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Pediatric Ophthalmology

If you are looking for a Pediatric Eye Doctor in Long Beach, CA, contact the specialists at Eye Physicians of Long Beach! We are pleased to offer a variety of children’s vision care services, providing diagnostic consultations and ongoing management of eye disorders in children. Keep reading for more information on our pediatric ophthalmology services:

Pediatric Vision Screening

While most of us take our children routinely to the pediatrician or to the dentist, pediatric vision care is often overlooked.  Of course, often children cannot tell us when something is wrong with their vision so staying on top of their vision care is critical.  The American Association for Pediatric Ophthalmology and Strabismus publishes guidelines for pediatric screening as early as your first newborn visit.   There are many eye conditions that can be caught and treated early, so long as you make sure your child regularly visits the ophthalmologist.  An undiagnosed visual condition can cause a child’s vision to worsen and affect development down the line.

Why are Routine Exams Necessary?

Your child’s eye health can affect his or her growth and development.  Our board certified and fellowship trained pediatric ophthalmologist will perform a thorough exam to help diagnose, manage, and treat your child’s eyes.  While vision screenings can be done by a pediatrician or school nurse, many studies show they may be unable to detect some visual issues.  While school and pediatric screenings can be useful, it is important to keep in mind that they are not a replacement for a comprehensive eye exam by a pediatric ophthalmologist.

What Does the Pediatric Ophthalmology Exam Entail?

Our pediatric ophthalmologist will check your child for strabismus (misaligned eyes), amblyopia (a “lazy” eye), and a need for glasses (if your child is nearsighted, farsighted, or has a non-spherical shape to the lens called astigmatism). The examination can involve dilating the eyes on the first visit, as this will ensure that your child is free of any of these conditions.  The entire exam with dilation will often take 1-2 hours to complete.  For children who have been diagnosed with a visual condition, follow up appointments will be scheduled on a regular basis.  To prepare your child for his or her first visit to our pediatric ophthalmologist, please see the video below.

Amblyopia (lazy eye)

What is amblyopia?

Amblyopia, also known as “lazy eye,” is decreased vision in one or both eyes due to abnormal development of vision in infancy or childhood. It is the leading cause of vision loss in children.  In amblyopia, there may not be anything visibly wrong with the vision.  The vision loss occurs because the nerve connections between the brain and the eye do not develop fully. The brain does not “learn” to see a full 20/20 with the weaker eye.  As a result, the brain favors one eye, usually due to poor vision in the other eye.

What causes amblyopia?

Common causes are astigmatism (abnormal shape of the eye), strabismus (abnormal alignment and tracking), and cataracts (cloudy lens of the eye).

How is amblyopia diagnosed and treated?

In order for vision to develop to its full potential, a child should have a comprehensive eye examination by a pediatric ophthalmologist.  Treatment can involve starting eye glasses so the brain receives a clear image from the eyes and vision develops fully. A child may need to wear an eye patch or use eye drops in the stronger eye to allow the weaker eye to develop a better connection with the brain.

Strabismus (misaligned or crossed eyes)

What is Strabismus?

Strabismus is a condition that causes a misalignment of the eyes. As a result, the eyes are unable to look in the same direction at the same time.   Strabismus is often referred to as being “cross-eyed” or having a “lazy eye.”  The misalignment can affect either one or both eyes and can affect children and adults.  It is estimated that 4% of the population in the US has strabismus.

Strabismus is often described according to the direction of the eye movement.  The eyes can cross inward, deviate outward, or move up or down. In addition to the cosmetic and psychosocial effects of strabismus, the condition can lead to vision problems and loss of eyesight.  Some children and many adults may complain of seeing double vision or a second shadow image.  Additional issues that can arise as a result of this condition include decreased depth perception, difficulty in reading and tracking, and balance.

How is Strabismus Treated?

Pediatric strabismus can be treated with glasses, patching, or eye muscle surgery.  Our pediatric ophthalmologist will perform a thorough eye examination and tailor the treatment to your child’s examination findings and symptoms.  

Adult strabismus treatment can also include glasses or eye muscle surgery.  Many studies have shown that misaligned eyes can affect social interaction, self-confidence and even employment opportunities. Recent treatment advancements have enabled most adults with misaligned eyes to have surgical correction, often using adjustable sutures.  This surgical correction can be done at any age and should be considered as a treatment option, especially if one is experiencing double vision. 

What does Strabismus Surgery Entail?

