Pediatric ophthalmological conditions: Clinical

In children, some causes of vision changes don’t typically cause pain and these include amblyopia, strabismus, and congenital cataracts.

Causes of vision changes that do cause pain include retinoblastoma, conjunctivitis, corneal abrasion, and retinal detachment.

Routine vision checks are done at well-child visits, and they should be done at least once when a child is between three and five years of age. And it can be done with red reflex testing, which is where an ophthalmoscope is used to compare the reflex in both eyes for asymmetry. It’s done in a dark room, where the light is directed into both eyes at the same time from a distance of 1 to 2 feet. If screening detects an abnormal red reflex further testing is required.

Sometimes, a concern is raised when parents notice that their child doesn’t seem to track their face or follow objects, or they might notice nystagmus, which are involuntary eye movement.

Parents might also notice that the normal "red eye" glow of the pupil is missing in photos.

Older children may complain of blurred vision, but most are unaware of their visual deficit.

Diplopia or double vision; visual inattentiveness, which is when people ignore things on a portion of their visual field; gray cloudiness of the pupil which is normally black; and photophobia may also be present.

Risk factors include a history of prematurity, a family history of childhood cataract, retinoblastoma, retinal dysplasia, childhood glaucoma, or recent eye trauma.

The first eye pathology that’s not painful is amblyopia, where the diminished vision is usually in one eye, and is secondary to abnormal visual stimulation of the visual cortex.

Because the retina is not stimulated with a clear, focused image, or because the visual axes may be misaligned, there’s abnormal visual stimulation of the visual cortex and suppression of the retinal image formed by 1 of the eyes.

Simply put, the brain focuses more on one of the eyes, while the other receives a weaker input, thus seeing worse, which is why the condition is also called ‘lazy eye’.