Medically Reviewed by Johnny Khoury, M.D.
Children are at risk for some eye conditions that adults are not. Going to a pediatric optometrist on a regular basis will ensure your child gets routine care to treat any vision issues that develop.
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It is rare that a child will need surgery to treat an eye condition, but some disorders may involve surgery as one treatment option.
Refractive errors like nearsightedness, farsightedness, and astigmatism should be treated with glasses or contact lenses first, but in very rare instances, a child may need laser surgery like LASIK.
Eye Conditions Impacting Children
There are many eye conditions that impact vision, which are typically associated with progressive diseases or getting older. For example, nearsightedness slowly gets more severe over time, and cataracts are associated with older adults. However, several conditions impacting vision start in children or are congenital, meaning the child is born with the condition.
It is important for parents to ensure their children receive regular eye exams to detect and treat any vision problems that begin. Problems with the eyes can make activities and learning harder. Learning to read, enjoying outdoor sports, and even making friends, in some serious cases, can all be impacted by problems with the eyes.
Optometrists and ophthalmologists recommend that babies receive their first comprehensive eye exam at 6 months old. If the child’s vision is clear, they do not need another eye exam until they are about 3 years old. Their next eye exam should be just before they start school, at 5 or 6 years old.
If your child’s optometrist does detect any underlying vision problems, correcting these can begin as early as possible. There are many approaches to treating trouble seeing, with glasses being the most popular solution. In rare cases, however, a child might need LASIK or another eye surgery to treat the condition.
Visual Problems in Children That May Require Eye Surgery
Eye conditions in children are slightly different than those that occur in adults. For example, children typically do not have refractive errors like nearsightedness or farsightedness until they are a few years old. They are, however, more likely to be affected by specific defects or congenital issues, and these are more likely to impact how they understand the world.
Conditions most likely to affect children include:
Blocked tear ducts
There are several potential causes of blockage, but the result is fewer tears to keep the eye healthy. Tears will not drain normally, and this can lead to watery, irritated eyes that can experience chronic infections.
Babies might be born with tear duct blockages, but these typically resolve by their first birthday. An ophthalmologist may recommend parents use a special massage technique around the tear duct area to loosen anything obstructing the duct. It is important that you do not try this without instructions from a medical professional.
In very rare cases, the child may need surgery to open the duct and allow tears to flow to keep the eye healthy.
This common disease is also called pink eye. It is caused by a viral or bacterial infection that can be highly contagious or allergies, which are not contagious.
The eye will look red or pink due to inflammation in the conjunctiva, or the white part of the eye and the inside of the eyelids. Sometimes, the eye may water or leak tears, or there could be a discharge. The eye may be itchy or uncomfortable, and it can be difficult to prevent children from scratching their eyes, which can make conjunctivitis worse and spread the disease to others.
Children with bacterial or viral conjunctivitis should stay home from school until the disease clears up. To know the difference between types of conjunctivitis, your child will need a diagnosis from an optometrist or ophthalmologist.
Often, conjunctivitis clears up on its own or with medication. It is very rare that the infection spreads into the eye, but this is possible. Getting a medical diagnosis as soon as symptoms begin will help to prevent further damage.
Any damage caused by an eye infection may require surgery later in life. An optometrist or ophthalmologist may recommend waiting on eye surgeries until the child is an adolescent or young adult.
This is a condition in which the eyelid droops, covering one eye partially or entirely. This blocks vision, and the child may not be able to move the eyelid so they can see better. In rare instances, ptosis may require surgery, especially if the child’s eye closes.
This is misalignment of the eyes due to poor muscle tone in one eye. Special glasses or an eye patch can help to realign the eyes, as with amblyopia; however, extreme cases or instances in which the child did not receive early treatment may lead to surgery later in life.
Strabismus is more treatable with surgery on the eye muscles than amblyopia, which is poor vision in one or both eyes that may influence whether the child develops strabismus or not. There is no surgery to correct amblyopia; it is only treatable when diagnosed at a young age.
However, strabismus may be treated with surgery if necessary. There are about 1.2 million strabismus surgeries every year, making it the third most common eye surgery in the United States. It has a high success rate, and complications for children are very rare
Congenital diseases occur just after birth and require special treatment, which often means surgery. These include:
- Retinoblastoma, or a malignant tumor that appears in the first three years of life, which can lead to vision loss.
