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Normal vision is a sense that develops during infancy and childhood. Pediatric ophthalmology emphasizes early diagnosis and treatment of pediatric eye diseases in order to obtain the best possible visual outcome. Eye disease in children is not always limited to the ocular system and may be a sign of systemic disease.


Nonspecific signs and symptoms commonly occur as the chief complaint or as an element of the history of a child with eye disease. Five of these findings are described here, along with a sixth—leukocoria—which is less common, but often has serious implications. Do not hesitate to seek the help of a pediatric ophthalmologist when you believe the diagnosis and treatment of these signs and symptoms require in-depth clinical experience.


Redness (injection) of the bulbar conjunctiva or deeper vessels is a common presenting complaint. It may be mild and localized or diffuse and bilateral. Causes include superficial or penetrating foreign bodies, trauma, infection, allergy, and inflammation associated with systemic entities such as Stevens-Johnson syndrome (SJS), uveitis, or Kawasaki disease. Irritating noxious agents also cause injection. Subconjunctival hemorrhage may be traumatic, spontaneous, or may be associated with hematopoietic disease, vascular anomalies, or inflammatory processes. Uncommonly, an injected eye can be due to an intraocular or orbital tumor.


Tearing in infants is usually due to nasolacrimal obstruction but may also be associated with congenital glaucoma, in which case photophobia and blepharospasm may also be present. Allergic or viral conjunctivitis or corneal abrasions can cause tearing.


Purulent discharge is usually associated with bacterial conjunctivitis. Watery discharge occurs with viral conjunctivitis/keratitis, iritis, and corneal abrasions/foreign bodies. Mucoid discharge may be a sign of allergic conjunctivitis or nasolacrimal obstruction. Infants with nasolacrimal duct obstruction commonly have tearing associated with yellow crusts, but their eye remains white and quiet. A mucoid discharge due to allergy typically contains eosinophils, whereas a purulent bacterial discharge contains polymorphonuclear leukocytes.


Pain in or around the eye may be due to foreign bodies, corneal abrasions, lacerations, acute infections of the globe or ocular adnexa, iritis, and elevated eye pressure. Large refractive errors or poor accommodative ability may manifest as headaches and eye strain. Trichiasis (inturned lashes) and contact lens problems also cause ocular discomfort.


Acute aversion to light may occur with corneal abrasions, foreign bodies, and iritis. Squinting of one eye in bright light is a common sign of intermittent exotropia. Photophobia is present in infants with glaucoma, albinism, aniridia, and retinal dystrophies such as achromatopsia. Photophobia is common after ocular surgery and after pharmacologic dilation of the pupil.


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