Infectious and inflammatory conditions of eyes use full to all medical profession

1. INFECTIOUS AND INFLAMMATORY CONDITIONSOF EYES
CONJUNCTIVITIS
Definition:
Conjunctivitis (“pink eyes”) is an inflammation of the conjunctiva of eye.
Aetiology:
Conjunctivitis during childhood is caused due to allergy or infection by bacteria or
virus. The most common bacterial causes are hemophilus influenza, streptococcus
pneumonia and Chlamydia. Viruses that cause conjunctivitis are Adenovirus and Herpes
virus.
Pathophysiology:
Microbes enter the eye on contactwith infected object
Inflammation of eye
Dilation of blood vessels of eye
Swelling, redness, exudates and discharge
Clinical features:
 The clinical features of conjunctivitis include –
 Redness of eye (Hyperemia)
 Tearing and itching in eyes
 Exudation (flaky and sticky substanceon eye lid margins)
 Other symptoms may include –

2.  Photpphobia
 Pseudoptosis (droping of upper eye lid)
 Periorbital cellulitis
 Pain in eye
 Fever
 When a viral infection is the cause, the child may also have fever, sore throat and
runny nose.
Diagnostic evaluation:
The diagnosis is made mainly on the basis of clinical features. A culture of the
drainage may be obtained to confirm the diagnosis.
Causes Associated symptoms Management
1. Viral Often associated with other
symptoms of generalized viral
illness.
 Hygiene
 Rest
1. Bacterial Yellow, green or white pus with
photophobia.
 Antibiotic eye
drops or ointment
with hygiene.
1. Chlamydial Cough, history of maternal
infection. Pain, photophobia and
skin lesions.
 Systemic
antibiotics
 Evaluation by
specialist.
 Antiviral agents
1. Allergic Itching, seasonal onset of
symptoms, other allergic
features, watery discharge.
 Antihistamine
eye drops
 Avoidance of
allergens.

3. 1. Chemical Watery discharge, onset of
symptoms when exposed to
cigarettes or other irritants.
 Avoidance of
irritating
substances.
1. Trauma Pain, photophobia and increased
tear production
 Eye patch
 Referral to
specialist
Prevention:
 If conjunctivitis is allergic or viral in origin, nursing management focuses primarily
on comfort measures. Following nursing care needs to be given –
 Apply cold compress on the eye.
 Reduce exposure to light.
 Prevent rubbing of the eye.
 Acetaminophen may be administered to relieve discomfort.
 If conjunctivitis is caused by bacterial agents, nursing care includes:
 Clean the eye using sterile water and cottonswabs, from inner canthus to outer
canthus.
 Apply the prescribed antibiotic ointment or eye drops.
 Use of dark glasses is advised, in presence of photophobia.
Family Teaching:
 Advise the following ways to prevent transmission of infection to others:-
 Use good hand washing after touching the eye.
 Use separate towel, sheet and pillow case for infected child.

4.  Do not allow the medicine dropperto touch child’s eyes during medication
instillation.
 Discard old contact lenses (if child is using) and use new ones after infection has
resolved.
OPHTHALMIA NEONATRUM
Definition:
Purulent discharge from eye of a new born, within 21 days of birth is known as
ophthalmic neonatrum. Most cases develop this condition within 48-72 hours of life. It is
mostly bilateral.
Etiology:
The organisms that may cause ophthalmia neonatrum are – Neisseria gonorrhoea,
Staphylococcus aureus, E.coli, pseudomonas aeruginosa, certain viruses and Chlamydia
trachomatis.
Mode of infection:
 The mode of infection include:-
 Intrauterine infection
 Infection during the process ofdelivery (most common)
 Infection after birth
Pathology:
Due to infection, the blood vessels dilate and there is formation of new blood
vessels around the papillae. Numerous polymorphs are present in the epithelium which
leads to purulent discharge and exudates formation in the eye.
Clinical features:
 It is a bilateral infection which has the following clinical manifestations:-
 Eyelids are tense and swollen.

