Pediatric Ophthalmology
The UC Irvine eye clinic for children with special needs:
Poor vision can delay learning under the best of circumstances. But for a child
with special needs (Down Syndrome, Autism Spectrum Disorder, etc.) optimizing
functional vision is critical for learning, communicating and social interaction.
Many of these conditions have, as a hallmark, poor vision that goes undiagnosed
and untreated. Often the examination process is stressful for the guardian,
the patient and the examiner. Such children may not be able to sit still,
concentrate, communicate, etc. When treatment is prescribed, compliance often
is an issue.
At the Gavin Herbert Eye Institute, we have designated
the first eye clinic setting designed for children with special
needs.
We do not ask these patients to perform as small adults.
The room resembles a comfortable play room. All the instruments
are concealed and portable or handheld, and are introduced for
only the few seconds they are necessary. All materials are presented
table-top with the cooperation of the accompanying guardian. Computer-controlled
images are projected onto wall-sized screens.
The concept is that these patients need comfortable surroundings
and age and ability appropriate visual stimuli. Then, as their
attention is gained, we employ modern technology to rapidly capture
objective images of the eye and its functioning. With modern diagnostic
tools , it often requires a mere 0.3 to 0.5 seconds to capture
information on refractive error, vision and ocular health. After
the child has left the office, we gather the data and review these
findings and make recommendations.
For information or an appointment with Dr. Charlotte Gore, Stephen Prepas, MD, or Dr. Donny Suh, call 949-824-2020. For more information about Dr. Gore, Stephen Prepas, MD, or Dr. Suh, please click
here.
Pediatric ophthalmologists are also the specialists for eye-muscle
surgery AT ANY AGE. Far too often, adults tolerate the troublesome
appearance and double vision of eye alignment disorders, collectively
referred to as strabismus.
IF YOU ARE AN ADULT WITH DOUBLE
VISION, PLEASE BE AWARE THAT SURGERY EXISTS TO CORRECT THIS
CONDITION.
"As a strabismus surgeon, I still see patients who have held
their head in an unhealthy position, painfully undergoing therapy
for neck, back and knee problems ALL THEIR LIVES, all related to
an untreated eye muscle imbalance, which forces the head and body
into an unnatural position to avoid double vision. If you have
thought that nothing can be done for these conditions, please seek
consultation" says Dr. Lingua.
A few words on some common problems…
You can also link to the web site for the American Association for Pediatric
Ophthalmology and Strabismus, for more detailed explanations on the diagnosis
and treatment of the more common eye problems that children encounter. Go
to www.aapos.org and click on “Info for Patients.” The information
was collected from pediatric eye specialists across the nation. Here is an
introduction to the information available:
Conditions - Click
for more details
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Physicians
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Abnormal Head Position
An abnormal head posture or position occurs when the eyes are not looking directly
at the target of interest. Abnormal head positions can include chin up, chin
down, head tilted to the right or left, and face turns to the right or left.
The abnormal position of the head could be due to an ocular or a non- ocular
problem.
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Accommodative Esotropia
Accommodative esotropia or refractive esotropia is eye crossing that is caused
(partially or wholly) by focusing efforts of the eyes as they try to see
clearly
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Achromatopsia
Achromatopsia is a non-progressive visual disorder which is characterized by
decreased vision, light sensitivity, and the absence of color vision.
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Adjustable Sutures in Strabismus Surgery
Adjustable suture surgery is a technique that allows for change in eye muscle
position in the immediate postoperative period. It may improve the chance
for desired eye alignment.
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Treatment Options for Adult Strabismus
Recent treatment advances allow most adults with misaligned eyes to have surgical
correction.
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Albinism
The word albinism refers to a large group of inherited conditions. People with
albinism have little or no pigment in their eyes, skin, and/or hair. They
have inherited genes that do not make the usual amounts of melanin, the major
pigment giving color to our skin and eyes.
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Allergic Conjunctivitis
Allergic conjunctivitis is a reaction of the eye to things in the environment
such as dust, pollen, animal dander, and medications. Commonly called, “pink
eye”
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Amblyopia
Amblyopia or "lazy eye" is a common vision problem in children and
is responsible for vision loss in more children than all other causes combined.
Amblyopia is decreased vision of a child that results when one or both eyes
send a blurry image to the brain. One in 20 children have amblyopia!
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Anesthesia for Adults having eye surgery
A “general,” “local,” or “topical”anesthesia
is necessary during all kinds of surgery to reduce or eliminate pain. Adult
eye muscle surgery is often done with LOCAL anesthesia
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Anesthesia for Children having eye surgery
A “general” anesthesia is typically necessary during all kinds
of children’s eye surgery.
