Paediatric Strabismus

Facts

A squint is a condition where your eyes look in different directions. One eye turns inwards, outwards, upwards or downwards while the other eye looks forwards. The medical name for a squint is strabismus.

The misalignment of the eyes can be caused by different factors. It can be an early developmental problem where the brain struggles to identify that the two eyes should work as a pair. It can be caused by an abnormality with the eye muscles or an uncorrected vision problem, such as myopia (shortsighted), hypermetropia (longsighted) or Astigmatism.

When to see a doctor?

Squints in children are relatively common. They usually develop before a child is five years of age, but they can appear later.

Up to around three months of age, many babies occasionally squint as their vision develops. This is normal and nothing to worry about. If your child still has a squint after this age, you should visit your Doctor. It is very important that a squint is picked up and treated as early as possible to avoid vision problems developing. If a squint is identified when a child is young, there is a good chance that it will be successfully treated.

Can adults get a squint?

Occasionally, squints that have been corrected during childhood reappear in adulthood. New squints in adults, without any history of a squint in childhood, can be caused by problems with the ocular muscles and/or the eye movement system. You should visit your Doctor as soon as possible if you develop a new squint. They should refer you to an ophthalmologist who will carry out an examination to identify the cause.

Squints that affect adults may cause double vision because the brain has been trained to collect images from both eyes. Squints may also cause a cosmetic problem in adults; in such cases, the appearance of a squint can lead to low self-esteem

What is Amblyopia?

Amblyopia is also known as a ‘lazy eye’. Amblyopia is an early childhood condition where a child’s eyesight in one eye does not develop as it should. The problem is usually in just one eye, but can sometimes affect both of them. Amblyopia affects approximately 2% of children.

When a patient has amblyopia the brain focuses on one eye more than the other, virtually ignoring the ‘lazy eye’. If that eye is not stimulated properly the visual brain cells do not mature normally.

What causes a ‘lazy eye’?

Anything that interferes with clear vision in either eye during the critical period (birth to 6 years of age) can cause amblyopia. The most common causes of amblyopia are constant strabismus (constant turn of one eye), anisometropia (different vision/prescriptions in each eye), and/or obstruction of an eye due to cataract, trauma, lid droop, etc.

Why does my child need to wear a patch?

Occlusion (patching) is used to make a lazy eye work on its own and so improve the vision by encouraging the development of the nerve pathways from that eye to the brain. The patch is worn over the good eye and the amount of time the patch must be worn is decided by the Orthoptist/Ophthalmologist and relates to the extent of the visual problem. If patching is implemented early on, a good level of vision can be achieved. When patching is started in an older child, it is more difficult to achieve good vision.

What is an Orthoptist?

An Orthoptist specialises in diagnosing and treating visual problems involving eye movement and alignment.

The Orthoptist at Moorfields Dubai provides clinical support to all the specialist services at the hospital. She sees both adults and children who have strabismus (a squint), disorders of eye movements, or binocular vision.

What is an Optician?

An Optician will see adults and children for refraction; with this assessment, an optometrist can determine the optical power of the eye, the presence of any “refractive” error that requires spectacle correction, and the best vision that an eye can achieve with an appropriate correction. Younger children have drops to make the pupil (the dark center of the eye) larger and this makes the test more accurate.

What is an Ophthalmologist?

An Ophthalmologist is a specialist in medical and surgical eye problems. Since ophthalmologists perform operations on eyes, they are considered to be both surgical and medical specialists. They will check both the structure and health of the eye. They will make the final decision on the management and will do any surgical procedures required.

Myopia

Myopia is a common refractive condition which causes individuals to be near-sighted: they see near objects clearly but distant objects are blurry. Myopia occurs when the cornea and lens focus the light in front of the retina instead of exactly on it. Symptoms of myopia include; difficulty seeing distant objects, squinting frequently, holding books or other objects very close to the face, difficulty seeing writing on signs or watching television and difficulty with driving (particularly at night). Myopia should be diagnosed by a qualified Optometrist, Ophthalmic Surgeon or Eye Specialist. Myopia is best treated with eyeglasses or contact lenses which compensate for the elongated shape of the eye allowing the light to focus properly on the retina. Refractive surgery is another option that eliminates dependence on glasses or contact lenses.