5.  Conjunctiva is congested and swollen.
 Excessive tearing or turbid and thick discharge from eyes.
Management:
A swab must be taken from purulent eye discharge and sent for culture and sensitivity.
Depending upon the result, the physician prescribes appropriate antibiotic ointment or
eye drops. Crystalline Penicilline, Chloramphenicol, Erythromycin or Gentamycin eye
drops may be prescribed by the physician. Polymixin is used for pseudomonas infection.
Eye care:
The infected eye or eyes are cleaned with strile swabs moistened with normal
saline. Each swab will be used once only for wiping the eye from inner canthus to outer
canthus. Wash eyes as frequently as possible with warm sterile normal saline.
 After cleaning of eyes, instill crystalline penicillin eye drops.
 Every 5 minute for ½ hour
 Every 1 hour for 12 hours
 Every 2 hourly for 3 days.
 In case of Gonococcalor Chlamydia infection, systemic antibiotic therapy is
required.
Prevention:
Ophthalmia neonatrum can be prevent by following simple measures:-
 Properantenatal care of pregnant women.
 Treatment of infected vaginal discharge during pregnancy.
 Use of aseptic techniques while delivery and in care of newborn.
 Cleaning of each eye with sterile swabs dipped in sterile water, as soonas
the head is delivered and instillation of chloramphenicol eye drops in each
eye as a prophylactic measure.

6. Complications:
If the condition is not treated, there can be generalized haziness of cornea or
corneal ulcers, which may lead to blindness.
RETINITIS:
Definition:
Inflammation of retina is known as retinitis. It usually occurs in association with
inflammation of choroid (chorio-retinitis) or optic nerve (neuroretinitis). Primary
retinitis is rare.
Etiology:
Primary retinitis may be an allergic reaction to some endogenous toxin. In few
cases, the toxin is produced from some active or latent septic focus (like dental sepsis,
septic tonsils) but in most of the cases it is tuberculoprotin from a latent focus in lung or
any lymph node.
Pathophysiology:
 Due to infection, inflammation occurs
 Exudates formation
 Exudates pass through the brunch’s membrane and reach retina
 Exudates from the retina reach the vitreous
 Floating of black spots in front of eye and retina becomes oedematous
 Distortion of image and blurring of vision
Clinical features:
The child presents with the following clinical features:-
Floating black spots in front of eye.
Metamorphopsia (distortion of image)
Micropsia (objects appear smaller)
Photopsiaor subjective flashes of light due to retinal irritation.

7. Diagnostic Evaluation:
The diagnosis of retinitis is established with the help of fundoscopy, which
show:-
 Localized grey patch with blurred margins in retina.
 Few hemorrhagic spots or exudates on retina.
 If the gray patch is close to optic disc the margin becomes oedematous.
 Vitreous humour is slightly hazy.
 If central area is affected, there is permanent defect of visual acuity with
central scotoma.
Management:
Management of retinitis is as follows:-
 Protect the eye from light by wearing dark goggles.
 Atropine eye drops are instilled thrice daily.
 Eye care should be done using warm sterile water.
 Sub conjunctival or retro-bulbar injection of corticosteroid may be helpful in
arresting the inflammatory process.
 Sodium salicylate may be given for pain relief.
 Systemic antibiotics are prescribed to treat focal sepsis, if present anywhere
in the body.
 Antihistamines are helpful in allergic type.
 Systemic corticosteroids are effective in controlling inflammation.

8. STYE:
Definition:
Stye or hordeolum is an infection of the sebaceous glands near the eye lashes.
A pustule in the eyelash follicle is known as stye.
Etiology:
A stye may be caused by bacterial or viral infection. It is most often caused by
staphylococcus infection.
Clinical features:
The clinical features of hordeolum are as follows:-
 Pustule in eyelash
 Pain and tenderness
 Localized swelling of eyelid
 Redness in eye
 As hordeolum forms, it gets filled with purulent material and becomes red and
painful.
Management:
 Warm compress must be applied on eye, several times in a day.
 Eye care is done frequently.
 Antibiotic eye drops are instilled.