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Anatomy of the Eye
The human eye is a complex structure. The following list describes the
parts of the eye in detail.
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Aniridia
Aniridia means an absence of the iris or the colored part of the eye. A small
rim of iris may be visible only with use of a special instrument by an ophthalmologist.
The pupil is large and the condition in present in both eyes.
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Anisocoria and Horner's Syndrome
The term anisocoria refers to pupils that are different sizes at the same time.
The presence of anisocoria can be normal, or it can be a sign of a medical
condition. In Horner’s syndrome, the pupil in the involved eye is usually
smaller and does not dilate as well as the other eye.
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Astigmatism (distorted sight): a Refractive Error
Refractive errors are the result of the eye improperly focusing light on the
retina. The following list of conditions are the result of refractive
errors.
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Bell’s Palsy
Bell’s palsy, is a weakness of the muscles of the face that comes on
suddenly and is not caused by any known underlying condition. Bell’s
palsy is also known as idiopathic facial palsy (“idiopathic” means
of unknown cause and “palsy” means paralysis). Although more common
in adults, Bell’s palsy can occur in children.
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Brown Syndrome
Brown syndrome (named after Dr. Harold W. Brown) is also known as Superior
Oblique Tendon Sheath syndrome. It is a mechanical problem in which the superior
oblique muscle/tendon (on the outside of the eyeball) does not move freely.
This can cause an abnormal head “tilt”.
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Capillary Hemangioma
A capillary hemangioma (“strawberry” birthmark) is a benign, abnormal
overgrowth of blood vessels. If near the eye, glaucoma can occur.
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Cataract
A cataract is any cloudiness or opacity of the normally clear lens of the eye.
Cataract size ranges from very small to entire lens involvement. If it occurs
early in a child’s life, a surgical emergency is considered.
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Cellulitis
Preseptal cellulitis is swelling of the superficial or anterior portion of
the eyelid in front of the septum. The septum is a sheet of connective tissue
that separates the anterior superficial eyelid from the orbit (bony socket
that contains the eye). Immediate treatment is necessary.
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Chalazion (stye)
A chalazion is a bump in the eyelid that is usually about the size of a small
pea although it is occasionally smaller or larger. More than one chalazion
can occur in an eyelid at the same time.
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Coats Disease
Coats disease is a congenital abnormality of retinal blood vessels. The dilated
vessels leak fluid which may cause exudates to deposit in the retina and
possibly lead to retinal detachment.
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Congenital Nasolacrimal Duct Obstruction
Tears normally drain through small openings in the corners of the upper and
lower eyelids called puncta and enter the nose through the nasolacrimal duct.
Tear duct obstruction prevents tears from draining through this system normally,
resulting in tearing, mucous and secondary infection.
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Conjunctivitis
Conjunctivitis or "pink eye" is a condition where the eyes look pink
or red and may have discharge. Symptoms may include burning, irritation, discharge,
or crusting of the lashes.
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Convergence Insufficiency
Convergence insufficiency is the inability to maintain binocular function (keeping
the two eyes working together) while working at a near distance. Typically,
one eye will turn outward (intermittent exotropia) when focusing on a word
or object from closer than a certain distance.
This can cause trouble reading, headaches, and loss of attention
at school.
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Cortical Visual Impairment
Cortical visual impairment (CVI) is decreased visual response in both eyes
due to an abnormality affecting the part of the brain responsible for sight.
It is one of the most frequent causes of visual impairment in children from
developed countries.
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Cranial Nerve Palsy
The brainstem connects the spinal cord to the brain. The brainstem performs
spinal-cord like functions for the head. The cranial nerves emanate from
the brainstem. They provide sensory and motor functions that deal with
the special senses (olfaction, sight, hearing, equilibrium, and taste). Cranial
nerve palsies result in strabismus.
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Cranial Nerve VI (6) Palsy/Abducens Palsy
Sixth cranial nerve palsy is weakness of the nerve that innervates the lateral
rectus muscle. The lateral rectus muscle pulls the eye away from the
nose and when the lateral rectus muscle is weak, the eye turns inward toward
the nose (esotropia). The esotropia is larger on distance fixation and on
gaze to the same side as the affected lateral rectus muscle.
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Dermoid Cyst
A dermoid is an overgrowth of normal, non-cancerous tissue in an abnormal location.
Dermoids occur all over the body. The ones in and around the eye are usually
comprised of skin structures and fat.
