Author: Boston Eye Physicians and Surgeons

As new parents you have a constant cycle going: cry, feed, change, burp, comfort, and the cycle goes on for what may seem like a sleep-deprived level of infinity. There are so many things to do and worry about. Worrying about your child’s eyesight should be on your radar but not cause you more sleepless nights.  Here are a few things to be aware of when it comes to your infant and his/her vision.

There are a number of common childhood diseases and disorders to be on the look out for in the early months that you should bring to the attention of your pediatrician.

Conjunctivitis (Pink Eye)

This very contagious eye disease is notorious for causing red, itchy, crusty eyes in infants and young children. Usually the pediatrician can prescribe ointment or drops to clear up a bacterial infection. If it is viral in nature, waiting it out is usually the best course of action. If you notice pink eye in your infant, or if the condition worsens, you’ll want to get treatment immediately. Warm compresses can also greatly alleviate the pain from conjunctivitis in infant cases.

Clogged Tear Ducts

It’s common for newborn tear ducts to clog and for tears to overflow onto a baby’s cheeks, or crusty build up to occur in the corners of the eyes. Keeping your infant clean is important for eye and ear health. Again, a warm cloth compress can help but if the pus drainage and crusting last throughout the day, call your doctor.

Crossed Eyes

Many babies cross their eyes because the muscles that control the eyes are still weak and underdeveloped. However, if your child is 4 months old or older and frequently cross-eyed, or if it occurs at the same time each day or during the same activity, an eye exam is warranted. You will want to correct your infant’s vision while they’re young so this problem does not continue throughout life. Glasses can be made to train this muscle of the eye, and strengthen vision to correct their eyes to see straight. Ask your eye doctor about crossed eyes in your infant, and take care of  this eye issue before it becomes an issue.

Eye Sty

A sty looks like a red, sore lump near the edge of the eyelid; it is caused by an infected eyelash follicle. These can be extremely painful and irritating for babies. When you notice your infant crying often, touching their face, and clearly irritated, check the eye areas for these red sores. If you notice something even remotely sty looking, call your eye doctor before this gets any worse! Your eye doctor can tell you about treatment methods and relief of pain for your infant.

Amblyopia (Lazy Eye)

Amblyopia is a term used to mean poor vision in an eye that has not developed normal sight (usually during early childhood). It occurs when visual acuity is much better in one eye than the other. Amblyopia is common and affects two or three of every 100 people in the U.S. Again, discuss your observations with your doctor. They may recommend an eye appointment for further evaluation.

Ever feel like the lights are too harsh or bright?  Does the sun’s glare really bother you?  Do the florescent lights at work cause you to squint and give you a headache?  There is a chance that you may be photophobic. Sensitivity to light, the inability to tolerate light, is medically known as photophobia. For someone with this type of sensitivity, any type of light source, whether it is sunlight, fluorescent light, or incandescent light, can cause discomfort. What are the symptoms of this disorder? What causes it? What can possibly help? Let’s take a closer look.

What are the symptoms of photophobia?

Photophobia typically causes a need to squint or close the eyes. Some people may develop a  headache, nausea, or other symptoms that may be associated with photophobia

What causes this disorder?

While the origin and management of light sensitivity remain elusive even today there are some common conditions that can be related to photophobia. For example:

• Migraines – Migraines are headaches that can be triggered by a number of factors, including hormonal changes, foods, stress, and environmental changes. Photophobia is a common symptom of migraine headaches. Many people report needing to be in a dark room with something shielding their eyes to receive any comfort.
• Brain Conditions such as: Encephalitis, Meningitis or Subarachnoid Hemorrhage. Light sensitivity is commonly associated with a few serious conditions that affect the brain. Due to inflammation, bleeding or an infection in the brain, light sensitivity may result. Treatment for these disorders may help photophobia.
• Eye Disorders such as: Dry Eye Syndrome, Conjunctivitis, Corneal Abrasion or Scleritis. These eye disorders that should be examined and diagnosed by your eye doctor and treated for the root cause, not just the symptom of light sensitivity associated with it.

What can help?

