The first pediatric ophthalmologic examination should be performed in the neonatal period by a pediatrician right after delivery even if no complaints are present. The pediatrician will macroscopically evaluate whether there are any abnormalities in the eyeball and the surrounding tissues. Then, the pediatrician will flash a light on the eye to examine the reflection of the light back from the eye. In case of any problems, such as a white reflection from the pupil instead of a red one, the infant should immediately be referred to an ophthalmologist. For preterm infants, a fundus evaluation should be held at 4 weeks after birth for premature retinopathy, and follow-up with appropriate intervals and treatment, if necessary, should be planned.
At 6 months of age, failure to form eye contact, strabismus, eye rubbing, light sensitivity and white colored reflection in the pupil in photographs will absolutely require a repeat ophthalmologic examination. The most significant problems occurring or becoming evident in this period are strabismus, an ocular tumor called retinoblastoma or congenital glaucoma. It will be more suitable to conduct a further examination at month 18 before reaching the 2-year mark as the child will become less cooperative at that age. Such examination is significant for detecting any refractive errors that may lead to lazy eye in the future. In addition, it is easier for children to get accustomed to wearing glasses at this period if such need arises. Even if the eyes are observed to be completely normal, ophthalmologic examination should be repeated at age 3 when good communication with children is usually possible enabling visual acuity measurement, biomicroscopic examination and fundus examination. Generally, a lazy eye condition that has developed in a single eye may be overlooked if an ophthalmologic examination is not conducted. Ophthalmologic examination should also be repeated for preschoolers in order to evaluate their visual acuity, as refractory errors remaining uncorrected at school age may negatively affect success and communication at school.
Watering at the initial months of infancy may be due to blocked tear ducts that lead to the nose. Typically, the membrane-like structure existing at this region in the fetus will automatically open closer to birth or in the neonatal period. However, in 5% of infants, such opening does not occur, which may lead to watering in one or both eyes or sometimes crusting or redness. This can be verified by a simple test. In 50 to 90% of infants, such blockage will automatically open in the first 6 months. During this period, massaging and antibiotic eye drops, if necessary, will be applied. A probing procedure will be performed on infants failing to experience such opening until 1 years of age and developing frequent infections. Probing is performed under anesthesia by advancing a thin device through the tear ducts into the nose.
Redness in the eye is a frequent problem which develops due to various reasons. The most common cause is conjunctivitis which is the inflammation of the thin transparent membrane that covers the eye surface. Conjunctivitis progresses with complaints such as burning, stinging, itching, redness and crusting. Conjunctival inflammation may be infectious, allergic, immunologic, toxic or traumatic. Infectious ones are induced by bacteria and viruses. They may develop in parallel to upper respiratory infections. Sometimes, corneal inflammations can also cause such complaints. Corneal and conjunctival inflammations may also progress together. Another condition that progresses with redness and crusting in the eye is the inflammation of the eyelash roots. In pediatric cases, it is usually the result of bacteria called staphylococcus. The treatment involves eyelash cleaning, antibiotic eye drops and eye ointments. Hand hygiene is crucial. Some conjunctivitis cases are induced by allergies. They may be seasonal or constant. Itching and watering are the prominent symptoms. Seasonal allergies are quite common in childhood. Vernal conjunctivitis which is a specific form of allergic conjunctivitis may be severe enough to cause structural changes in the eye surface and requires long-term treatment.
An intraocular inflammation called uveitis causes complaints of redness and light sensitivity. Such symptoms should not be confused with conjunctivitis. Pediatric uveitis may be comorbid with systemic inflammatory disorders or parasitic infections. Early diagnosis and treatment are crucial as this condition may cause severe vision loss.
