Paediatric Ophthalmology (Eye) Service
| Consultant : |
Dr Inez Wong |
| Consultant : |
Dr Ganga Sundar |
| Visiting Consultant : |
Dr Sonal Farzavandi |
| Registrar : |
Dr Manjunath Gupta |
| Orthoptist : |
Ms Carol Child |
The Paediatric Ophthalmology service at NUH provides comprehensive evaluation and treatment for infants, children and adolescents with ocular problems. These range from life-threatening conditions such as retinoblastoma (tumour in the eye) to sight-threatening conditions such as congenital cataract, glaucoma or cornea opacification, to more common problems such as refractive errors and amblyopia (lazy eye). In addition, the Strabismus service also manages medical and surgical problems of strabismus (deviation of the eyes) in both adults and children.
The service comprises of a team of paediatric ophthalmologists, orthoptist and optometrists. In addition, there is support from other subspecialties within the ophthalmology department such as the vitreo-retinal, neuro-ophthalmology, glaucoma and oculoplastic services.
Services provided
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Vision screening
Very few children complain about vision problems because they do not know that their vision is not normal. Many sight-threatening diseases, if detected early, can be cured or treated to slow the progression of visual loss. The most important preventive step is receiving routine examinations by a qualified eye care professional. Children should receive their first comprehensive eye examination before the age of four, unless a specific condition or family history warrant an earlier examination. Vision testing can be performed for any age, including preverbal children and babies.
Refractive errors
This is a group of disorders affecting the focusing system of the eye, and includes myopia (short-sightedness), hyperopia (long-sightedness) and astigmatism. Although the problem can easily be treated with spectacles, accurate determination of the spectacle power in young children involves the instillation of eyedrops (cycloplegic refraction). Futhermore, it is important to detect refractive errors early as they can occasionally cause "lazy eye".
Amblyopia
Lazy eye, or amblyopia, is reduced vision in an eye that has not received adequate use during early childhood. This reduced vision is not correctable by glasses or contact lenses. The most common causes are strabismus (crossed eyes), or a difference in image quality between the two eyes (one eye focusing better than the other). Treatment usually involves applying a patch over the good eye, but eyedrops are also sometimes used. Unfortunately treatment is seldom successful once a child has reached 9 years of age, so early detection is important.
Strabismus
Strabismus or squint is a condition where the eyes are not aligned. The "squinting" eye may turn in different directions e.g. towards the nose in esotropia, away from the nose in exotropia, or up or down. It can affect any age group, from babies to adults. Early diagnosis is important in children to prevent amblyopia, and for proper development of 3-dimensional vision (steropsis). Some forms of strabismus can be treated medically or observed, but others may require surgery.
Retinopathy of prematurity
A comprehensive screening service for retinopathy of prematurity (ROP) is provided within our hospital for premature babies with low birth weight. We work closely with our neonatologists from the University Children’s Medical Institution in the prevention of ROP, in particular in the monitoring of oxygen levels the babies are exposed to in the intensive care setting. Laser therapy is used to treat cases with ROP meeting treatment criteria in accordance with established international guidelines. Advanced support is provided by vitreoretinal service.
Ocular tumours
Multi-disciplinary management of pediatric ocular tumours, such as retinoblastoma, is provided in conjunction with the pediatric oncology team. Various members of the team including the pediatric ophthalmologist, oculoplastic surgeon, vitreoretinal surgeon, paediatric oncologist, radiotherapist, geneticist, and ocularist work closely to tailor the treatment for individual patients.Treatment depends on the stage of the disease and may be in the form of laser, cryotherapy, surgery, radiotherapy or chemotherapy, either alone or in combination.
Paediatric cataract
Cataracts (clouding of the lens) can affect children, or even newborn babies. Visually significant cataracts need to be removed. We offer paediatric cataract surgery, including intraocular lens implantation and contact lens fitting. Visual rehabilitation is the key to successful treatment, and long term monitoring is required to look out for complications that may be potentially blinding.