9.  If the hordeolum does not resolve spontaneously, incision and drainage of
purulent material is be done.
Prevention:
This type of infection can be prevented by observing hand washing practice and
maintaining personal hygiene.
NON IFLAMMATORY CONDITIONSOF EYE:
CATARACT:
Definition:
Cataract is the development of opacity in the crystalline lens of eye. As light cannot
pass through the opacity, vision becomes blurred.
Incidence:
Congenital cataract affects 1/in 250 newborns.
Types:
Cataract can be of the following types:-
 Unilateral or bilateral
 Partial or complete
 Congenital or acquired

10. Etiology:
Cataract
 Intrauterine infections in early
months of pregnancy like German
measles and toxoplasmosis
 Maternal mannutrition
 Galactosemia
 Chromosomal anomalies like Down’s
syndrome
 Ocular malformation
 Mental retardation
* Trauma
* Retrolantal fibroplasias
* Uveitis
* Glaucoma
Pathophysiology:
The lens capsule is formed during the fourth and fifth week of gestation. It is a clear
membrane which allows light to enter the eye and refract the rays for a clear image on
retina. If there is any reason that interferes with lens development, the lens becomes milky
white and cloudy, obscuring light rays and thus vision.
Diagnostic evaluation:
Infants with a family history or prenatal history paving them at risk for cataract
should be assessed soonafter birth. The opacity or cloudiness of lens can be seen with
naked eye. When the nurse does eye examination using a penlight, it reveals absence of red
light reflex and white papillary reflex.
Management:
The definitive treatment for cataract is surgical removal of the cataract from affected
eye. The affected lens is removed and artificial intraocular lens is put in the affected eye.

11. The time at which cataract surgery is performed, is crucial to prognosis. If cataract is
noticeable at birth; surgery must be done before 8 weeks of age, to prevent irreversible
visual impairment.
Post-operative care:
After surgery the child needs eye patching or shielding for several days.
Instillation of antibiotic and steroidal eye drops several times a day.
GLAUCOMA
Definition:
Glaucoma is the condition of increased intra ocular pressure (IOP), causing gradual
loss of sight.
Types:
Glaucoma has two forms:-
 Congenital or infantile glaucoma:
It occurs in children under 3years of age. It may be present at birth.
 Juvenile glaucoma:
It affects children older than 3 years of age and is usually secondaryto some other
disease.
Incidence and Etiology:
Congenital or infantile glaucoma occurs in 1 out of 10,000 live births. It occurs due to
defect in the drainage system of eye. It is usually caused by a developmental anomaly of the
iridocorneal angel of eye known as trabeculodysgenesis.
Juvenile glaucoma occurs secondaryto some other disease like retinoblastoma, trauma
to the eye etc.

12. Pathophysiology:
Due to defective development of the trabecular meshwork, sufficient amount
of aqueous humor is not drained out of the intra ocular space. This leads to
accumulation of aqueous humour in the anterior chamber of eye, resulting in
increased intra ocular pressure. This increased pressure causes damage to the
ganglion cells of retina, leading to necrosis of the optic disc, which results in
blindness.
Clinical features:
The clinical features of glaucoma are:-
 Excessive tearing.
 Involuntary closing of eyelid
 Photophobia
 Enlargement of eyeball (Buphthalmos)
 Haziness or clouding of cornea
 Pain in the eyeball
Diagnostic evaluation:
Intraocular pressure of eye is measured by tonometry. The normal pressure is 12 to 20
mm Hg. Formeasurement of intraocular pressurein infants and young children, anesthesia
may be required. Assessment of corneal diameter and examination of retina is doneto
assess any damage to optic nerve due to increased pressure.
Management:
The definitive treatment is surgery. Goniotomy or Trabeculotomy is done to open the
channel of outflow of aqueous humour from the anterior chamber of the eye, thereby
reducing intra ocular pressure.

13. Post-operative care:
The post-operative nursing care aims at the following:-
 Management if intraocular pressure
 Management of pain
 Reducing fear and anxiety
Teaching care givers about home management these aims can be achieved by taking
the following steps:-
 Prevent increase of intra ocular pressure by preventing straining, crying
and getting startled.
 Eye patch must be applied.
 Administer the prescribed analgesic and antibiotics
 Educate the care givers about recognition of signs of increased intra
ocular pressure, signs of infection, instillation of eye drops and need for
follow up.
PTOSIS:
Definition:
Drooping of upper eyelid by weakness of ocular muscles is known as ptosis. It
occurs due to weakness of levator palpebrae or less frequently, the muller muscles.
Etiology: Ptosis occurs onfollowing conditions:
 Myasthenia gravis
 Eyelid injuries
 Third nerve palsy
Diagnostic evaluation:

