Pediatric Ophthalmology & Strabismus service
Pediatric Ophthalmology & Strabismus service:
The Pediatric Ophthalmology & Strabismology Service of Narayana
Nethralaya has grown to be a major referral centre for pediatric eye disorders.
Adult patients suffering from squint and double vision are also dealt with. This
service is involved in diagnosis & management of an entire gamut of pediatric
eye diseases including refractive errors (short sight, long sight or
astigmatism), congenital cataracts, congenital glaucoma, amblyopia, squint,
retinal diseases, congenital anomalies, pediatric eye cancer, oculoplasty etc.
The department provides appropriate therapeutic intervention for all stages of
retinopathy of prematurity, a blinding disease of the premature newborn. We also
have facilities to provide vision stimulation and rehabilitation for children
with low vision.
Today we see nearly 100 pediatric out patient per day and perform close
to 50 pediatric surgeries every month. The department utilizes a comprehensive
array of visual acuity screening systems applicable to all age groups, pre
verbal and pre school inclusive [Teller acuity charts, Stereoopticals, USA;
Smart system PC II Plus, M&S Technology, IL, USA; Sheridan Gardiner charts; HOTV
charts; Lea symbol charts, and electrophysiological tests like ERG, EOG, VEP and
baby vision program.
Thorough examination of the ocular motor system [strabismus] and the associated sensory abnormalities are assessed using a wide range of techniques:
Fixation targets for distance and near & accommodative near targets
Prisms (Fresnel prisms, Luneau loose and prism bars),
Worth Four dots Test torch for near and distance,
Stereoacuity charts (Titmus Fly test, Random dot test, Lang's test)
Neutral density bar,
Contrast sensitivity tests
Color vision charts (D-15 test, HRR test, Ishiara's pseudoisochromatic
In addition the genetics and the metabolic laboratory backup ensure excellent
diagnostic and research potential.
The pediatric ophthalmology wing at the Narayana Nethralaya II at health city
provides a very child friendly ambience with a play area and a reading room for
older children. Of note is the nappy and diaper changing room, the restrooms
made especially keeping children in mind as well as the feeding room that caters
to the needs of the very small infants and newborns. (Virtual Video Later)
Besides, we have a dedicated, state of art operating room for pediatric eye
surgery with microscopes, vitrectomy machines etc. and sophisticated instruments
for various surgeries like:
Correction of vertical and horizontal squints,
Glaucoma surgeries like trabeculotomy, trabeculectomy, drainage implants,
Cataract (cataract surgery with or without primary posterior capsulotomy
and/ or IOL implantation),
Endoscopic and external dacryocystorhinostomy with or without intubation for
dacryocystitis & probing for pediatric nasolacrimal duct obstruction,
Evisceration for cosmetic correction with ocular prosthesis
Enucleation with implants and a comprehensive management of retinoblastomas
(like cryotherapy, TTT, chemotherapy),
Childhood eye injuries
Minor procedures like foreign body removal and chalazion etc.
Using the expertise of excellent anesthesiologists at Narayana Hrudayalaya,
Narayana Health city, where major pediatric cardiac surgeries are performed, we
are equipped to perform ocular surgeries with ease in newborns especially those
with multisystem ailments and at a very early age.
This service is actively involved in research, teaching and training. It is
proactive in conducting screening schools camps all around Bangalore and also
exclusively caters to the needs of the underprivileged children of our society
offering them the same quality of eye care which is their right for no cost at
In short, all the possible diagnostic and treatment facilities are made
available to the children of all strata under a single roof.
Is it a sign of good luck or a sight stealing condition?
Squint is not a sign of good luck. It affects your child’s vision and appearance
Loss of vision is preventable if squint is treated as early as 1 to 2 years of
As the child grows older, it becomes more difficult to treat squint and regain
the lost vision. However, cosmetically straightening the eye is possible at any
Squint is a misalignment of the eye where the two eyes are pointed towards
Thr misalignment may be constant for a few, while it may be intermittently
occurring for some others.
The deviation of the eye may be in any direction inward, outward, upward or
If the child is not treated at the appropriate time, a condition called
amblyopia occurs, which eventually leads to permanent loss of vision
Causes of Squint
Weakness of the eye muscles or problem in the nerves supplying the eye
Blurred or poor vision caused due to cataract, corneal, scars, glaucoma,
refractive errors, optic nerve disease, retinal disease, tumors of the eye etc.,
Symptoms of Squint
One eye or both eyes point to different directions.
Children can have defective vision in one eye or both eyes.
Children with squint, some-times close one eye in bright sunlight .