While there is no definitive cure, yet, there are some steps you can take to help alleviate the discomfort of photophobia.

Home-care – Stay out of the bright light when you are most affected. Use tinted glasses that can protect you from damaging rays of the sun and provide some protection from the glare and painful brightness.

Medical treatment – The type of treatment you need will depend on the underlying cause. Types of treatment include:

• medications and rest for migraines
• eye drops that reduce inflammation for scleritis
• antibiotics for conjunctivitis
• artificial tears for mild dry eye syndrome
• antibiotic eye drops for corneal abrasions
• anti-inflammatory medications, bed rest, and fluids for mild cases of encephalitis; severe cases require supportive care, such as breathing assistance
• antibiotics for bacterial meningitis; the viral form usually clears up on its own within two weeks
• surgery to remove excess blood and relieve pressure on your brain for subarachnoid hemorrhage

Heading off to a doctor’s appointment can be an anxiety-ridden event for many people.  Going to the eye doctor should not induce stress and nerves however, if you know what to expect.  Eye exams are fairly straightforward and usually involve minimal discomfort.  Let’s take a look at what you can expect from a typical eye exam.

A comprehensive eye exam can take about an hour or so depending upon the tests your optometrist or ophthalmologist wants to perform.  These may include:

• Visual Acuity Exam – One of the initial tests your doctor will perform will be an examination of the sharpness of your vision.   These types of tests are usually performed using a projected eye chart to measure your distance visual acuity and a small, hand-held acuity chart to measure your near vision.
• Screening for Color Blindness – In addition to detecting hereditary color vision deficiencies, color blind tests also can alert your eye doctor to possible eye health problems that may affect your color vision.
• Retinoscopy – This test can give the doctor an approximation of what your prescription for your eye glasses will be.  Usually it involves looking at a chart and examining whether the letters/numbers look sharper in one lens or the other.
• Refraction – This is the test that your eye doctor uses to determine your exact eyeglass prescription. During this test an instrument called an instrument called a phoropter in front of your eyes and shows you a series of lens choices. He or she will then ask you which of the two lenses in each choice looks clearer. Or the doctor may use an autorefractor or aberrometer to automatically determine your prescription.
• Slit Lamp or Biomicroscope Exam – This allows your eye doctor to get a highly magnified view of the structures of your eye to thoroughly evaluate your eye health and detect any signs of infection or disease.
• Glaucoma Test – There are a couple different ways your doctor could examine your eyes for glaucoma.  One is the well-known “puff of air” test and the other is the  exam using numbing eye drops and the applanation tonometer, which will measure the pressure of the eye.
• Pupil Dilation – Your doctor may choose to dilate your pupil to get a better look at the structures of your eye.   Dilation will make your eyes sensitive to sunlight so you may want to bring sunglasses.

Has your child begun to have trouble seeing the board at school or squints at the TV or movie screen?  Do street signs and people’s faces seem out-of-focus or blurry until they get a bit closer?  If you or your child are experiencing any of these symptoms, you may be suffering from a medical eye disorder known as myopia – also known as nearsightedness. Nearsightedness is a very common vision condition affecting nearly 30 percent of the U.S. population. Let’s examine this prevalent eye disorder including: symptoms, causes and treatments.

Nearsightedness –

This disorder allows for clear vision for objects that are near but blurry vision for items that are further away – thus the name nearsighted.  People who are afflicted with this may notice blurred vision or fuzzy vision, and possibly experience eye strain headaches.

Causes- 

The main cause of nearsightedness is the excessive curve or shape or the cornea directing the image not squarely on the retina.  As a result, the light entering the eye isn’t focused correctly and distant objects look blurred. Some research finds that nearsightedness is inherited from relatives who also experienced this eye disorder.  Other research shows evidence that eye strain and too much close work is to blame for this disorder.

Treatments –

• Corrective Lenses – After a comprehensive optometrist examination glasses or contact lenses may be prescribed for patients experiencing this blurriness. Depending on the amount of nearsightedness, you may only need to wear glasses or contact lenses for certain activities, like watching a movie or driving a car. Or, if you are very nearsighted, they may need to be worn all the time.
• Surgery – Laser Surgery – Reshaping the curve of the cornea is possible in some cases of nearsightedness and will result in no corrective lenses being needed. Refractive surgery procedures are also now available. These procedures involve implanting a small lens with the desired optical correction directly inside the eye.