14. Assessment of the child shows drooping of eyelid and impaired vision as the eyelid
covers the pupil.
Management:
The problem needs surgical correlation to raise the eyelid and increase visual field.
Patching of the eye is needed postoperatively for few days.
REFRACTORYERRORS:
Refraction is the process bywhich the cornea and lens of the eye bend light rays, to
focus on the retina. When the bending of rays and length of eyeball are uncoordinated, the
image does not fall on a single point on retina. This results in refractory errors. When
refraction is normal it is known as ‘emmetropia’.
Incidence and etiology:
Refractory disorders are the most common type of visual disorders in children that occur
due to the following reasons:-
 Abnormal curvature of refractive surface
 Abnormal position of refractive surfaces
 Abnormal anterio-postetior length of eye ball
 Abnormal refractive index of refractive media of eyeball i.e. lens (as in cataract)
and vitreous humor (after vitrectomy)
Types:
He following Refractive disorders may be present in children:-
 Myopia (Near sight)
 Hyperopia (Far sightedness)
 Astigmatism (Blurred vision)

15. A.MYOPIA (NEAR SIGHTEDNESS)
Definition
Myopia is the condition in which the parallel rays from distant object focus in front of
retina.
Types
i. Congenitalmyopia: It is present at birth and may be unilateral or bilateral. It is
usually associated with convergent squint.
ii. Simple myopia: This is the commonest type and is not associated with any
degenerative changes in retina and choroid. It starts in early adolescence, increases
during schoolyears and becomes stationary after the age of 25 years.
iii. Progressive myopia: This type progresses rapidly and is accompanied by
degenerative changes in vitreous, choroids and retina.

16. Pathophysiology
When the length of eyeball in anterio-posterior axis is more due to over development of
the eye, or if the refractive index of lens is greater than normal or if the curvature of
cornea is greater than normal, it causes the light rays to focus in front of retina.
Clinical Features
 The clinical features of myopia are as follows:
 Dimness of vision for distant objects – The child usually complains that he/she
cannot see the writing on blackboard in school.
 If the defect is severe, apart from dimness of vision for distant objects, the child
complains of headache on reading.
 The child is seen holding books closely to eyes, while reading.
Management
The defect should be corrected by prescribing a concave lens; of appropriate strength for
the child. Photorefractive keratectomy laser surgery may be used to correctmyopia.

17. B. HYPEROPIA (FAR SIGHTEDNESS)
Definition
Hyperopia is the condition in which parallel rays from a distant object focus behin the
retina. This is the most common refractory error.
Pathophysiology
 When the length of eyeball in anterio-posterior axis is shorter than normal or if the
refractive index of lens is low or if the curvature of cornea is less than normal, the
light rays focus behind the retina resulting in difficulty with near vision.
Clinical Features
The Clinical features of hyperopia are as follows-
 Diminished vision, both for near and distant objects.
 In less severe hyperopia, the child complains of reading problem.
 There may be headache, transient blurring of vision (particularly while reading), pain
in eyes, heaviness of eyelids and redness of eyes.

18. C. ASTIGMATISM
Definition
Astigmatism is the refractory error in which refraction differs in different meridians of
eye. In the horizontal meridian, the eye is emmetropic while in the vertical meridian, it is
hypermetropic or myopic.
Types:
 Irregular astigmatism: Here the rays of light are reflected very irregularly due to
irregular corneal curvature, as in case of corneal scar.
 Regularastigmatism: In this type, the meridians of greatest and least curvature are
at right angles to each other. They are called principal meridians. It is of the
following types:
o Simpleastigmatism: In this type, one meridian is emmetropic (normal
refraction) while other is either myopic or hypermetropic/hyperopic.
o Compoundastigmatism: In this type, both the meridians are either myopic
or hypermetropic/hyperopic.
o Mixed astigmatism: When one meridian is myopic and the other is
hyperopic, it is known as mixed astigmatism.

19. Pathophysiology
Astigmatism occurs where there is uneven curvature of the cornea or lens or both,
preventing light rays from focusing correctly on retina. It also occurs due to dislocation of
the lens.
Management
For the correction of regular astigmatism, cylindrical lens of proper strength is
prescribed. In case of irregular astigmatism, correction in eye sight can’t be made with
cylindrical lens, but use of contact lens can be helpful.

