Poor Vision for Children
(Paediatric Ophthalmology)

1. Refractive Errors

Can be in different forms – near sightedness (myopia), far sightedness (hyperopia), astigmatism (cylinder). Occurs when light is not properly focused on the retina, resulting in blurred vision.
Symptoms: blurred vision (near or distance), squinting, eye strain, abnormal head posture.

2. Strabismus (Squint)

Misalignment of the eyes (inward, outward, upward, or downward).
Symptoms: double vision (in older children), abnormal head posture.

3. Amblyopia (Lazy Eye)

Reduced vision due to disrupted visual development, often caused by uncorrected refractive errors, strabismus, or visual deprivation (e.g. cataract, droopy eyelid).

4. Eyelid and Ocular Surface Conditions

• Allergic eye disease: redness, itching, tearing, discharge
• Infective conjunctivitis: red eye, sticky discharge, crusting
• Stye or chalazion: painful eyelid lump
• Ptosis: drooping eyelid obstructing vision
• Blocked naso-lacrimal duct: persistent tearing or sticky lashes in infants

5. Other Causes

• Eye injuries (sometimes children may not tell their parents when they sustain an injury)
• Cataract
• Glaucoma
• Corneal, retinal, or optic nerve diseases
• Inherited disorders
• Tumours (e.g. retinoblastoma)

There can be many causes for poor vision in a child. Some of these are very simple and treated easily, while others may be very difficult to manage and sometimes may even be life threatening.

Therefore, it is prudent to contact an ophthalmologist at the earliest if you suspect poor vision in your child. He or she will confirm poor vision and then look for the cause of the same. A timely treatment is very crucial in saving the sight and sometimes the life of the child.

Normally a child should be able to recognize the mother and have a social smile by 6-8 weeks of age. If the child has poor vision in both the eyes, then he/she may not recognize the mother or may not respond to the visual stimuli. Once the child starts walking, he/she may frequently bump into objects.

If the child has poor vision in only one eye then it may be difficult to notice it. The eye with poor vision may not be aligned properly with the other eye, thus causing squint (strabismus). The child may also have rhythmic jiggling movements of the eyes (nystagmus).

Sometimes the cause of poor vision may be visible as a whiteness of the cornea or whiteness behind the pupil. In some cases the eyes of a child with glaucoma may be watering and very sensitive to light.

The poor vision may also be noticed incidentally when the child is being examined by a doctor or during vision screening in the school.

If the poor vision in a child is not treated early enough, the eye may not develop properly and develop a condition called amblyopia (lazy eye). Therefore, if the eye is treated at a later stage, the eye may not get good vision. It is very important to treat the cause of poor vision, e.g. refractive error, cataract, glaucoma, diseases of cornea etc. as early as possible to prevent amblyopia.

Early detection is also very important in case of tumor (retinoblastoma), which if detected early, may be treated easily without having to remove the eye. If it is not detected, then it may even lead to loss of life.

Myopia Control Treatment

Atropine 0.01% for the control of myopia is now available in our clinic

Singapore has one of the highest prevalence rates of myopia in the world. It is important to detect myopia early and reduce the progression of myopia, as the earlier a child develops myopia, the higher the tendency of developing severe myopia and its complications later in life.

Atropine eyedrops have been used for years to control the progression of myopia. However, the earlier doses of Atropine were higher and were associated with more complications such as difficulty with near reading and glare from the dilatation of the pupil. Children on these eyedrops required reading glasses as well as tinted glasses in order to overcome these side effects.

In recent years, low dose atropine eyedrops of 0.01% have been researched and found to be effective in slowing myopia progression by 50-60% over a 2 year period, with minimal side effects. Children on these lower dose of atropine did not require tinted or reading glasses for work.

Each treatment course is for 2 years and the effect of atropine usually builds over time, having an improved effect in the second year compared to the first.

These low dose atropine 0.01% eyedrops which are effective in controlling the progression of myopia, with minimal side effects are now available in our clinic as a once a day dosing. A comprehensive examination by our specialists is usually performed to assess if your child is suitable for atropine treatment. This is usually followed by regular follow-ups to monitor the control of myopia.

Consults for children typically will take more time compared to a general ophthalmology review. Age appropriate vision checks will be performed depending on your child’s age. An orthoptic assessment will be performed if there is a strabismus/ squint to assess binocular function and a cycloplegic refraction may also be required in some cases which will result in a longer appointment time.

This involves the use of eyedrops to relax the muscles of accommodation in order to obtain an accurate degree. This will also cause dilation of the pupils and allow examination of the back of the eye. It is advisable that your child has sufficient rest prior to the appointment. Please also bring any previous eye records, glasses/contact prescriptions, if any.