Tears drain from the eyes through two tiny holes in the top and bottom lids into a little tear sac under the skin between the eye and the nose and then through a thin tube into the back of the nose. In almost 10% of babies the tear drainage tube (nasolacrimal duct) is not open at birth. These babies tend to develop a watery and sticky eye a few weeks after birth when they start producing a normal volume of tears and the tears have nowhere to go. In the vast majority of cases the duct opens without any intervention some time during the first year of life. The sac should be pressed gently two or three times a day to empty it of stagnant tears and all the stickiness should be cleaned away using saline or boiled (cool) water. No antibiotics are needed unless the eye gets red. If the wateriness persists beyond one year it starts to get less likely to settle spontaneously. For these babies we offer a simple probing procedure under anaesthetic to open up the drainage pathway and let the tears flow away.
If your child is prescribed glasses it may be for a variety of reasons. They may have poor vision, eyestrain symptoms, a squint that can be improved by glasses or a difference in prescription between the eyes which will lead to lazy eye (amblyopia) if not treated. If your child already wears glasses please bring them to the appointment so that vision can be checked with them on. We will be able to advise you whether a change is required. Children learn to see from birth until about 8 years of age. When young children are given glasses it is to promote normal visual development and so they should wear them as much of the time as possible to give the brain the best chance of developing good sight in both eyes. If your child is given glasses as part of the treatment of lazy eye they will need to adapt to them for several months before starting the second stage of amblyopia treatment which is usually wearing a patch (occlusion) on the good eye to force the brain to learn to use information from the weaker eye.
If your child seems not to see well or appears to have a squint (turn) in the eye do not delay and bring them for a test. Babies older than 4 months of age and children should be able to hold their eyes straight, and failure to do so can adversely affect the development of their vision.
If your child seems fine but someone in the family is affected by squint or lazy eye or needed glasses at a very young age then getting an eye test done at about age 3 years is sensible.
Children with no eye problems in the family and no general health problems should have a test at the age of about 4 or 5. This is often done at schools – check whether your school will be doing vision screening.
If your child has general health problems check with your paediatrician whether they need an eye test. Many children with developmental problems benefit from eye checks.
Most physicians examine the eyes during children’s medical examinations. However, they will refer children to someone who is a specialist in ophthalmology if they encounter any sign of amblyopia, difficulty in measuring vision, or if they suspect an abnormality of the alignment or structure of the eyes. It is recommended that all children have their vision checked by a paediatrician, family physician, or ophthalmologist by the age of three, or sooner (age six months to a year) if there is a family history of eye problems. Fortunately, ophthalmologists can perform a complete eye exam on children of any age.
Your child will first be seen by an orthoptist who is an expert in assessing what children can see and whether they are using their eyes together. Afterwards, eyes drops will be put in to make the pupils dilate (get bigger) and relax the focusing muscles of the eyes. These drops take at least 40 minutes to work and prepare the eyes for the next part of the appointment called refraction. Refraction uses lights and lenses to measure the optics of the eye so that correct glasses can be prescribed. This is usually done by the optician (optometrist) but may be done by the consultant. Finally the doctor will examine the eyes front to back, make a diagnosis and discuss the treatment options with the parents. Your child may be given eye drops or a glasses prescription, an operation may be recommended or we may be able to reassure you that no eye treatment is needed.
The effect of the drops lasts for 3-4 hours so it is advisable to bring some sunglasses for your child to wear when they leave, as they will find the bright sunshine slightly uncomfortable. Your child may have trouble focusing on near work until the drops wear off – if the child is returning to school the teacher should be informed.
Diabetes is first and foremost a disease that affects blood vessels all over the body, including the eye. The tiny blood vessels in the retina are often among the first to show changes – they can leak, they can dry up and disappear, and new ones can grow where they do not belong. Some of these changes are very mild and eyesight is unaltered. Others are much more severe and vision can be lost.
Good eyesight in diabetes is not an indication that there is no problem in the retinas. Many severe changes can develop to an advanced stage before they show themselves in reduced vision. All people with diabetes should have their eyes regularly monitored in some way (having photographs done or being examined by a doctor).
Treatment often works to save the eyesight but it works best when it is applied early in the disease. This again means that regular follow-up is important. As a rule every person with diabetes should be evaluated once a year as a minimum. When changes start to occur then the monitoring needs to be done more frequently.
There can be different reasons for this, however most commonly this is due to excessive skin from the top lid or bags forming under the lower lids. Both of these can be successfully corrected with what is called a blepharoplasty. Some patients are not keen on surgery and it is possible to consider alternatives to improve skin changes and wrinkles.
It is not necessarily dangerous but if the lid positioning covers the pupil it will affect the vision. Only in these cases does the lid need to be lifted with surgery, which can be done as early as 3-4 months of age. When surgery is done early in life it usually needs to be repeated around the age of 4-5 years. It is important to have this checked early to exclude other problems that can present with this such as astigmatism.
Retinal detachment is uncommon but may be very severe when it happens. Often a person may be aware of symptoms that indicate a detachment is happening, yet they do not realise the significance of the symptoms and do nothing about them. There is no pain with detachment and the eye does not go red or look in any way different from the outside.
The main symptoms are an increase in the severity of floaters, flashing lights, and a shadow in the vision. We all have some black dots and spots floating in the vision. These are imperfections and condensations in the vitreous jelly in the eye and are of no significance. Retinal detachment is often preceded by a partial separation of the jelly from the retina, and this may dramatically increase the number, size and severity of floaters. In other words, a sudden change in floaters may be significant and it is advisable to see an eye specialist if this occurs.
Flashing light in the “corners” of the eye, often best seen at night after the lights have been turned off, are also an indicating that the jelly is more mobile in the eye – again, see an eye doctor if the symptoms start.
Once a retinal detachment is developing the vision starts to be affected. The most common description that patients give is that there appears to be a “smudge” or “thumbprint” in the vision – it is just not clear. Later the impression may be of a curtain being drawn across the vision. Clearly this is serious and immediate eye consultation is needed.
The eye needs light in order to work, but too much bright sunlight (as we have here in the UAE) may be associated with damage to the retina (age related macular degeneration). It is sensible therefore always to wear a hat/cap with a brim or dark glasses when out in bright light.
The most important environmental factor associated with eye disease is smoking – smoking is bad for retinas. Yet another reason to give up the habit!
Diet is also important – dark green leafy vegetables (spinach, kale, and broccoli) contain micronutrients that are important for the health of the retina. A balanced diet is sensible for many reasons.
Vitamin and mineral supplements in the form of pills or powders have a limited role in protecting the eyes in someone eating a balanced diet. There are some forms of age related macular degeneration that can be helped by these pills – consult your doctor if in doubt. Remember that too many supplements can also be harmful so always only take the recommended dosage.
Some common signs to look for include:
- One or both eyes appear misaligned or do not track together
- Turning or tilting the head to see things
- Squinting, closing one eye, or blinking excessively
- Poor hand-eye coordination or excessive clumsiness
- Frequent headaches or strained eyes
- Frequent nausea or dizziness
- Holding things very close to their face
Trouble signs that require immediate attention include:
- A white pupil
- Swelling or droopy eyelid
- Excessive redness, tearing, or discharge
- Double vision
The same ultraviolet (UV) rays from the sun that can harm your skin can also cause eye damage. This applies just as much to infants and children as to adults, so sunglasses are recommended for children as well. Make sure the sunglasses have a label which says they give full protection from UV radiation.