You start to notice it slowly.  The fine wrinkles at the corner of your eyes.  The hairs that look like they might be gray.  And the reading material that looks blurry.  Growing older has it’s downside for sure.  While we can’t help you with the wrinkles or the hair we can tell you what might be going on with your vision.

If you find that the morning newspaper needs to be held further and further away to be clear or the text in your book looks blurry then you may have Presbyopia.  Presbyopia is the gradual loss of your eyes’ ability to focus on nearby objects. It’s a natural, often annoying part of aging. Many people become aware of presbyopia when they start holding books and newspapers at arm’s length to be able to read them. A basic eye exam with your eye doctor can confirm presbyopia.

What are the Symptoms of Presbyopia?

The American Optometric Association explains the main signs that you may be developing presbyopia. . .

• Holding reading materials at arm’s length
• Blurred vision at normal reading distance
• Eye fatigue
• Headaches when doing close work (sewing, handwork, reading, computer work)

What Causes Presbyopia?

As we age, the crystalline lens in the eye that bends the light in order to hit the retina loses elasticity. As your lens becomes less flexible, it can no longer change shape to focus on close-up images. As a result, these images appear out of focus.  Its effects can begin suddenly, usually around age 40, and can worsen over time.

How common is this and what are the risk factors involved in developing Presbyopia? 

This eye disorder is extremely common.  Millions of Americans report having Presbyopia.  The largest grouping are people over the age of 40.  Age is, in fact the greatest risk factor in developing presbyopia.  Almost everyone experiences some degree of presbyopia after age 40. Having other medical conditions can also be a factor leading to this.  For example, being farsighted or having certain diseases — such as diabetes, multiple sclerosis or cardiovascular diseases — can increase your risk of premature presbyopia, which is presbyopia in people younger than 40. Finally, certain medications are also associated with presbyopia.  For instance antidepressants, antihistamines and diuretics can be factors in premature presbyopia.

What are the Treatments for Presbyopia?

Eyeglasses are the simplest and safest means of correcting presbyopia. Eyeglasses for presbyopia have higher focusing power in the lower portion of the lens. This allows you to read through the lower portion of the lens and see properly at distant through the upper portion of the lens. It is also possible to purchase reading eyeglasses.For people who already wear eyeglasses bifocals may be an option.  Talk to your eye doctor about what options may be available for your unique eyes.

The National Institute for Heath and the Mayo Clinic both describe a retinal detachment as an emergency situation in which a critical layer of tissue (the retina) at the back of the eye pulls away from the layer of blood vessels that provides it with oxygen and nourishment. This lack of oxygen leaves the cells at risk and possible vision loss in the affected eye.  For this reason, if you suspect that the symptoms listed below are happening to you please contact your doctor immediately.

Warning Signs of a Retinal Detachment –

• Appearance of floaters (bits of floating debris through your field of vision). They may look like string, dots or webs.
• Flashes of light in the affected eye.
• Shadow or dark area in field of vision. (Think of it as a curtain coming down.)

Types of Retinal Detachments –

• Rhegmatogenous – This most common type of tear or detachment and happens when liquid gets under the retina and separates it from the retinal layer.
• Tractional – This type is caused by scar tissue on the retina.  As it retracts and causes the detachment.
• Exudative – Often caused by retinal disease, this type of detachment is often caused by an injury or trauma to the eye.

Causes of Retinal detachment can be a number of things including:  a trauma to the eye, advanced diabetes, an inflammatory disease or shrinkage of vitreous. People who are at a higher risk for this event are: over 40 years old, have extreme myopia, have a history of retinal detachment, previous cataract surgery and/or an eye trauma.

Treatment Methods – Most tears and detachment can be treated with laser surgery or a freeze treatment called cryopexy. These procedures are usually performed in the doctor’s office. During laser surgery tiny burns are made around the hole to “weld” the retina back into place. Cryopexy freezes the area around the hole and helps reattach the retina.