Lacrimal Probing in Children

The tear duct is a channel/passage which runs from a tiny opening in the medial lids through the bone to the inside of the nose, and drains the tears and mucus the eye produces. It should open just before or just after birth but sometimes remains blocked for a considerable time after that, causing watering and discharge from the eye. It is harmless, and does not affect the health of the eye or the vision, although it can make the eyelids red and sore and slightly increases the frequency of infective conjunctivitis.

Keratoconus

Keratoconus is a progressive thinning of the cornea. The cornea is the clear front window of the eye, which, along with the intra-ocular lens, focuses light on to the retina. The cornea normally is a smooth, round dome-shaped structure; however in keratoconus it becomes very thin and irregular and it starts to protrude from the centre or below the centre like a cone. This causes blurry vision that is often not completely correctable with glasses.
The disease is multifactorial in origin but there is a strong genetic component which makes it more frequent in certain parts of the world or within certain families.

Intravitreal Injection

The macula is the central part of the retina at the back of the eye. It is responsible for fine vision (reading, writing, watching television, and recognising faces). Patients with diabetes may develop macular oedema (swelling of the retina) due to leaking of fluid from blood vessels. This causes the vision to become blurred.
A course of three injections is recommended with each injection administered one month apart. The procedure is carried out in a clean environment using sterile technique. The eye is cleaned and local anaesthetic drops are given to numb the eye.
The eye may or may not be covered after the injection. If a pad is applied, this may be removed when you reach home.

Hypermetropia

A refractive condition of the eye in which vision is better for distant objects than for near objects. It can be called far sightedness or hypermetropia. Symptoms of Hypermetropia can include; blurred vision, asthenopia (eye strain), accommodative dysfunction, binocular dysfunction, amblyopia and strabismus. It results from the eyeball being smaller than average, causing images to be focused behind the retina. Hypermetropia should be diagnosed by a qualified Optometrist, Ophthalmic Surgeon or Eye Specialist.
A full Optometric Examination should be performed to assess the degree and extent of the problem. Eyeglasses and contact lenses are the treatment of choice for most people with far sightedness but refractive surgery can also cure some cases of hyperopia.

High Precision Refractive Surgery

When you decide on an eye laser treatment, you expect the best possible results. The more fully developed the methods are, the better the outcome will be. The SCHWIND AMARIS 750S offers you the leading technology for your laser treatment – superior in all important aspects: Speed, precision, safety and comfort.

Diabetic Retinopathy

Introduction

  • Diabetic retinopathy is a complication of diabetes and leads to high blood sugar, resulting in retinal disease, which can interfere with its ability to transmit images to the brain through the optic nerve.
  • Blood vessels in the retina play an important role in supplying it with oxygen and nutrients, which keep it healthy and working effectively.

Diabetic Retinopathy can result in damage to the blood vessels; these may then bleed, leak or become blocked leading to cell damage in the retina itself.
There are varying forms and levels of severity of diabetic retinopathy – for example, when the retina becomes very damaged, new blood vessels may grow on it and can burst, leading to bleeding and blurred vision. If the macula (the central area of the retina) is affected – this is called Diabetic Maculopathy – the disease has reached a much more advanced and serious stage.
High blood pressure combined with diabetes leads to an even more dangerous condition.

Types of Diabetic Retinopathy

Non Proliferative Diabetic Retinopathy
Generally, this type of diabetic retinopathy does not affect vision because at the initial stage there are just a few enlarged blood vessels, with very minimal bleeding and leaking in the retina.
An examination of the retina by an ophthalmologist will reveal some marks indicating the presence of the condition.
Proliferative Diabetic Retinopathy
This condition can lead to seriously impaired vision as blood vessels grow in the retina and the threat is bleeding from these vessels which can lead to retinal damage, and even to retinal detachment at the back of the eye. Laser treatment is essential to avoid serious long term damage.
Diabetic Maculopathy
Diabetic maculopathy occurs when blood vessels leak into the central area of the retina, which can lead to it swelling and affecting the quality of vision. Laser procedures, injections or surgery are the main treatment options.
Exudates are deposits in the retina from leaky vessels. Haemorrhages in the retina of varying sizes.
Microaneurysms.
Optic Nerve with abnormal new vessels that have bled. Scars from previous laser treatment.
Vitreous haemorrhage in front of the retina.
End stage proliferative Diabetic Retinopathy with fibrousbands.
Retinal Detachment.
Cross sectional scan showing thickening of the macula and exudates.
Exudates (yellow) and haemorrhages in the central retina