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Diabetes Mellitus and Diabetic Retinopathy
Diabetes mellitus is a group of metabolic diseases characterized by elevated
blood glucose levels resulting from defects in insulin secretion, insulin
action, or both. Diabetes may cause blood vessels in the retina (the light
sensitive lining of the eye) to become damaged (leaky or blocked) or grow
abnormally.
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Dilating Eye Drops
Dilating eye drops contain medication to enlarge (dilate) the pupil of the
eye. There are two types of drops: one type stimulates contraction of the
muscles that enlarge the pupil (such as phenylephrine); the other type relaxes
the muscles that make the pupil constrict (such as cyclopentolate). These
are frequently used at your first eye examination
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Dissociated Vertical Divergence (DVD)
DVD is a condition in which one eye drifts upward. The eye may drift upward
only occasionally or be deviated almost constantly.
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Down Syndrome and the Eyes
Down syndrome is caused by a duplication of all or part of chromosome 21 making
three copies of the chromosome rather than the usual two copies. Individuals
with Down syndrome are at increased risk for a variety of eye and vision
disorders.
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Duane Syndrome
Duane syndrome, also called Duane retraction syndrome (DRS), is a group of
eye muscle disorders that cause abnormal eye movements. People with Duane
syndrome have difficulty rotating one or both eyes outward (abduction) or
inward (adduction).
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Esotropia
A type of strabismus in which one or both eyes turn inward. It can be intermittent
or constant.
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Exotropia
Exotropia refers to eyes that turn outward. It is the opposite of crossed eyes,
or esotropia.
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Eye Safety Questions and Answers
The following list addresses common questions related to eye safety.
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Fetal Alchohol Syndrome
Fetal Alcohol Syndrome (FAS) describes changes in a baby born to a mother whose
pregnancy was complicated by alcohol consumption.
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Fourth Nerve Palsy/Superior Oblique Palsy/Trochlear Palsy
A superior oblique palsy is a weakness of the superior oblique muscle, one
of the extra ocular muscles of the eye. A palsy refers to a complete weakening
of the muscle while a paresis is a partial weakening. This condition is usually
unilateral (one eye) but can be bilateral (both eyes). As the fourth cranial
nerve innervates the superior oblique, this is also known as a fourth nerve
palsy.
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Glasses for Children: Questions and Answers
The following list addresses comon questions about glasses for children.
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Glaucoma
Glaucoma is a group of diseases characterized by damage to the optic nerve
that often occurs when the eye pressure is elevated and can result in severe
vision loss.
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Headaches in Children: Questions and Answers
The following list addresses common questions about headaches in children.
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Herpes-related Eye Disease
Herpes is a family of viruses with many different subtypes. Eye infections
and mouth cold sores are most commonly caused by Herpes Simplex Virus (HSV)
Type I.
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Hyperopia (farsighted): a Refractive Error
Refractive errors are the result of the eye improperly focusing light on the
retina. The following list of conditions are the result of refractive
errors.
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Hyphema
A hyphema is an accumulation of blood in the space between the cornea and the
iris.
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Idiopathic intracranial hypertension?
Idiopathic intracranial hypertension (IIH) is a disorder that results
from an increase in the pressure of the Cerebro-Spinal Fluid (CSF) that cushions
and protects the brain and spinal cord. The CSF is constantly produced
in the brain and reabsorbed back into the bloodstream at a fairly constant
rate. This allows the fluid pressure around the brain to remain constant.
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Infantile Esotropia
Esotropia is an inward turning of one or both eyes. Infantile esotropia begins
at birth or during the first year of life. Infantile esotropia is also called
congenital esotropia.
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Intraocular Lens Implant (IOL)
An intraocular lens implant is a synthetic, artificial lens placed inside the
eye that replaces the focusing power of a natural lens that is surgically
removed, usually as part of cataract surgery (see cataracts).
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Iritis
Iritis is inflammation of the iris. Frequently, children with arthrirtis are
screened for iritis.
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Juvenile Idiopathic Arthritis/Juvenile Rheumatoid Arthritis
Juvenile Idiopathic Arthritis is defined as arthritis (inflammation of the
joints) of greater than 3 months' duration with onset at less than 16 years
of age.
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Keratoconus
Keratoconus is a condition that is due to progressive steepening of the cornea
resulting in a "cone" shaped appearance. The cornea becomes thin
near the center and may lead to myopia (near sightedness) and/or severe astigmatism.
It is usually bilateral and typically begins to develop during adolescence.