Paediatric glaucoma
Although glaucoma commonly affects the elderly, primary infantile glaucoma affects 1 in 20,000 babies. Glaucoma also develops in babies and children with other diseases. The prevention of blindness depends on detection and proper treatment. Signs of glaucoma in children include enlargement of one or both eyes (buphthalmos), excessive tearing, cloudy corneas, sensitivity to light, and myopia. Treatment of pediatric glaucoma differs from that of adults, and a range of medical and surgical options are available. Monitoring of visual development is important in these children.
Congenital cornea opacification
This is a rare condition where the cornea which is normally transparent has become opaque in a baby. There are many causes for it including a group of conditions where the anterior segment of the eye has not developed normally. An ultrasound examination is often very useful in the assessment of this condition as the opacified cornea may prevent a good direct examination. Treatment is difficult and depends on the severity. Some cases may need a cornea transplant.
Allergic eye diseases
Allergic eye diseases are very common in children, and can range from mild allergic reactions to potentially blinding conditions such as vernal keratoconjunctivitis (VKC). It is particularly common in children who have asthma, allergic rhinitis or eczema or have a family history of such conditions. Typical symptoms are itchiness, tearing, frequent blinking, sensitivity to light, discharge or red eye. Timely treatment will keep the symptoms at bay and prevent visual loss from cornea scarring.
Tearing in infants and congenital nasolacrimal duct obstruction
Congenital nasolacrimal duct obstruction (CLNO) affects around 6% of infants and causes persistent tearing in one or both eyes. There may be purulent discharge if there is a secondary infection. The tear duct has failed to open at the time of birth, but many cases resolve spontaneously. Lacrimal massage may help to overcome the obstruction. However, if symptoms persist beyond the age of one year or if there is recurrent infection, nasolacrimal duct probing is highly successful in opening the tear duct. Occasionally a tube may be employed to maintain its patency.
Ptosis and other eyelid disorders
A drooping eyelid is called ptosis, and when it presents at birth or in the first year of life, it is known as congenital ptosis. In severe cases, the drooping eyelid can cover part or all of the pupil and interfere with vision, resulting in amblyopia. Such cases may need early surgery to lift up the eyelid. All pediatric patients presenting with either unilateral or bilateral droopy eyelids need a thorough examination to rule out other conditions that may mimic congenital ptosis.
Epiblepharon
Epiblepharon is a common problem in Asian children, where there is inturning of the lower lid lashes, giving rise to irritation, itchiness and rubbing behavior. As the child grows, the direction of the lashes can sometimes correct itself, so the initial management is usually conservative, and involves the regular use of lubricating eyedrops. However, surgery to evert the lashes is sometimes required for symptomatic relief, especially if the lashes are causing scratches or "erosions" on the lower part of the cornea.
Trauma
Ocular injuries are the most common cause of preventable acquired uniocular blindness in children. In contrast to adults, the cause is usually accidental, and include sports-related injuries. As children may not complain of symptoms, it is important to bring for a complete eye examination even if the injury appears to be trivial. Ocular injuries can lead to reduced vision, or even blindness and must be treated urgently.
Inherited eye diseases
Genetic factors play a role in many kinds of eye disease. Apart from eye diseases that are known to be inherited such as congenital cataract, glaucoma, retinal dystrophy, optic atrophy and other eye malformations; we now know that even common vision problems may have a genetic influence, including strabismus and refractive errors. Furthermore, eye abnormalities are present in some inherited systemic disease and may help confirm the diagnosis of the disease.
Neuro-ophthalmological problems
Some children have visual disorders that are secondary to disorders in the brain including optic nerve abnormalities, cortical blindness, delayed visual , cranial neurotpathies etc. In addition to the pediatric ophthalmologist, these children will receive attention from the neuro-ophthalmologist who specializes in visual problems related to brain disorders.
For appointment, click here.
Click here to read more about Paediatric Ophthalmology Service at NUH.
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