20. DISORDERSOF IMPAIRMENT OF EYE MUSCLES
Eye movements are coordinated and controlled by six small muscles, innervated by
cranial nerves III, IV and VI. If these muscles are affected, vision becomes impaired.
Disorders of eyes, related to impairment of muscles are – Strabismus and Amblyopia.
STRSBISMUS (SQUINT)
Definition
The deviation of visual axis from normal alignment is known as strabismus. The
visual line of each eye does not simultaneously focus on the same object due to lack of
muscle coordination resulting in a crossed – eye appearance.
Types
Strabismus is of two types:
i. Paralytic or non-concomitant type
ii. Non paralytic or concomitant type

21. Paralytic or non-concomitanttype
This type occurs due to weakness or paralysis of one or more extra ocular muscles.
There is limitation in movement of eye and diplopia occurs. Congenital paralytic strabismus
occurs due to neuromuscular anomalies or birth trauma. Acquired strabismus results due to
intracranial tumors, myasthenia gravis, CNS infections, polio, encephalitis, diphtheria toxin,
lead toxicity, botulism, thiamine deficiency and fracture of base of skull.
Non paralytic or concomitant type
This is the commonest type. The movements of individual ocular muscles are present,
but coordination is lacking. Diplopia does not occur in this type.
According to another classification, strabismus is of three types-
i. Esotropia
ii. Exotropia
iii. Hypertropia
Another Classification of strabismus classifies it into three types-
i. Esotropia (convergent): In this type, the eyes turn towaaards the midline.
ii. Exotropia (Divergent): In this type, the eyes turn away from the midline.
iii. Hypertropia: In this type, the eyes are out of vertical alignment. One pupil
appears higher than the other.
Diagnostic Evaluations:
Hirschberg test
A pen light is held such that the light is facing straight ahead and is approximately 12
inches from the child’s head. Using one hand the ophthalmologist turns the child’s head so
that the light is in midline position towards child’s eyes. The ophthalmologist than observes
the light reflection from cornea. The reflected light should be seen symmetrically in the
center of bothcorneas.

22. In esotropia, light reflection is displaced to the outer margin of cornea as the eye
deviates inward. In exotropia, light reflection is displaced to the inner margin of cornea, as
the eye deviates outward.
Cover-Uncover/test
This test is performed on infants greater than 6 months of age through schoolage. Place
the child in a seated position on the examining table or caregiver’s lap. The physician stands
2 feet away, in front of the child. The child is asked to focus attention on penlight in the
hands of the physician. A cover card or hand is placed over one eye. Wait until the
uncovered eye focuses, then remove the cover card or hand and evaluate the eye just
uncovered for focusing movement.
The normal finding is that neither eye moves when cover card or hand is being removed.
It is abnormal for one or both eyes to move to focus on pen light during assessment.
Strabismus after 6 months of age is abnormal and indicates eye muscle weakness.
Management Early diagnosis and treatment is desirable, as failure to do so results in
permanent Amblyopia. The goal of treatment is to attain the best possiblevision in each eye
while also attaining binocular vision.
Treatment can be medical or surgical. To develop best possible and equal or near
equal vision in both eyes, it is essential that all refractory errors be corrected after accurate
assessment of visual acuity. Also other associated conditions such as cataract should be
treated.
MedicalManagement
The medical approach may utilize occlusion therapy and orthoptic training for correction
of strabismus.
a. Occlusion therapy:
Occlusion therapy is recommended, if the squinting eye is amblyopic. Vision improves
in squinting eye by continuous exercise. For this purpose, the normal eye has to be
absolutely occluded for 1-2 weeks or longer (at a time for 6-8 weeks).

