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September 2011

What's Up, Doc?

Here's Looking at You, Kid!

All About Eye Care

By William "Dr. Bill" Incatasciato, M.D.

Eyes may be the window to the soul, but the average person knows very little about them. I’ve put together some answers to eye- and vision-related questions parents have asked me over the years:

Your Baby’s Precious Eyes

Can infants see in color? How far can they see? Do they see clearly? As far as we can tell, infants can see in color (though not as well as adults) and can see distances out to the horizon. However, they have better vision close in. As they grow month to month, it becomes easier for them to distinguish more color shades and see sharper images. Most of the time, their eyes function normally from birth, but it’s the brain that is slow— it needs time to develop so it can better interpret the signals it receives from the eyes. With time, babies will learn to better distinguish objects and can then track those objects with their eyes. I’ve met many parents who have spent boatloads of money getting their children expensive black and white/sharp contrast toys, but in reality any object with contrasts will work just as well. Keep offering infants new things to look at, and change the positioning of those items every so often. This forces babies to look around more so they will better understand their world.

I’ve noticed my baby crosses her eyes every so often. Is this normal? Yes, newborns commonly cross their eyes. As they learn to control their eye muscles, they’ll do this less and less until about 3 to 5 months, when the behavior will most likely stop. Persistent eye crossing is called strabismus (lazy eye). If your child’s eyes still cross, your pediatrician will refer her to an ophthalmologist to see why this is going on. If this problem isn’t corrected, the baby will develop a condition called amblyopia. Normally, the brain receives a set of images from both eyes. The brain then puts them together to form a 3-D image. If the eyes aren’t coordinated, the brain gets two very different images—like a double exposure—and will ignore the image from the “weak” eye. Usually, patching the good eye will force the other eye to focus better.

My baby has a tear coming down her cheek all the time. How do I stop it? Many times, infants have a condition called dacrostenosis. This is a blockage of the duct that connects the eye to the nose. As a result, the child appears to be crying continuously. The condition usually goes away by 6 to 9 months of age. Sometimes doctors will recommend an eye massage technique to help it along. If it still doesn’t go away, your pediatrician may send you to an ophthalmologist for treatment. This must be done before one year of age for optimal effectiveness and to avoid the possibility of needing surgery. My daughter had this problem. We had to eventually visit the ophthalmologist to have her left duct probed open. It sounds painful, but it doesn’t hurt. (If your child is like mine, she’ll scream more at having her arms pinned down than at the actual procedure!)

Why do pediatricians always shine a light into babies’ eyes when performing exams on them? A possible, but rare, newborn condition is a tumor in the eye or a cataract. That’s why we shine the light; we’re looking for the same “red eye” that you see in photographs. If we see red eye, we know that the inside of the eye is normal.

Why do premature infants need frequent visits to the ophthalmologist? Premature infants can develop a condition called retinopathy of prematurity. Basically, the blood vessels to the interior of the eye grow in abnormal patterns. This can cause the retina to detach and lead to blindness. Depending on the severity, the ophthalmologist can perform a variety of surgical procedures to control this condition. In many cases, it will even heal on its own.

Older Kids

Sometimes, when I ask my son to look for something in his room, he tells me he “can’t find it,” even though he is literally standing an inch from the missing item. Could he have a vision problem? This is a good one! Don’t worry… by the time he turned 6 years old, his visual acuity had probably normalized to standard adult vision. He is just demonstrating selective vision and will outgrow this “problem” when he turns, oh, say 30! This goes along with selective hearing.

My husband and I both wear glasses. How will we know if and when it’s time for our daughter to get them, too? When a child needs glasses, she may not realize there is a problem. The fuzzy vision she has been experiencing may seem “normal” to her. Only after wearing glasses do kids sometimes realize what they were missing. This happened to me as a teenager when I drove to the local Sears Optical to pick up my glasses, which had been prescribed to me by an optometrist during a routine eye exam. I was thinking, “My vision is perfectly fine! I only squint when I look at the chalkboard [does that show my age?]. I really don’t need these glasses!” I was in for a big surprise when, on the way back, I noticed that the trees actually had individual leaves and that they weren’t just big green blobs!
Kids will often squint, rub their eyes a lot, sit closer to the TV, have difficulty reading or complain of headaches when they are having vision problems. A visit to the optometrist can help. Also, pediatricians routinely screen for near-sightedness and far-sightedness during kids’ annual physicals.

When Problems Arise

“Pink eye” seems to go around my child’s school like wildfire. How do I combat it? Infections can be either bacterial or viral; either way, we call it “pink eye,” or conjunctivitis. Generally these are mild infections, but some types can cause serious harm. The best way to avoid getting pink eye is to wash your hands frequently with soap and water. If your child does get it, pink eye can be easily treated with antibiotic eye drops. More serious eye infection may require oral or IV antibiotics and an ophthamologist referral. Sometimes if a mom is pregnant, a certain type of infection inside her body can affect the fetus, causing cataracts or other problems.

Most viral eye infections tend to go away on their own. But varicella and herpes infections are more serious and need a lot of medical attention. These patients are sent to the ophthalmologist immediately.

When something gets in my child’s eyes, what do I do? Eye trauma can be mild, like getting a little dust in your eyes, or it can be severe, requiring emergency surgery. As pediatricians, we see lots of cases of irritated conjunctivae (the clear skin that covers your eyeball) and corneal abrasions. Once in a while, we’ll have a puncture-type injury. Several years ago, I had a teenager come in to the office who had accidentally punctured his eyelid and eye with a metal rod. Being the typical teen, he waited three days to tell his parents he still couldn’t see out of that eye. Luckily, things turned out well for him.

If your child does get something in his eye, try to wash it out with water. Don’t let him rub the eye. If a foreign body is stuck in the eye, don’t try to pull it out; take your child immediately to the emergency room for quick and proper treatment.

My child blinks a lot. What do you think about that? My first thought is allergies, which people often associate with nose and throat problems but can also affect your child’s vision. The typical symptoms are watery and itchy eyes, as well as blurry vision. Many times, parents bring in their kids with the complaint of excessive blinking. Treatment can be allergy eye drops, oral allergy medications and/or avoiding the cause of the allergy (pets, pollen, dust, etc).

What is color blindness? Color blindness isn’t really blindness, but rather an inability to distinguish between certain colors, like red and green. This condition seems to affect boys more than girls.

Are We Seeing Eye to Eye?

Due to space constraints, I can’t cover every potential eye problem in this article. That said, if you see any of the following eye-related symptoms, please seek medical care: severe pain, loss of vision, extreme sensitivity to light, excessive swelling, excessive discharge from the eye, any severe trauma, foreign bodies and/or any ongoing issue that won’t go away. When in doubt, call your pediatrician and ask for an opinion.

The eyes are indeed a precious thing, and, as parents, it is our responsibility to know a bit about them just like we should know about any other aspect of our children’s health. For more information about eye-related pediatric issues, visit www.AAP.org or www.aoa.org.


William “Dr. Bill” Incatasciato is a pediatrician at Capital Area Pediatrics in the Countryside Shopping Center in Sterling. For more information about Dr. Bill and/or his practice, visit CapitalAreaPediatrics.com.