Our Specialties

Paediatric Ophthalmology and adult strabismus

A child’s eye is not a miniature adult eye, it is a whole new visual system, which is constantly changing with the growth of the child.
The new born’s visual system is not fully developed at birth, though the eyes are structurally developed fully. The child is born farsighted or with a plus power which gradually reduces as the eye lengthens with age. In the first 2-3 months the eyes may tend to wander as the child is constantly learning to use the connections between the brain and the retina.

By 3 months the child will be able to fix at an object in front of the eyes and follow its motion, the eyes have now begun to work in tandem.

By 5 months depth perception would have developed

By 9 months the final colour of the iris or what is referred to as colour of the eye would have developed.
The 2 eyes move in unison and in different positions of gaze, including convergence which is the movement to see a near object. All these synchronised movements require the perfect coordination of 6 extra ocular muscles controlled by 3 cranial nerves which travel from the back of the brain to the eyes to control these muscles.

The inside of the eye has a muscle called the ciliary muscle which helps in focussing (we could call it the “focussing muscle”) near and far objects. The tone of this muscle is very strong in children and the contraction of this muscle often overcomes the need for glasses in children.

In the early years parents must look for any delay in these eye developmental milestones, or any misalignment of the eyes, if there is a doubt an ophthalmologist’s opinion must be sought.

Children born 3 weeks or earlier (preterm babies) from the expected date of delivery must have an eye evaluation in the first few weeks after birth. Low birth weight babies and children on prolonged oxygen therapy after birth will need eye evaluation early in life. In most such instances the neonatologist/paediatrician will advise the timing of the eye evaluation. Parents must check with the paediatrician if an early eye evaluation is required.

Any white reflex in the eyes needs urgent evaluation.

Children who constantly see with their face turned or neck tilted to one side must be seen by an ophthalmologist.

Sometimes these postures becomes a mannerism for the child, constant counselling by the parents will help them correct themselves, if they still do not, an eye evaluation is warranted.

Excess watering from one or both eyes in a child needs an ophthalmologist evaluation. In the first few months of life, some children have a block of the nasolacrimal duct ( the tube that drains the tears from the eyes to the nose and the throat). Any redness in the eyes needs ophthalmic examination.

Some children develop an allergic redness in their eyes resulting in redness and itchiness prompting the child to constantly rub the eyes. Children should be counselled to avoid rubbing as it can induce astigmatism. This condition needs thorough evaluation and treatment.

Upon examination by an ophthalmologist if a child is prescribed glasses, he/ she must wear the glasses or else visual development will not happen. The glasses must be worn at all times of the day.
Visual pathway development is completed by the age of 9 years much before puberty and physical development. Not wearing glasses if and when required results in subnormal vision which cannot be corrected in adulthood. It results in a condition called amblyopia or lazy eye. Children with high cylindrical power or high plus power are particularly prone to become amblyopic, if not compliant with glasses.