Health Awareness blog

Squint is common in early childhood. Up to 1 in every 15 children found to have squints when they start schooling. In special population like child with brain damage or learning disability, the incidence of squint is even higher.

All fixed squints and any squint that persists after 5-6 months of age require careful evaluation. Most cases of squint in children are non paralytic. There is normal range of external ocular movements. In this type of squint, the angle of squint between bilateral eyes is constant in every directions of gaze. Paralytic squint is cause by paralysis of one of the ocular muscle. This is rare in children. Most cases occur due to failure of development of binocular coordination of unknown etiology. However, some may be caused by cataract, glaucoma, retinal disease or retinoblastoma. Latent squint is difficult to diagnose. In this case, there is imbalance of extra ocular muscle. However, the eyes do not deviate the entire time make it not visible on inspection. Decrease visual acuity of one eye may lead to latent squint. It means that the visual acuity or the eyesight should be tested in all children with squint.

Classification of squint:

The diagnosis is mainly made from clinical examination. Symmetrical corneal reflection or occlusion testing may assist diagnosis in less obvious cases. Epichontic folds, low nasal bridge and hypertelorism (wide-spaced eyes) such in the Down Syndrome children may give rise to false appearance of squint.  This is called pseudo-squint which is not significant

Early recognition and management of squint ensure better prognosis. If not detected early, it will lead to suppression of vision from the squinting eye in order to prevent blurry of vision or double vision. When unused, this deviated eye may end up with amblyopia or diminished acuity of the central vision. The lesion may be permanent and lead to condition of “lazy eye”. The child will have problem in later life. If left alone without treatment, the vision in the squinting eye may be lost permanently, denying the child binocular vision for life. Early treatment before the school age may prevent this problem.

Refractive errors are very common in children with squint. Correction of refractive error and occlusion of the non squinting eye are mandatory. Many cases can be cured with early use of spectacles. Rarely, occlusion of the non squinting eye is done. The occlusion of the eye means to force the child to use the squint eye. This treatment may be need for several months and is unpopular among children. Surgery is sometimes indicated in selected cases.

Reference:

1. Simon J Newell et al. Lecture Notes Paediatrics. 8^th edition. 2008. Blackwell Publishing.
2. Paediatrics Colour handbook. 1999. Mosby Elsevier.

This is one of the commonest eye problems that usually present in general practice. The patients usually presented with red eye associated with feeling of eye discomfort. Some even described as sore eye. The patients usually complaint of watery eyes associated with sticky eye discharge mainly on waking up in the morning. On examination, there is present of enlarged papillae under the upper eyelid. Pre auricular lymph nodes may be enlarged however there is no change with vision.

                There are few types of conjunctivitis. Infective conjunctivitis is caused by bacteria or viral. Ophthalmia neonatorum affected neonates. The other type is allergic conjunctivitis.

                Clinically, infective conjunctivitis is difficult to distinguish from other type of conjunctivitis. Like I have told earlier, it usually caused by bacteria or viral infection. Symptoms mainly started in one eye. Over time, it will infect the other eye as well. Most of the time, the treatment is empirically, however if symptom does not resolved, eye swab culture and sensitivity should be taken to optimized treatment. The disease usually self limiting and will get better over time. The key is isolation so it does not spread to others. If symptom persist, antibiotic eye drops (e.g .: chloramphenicol eye drop 2 drops 3-4 times daily) will be prescribed up to 5 days.

                Allergic conjunctivitis is due to exposure to allergens. Bilateral eye will be affected. The symptoms appear seasonally (e.g.: hay fever) or during contact with any allergen (e.g.: dust or animal fur). The patients will complaint of red and watery eyes. Photophobia might be present.  Most of the time, there is also personal history or family history of atopy. Upon eye examination, follicles will be seen in the lower tarsal conjunctiva while ‘cobblestones’ will be found under the upper eyelid. As for management, topical or systemic antihistamine will be needed. For example piriton, loratadine and sodium chromoglycate eye drop. Topical steroids should be avoided due to long term complications of cataract, glaucoma or fungal infection.  Persistent allergic conjunctivitis needs a referral to see ophthalmologist.

                Ophtalmia neonatorum is seen in neonates (baby age less than 40 days). It is caused by Nisseria gonorrhea infections. It manifests as a purulent discharge from the eyes.  Swab culture and sensitivity may be needed to determine the pathogen. Topical antibiotic is given for treatment. In few cases, ophthalmologist referral is needed for expert opinion and management.

Reference:

1.       Oxford Handbook of General Practice. Oxford University Press. 2005.