Paediatric ophthalmology is a specialised area in ophthalmology that aims to diagnose and manage the various eye conditions and vision issues in children. Unlike the mature visual pathway of an adult, a child’s visual pathway continues to develop until they are about 7-8 years old. It is therefore important that possible disruptions to this development be detected and managed early so as to optimise the child’s visual potential.

Common paediatric eye conditions may include (and are not limited to) strabismus, refractive errors, amblyopia, nasolacrimal duct obstruction, retinopathy of prematurity, congenital cataract, congenital ptosis, congenital glaucoma, and inherited eye disorders.

Amblyopia is a term used for the reduced vision in one or both eyes due to abnormal development of the visual pathway – in other words, the eye or eyes are unable to properly communicate to the brains because vital neural connections were not evolved during a child’s critical period of development. If not diagnosed and treated early, it can be a cause of permanent visual impairment in children or later as an adult. Common causes for amblyopia include: refractive errors, strabismus, and ocular pathology.

In some instances, amblyopia can be improved by wearing the correct glasses alone. More often, however, children with amblyopia will require patching therapy, or atropine penalisation. Dr Deepa Taranath work with a team of qualified orthoptists who specialise in paediatric eye assessments and amblyopia treatment, and together they will design management plans to best cater for and optimise your child’s visual potential.

Myopia, a term more commonly known as “shortsightedness” and “near-sightedness”, refers to the condition where images can be seen clearly at near, but appear blurry at distance without optical correction (i.e. glasses or contact lenses).

Aside from the financial burden of constantly updating glasses, highly myopic eyes are more at risk of serious issues. This is because people with myopia tends to have longer eyeballs, and unfortunately, it also means the retina ( the innermost layer of the eye) has to stretch in order to accommodate for this larger size. As a result of the stretching and consequent thinning, myopic eyes are more prone to retinal tears, retinal detachments, macular degeneration, and even myopic neovascularisation (where the retina develops abnormal blood vessels that are prone for bleeding).

The best way to try and prevent these myopic complications from happening is to slow the rate of progression once your child has been diagnosed with myopia and their prescription demonstrably increased within a short period of time. Because myopia has become endemic in many parts of the world (particularly East Asia), many methods of intervention have been introduced. Unfortunately, not all of these are evidence-based practices. The World Society of Paediatric Ophthalmology and Strabismus released their Myopia Consensus Statement in 2023, and you can read more about the types of interventions and short summaries of their clinical trial findings here.

Also find the RANZCO position statement for myopia progression control that summarises the treatment options here.

Strabismus refers to a misalignment of the eyes where one does not appear straight when looking at an image. The misaligned eye may appear to drift inwards (esotropia), outwards (exotropia), up (hypertropia) or even downwards (hypotropia). At times, you may notice it may not be isolated to one eye, but that either eye could drift and become misaligned. Strabismus may also sometimes be known as a “squint”, “lazy eye”, or “crossed eyed”. In some cases, strabismus may lead to symptoms such as double vision (diplopia), reduced depth perception, abnormal head posture, eye strain and headaches (aesthenopia).

There are many possible causes for strabismus, including congenital, neurogenic (i.e. when one of the nerves that control the eye muscles is malfunctioning), after a stroke, or after facial or eye trauma. It can also stem from other medical conditions such as hyperthyroidism, myasthenia gravis, or multiple sclerosis.

The multi-faceted nature of strabismus can mean that treatments for strabismus are not “one size fits all” – rather, the option with the best outcome may be individual to your condition. A thorough orthoptic examination as well as other investigations may therefore be necessary to determine the best treatment option available for your needs, be it conservative management (such as with prisms or orthoptic exercises), Botox, or eye muscle surgery.

Hemifacial spasm describes the persistent, involuntary contraction of facial muscles on one side of the face; similarly, blepharospasm pertains to chronic eyelid twitching. These conditions can occur due to a blood vessel pressing near the nerves that control the face or eyelid muscle, or after trauma resulting in injury to the nerves. They can also be idiopathic (that is, no identifiable cause) – this is more common in females between ages of 40-60.