- Infantile cataracts, or congenital cataracts, which are a clouding of the lens in a newborn’s eye. They may be removed a year or two later with surgery.
- Congenital glaucoma, which is high fluid pressure in the eye, leading to damage to the optic nerve and other structures in the back of the eye. Treatment is often medication and surgery to drain the fluid.
- Genetic or metabolic eye diseases, like type I diabetes, leading to a higher risk for cataracts or other causes of vision loss that may require surgery later in life.
Are Children Eligible for LASIK?
Ophthalmologists agree that refractive surgeries should be reserved for patients 18 or older, per U.S. Food and Drug Administration (FDA) guidelines.
Children younger than 18 are not considered to have stable vision because their eyes are still developing and are constantly changing in shape. Because the key part of the success of LASIK is the actual reshaping of the eye, any vision improvements to be gained by LASIK surgery in someone so young would only be temporary. If a child undergoes eye surgery to correct problems such as nearsightedness, he or she has a high likelihood of needing a second operation later.
The FDA recommends that kids who change their contact lenses or eyeglasses within the past year should not undergo refractive surgery. If you’re considering LASIK for your child within a year of replacing the eyewear, they may be ineligible.
In extreme cases such as anisometric amblyopia, where traditional therapies are ineffective, children can receive LASIK treatment as a last resort.
Despite the FDA regulations, some children will require refractive surgery to prevent worsening eyesight. In such cases, surgeons prefer other non-LASIK techniques such as surface ablation because LASIK surgery involves cutting the cornea.
Children also tend to rub their eyes more than adults. Doing so after surgery can wipe out the flap that is created during LASIK, which would render the procedure ineffective.
Kids with high refractive errors who are candidates for surgery can receive PRK to produce improved and stable vision.
Other alternatives for correcting refractive errors include contact lenses and eyeglasses—listing the most common approaches employed in children.
Best Age for LASIK
For most people, eyes continue to develop until their mid-twenties. Ophthalmologists generally consider someone between ages 20 and 40 to be in the ideal age for receiving LASIK treatment.
If you’re 18 years or older and have had a stable prescription for the past year, then you qualify for refractive surgery. Younger patients may not be eligible for the procedure, but there is no definite upper age limit for LASIK.
Refractive Errors in Children Only Require Surgery in Special Cases
If you or members of your family had childhood eye diseases or congenital conditions, it is important to let your pediatric optometrist know this. Many conditions impacting young children’s vision are genetic and treatable when diagnosed early.
Detecting refractive errors — nearsightedness, farsightedness, and astigmatism — in children is very important. When detected as early as possible, the child can get glasses, or contact lenses if they are older, which will help them see clearly so they can learn and enjoy playing with friends.
In rare cases, a child may not be able to wear glasses to correct their refractive error, so refractive surgery like LASIK/PRK may be an option. There are two reasons a young child would undergo a laser corrective surgery for their refractive issue.
- They have bilateral high refractive errors that make seeing without glasses dangerous or very difficult, but they cannot be trusted to keep their glasses on.
- They have anisometric amblyopia, or poor sight in their eyes, and conventional approaches to treatment have failed.
Most refractive errors progress throughout childhood and only begin to slow down or stop changing when the individual is a young adult or middle aged. Undergoing refractive surgery (LASIK) for a condition like nearsightedness does not make sense until the individual is 18 or older, and their refractive error is no longer dramatically changing.
In rare instances, a child may benefit from refractive surgery. Your pediatric optometrist or ophthalmologist will let you know if this is an option for your child.
Prevention & Early Detection
Detecting and treating eye problems is an important part of the development of children. Vision is an important sense when it comes to learning. Having poor vision – especially if undiagnosed and untreated – will limit how well a child can learn.
At six months, an infant’s vision should be as good as an adult’s in; depth perception, color vision and focus ability. Experts recommend that children receive their first comprehensive eye exam at age six months. If the ophthalmologist or optometrist confirms the vision is satisfactory, the following exam should be on the third birthday. Before the child starts school, they should also go for a complete eye exam.
If the eye doctor finds any visual issue, early intervention, including eyewear or surgery, is essential in preventing more serious vision problems in the future.
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