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INTRODUCTION

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 can also be a manifestation of systemic disease.

COMMON NONSPECIFIC SIGNS & SYMPTOMS

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—abnormal red reflex. 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.

RED EYE

Redness (injection) of the bulbar conjunctiva or deeper vessels is a common presenting complaint. It may be localized or diffuse. Causes include infection, inflammation (ocular or systemic, like Kawasaki disease or Stevens-Johnson syndrome [SJS]), allergy, irritation from noxious agents (acidic or alkali exposure), and trauma. Subconjunctival hemorrhage may be traumatic, spontaneous, or associated with hematopoietic disease, vascular anomalies, or inflammatory processes.

TEARING

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. Any irritation in the eye can cause tearing including infections, allergy, and dryness.

DISCHARGE

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 & FOREIGN-BODY SENSATION

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.

PHOTOPHOBIA

Acute aversion to light may occur with corneal abrasions, foreign bodies, and uveitis. Squinting of one eye in bright light is a common sign of intermittent exotropia (eye drifting). 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.

ABNORMAL RED REFLEX

Checking for an abnormal red reflex is a crucial part of every pediatric exam starting from the newborn period. Abnormal red reflex can be unilateral or bilateral. Any abnormality altering the penetration of light into the retina can result in abnormal red reflex. This ...

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