PAEDIATRIC OCULOPLASTY AND PAEDIATRIC OCULAR ONCOLOGY

Paediatric Oculoplasty deals with problems related to tear drainage system of the eye, eyelid abnormalities or diseases, and conditions related to the bones around the eyes, bulging of the eyes and injuries around them. Apart from the above they also deal with tumours in and around the eyes.

What are the symptoms?

Constant watering from the eyes with sticky discharge which is a common problem in infants could be due to the blockage of the tear drainage system. Some children may be born with droopy eyelids which does not only affect the appearance but also obstructs the vision development. Apart from this, abnormal positioning of the eyelids or underdeveloped eyelids could also be present. Due to injuries, there could be torn eyelids and adjacent structures.

Bulging of the eyes could be due to a tumour behind the eyes or involving the optic nerve or sometimes lack of space in the bone cavity which is orbit.

In a condition called anophthalmia, children are found not having eyeballs in their eye socket.

When photographed, some children may show a white reflex in the eye due to a tumour inside the eye.

• Tearing of one or both eyes with or without discharge
• Matting together of the eyelids upon awakening
• Drooping of one or both eyelids
• Swelling next to the nose and lower eyelid
• Swelling above the eyes are on the outside corner of the eye
• Bulging of the eye
• Displacement of the eye
• Bruising around the eyelids

How to diagnose these conditions?

A visit to the paediatric ophthalmologist will be able to help you get the right specialist in the field. A detailed examination and in some cases investigations such as MRI and CT scan of the orbit and brain may be needed.

How are these conditions treated?

Most of these problems may require surgical treatment whereas some may require medical therapy. In a few conditions, the children may need to undergo both surgical and medical therapy.

For cosmetic appearance where the eyeball is absent or surgically removed, an artificial custom-made prosthetic eye could be fitted. By improving the function and appearance of the eyes, oculoplastic surgeries combine medicine and aesthetics. The goal of oculoplastic surgery is to restore a symmetrical appearance of the eyelids, orbit and face and, in some patients, to make a prosthetic eye comfortable.

What are severe corneal conditions?

The cornea is a small transparent structure in the eye which contributes significantly to the clarity of vision. This is in fact known as ‘an apple of the eye’. This tiny structure could be affected by various diseases, some of those are congenital and inherited whereas others could be acquired.

Corneal opacity, infections, break or tear, corneal dystrophies (abnormal deposits within the layers of the cornea), corneal ectasia (change in the shape of the original structure) are some of the conditions affecting the Cornea.

What are the common symptoms associated with corneal problems in children?

In most of the corneal problems, symptoms are obvious and can be seen with the naked eyes. However, some conditions may be present even without an apparent symptom. Infants, unlike adults, cannot express their symptomatic difficulty, such as a blurring vision. But, there could still be some obvious indication that could direct us to the underlying condition. Symptoms such as sensitivity while looking at the bright objects, redness and watering of eyes and constant rubbing of the eyes. These symptoms associated with pain, discharge and whitish appearance or whitish spots on the black portion of the eyes are very common that could be noticed in cases of infections.

One of the very common causes that damage cornea is an injury. Children use sharp pencils or pens or some children even play with sharp instruments which could critically injure the cornea.

How to diagnose these conditions?

A detailed eye examination by a paediatric ophthalmologist using a microscope will reveal these problems. In some cases, corneal topography and optical coherence tomography may be warranted.

How are these conditions treated?

Corneal infections may be treated with eye drops or tablets. In some cases, glasses or contact lenses may be prescribed. In the cases where the transparency of the cornea is affected, surgical procedures such as complete or partial corneal transplant may be needed.

How are these conditions treated?

Eye allergy, also known as allergic conjunctivitis is more common in children than in adults. According to a recent epidemiological survey, about 25% of the population in India suffers from allergic conjunctivitis, out of which children contribute to a significant number. Allergy is usually caused by pollens or allergens in the environment, which make direct contact with the surface of the eye and trigger inflammation. In 2001, it was found that about 2% of children with allergic conjunctivitis lost their complete vision whereas around 8.4% of children developed corneal blindness.