Can it be prevented?

Compliance with treatment for diabetes helps control blood sugar levels and blood pressure and so the serious complications of diabetes, including diabetic retinopathy.
Treatment compliance along with regular check ups to monitor blood pressure will help avoid the serious long term effects of diabetes; positive lifestyle choices from balanced diet to regular exercise and not smoking all have a beneficial effect.

What can I do?

Early diagnosis and treatment of diabetes and diabetic retinopathy will generally help prevent serious vision loss for most patients and regular visits to the doctor and ophthalmologist are an essential part of the monitoring process.

Dacryocystorhinostomy

[:en]Blocked Tear Duct. The tear ducts start at the inner corner of the eye with two small holes in the corner of the eyelids. Each hole is known as a punctum, they lead into small tubes known as canaliculi, which in turn drains into the lacrinal sac. This lies between the corner of your eye and your nose which has a duct at the bottom, which drains into your nose, which drains nasolacrimal duct. They continue into small channels that join up and reach the lacrimal sac, which leads into the nasolacrimal duct. The tear ducts do not have much spare capacity and this is why we cry. The channels tend to become narrower with age, especially if there has been nose or sinus disease. An obstruction of the tear ducts will give you a watery eye. Syringing of the lacrimal system with a blunt cannula will determine the type and the site of the blockage. Occasionally a special radiograph is necessary. Called a dacrocystogram, which visualizes the locrimal duct at the eye following the injection of an x-ray dye into the duct.
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Return to Educational Leaflets Homepage[:ar]الوقائع:

  • تنطلق الأقنية الدمعية من ثقبين صغيرين في الزاوية الداخلية للعينين ثم تنضم إلى الكيس الدمعي لتبلغ بعده القناة الأنفية الدمعية.
  • إنّ القنوات الدمعية قليلة السعة وهذا ما يجعلنا نبكي. كما أنها تضيق مع التقدم في السن.
  • خاصّة لدى الإصابة بإلتهاب الجيوب الأنفية.
  • يؤدي انسداد الأقنية الدمعية إلى تدمع العينين.
  • إن إدخال قُنَيّة (أنبوب) كليلة (غير حادة) إلى الجهاز الدمعي من شأنه تحديد موقع الإنسداد.
  • في بعض الحالات يتم اللجوء للتصوير الشعاعي الخاص.

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Amblyopia Therapy

What is Amblyopia?

Lazy eye – the medical term is Amblyopia – is a common eye condition amongst younger children. It means that one eye is not developing properly and becomes ‘lazy’ because the brain is working harder with the good eye to compensate. The problem is that if the brain ignores the lazy eye, the cells in the brain that create vision do not develop properly. Generally, Amblyopia affects just one eye but sometimes both eyes can have a problem.

What causes a ‘lazy eye’?

For children, the most important period for the development of vision is from birth to the age of 6 and if there is any interference with development during this period, then this can lead to amblyopia which is commonly caused by a squint (strabismus) in one eye, anisometropia (different vision/prescriptions in each eye), and/ or obstruction of an eye due to cataract, trauma, lid droop, etc.

Why does my child need to wear a patch?

The best and simplest way to treat lazy eye is to cover or patch (known as occluding) the other eye so the vision in the lazy eye can improve and develop the pathways to the brain.
The patch is worn over the good eye and the amount of time the patch must be worn is decided by the Orthoptist/Ophthalmologist and relates to the extent of the visual problem.
With early treatment by patching, vision can develop successfully but this becomes more difficult with older children and the level of vision achieved may not be as good.