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Learning Disabilites and the Visual System
Learning disability is a lifelong condition which interferes with the ability
to learn. This includes: learning to read, reading comprehension, writing
and spelling, mathematical operations, learning a foreign language, and organizing
written and spoken language. Individuals with LD may be particularly gifted
in other skills and are typically of normal intelligence.
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Leber's Congenital Amaurosis
Leber Congenital Amaurosis (LCA) is an inherited condition in which findings
commonly first appear after 2-3 months of age. LCA affects both the rods
and cones (cells which detect light) of the retina.
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Leukocoria
Leukocoria means "white pupil." It occurs when the pupil (the round
hole in the colored part of the eye) is white rather than the usual black.
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Marfan Syndrome
The Marfan syndrome is a heritable condition that affects the strength of the
connective tissues that hold parts of the body together and provide a framework
for growth and development. Because connective tissue is found throughout
the body, patients with Marfan syndrome have problems with a number of systems
including the skeleton, eyes, heart and blood vessels, nervous system, skin
and lungs.
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Molluscum Contagiosum
Molluscum contagiosum is a common viral infection in children. It causes bumps
on the skin including the eyelids and eyelid margins (ocular molluscum).
The bumps are usually pearl-like and dome-shaped with a central crater (umbilication).
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Monocular Elevation Deficiency/ Double Elevator Palsy
Monocular Elevation Deficiency, also known by the older term Double Elevator
Palsy, is an inability to elevate one eye, usually resulting in one eye that
is pointed downward relative to the other eye (hypotropia).
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Myasthenia Gravis
Myasthenia gravis is an autoimmune disease in which antibodies attack normal
skeletal muscle tissue and render it weak. It occurs in both children and
adults and can affect different muscle groups in the body.
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Myopia (nearsighted): a Refractive Error
Refractive errors are the result of the eye improperly focusing light on the
retina. The following list of conditions are the result of refractive
errors.
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Neurofibromatosis
Neurofibromatosis is a condition characterized by multiple growths which derive
from primitive cells in the body. The growths occur along nerve paths, anywhere
in the body. Neurofibromatosis skin lesions are typically flat, pigmented
patches but occasionally are elevated flesh-colored bumps. These bumps can
be called “café-au-lait” spots.
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Nystagmus
Nystagmus is an involuntary, shaking, “to and fro” movement of
the eyes.
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Optic Nerve Atrophy
Optic nerve atrophy (ONA) is mild to severe damage to the optic nerve that
can adversely affect central vision, peripheral vision and color vision.
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Optic Nerve Drusen
Optic nerve drusen are abnormal globular concretions of protein and calcium
salts which accumulate in the optic nerve and usually become visible after
the first decade of life. They occur in both eyes more often than just one.
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Optic Nerve Hypoplasia
Optic nerve hypoplasia (ONH) is a congenital condition in which the optic nerve
is underdeveloped (small).
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Optic Neuritis
Optic neuritis is a condition that involves inflammation of the optic nerve.
The optic nerve carries the visual signal from the eye to the brain.
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Orthoptist and Orthoptics: Questions and Answers
Certified orthoptists are allied health professionals uniquely trained in evaluation
and management of children and adults with eye movement abnormalities. They
practice orthoptics and are recognized among the highest levels of ophthalmic
medical personnel.
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Patching Tips for Parents
Patching is sometimes recommended when children are diagnosed with amblyopia
or lazy eye. It works by handicapping the eye with normal vision so that
the vision in the poorer seeing amblyopic eye improves. The following list
includes patching tips for parents.
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Pediatric Ophthalmologist
All ophthalmologists (medical doctors) have training in children’s eye
problems, but the pediatric ophthalmologist has had additional training and
practice in examining children and caring for their eye problems. If your primary
care doctor suggests that your child have his or her eyes checked, a pediatric
ophthalmologist will have the greatest knowledge of the possible conditions
and the greatest experience in examining children effectively.
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Pseudostrabismus
Strabismus is the medical term for eye misalignment. Pseudostrabismus refers
to a false appearance of strabismus. Most often the eye(s) have the false
appearance of turning inward.
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Pterygium
Pterygium means "wing" and refers to a wing-like growth that spreads
over the cornea. Pterygia are more common in warm climates such as the tropics
and are associated with early exposure to the sun (especially during childhood
and teen years).
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Ptosis (tow-sis)
A droopy eyelid or ptosis can be present at birth (congenital) or occur later
in life (acquired). Poor development of the levator palpebris muscle in the
upper eyelid with resulting abnormal function is the most common cause of
congenital ptosis. Acquired ptosis has many causes. Ptosis can involve one
or both upper eyelids, with or without asymmetry.