Depending on the severity and chronicity of the condition, hemifacial and blepharospasms can heavily impact your daily activities, such as reading, socialising, or driving. One possible treatment for these conditions is Botox injections into affected muscles – these temporarily paralyse the affected muscles and prevent them from contracting involuntarily. The effect of Botox injections usually last between 3-4 months.

A cataract occurs when the natural lens in the eye becomes cloudy, causing vision to become increasingly blurry. Other symptoms may include glare, haloes, and colours appearing less vibrant than before. Most cataracts develop gradually with age. it is possible for patients to have had cataracts for many years before they feel their vision is impacted. However, it is possible for cataracts to progress much more rapidly in patients with certain systemic conditions such as diabetes. It can also occur post-trauma, eye inflammation (such as uveitis), or after certain eye surgeries (such as vitrectomies).

The only definitive treatment for cataract is surgery, which involves extracting the cataract from the eye and replacing it with an artificial lens implant. Before deciding on surgery, a number of testing and lens implant calculations will first be done, and you will have a consultation with Dr Deepa Taranath to determine what type of lens will best suit your lifestyle.

Pterygium is the benign, fleshy growth across the clear part of the eye, known as the conjunctiva. It is commonly associated with UV exposure, windy environments, and age. The combination of these factors make pterygia common amongst the Australian population, particularly in Queensland. Pterygium can cause discomfort and irritation, and is particular problematic once it encroaches the visual axis because it can distort or obscure vision.

Conservative management options such as lubricating eye drops or ointments can be used to relieve discomfort , but the only definitive surgery involves surgical excision of the pterygium with conjunctival autograft with fibrin glue. This technique has very low recurrence rate.

There are a number of inherited or genetic conditions that can affect different parts of the eyes.

Some, like anterior segment dysgenesis (ASD), affect the front of the eye which includes the cornea, the iris, the trabecular meshwork, and the ciliary body. This can give rise to other disorders such as glaucoma, cataracts, or clouding of the cornea itself.

Others affect the photoreceptors (i.e. the cones and the rods) at the back of the eyes. Common inherited retinal problems include cone-rod dystrophy, retinitis pigmentosa, Leber congenital amaurosis, and Stargardt’s disease.

There are also hereditary optic nerve disorders which interferes with the eye’s ability to transmit signals to the brain, including optic trophy and Leber hereditary optic neuropathy.

It is important that patients with genetic eye disorders have a thorough eye examination in order to understand their visual potential. This knowledge enables better understanding, management and support so the patient can continue to participate in everyday activities and the things they enjoy. Patients may also be recommended to seek genetic counselling – aside from providing further information on their condition, counselling can assist in family planning, as well as keep patients updated on the promising research going on around the world.

There are a number of common eyelid issues that may cause irritation, discomfort, or weeping.

These conditions may include:

• Chalazion – this is a lesion or a lump in the eyelid that can occur when the oil glands in the eyelid becomes blocked, which can become red and swollen
• Blepahritis – this is the inflammation of the eyelids, usually caused by either bacterial infection, or other skin conditions
• Droopy eyelid – this can occur due to:
  • 1) dermatochalasis (excess skin or fat around the eyelids), or
  • 2) ptosis (weakening of the eyelid muscles)
• Ectropion – when the lower eyelid droops and rolls OUTwards away from the eye
• Entropion – when the lower eyelid droops and rolls INwards towards the eye

There are a number of eye conditions that may impact vision and require continual management and monitoring. These may include glaucoma, age-related macular degeneration, diabetic eye diseases and uveitis. You may also need ongoing eye monitoring if you are being managed on certain long-term medications such as hydrochloroquine (or Plaquenil) or fingolimod (or Gilenya).

Occasionally, your primary carer (that is, your GP/family doctor or local optometrist) may also refer you for a second opinion on acute eye problems. These may include painful eye, eye injuries (e.g. foreign bodies, corneal abrasions), flashes/floaters, or sudden changes in vision.