Dell Children’s Medical Center of Central Texas
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Dell Children's Eye Center
Common Vision Problems

Many children have vision problems that are related to the muscles of the eye. These conditions include what are commonly referred to as "lazy" and "crossed" eyes. Also, children (and adults) are frequently diagnosed as being either farsighted or nearsighted.

Amblyopia (lazy eye)
Amblyopia is loss of vision in an eye from lack of use. For a variety of reasons the amblyopic eye is at a disadvantage and the seeing part of the brain ignores it. The eye may have blurry vision from a strong need for glasses. It may cross inward and be ignored because it causes double vision. Or, something like a cataract may block a clear image from forming in the eye. Whatever the cause, the amblyopic eye is essentially "turned off" by the brain. Treatment first involves correcting the cause of the blocked, blurred or double image. Then the "good" eye may need to be patched (covered) to force the amblyopic "bad" eye to turn back on and be used by the brain. (See Patching)

Cataracts
Cataracts are a clouding of the focusing lens in the eye. They are rare in children, but do occur. Most pediatricians screen for cataracts in infants as part of their normal routine. Small cataracts that do not block vision can be followed without treatment. Larger cataracts that block vision can be removed. Vision can then be rehabilitated with intraocular lens implants, contact lenses, glasses and patching.

Color Blindness
Color blindness varies from a general decrease in one's ability to detect color differences to complete color blindness where everything is a shade of gray. It is much more common in boys who get the gene from their mothers.

Congenital Anomalies
Congenital anomalies and syndromes are usually complex and varied. An eye exam can be done to look for specific findings to assist in diagnosis and / or provide a treatment plan.

Esotropia
Esotropia, commonly called crossed eye(s), is a turning inward of one or both eyes. It can occur spontaneously at any age, usually in the infant or toddler years. It can be caused by hyperopia (farsightedness), in which case glasses or bifocals usually correct the problem. Other times, eye muscle surgery is necessary. Esotropia is often associated with Amblyopia (lazy eye) which is a loss of vision, usually in one eye, from lack of use. See Amblyopia.

Exotropia
Exotropia means one eye drifts outward intermittently or all of the time. It occurs most commonly in toddlers, but can happen at virtually any age. Rarely, it can be secondary to a neurological problem, but most often, it occurs spontaneously, with no known cause. Treatment usually involves eye muscle surgery, but rarely it can resolve spontaneously. Some children that happen to be myopic (nearsighted) can control their exotropia by wearing eyeglasses.

External Eye Disease
External eye disease is common in children. It manifests itself as blepharitis (eyelid inflammation), hordeola (styes) and chalazia (bumps on the eyelid). Treatment includes application of heat, eyelid hygiene with lid scrubs and topical antibiotics. Occasionally a chalzion will require surgical excision.

Eye Tumors
Fortunately, eye tumors are rare in children and infants. Most, but not all, are benign. A short list includes hemangiomas, dermoid cysts, dermolipomas, benign cysts and retinoblastomas. The doctors will discuss these tumors with you as indicated.

Glaucoma
Glaucoma is rare in infants and children. It is however, a serious disease where a build up of pressure in the eye causes loss of vision. In children it sometimes can be treated with eye drops, but more often requires surgery.

Hyperopia (far-sightedness)
Is a common visual condition visual condition where objects up close are more difficult to see clearly than objects that are far away. Many children and young adults who have a small or moderate amount of hyperopia don't recognize a visual problem, seeing clearly at all distances. This is because the lenses in their eyes can flex (change shape) easily to focus at a variety of distances. However, when we get around 40 years old the lenses in our eyes get "stiff" and focusing at near is impossible. That is why most people eventually need reading glasses or bifocals. Large amounts of hyperopia can cause esotropia (crossing of the eyes) which is usually correctible with glasses, bifocals or contact lenses.

Hypertropia AKA Hypotropia
Hypertropia means that one eye drifts above or below the other eye. It may occur without a known cause or it may be the result of a head injury, thyroid disease, or a neurological problem, such as brain tumor or stroke. Treatment includes prism in glasses, correction of the original cause or eye muscle surgery. Dissociated vertical divergence and over action of the inferior oblique's are hypertropias that usually occur with horizontal eye muscle problems. If severe in nature, they can be corrected with eye muscle surgery.

Nasolacrimal Duct Obstruction
Nasolacrimal obstruction is commonly referred to as tear duct obstruction or a blocked tear duct, and usually occurs in infants, resulting in tearing and discharge from one or both eyes. Drainage of tears from the inner corner of the eye into the nose is blocked. Eighty percent of nasolacrimal obstructions resolve spontaneously requiring only eyelid cleansing and/or antibiotic drops. When the blockage does not resolved spontaneously then Probe and Irrigation is recommended. Ninety-five percent of the time this procedure is successful. If the nasolacrimal ducts re-obstruct then other procedures can be performed, such as dacryocystoplasty, intubation or infracture of the turbinates. These will be explained to you by the doctors as indicated.

Strabismus
Is a general term for all eye misalignments such as Esotropia, Exotropia, Hypertropia, and Disasociated Vertical Divergance (DVD). See those topics for more information.

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