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Refractive Errors: Myopia (nearsighted), Hyperopia (farsighted),
Astigmatism (distorted sight)
Refractive errors are the result of the eye improperly focusing light on the
retina. The following list of conditions are the result of refractive
errors.
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Retinitis Pigmentosa
Retinitis pigmentosa (RP) is a group of diseases characterized by a gradual
loss of vision (night and peripheral, predominantly) caused by changes in
the retina (pigment and neural cells, blood vessels, etc).
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Retinoblastoma
Retinoblastoma is a malignant tumor of the eye(s) that originates from the
retina (light-sensitive lining of the eye). One (unilateral) or both (bilateral)
eyes may be affected and typically occurs in children less than 5 years old.
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Retinopathy of Prematurity (ROP)
Retinopathy of prematurity (ROP) is a potentially blinding disease caused by
abnormal development of retina blood vessels in premature infants.
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Retinoschisis (Congenital X-linked Retinoschisis, Juvenile
X-linked Retinoschisis)
The retina is the back part of the eye that sends images to the brain. The
retina consists of ten layers with the inside surface consisting primarily
of nerve fibers. The term “schisis” means split. Hence retinoschisis
is a split in the layers of the retina.
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Retinoscopy: How We Determine Glasses for Nonverbal Children
Retinoscopy is a technique to determine objectively the refractive error of
the eye (farsighted, nearsighted, astigmatism) and the need for glasses.
The test can be quick, easy, reliably accurate and requires minimal cooperation
from the patient.
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Rubinstein-Taybi Syndrome
Rubinstein-Taybi syndrome (RTS) is a genetic multi-system disorder characterized
by facial abnormalities, broad thumbs and great toes, and developmental disability.
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Shaken Baby Syndrome
Shaken baby syndrome (SBS) is a constellation of findings (including serious
brain injury) that occurs when a baby is shaken repeatedly or the head impacts
a hard object.
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Sixth Nerve Palsy/Abducens Palsy
Sixth cranial nerve palsy is weakness of the nerve that innervates the lateral
rectus muscle. The lateral rectus muscle pulls the eye to the side, away
from the nose. An eye affected by sixth nerve palsy turns inward (esotropia).
The esotropia is larger when looking at a distance and also to the same side
as the affected lateral rectus muscle.
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Stickler Syndrome
Stickler syndrome is a progressive genetic disorder of connective tissue throughout
out the body.
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Strabismus
Strabismus is any misalignment of the eyes.
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Strabismus Measurements and Techniques
Strabismus is measured in several different ways, depending on the level of
cooperation of the patient. Light reflex tests are easiest to perform, and
cover testing requires more cooperation and is more accurate.
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Strabismus Surgery
Strabismus surgery strengthens or weakens eye muscles, which changes the alignment
of the eyes relative to each other.
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Sturge-Weber Syndrome
Sturge-Weber syndrome is characterized by a reddish discoloration of the skin
on one side of the face (port wine stain) and malformation of blood vessels
of the brain.
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Superior Oblique Palsy/Trochlear Palsy/Fourth Nerve Palsy
A superior oblique palsy is a weakness of the superior oblique muscle, one
of the extra ocular muscles of the eye. A palsy refers to a complete weakening
of the muscle while a paresis is a partial weakening. This condition is usually
unilateral (one eye) but can be bilateral (both eyes). As the fourth cranial
nerve innervates the superior oblique, this is also known as a fourth nerve
palsy.
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Third Nerve (Cranial Nerve III [3]) Palsy/Oculomotor Palsy
Palsy or weakness of the third cranial nerve causes loss of movement of the
eye up, down, and in as well as drooping (ptosis) of the upper eyelid. In
a complete palsy, the pupil may be enlarged, and the ability of the eye to
focus at near (accommodate) may be impaired. The weakness of the third nerve
may be partial or complete.
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Thyroid Eye Disorders
The following list details several disorders that are the result of a malfunctioning
thyroid gland.
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Toxoplasmosis
Toxoplasmosis is an infection with the protozoan intracellular parasite Toxoplasma
gondii. In the eye, Toxoplasma infections frequently cause significant inflammation
and subsequent scarring which may temporarily or permanently impair vision.
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Vision Screening
Vision screening is an efficient and cost-effective method to identify children
with visual impairment or eye conditions that are likely to lead to visual
impairment so that a referral can be made to an appropriate eye care professional
for further evaluation and treatment.
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For ophthalmology
appointments, please call:
UC Irvine Medical Center
714-456-7183
Gavin Herbert Eye Institute Building
949-824-2020
Laser Refractive Surgery
949-824-9970
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