If any of these symptoms are happening seek immediate medical help.

Ever been at the beach gotten sand in your eyes?  Or had a grandchild poke you in the eye inadvertently?  Or possibly, have you had a piece of debris get caught in your eyelash only to hurt your eye when you try to rub it out?  Any of these things, although they may seem minor, could lead to a corneal abrasion.  Let’s look at corneal abrasion causes, symptoms and treatment methods.

To understand what a corneal abrasion is first you must understand a little about the parts of the human eye.  The cornea is the clear, protective covering over the iris, which is the colored part of the eye, and the pupil — the black circle in the middle of the eye. The cornea is important for both vision and protection of the eye.  A corneal abrasion  then, is a scratch on that outermost covering of the eye.  Common causes include: being poked in the eye (makeup or finger), getting debris in the eye, aggressively rubbing the eye, bad hygiene with contacts, or potentially chemical burns.  If any of these events or circumstances have happened and you are experiencing pain and discomfort then you may have a corneal abrasion.  Symptoms that may also give evidence to this include:  tearing of the eye, feeling like something is in your eye, redness, eye pain, stinging or even blurred vision.

No one likes having something in their eye or even the feeling like something is in the eye.  One of the most important things to remember, should this happen to you, is NOT to rub the eye.  This could lead to the abrasion or cause more damage.  instead let the eye water to flush debris out, pull the top eyelid over the bottom eyelid and allow for watering or gently wash the eye with warm water.  If this does not rid your eye of the symptoms and pain see your doctor.

If your eye doctor believes you have suffered a corneal abrasion he/she may give you eye drops or ointment to prevent infection and to stop the pain.  In the case of a minor corneal abrasion the scratch will most likely heal on its own.  Larger or deeper scratches make take longer to heal and will require a patch, discontinued use of contacts and shaded glasses to shield the eye.

Do you experience small moving spots that appear in your field of vision?  Do you notice these “floaters”  more when there is bright light or the background is a solid color like a blue sky or a solid white wall?  Then you may be experiencing eye floaters.  While these shadows or spots may be annoying at times they rarely interfere with good vision.  Lets look at what these floaters are and what may be causing them.

What are Floaters?

According to the Mayo Clinic, Floaters are  spots in your vision. They may look to you like black or gray specks, strings or cobwebs that drift about when you move your eyes and appear to dart away when you try to look at them directly. Symptoms may include: spots of black or grayish blobs, spots that drift through your field of vision, spots that move when your eyes move, or possibly squiggly lines that are fairly transparent.

Causes of Floaters

Eye Floaters are usually caused by small flecks of a protein called collagen. The most common causes of these flecks of protein include:

• Age-related eye changes- As we age the vitreous jelly that fills our eyeballs begins to liquify.  As the vitreous shrinks and sags, it clumps and gets stringy. Bits of this debris block some of the light passing through the eye, casting tiny shadows on your retina.
• Inflammation – This swelling at the back of the eye called the uvea  may be causing the floaters to appear.
• Bleeding in the eye. Bleeding into the vitreous can have many causes, including injury and blood vessel problems. Seek immediate medical attention of floaters appear after a blunt injury to the eye.
• Torn Retina – Retinal tears can occur when a sagging vitreous tugs on the retina. Without treatment, retinal tear may lead to retinal detachment. Due to this more serious cause it is imperative to see a doctor if you are suddenly getting many more floaters than usual.  It is also important to immediately seek medical help if these floaters not only increase in numbers and frequency but also are accompanied by flashes of light.  Retinal tears are sight threatening conditions that should be treated immediately by an eye doctor.

We know we don’t want to plan for emergencies to happen, but there’s nothing more important than being prepared in the case they do occur. Eye emergencies can happen anywhere. You could be at home, at work, at school, or doing chores.

Common Occurrences Of Emergency Situations

• While spring cleaning, cleaning solution gets accidentally sprayed in your eye.
• Your son is pitching the game of his life until the batter hits a ball directly at his face and his eye is completely swollen shut.
• A day at the beach turns painful when the wind picks up and the sand gets lodged in your eye causing pain and blurred vision.