Some children turn their face or tilt their head in a specific direction in
order to use their eyes together.
The child sometimes experiences double vision or confusion.
Treatment to prevent permanent loss of vision
Squint due to refractive errors is corrected by prescribing suitable
Patching of the normal eye.
Surgical treatment is given to the child based upon the improvement in
vision by spectacles correction and patching therapy.
The misaligned eyes can be straightened through surgery. In this surgery, the
muscles, are detached from their original insertion and shifted to an different
spot. The amount of shift is based on the measurement done with special prisms.
Surgery is usually done under general anaesthesia for children. It is ensured
that the child is free from any illness like fever, common cold, cough etc., for
subjecting to general anaesthesia.
Surgery is done either on both eyes simultaneously or one eye at a time.
The surgery is done on the white portion of the eyeball.
The eyeball is not opened.
Stay in the hospital is only for a day after the surgery.
Treatment does not stop with surgery. Glasses may have to be continued to
maintain clarity of vision. Patching therapy may be needed to be continued for
some time after the surgery.
What is amblyopia?
Amblyopia means reduced vision in a normal anatomical eye.
When does amblyopia develop?
Amblyopia develops due to any the following:
Squint/Strabismus(eye not positioned straight).
There is great difference in the power of both eyes(one eye focusing
differently from the other) .
Catract(clouding of the lens) .
Severe ptosis(droppy eyelid).
Heredity(parents with amblyopia/strabismus).
Any disease that affects the eye.
Amblyopia develops during childhood. Children under 9 years of age whose
vision is still developing are at a risk for amblyopia.Younger the child,
greater the risk.
Why does amblyopia develop?
Amblyopia develops because when one eye is turned as in squint, two different
images are sent to the brain. In a young child, the brain learns to ignore the
image of the deviated eye and see only the image of the better eye. Similarly
when there is difference in power of both eyes, the blurred of defocused image
formed by the eye with more power is avoided by the brain. For the retina to
capture the object, it needs adequate light and visual stimulus. This being
absent in presence of cataract either in one or both eyes results in amblypioa.
High or moderate degree of refractive power present in both eyes when not
corrected early and adequately also results in amblyopia.
What should be done?
Amblyopia can often be reversed, if detected and treated early. As soon as
amblyopia is detected, active measures should be taken to treat it. Co-operation
of the patient and parents is required to achieve good results. If left
untreated or not treated properly, the reduced vision or amblyopia becomes
permanent and once it becomes permanent, vision can not be improved by any
How is amblyopia treated?
The most effective way of treating amblyopia is to make the child use
amblyopic eye. Covering or patching the good eye to force use of the amblyopic
eye may be necessary to ensure equal and normal vision.
This can be achieved by
Prescribing proper spectacles if the patient is found to have refractive error.
Removal of cataract when indicated.
Occluding the normal eye Surgery when amblyopia is accompanied by strabismus.
Occlusion means closure of normal eye with a patch and this makes the child use
the amblyopic eye. Occlusion is done from few hours to few days depending upon
the age of patient, type and severity of amblyopia. In cases having less serve
amblyopia partial occlusion by making one glass translucent, may be sufficient.
Older children can do reading exercises with patching of the normal eye at home.
Those patients who are doing patching need periodic follow up, which is decided
by an ophthalmologist. Duration of treatment many extend from months to years.
Once the vision is improved up to the level of the normal eye, it has to be
maintained by occluding the normal eye for few hours during critical year of
age. The ophthalmologist will decide whether or how long the occlusion should be
continued. Loss of vision from amblyopia is preventable if treatment is begun
Facts on patching
Patching is not a pleasant thing for a child, so initially the child will be
reluctant to undergo it.
In a young child, it is done for the shorter periods initially and gradually
the duration is increased to get bettor compliance.
Acceptance is good as soon as vision is increased in amblyopic eye.
Method of patching should be according to the interests of the child.
Patch should be stuck directly on to the face over the eye.
If the child wears glasses, the patch should still be placed on the face, not
on the glasses.
Glasses can also be used an occlude only in older children.
Many children try to take the patch off. This problem usually disappears as
the child gets used to wearing the patch.
Older children can be encouraged to read, and young children can be involved
in playing some interesting games during patching.
Precaution must be taken to prevent the child from peeping and looking around
the edge of the patch.
Patching schedule should be followed strictly.
Patching should not be stopped abruptly. It should be tapered off by
Regular follow up is a must.
How can we detect amblyopia early?
Many children do not complain of poor vision in one eye.
Routine eye examination in the first year & another by the third year life.
Regular vision checkup’s in school.