KATHERINE HARE, M.D. *
Pediatric Ophthalmology
Adult Strabismus

Dr. Hare has a special interest in routine, medical and surgical eye care for children ages 0-18.

Larson Eye Center is focused on pediatric ophthalmology and child vision. We are a leading center in Chicagoland dedicated to providing the best eye care for children. Katherine Hare, MD is our pediatric ophthalmology specialist serving the greater Chicagoland area.

Strabismus

Strabismus is a condition where your eyes don't look toward the same object together. One eye moves normally, while the other points in (esotropia or "crossed eyes"), out (exotropia), up (hypertropia) or down (hypotropia). Strabismus can lead to amblyopia. Strabismus is the physical disorder, and amblyopia is the visual consequence.

Strabismus Symptoms and Signs

Newborns often appear to have crossed eyes due to a lack of developed vision, but this disappears as the infant grows. True strabismus does not disappear as the child grows. Visit your eyecare practitioner if you're unsure if your child is demonstrating true strabismus. The earlier the diagnosis and treatment, the better the visual results. Without treatment, your child may develop blurry or double vision.

What Causes Strabismus?

Strabismus may be caused by unequal pulling of muscles on one side of the eye or a paralysis of the ocular muscles.

Strabismus Treatment

Treatment for strabismus is similar to amblyopia treatment:

• Vision therapy including patching or visual exercises
• Glasses with the correct prescription or bifocal or prism correction to aid in proper focusing,
• Eyedrops to help focus
• Surgery.

Surgery will correct the misaligned eyes but cannot resolve amblyopia caused by strabismus. Before scheduling a child for surgery, some eyecare practitioners inject the ocular muscles with Botox (botulinum), which temporarily relaxes the muscles. In some cases, strabismus is permanently corrected in this way.

Amblyopia

Amblyopia is reduced vision in an eye that has not received adequate use during early childhood.

What causes amblyopia?

Amblyopia, also known as "lazy eye," has many causes. Most often it results from either a misalignment of a child's eyes, such as crossed eyes, or a difference in image quality between the two eyes (one eye focusing better than the other.) In both cases, one eye becomes stronger, suppressing the image of the other eye. If this condition persists, the weaker eye may becomes useless. With early diagnosis and treatment however, the sight in the "lazy eye" can be restored.

What treatments are available?

Before treating amblyopia, it may be necessary to first treat the underlying cause.

• Glasses are commonly prescribed to improve focusing or misalignment of the eyes.
• Surgery may be performed on the eye muscles to straighten the eyes if non-surgical means are unsuccessful. Surgery can help in the treatment of amblyopia by allowing the eyes to work together better.
• Eye exercises may be recommended either before or after surgery to correct faulty visual habits associated with strabismus and to teach comfortable use of the eyes.

The correction may be followed by:

• Patching or covering one eye may be required for a period of time ranging from a few weeks to as long as a year. The better-seeing eye is patched, forcing the "lazy" one to work, thereby strengthening its vision.
  
• Medication—in the form of eye drops or ointment—may be used to blur the vision of the good eye in order to force the weaker one to work. This is generally a less successful approach.
  

What happens if amblyopia goes untreated?

If not treated early enough, an amblyopic eye may never develop good vision and may even become functionally blind.

Blocked Tear Ducts

A blocked tear duct occurs when the nasolacrimal duct, which drains tears from the eye into the nose, gets blocked (because of infection, trauma, etc.) or, more commonly, is blocked from birth (congenital nasolacrimal duct obstruction). It is estimated that up to 30 percent of newborns are born with a blocked tear duct.

Symptoms of a Blocked Tear Duct

Infants with a blocked tear duct will often:

• Have teary eyes, so that their eyes always seem extra moist or simply seem to produce a lot of tears (epiphora) that drain onto the child's cheeks
• Have eyes that appear crusted and matted with discharge, because mucoid material that is normally produced in the lacrimal sac backs up onto the eye, instead of draining through the nasolacrimal duct to the nose
• Have some redness around their eyes because these children often rub their eyes

Occasionally, when a tear duct is blocked, the nasolacrimal sac, which is located between the inner corner of your child's eye and his nose, will become infected. This condition, called dacryocystitis, can cause the area to become swollen, red, and painful, and your child may also have a fever. Most children with a simple blocked tear duct do not have other symptoms though.

Diagnosis of a Blocked Tear Duct

Children are usually diagnosed with a blocked tear duct based on the pattern of symptoms, including the excessive tearing and matting.

Keep in mind that many newborns don't start making tears until they are about two weeks old or a little older, so you may not notice any symptoms of a blocked tear duct, even if your baby is born with it.

Occasionally, a modified fluorescein dye disappearance test may be done, in which a fluorescein dye is placed on a child's eye. After 5 minutes, a special light is used to see if all of the dye has disappeared through the tear ducts and into the nose. If not, and the dye remains in the child's eye, then he likely has a blocked tear duct.

Treatments for Blocked Tear Ducts

Fortunately, most cases of blocked tear ducts go away on their own. Until your child's blocked tear duct does go away, treatments can include:

• Nasolacrimal massage, in which you massage the inside corner of your child's nose 2 to 3 times a day
• Cleaning any discharge or matter in the eyes with a warm washcloth
• Antibiotic eye drops when the the discharge in the eyes becomes excessive, like if you are having to wipe it away more than 2 or 3 times a day
• Oral antibiotics if your child develops symptoms of dacryocystitis

If your child's blocked tear duct does not go away on its own, especially by the time he is 9 to 12 months old, additional treatment by nasolacrimal duct probing may be necessary. In this procedure, a pediatric ophthalmologist will insert a probe into the nasolacrimal duct, attempting to clear anything that is blocking the duct. Occasionally, a canalicular stent, a silicone tube, is placed into the nasolacrimal duct if it continues to get obstructed.

What You Need To Know

• Although children with a complete blockage will always have symptoms, if your child has a partial blockage, you may only notice the symptoms when he is making extra tears or if his nose is blocked, like when he has a cold.
• If your younger child is repeatedly diagnosed with pinkeye, especially if his eye is not usually red, then he may have a blocked tear duct.
• Children can have a blocked tear duct affecting either one or both eyes.
• If your child's eye are tearing and he is fussy and irritable, instead of a blocked tear duct, your child may be evaluated for congenital glaucoma.
• If probing is done early, before a child is 6 to 8 months old, it can often be done by a pediatric ophthalmologist in their office, without general anesthesia, like would be necessary for older children.
• A pediatric ophthalmologist can be helpful when your child has a blocked tear duct, although your pediatrician can likely manage most simple cases.