23. b. Orthoptic training:
Specially designed visual exercises are taken in order to encourage the productionof
simultaneous and binocular vision, elimination of false projection and production of
stereoscopic apparition.
c. Pharmacologic therapy
Use of miotic drugs makes accommodation easier.
SurgicalManagement
Surgery involves shortening; lengthening or repositioning of extra ocular muscles
should be under taken at earliest if other modalities fail.
Nursing management:
Nursing assessment
It includes the following:-
 Assess for red light reflex, especially in newborns. Absence or asymmetry of red
light reflex may indicate congenital cataract or an intraocular tumor.
 Inspect eyes for redness of conjunctiva, cloudiness of cornea, excessive tearing,
ptosis or misalignments, which provide clue to congenital eye problems.
 Assess the visual acuity routinely in infants and children.
Nursing interventions:
Minimizing effects of vision loss.
 Encourage and assist parents in obtaining corrective lenses for child.
 Assist parents in locating and finding resourses such as financial assistance,
special education in braille or parental supportgroups.

24. Minimize bodyimage disturbance:.
 Encourage parents to focus on normalization rather than begin over protective
towards the child.
 Allow the child to play with peers and make his life as normal as possible.
 Encourage parental acceptance towards appearance of the child.
Prevent injury:
 Encourage the family to take care of child’s safety at home, schooland in
community.
 Advise the family to maintain a consistent and uncluttered furniture arrangement.
Notify the child of changes done in home setting.
Instruct the child to use a cane or other walking assistance device Promote normal growth
and development:
 Encourage the parents to provide many sensoryopportunities to the child such as
manipulating objects, hearing various sounds, noting the smells in environment etc.
Parentaleducation:
 Parents must be taught about instillation of medications and use of eye shield to
prevent injury to the eye after surgery.
 Bed rest may be required immediately postoperatively.
 Older children should be advised to avoid engaging in strenuous activities or contact
sports for at least 2 week.
 Avoid over feeding the child to prevent vomiting that may cause straining.
 Do not let the child cry.
 Encourage and teach parents to do eye care to remove eye discharge or crusts on
lashes by washing the eyes with warm water. Eye care can also be done by wiping off
the eyes with moist cotton balls.

25. AMBLYOPIA
Definition:
Amblyopia means poorvision in one eye that has not developed normal sight. It is
unrelated to an organic cause. The condition is sometimes called “lazy eye”. It occurs
when visual acuity is better in one eye that the other.
Incidence and Etiology
 Amblyopia occurs in approximately 2-3% of the population in preschoolage.
 The most common cause of Amblyopia is strabismus, where the brain suppresses
vision in deviated eye to avoid double image that is receiving. Eventually the eye
sight of deviated eye is lost.
 Other causes of Amblyopia are cataract, corneal opacity or prolonged patching of
eye to correctstrabismus and refractive Amblyopia, which occurs when there is
asymmetric refractive error in each eye.
Clinical Features
Infants and children with Amblyopia often do not display any symptoms. They may
occasionally over reach for an object
Diagnostic Evaluation
Amblyopia is usually asymptomatic because the good eye assumes the burden of
vision and the child is unaware that there is a problem. It is therefore essential, that child’s
eyes are examined periodically before the age of 7 years. If any difference in the visual
acuity of two eyes is detected the child should be referred to an ophthalmologist for
treatment.
Management
If the cause of Amblyopia is strabismus, surgery may be required. If the cause is a
cataract, then cataract removal surgery is done. Refractive Amblyopia is treated by
correcting refractive error with corrective lenses.

26. The main management of Amblyopia is occlusion of the good eye to force vision in
the “lazy eye”.
LESS COMMON EYE DISEASES IN CHILDREN
While the above eye disorders are common and easy to correct, if detected and treated
early, eye diseases can be much more serious. Some of them can be treated cured, others are
incurable. Fortunately, these diseases are rare
RETINOPATHYOF PREMATURITY(ROP)
Babies born with a very low birth weight have an increased risk of developing abnormal
peripheral retinal blood vessels that can cause the retina to become loose (detached retina),
which can lead to blindness. Thosebabies who do not develop this problem in childhood
still have an increased risk of retinal detachment later in life, and should be seen regularly
by an eye doctorto check for retinal detachments.
FAMILIAL (CONGENITAL)BLINDNESS
If there is a history of blindness in the family of either the father or mother, parents need
to seek genetic counselling to help determine the risk of blindness in their children.
RETINITIS PIGMENTOSA
In this inherited disease, the retina in eye degenerates more and more over time
(progressively). Children are unable to see at night (develop night blindness) and then lose
their side (peripheral) vision. Tunnel vision (no side vision at all, as if in a tunnel) develops,
followed by complete blindness.

