until the eyes stop producing discharge. Tear duct obstructions are very common in infants, and usually present   during the first month of life as tearing or discharge of the eye. Fortunately, 90 percent of these obstructions resolve by the age of 1. Although we follow these infants from a young age, we typically do not intervene unless the symptoms persist beyond this period. A probing of the tear duct done under mask anesthesia is effective in relieving these obstructions most of the time.  Blocked tear ducts do not adversely affect visual development. *Ocular allergies are common at all ages, particular seasonal allergies. These present as itchy, red, watery eyes, often with a scant discharge. The symptom of itch is the key to differentiating this condition from other causes of red eye. There are a number of ways to handle these symptoms, from simple artificial tears, to over-the-counter allergy drops, prescription allergy drops, or in some cases, steroid drops.




Should parents be concerned about frequent eye blinking?

Kazlas: Eye blinking may indicate that something is irritating the eye, perhaps a foreign body or some dust or an eye allergy or even dry eyes. If the eye exam is normal, it could indicate a behaviorism like a tic, which the child usually outgrows. If the eyelid blinking is accompanied by facial grimacing or uncontrollable facial movements, this could indicate a more serious condition which should be evaluated by a pediatric neurologist.


Should they worry about crusty or goopy eyes?

Kazlas: If the discharge is yellow or green or foul smelling, or if the white of the eye is red, then this may be conjunctivitis.


What are the types of eye specialists that children typically see?

Kazlas: A pediatric ophthalmologist is a physician and surgeon who has a medical degree (MD), and has completed, typically 5 years of training after graduating from medical school. In the 5 years after medical school, he/she completes an internship, an ophthalmology residency, and a fellowship in pediatric ophthalmology and strabismus. Make sure your pediatric ophthalmologist is certified by the American Board of Ophthalmology and is a member of the American Association for Pediatric Ophthalmology and Strabismus. A pediatric optometrist is a doctor of optometry (OD) who can diagnose childhood eye problems, prescribe glasses, and offer eye exercises and vision therapy. In Massachusetts, pediatric optometrists can prescribe eye drops but not medicines by mouth.


Is it best to see an eye doctor trained specifically in pediatrics? If so, why?

Kazlas: Only an eye doctor who specializes in children and sees many children of all ages and developmental stages will be able to obtain the information needed to make an accurate diagnosis. A pediatric eye doctor often has a “toolbox” full of stickers, toys, entertaining videos and the ability to sing “Wheels on the Bus” or other children’s songs to make the experience of getting their eyes examined as pleasant as possible!


How is a glasses prescription determined for children?

Mullon: A prescription for glasses for all children is determined by an objective measurement of the refractive error, by a process called cycloplegic retinoscopy, which requires no input from the child other than looking at the instrument. This measurement is almost always taken after the pupils are dilated with drops, as this is the only way to accurately measure the refractive error in children.


Is it true that before a child becomes “nearsighted,” he first becomes “farsighted”?

Mullon: Most children are born hyperopic, or farsighted, by measurement because the eye is a smaller eye. They develop normal vision without the need for glasses because the young eye compensates well for average amounts of hyperopia. They generally do not need glasses for this, unless they have amblyopia or strabismus. As children grow, they become less hyperopic, and some of these children will eventually become myopic, or nearsighted, as preteens, teens or young adults needing distance glasses. 




If a child is prescribed glasses, how should they be worn?

Mullon: Glasses are prescribed for children for different reasons. In some children, the glasses are given to help control their alignment and keep the eyes straight, thereby promoting development of binocular vision and stereopsis. In other children, the glasses are given to maximize visual development. … Older children are given glasses to see better at distance, and these can often be worn part-time or as desired. These children see an immediate benefit to the glasses. Myopic (nearsighted) children become more myopic over time as the eyes continue to grow, and therefore they find a greater need for the glasses over time. … For children with poor vision in one eye, glasses are often recommended for polycarbonate protection of the remaining good eye. These should be worn in any situation in which injury has a potential to happen.


What are some factors to consider in choosing eyeglasses for kids?

Mullon: Glasses should always be fit by a licensed optician, particularly glasses for young children. They should not be ordered on-line. It is important that the visual axis of the lens is in the correct position for proper visual development. They should sit well on the bridge of the nose, which is often challenging in young children. Straps behind the head, or temples which curl behind the ear are often helpful in toddlers. It is mandatory that glasses for children be made of impact-resistant polycarbonate or equivalent safety material.


What is astigmatism?

Mullon: Astigmatism usually refers to a cornea with a steeper curve in one direction and flatter curve in the opposite direction. It can be compared to the shape of the side of a football, which is curved differently end-to-end than it is around the middle, as opposed to a basketball, which is the same curvature all the way around. Astigmatism is measured by refracting the eye, the same process as measuring myopia or hyperopia. When glasses or contact lenses are made for astigmatism, a different power is ground in one meridian vs. the opposite meridian, to account for the difference in corneal curvature. People with significant astigmatism tend to have a blur of the image, or sometimes distortion. Significant amounts of astigmatism in young children can adversely affect visual development, and these children are placed in glasses at a young age to promote better vision.

For more information on children's eye health throughout childhood and deciding between glass and contacts, click here

Mary Alice Cookson is associate editor of Boston Parents Paper

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05 Feb 2014

By Mary Alice Cookson