Eye Emergencies Can Include:

Eye emergencies range from cuts, scratches, objects in the eye and burns, all that way to chemical exposure, and blunt injuries to the eye or eyelid. An eye emergency, therefore, could be any event where a person’s eyesight is at risk.

It is extremely important to seek medical attention for any eye/eyelid injury or problem.

When To Seek Immediate Care:

Seek IMMEDIATE emergency care if you believe your eyesight is in jeopardy, if you are in severe pain, or if you have any of the following symptoms:

• Sudden vision loss
• Pain in or around the eye redness accompanied by pain in the eye.  This could be from an unknown cause or from a blunt injury to the eye area.
• Halos (colored circles around lights)
• New floaters (spots, strings, cobwebs, or shadows before the eyes)
• Bulging of the eye or swelling of eye tissues.
• Flashes or streaks of light
• Double vision
• Sudden crossed, turned or “wandering” eye
• Bleeding of the eye. discharge, crusting or excessive tearing
• Eyelids stuck together, especially upon awakening
• Stinging or burning in the eye
• The intense sensation of something in the eye
• Pupils of unequal size
• Headaches and strains

Tips from the US National Library of Medicine:

After calling the doctor or ambulance, depending upon the severity of the problem, you may want to consider the following tips from the U.S. National Library of Medicine.

Small Objects In The Eyes

Try not to itch or rub the eye.  Try gently rinsing the object out with water. Seek medical attention to remove the object whether it is large or small.

Chemical Exposure

Flush with cool tap water right away. Turn the person’s head so the injured eye is down and to the side. Holding the eyelid open, allow running water from the faucet to flush the eye for 15 minutes. If the person is wearing contact lenses have them remove them after the water rinse.  Seek medical help right away. Do not delay.

Blunt Force Injury To Eye

Apply a cold compress or eye pack to the area to bring down the swelling.  Seek medical attention to be sure the eye is not injured. 

Most new parents spend countless hours looking into the eyes of their newborn or toddler enjoying the delight or wonder they see in them.  Sometimes, however, parents notice something other than delight.   They may notice a wandering of one eye, or eyes that don’t appear to work together.  If this is noticed beyond the first few weeks of life, a check by your Primary Care physician may be in order.  He or she may refer your child to a specialist in eye conditions (ophthalmologist or optometrist). Lazy eye is one possibility for this “wandering” especially if the baby was premature, had low birth weight or it runs in your family. Let’s look at the causes and potential treatments for children diagnosed with Lazy Eye.

Main Causes Of Lazy Eye

There are three common causes of Lazy Eye.

• Strabismic – this very common cause of lazy eye is caused by an imbalance in the muscles responsible for positioning the eyes.
• Deprivation – this occurs if there is a problem with one eye, such as a cloudy area in the lens (cataract). This “deprives” the child of clear vision in the eye.
• Refractive – This is the result of a significant difference in the vision in each eye.  This might be caused by nearsightedness, farsightedness or an imperfection on the surface of the eye (astigmatism).

Treatments For Lazy Eye

Ideally, a lazy eye will be diagnosed in childhood to increase the success of treatment.

• If the condition is caused by significant differences in sight such as near or farsightedness in the two eyes then corrective lenses may be in order.
• For children with one weak eye, a patch over the stronger eye may help build up the vision in the weaker one.  This is especially helpful in children over 4.
• Eye drops to blur the vision of the stronger eye to help strengthen the weaker one are also available.  A daily or twice-weekly drop of a drug called atropine can temporarily blur vision in the stronger eye. This will encourage your child to use his or her weaker eye and offers an alternative to wearing a patch.
• Surgery may be needed to repair eye muscles if your child has crossing or wandering eyes.  Your child may also need surgery if he or she has droopy eyelids or cataracts.

Are Your or Your Child Experiencing Trouble With Lazy Eye?

Contact BEPS for a consultation. We can discuss the best practices for getting both eyes as strong and healthy as possible. Reach out to us today!