27. LEBER’S CONGENITALAMAUROSIS
Blindness or near-blindness occurs in children with this disease because of loss of nerve
function in the retina of both eyes. A jerky movement of the eyes (nystagmus) may occur
along with hypersensitivity to light and sunken eyes.
CONGENITALGLAUCOMA
In this disease, high pressure of the fluid within the eye, together with an enlarged
cornea can cause nerve damage in newborns and infants. A common cause is malformation
of some parts of the eye. Too much tearing (excessive watering) can be a warming sign of
congenital glaucoma but may also indicate less serious conditions, such as a blocked tear
duct.
DERMOID CYSTS
These are bumps usually found on the side of the head near the eyebrow. They are not
cancer, but are actually capsules containing skin tissue, hair, fat, or other bodytissue.
Dermoid cysts should be removed before the child begins to walk because they can break
open during a fall and cause painful inflammation.
Warning Signs
 An eye doctor-either an optometrist or an ophthalmologist must be consulted, if any
of the following signs are present in the child:
 Eyes flutter quickly from side to side (nystagmus).
 Eyes are watery all the time.
 Eyes are always sensitive to light.
 Eyes change in any way from their usual appearance.
 White or yellow material appears in the pupil.
 Redness in either eye persists for several days.
 Pus or crust appears in either eye.

28.  Eyes look crossed or“wall-eyed”.
 The child constantly rubs his or her eyes.
 The child often squints.
 The child’s head is always tilted.
 Eyelids tend to droop.
 One or both eyes seem to bulge.
 One pupil is larger or smaller than the other (asymmetric pupil size).
 Baby does not make eye contact by 3 months of age.
 Baby does not focus on and follow objects by 3 months of age.
 Baby does not reach for objects by 6 months of age.
 Baby covers or closes one eye.
 One eye constantly or sometimes (intermittently) turns in, out, up or down.
BLINDNESS:
Definition:
According to W.H.O. “The inability to count fingers in day light from a distance of 3
meters is defined as blindness”
Prevalence and etiology:
 It is estimated that there are 16-18 million blind people in the world. In India, their
number is about 9 million. The main causes of blindness in children are:
 Vitamin A Deficiency
 Malnutrition
 Eye infections

29.  Injuries
 Congenital eye disorders like cataract
 Tumors
Problems of blind child:
 Problems of attachment:
 When a mother discovers that her child is blind, the initial reaction is often
of depression and grief followed by rejection of the child. Due to blindness,
the vital interaction between infant and mother is hampered.
 Inability to use hands as organ of perception:
 In normal sighted infants, hand coordination and reaching for objects is
developed until 9 months to one year. Those infants who do not receive
early intervention, the hand may not develop as an autonomus organ of
perception and they may develop as an autonomus organ of perception and
they not make sensitive discrimination and are incapable of Braille reading.
 Problem in locomotion:
 The blind children show marked delay in locomotion. While a normal
sighted child starts walking by one year, blind children start waking
independently by two years. There are constant difficulties in travelling
from one place to another.
 Dependence:
 The most capable blind child even if given an optimum environment, is
more dependent on parents or care takers than normal child. Routine self
care skills such as dressing, eating, toilet training, personal hygiene etc.
Present practical problem. They require special education (Braille system)
and can be trained in special schools. Integration into the society is also a
special problem.
 Behaviouralproblems:

30.  Certain common behavioural problems are seen in blind children like body
swaying, head knocking, eye rubbing, head rotating or repetitive hand
motions. The child may develop severe ‘blind deviant child syndrome’ in
which the child demonstrates stereotyped hand behaviour, rocking,
swaying and mutism or copying spoken words.
Management
 Early intervention can greatly alleviate the problems of blind children.
 Blind children can be helped in following ways:
 The blind child should be trained to recognize tactile and auditory stimuli which will
be helpful in locomotion.
 Help the child in speechdevelopment by providing speechtherapy.
 Occupational therapy or vocational training should be provided to these children so
that they can earn their living
 These children should be trained to recognize and use common household things.
 They should be trained to travel independently using various tools and techniques
like long cane, guide dog, GPS system etc.