Pediatric Ophthalmology

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​The Pediatric Ophthalmology and Optometry Department specializes in the prevention, diagnosis and treatment of vision problems and eye diseases. 

Among the eye problems treated are:

• Blocked tear duct
  
• Cataracts
  
• Crossed eyes
  
• Drooping eyelids
  
• Lazy eye
  
• Retinopathy prematurity​​​
  

Blocked tear duct

Tears from the surface of the eye are normally drained into the nose through the tear ducts. In children, the ducts may be blocked at birth because they have not fully developed. A blockage will cause tears to accumulate and overflow onto the cheek, even when the child isn't crying. The accumulation of tears can cause a buildup around the eye called mattering. At Marshfield Clinic, we have specialists who are trained to treat blocked tear ducts in infants.

Treatments

In most cases, blocked tear ducts simply get better on their own. Treatments are then focused on making sure the symptoms don't get out of hand and the natural process of opening the blockage is encouraged. This is done by:

Eye drops
Antibiotic medication in the form of eye drops can be given to reduce the amount of mattering (buildup) around the eye. This treatment does not actually help the duct open.

Massaging of the tear duct
In many cases, massaging the tear duct in a specific way may open the duct. Parents will be instructed on this simple technique that forces fluid through the membrane that is blocking the tear duct. If done properly, and on a regular basis, symptoms will improve quickly.

Probing the tear duct
If a blocked tear duct does not improve, probing of the tear duct is the recommended method of treatment. In this procedure, the child is put under with general anesthesia in an ambulatory surgery center and a thin wire probe is placed down the tear duct to pierce the membrane and open the blockage. This procedure takes between 3-5 minutes. There is no incision, scarring or sutures with this procedure and there is a success rate of approximately 99%.

Cataracts

When the lens of a child's eye becomes cloudy and interferes with vision, it is called a cataract. This problem will interfere with a child's visual development and can lead to other issues like Amblyopia (lazy eye). Marshfield Clinic has doctors who specialize in the care and treatment of cataracts in kids.

Treatments

Surgery is usually well tolerated by even the youngest children who have cataracts. The surgery is then typically followed by a rehabilitation process.

Surgery
Surgical techniques are used to almost completely remove the cataract, limiting the chances of it returning. After surgery, parents will be asked to use several different types of drops to help the child's eye heal. In addition, a patch may be worn over the operated eye for several days or weeks.

Rehabilitation
After the lens with the cataract is removed, vision will return with the replacement of a "new" lens. This can be done in the form of contact lenses, glasses or a lens placed within the eye during the cataract surgery. Your specialists will discuss these options based on the child's age and the type of cataract that is present. Follow-up throughout childhood is needed to manage Amblyopia (lazy eye).​

Sometimes a child's eyes don't work together as they should. This case, called strabismus, is known as being "cross eyed" or having a "wandering eye." Marshfield Clinic has a specialist with training in the treatment of crossed or wandering eyes.

Treatments

It's common for infants' eyes to wander, but if one eye wanders past the age of 2 or 3 months, your child needs care for the issue. Treating lazy eye involves making the child use the eye with the reduced vision (weaker eye). Currently, there are two ways used to do this:

Eye patching
A patch is worn over the child's stronger eye for a period of weeks to force the use of the crossed or wandering eye. Patching also promotes vision in the weaker eye and helps brain to better process images seen by the eyes.

Eye glasses
Glasses are often used to correct the misalignment (crossing or wandering) of the eyes. An eye care specialist will determine whether or not this is the appropriate treatment for the strabismus.

Surgery
Your doctor may recommend surgery to help align your child's eyes. During the surgery, eye muscles are adjusted to help better control how the eye moves. This surgery is quite common and the child can go home on the same day. The two types of surgery are:

• Recession, in which a muscle is moved to a new position on the eye.
• Resection, in which a section of an eye muscle is removed.​

Drooping eyelids

Ptosis is the drooping of an upper eyelid in one or both eyes. The issue may be barely noticeable or can sometimes cover the entire pupil. Without treatment a drooping eyelid can result in a child developing Amblyopia (lazy eye) in the eye with the drooping lid or rarely developing strabismus (wandering eye). A drooping eyelid can have long-term effects on vision if it goes untreated.

Marshfield Clinic has physician specialists who are trained specifically in the treatment of a drooping eyelid.

Treatments

Surgery
Surgery performed by an ophthalmologist or plastic surgeon is usually the best treatment for drooping eyelids. A Marshfield Clinic surgeon would tighten the muscles that lift eyelids, improving your child's vision and appearance. In severe cases the surgeon may attach the eyelid under the eyebrow allowing the forehead muscles to raise the eyelid.

​Lazy Eye

Sometimes a child's eye is found to have poor vision. This is termed amblyopia or "lazy eye." This can cause issues with the way the brain interprets what is seen by the eye.

Marshfield Clinic has a specialist with training in treatment of "lazy eye."

Treatments

Treating lazy eye involves making the child use the eye with the reduced vision (weaker eye). Currently, there are three ways used to do this:

Eye drops
Atropine is used once a day to temporarily blur the vision in the stronger eye so that the child will opt to use the lazy eye. This treatment stimulates vision in the weaker eye and helps the part of the brain manage vision more effectively.

Eye patching
A patch is worn over the child's stronger eye for a period of weeks which forces the use the lazy eye. Patching also promotes vision in the weaker eye and helps the brain to better process images seen by the eyes.

Eye glasses
Glasses may be needed if the amblyopia is caused by the eye being very far-sighted, very near-sighted, or a large amount of astigmatism relative to the non-amblyopia eye. The glasses may be all that is needed in some cases or may be used in conjunction with eye drops or patching. An eye care specialist will determine the appropriate treatment for the child.

Retinopathy of Prematurity

ROP refers to the abnormal growth of blood vessels behind the eyes. Premature babies are at risk because the blood vessels in their eyes have not fully developed at birth. In severe cases the blood vessels can detach from the retina and cause long-term vision problems. Marshfield Clinic has physicians trained specifically for diagnosis and treatment of ROP in infants.

Treatments

The early stages of ROP (1 and 2) often goes away without treatment. However, babies with more severe ROP may need more extensive treatment.

Laser Surgery
Surgery to remove the abnormal blood vessels is the most common and successful treatment for ROP. The surgeon will use a laser to remove the peripheral areas of the retina to slow or reverse the abnormal growth of blood vessels. Some vision is compromised with the surgery but the sharp, central vision needed for everyday activities like reading is saved.

In the later stages of ROP (3 to 5) other treatment options include:

• Scleral buckle - placing of a silicone band around the eye and tightening it to allow the retina to flatten back down onto the wall of the eye. Infants who have had a sclera buckle will have the band removed months or years later.
• Vitrectomy - removing the glassiness of the eye and replacing it with saline solution. This allows the scar tissue on the retina to be peeled back or cut away, allowing the retina to relax and lay back down against the eye wall. This treatment is only performed at stage five of ROP.
  
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