My Child’s Treatment

Patient name:
Patient number:
Glasses must be worn
Please patch the eye RIGHT LEFT
For hours a day.
If the child wears glasses, he or she should continue to wear them even with the patch.

Ocularist

[:en]An Ocularist makes and fits artificial eyes. Our aim at Moorfields Eye Hospital Dubai is to create a hand-crafted eye with a very natural look indistinguishable from the real eye. Made from acrylic, these artificial eyes are very strong, easy to maintain and are comfortable to wear. The Ocularist also provides a polishing and repair service.
To visit Our Staff Section click here[:ar]يقوم أخصائي العيون الاصطناعية بصناعة وتركيب العيون الاصطناعية. نحن في مستشفى مورفيلدز دبي للعيون نحرص على توفير عيون مصنوعة يدوياً تتميز بمظهر طبيعي تماماً ولا يمكن تمييزها عن العين الحقيقية. تصنع العيون الاصطناعية من الأكريليك، وهي لهذا تتمتع بصلابة عالية كما تسهل العناية بها وهي مريحة عند الاستخدام. كما يوفر أخصائي العيون الاصطناعية خدمات صقل العيون الاصطناعية وإصلاحها.
لزيارة صفحة طاقم العمل، اضغط  هنا.[:]

Ophthalmologist

[:en]Patients who need further specialist treatments for their eyes go to an Ophthalmologist. An Ophthalmologist is a medical doctor who specialises in the medical and surgical care of the eyes, visual system and in the prevention of eye diseases and injuries.
They provide the full range of care including routine eye examinations, diagnosis and treatment of eye disorders and diseases, including prescriptions for eyeglasses, medications, surgery, and management of eye problems that are caused by systemic illnesses.
An ophthalmic eye examination might include history (general, family, medications, allergies…etc), examination of the vision acuity (clarity and sharpness), physical examination, and focimetry (assessment of spectacles) depending on the patient case.
In addition, an Ophthalmologist can specialise in specific areas of eye care such as glaucoma, cornea, oculoplastic (abnormalities which mainly affect the function and aesthetics of, the eyelids and lacrimal system), paediatric ophthalmology (including genetic abnormalities including crossed eyes and lazy eyes), and diseases that affect the retina – a tissue that lines the inner surface of the eye.
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To read more on Parents and Children, click here

[:ar]يزور المريض أخصائي طب العيون إذا احتاج إلى علاج أكثر تخصصاً. أخصائي طب العيون هو طبيب يتخصص في الرعاية الطبية والجراحية للعيون وجهاز الإبصار وفي الوقاية من أمراض وإصابات العيون.
ويقدم أخصائي طب العيون طيفاً متكاملاً من خدمات الرعاية الصحية، بما في ذلك فحوصات العين الدورية، وتشخيص وعلاج اضطرابات وأمراض العيون، بما في ذلك وصف النظارات الطبية والأدوية والجراحة وإدارة الحالات وأمراض العيون الناتجة عن أمراض أخرى.
قد يتضمن فحص العيون لدى أخصائي طب العيون مراجعة للتاريخ الطبي (التاريخ الصحي عموماً والتاريخ العائلي والأدوية المستخدمة والحساسيات وما إلى ذلك)، وفحص دقة الإبصار (الوضوح وحدة النظر)، وفحص يدوي وتقييم للعدسات المستخدمة (focimetry) وذلك بحسب حالة المريض.
وبالإضافة إلى ما سبق، قد يتخصص طبيب العيون في مجالات محددة من طب وصحة العيون مثل الجلوكوما والقرنية والجراحة التجميلية للعيون (وهي علاج لتشوهات تؤثر على وظيفة ومظهر جفن العين ونظام تصريف الدمع) والأمراض التي تؤثر على شبكية العين – وهي النسيج المبطّن لسطح العين الداخلي.
لزيارة مكتبة الصور الامتحانية اضغط هنا.
لقراءة المزيد عن الآباء والأطفال ، انقر هنا.
لزيارة موظفي القسم انقر هنا.[:]