Strabismus surgery is almost always performed as an outpatient procedure. It is considered a reconstructive procedure and therefore is not intended for purely cosmetic purposes.  Following surgery, most individuals return to nearly all normal activities within a few days.  After surgery, the whites of the eyes will look red and patients often feel a foreign body sensation within the eyes, both of which can be alleviated with ice and over the counter pain medication. 

For strabismus surgery, the most common risks are redness, residual misalignment and double vision (usually temporary).  Most individuals have significant improvement in eye alignment after just one surgery.

Myopia (nearsightedness) Treatment

What is Myopia?

Myopia, commonly called near-sightedness, is when an individual cannot see distant objects clearly.  It is the most common eye disorder in the world, affecting between 25% and 50% of adults in the US, and between 85% to 90% of adults in some Asian countries. Due to the increasing rates of myopia in these populations, individuals are posed with an increased risk for retinal detachment, cataracts, and glaucoma.  Myopia has traditionally been treated with glasses, contact lenses, and laser surgery.  

Children today, especially as of late, are spending more time indoors and looking at screens, which has led to increasing rates of myopia. Many teenagers are also very self-conscious about wearing glasses and contacts or find it difficult to do so because of sports.  The doctors at Eye Physicians of Long Beach are responding and researching novel ways to reduce myopia.

What can be done for myopia in a child?

The first step is to see a pediatric ophthalmologist to make sure your child is accurately diagnosed and has adequate follow up.

Once a baseline exam has been performed, our pediatric ophthalmologist may recommend some lifestyle modifications such as increased outdoor time daily, taking a break after every 20 minutes of screen time or reading, and having good lighting when reading or using a screen.

When further intervention is needed, we use specially compounded dilute Atropine eye drops on a nightly basis.  Our doctors have been using this novel treatment since 2012.  It is believed that atropine acts directly or indirectly on the retina, inhibiting thinning or stretching of the eye, and thereby stopping or even reversing myopia.

In some children who do not respond to lifestyle changes or medication, specially designed multifocal glasses or soft contact lenses can be used to try to slow down or stop myopia progression.  The CooperVision MiSight® soft daily contact lens is now FDA approved for children aged 8-12 years of age and has been shown to slow the progression of nearsightedness.

Conjunctivitis (pink eye)

What is conjunctivitis?

Conjunctivitis is an extremely common eye infection, especially in children. This condition refers to the inflammation of the conjunctiva (the white part of the eyes).  There are many causes for pink eye ranging from viral infection, bacterial infection, pollen/allergic exposure, or chemical exposure (cleaning products, chlorine).

The common symptoms of conjunctivitis are redness of the eyes, itching, burning, swelling of the eyelids, and discharge (which ranges from clear to yellow/green).  It is important to know the different types of conjunctivitis and seek treatment by an ophthalmologist as soon as possible.

What is bacterial conjunctivitis?

This conjunctivitis is characterized by a yellow/green discharge in and around the eyelid. It can affect one or both eyes.  It is important to realize that bacterial conjunctivitis is extremely contagious. Therefore, it is imperative to practice good hand hygiene when in contact with someone with bacterial conjunctivitis.  Contact lens users are also at a higher risk for this type of infection.  Our pediatric ophthalmologist can help accurately and swiftly diagnose, culture, and treat bacterial conjunctivitis.   

What is viral conjunctivitis?

Viral conjunctivitis is often caused by the same viruses that cause respiratory infections in children.  It can be associated with a sore throat, runny nose, or the common cold.  It is highly contagious and poor hygiene helps spread this infection. Viral conjunctivitis is typically characterized by watery, red eyes and a slight discharge.  It often improves with artificial tears and cool compresses in about 5-7 days.

Blocked Tear Ducts (Nasolacrimal duct obstruction)

What is a blocked tear duct?

In our eyes, tears are drained by two small holes in the inner corners of our eyes and flow down a tube into the nose.  Tear duct obstruction in children commonly occurs at or near the time of birth and is caused by the failure of a membrane within this tube to open normally.  If the tear duct is blocked, there will be backflow of tears which can lead to crusting and discharge from the eye, especially when a child wakes up.  About 5-10% of children have symptoms of a blocked tear duct.

What are the signs/symptoms of a blocked tear duct?

Blockage of the drainage system causes tears to overflow onto the eyelashes, eyelids, and the side of the face.  The eyelids can become red and swollen (sometimes stuck together) with yellowish-green discharge when normal eyelid bacteria are not properly “flushed” down the obstructed system. Severe cases result in a serious infection of the tear duct system (dacryocystitis).

How is a blocked tear duct diagnosed?

A pediatric ophthalmologist is able to perform certain tests in the office to confirm the diagnosis. It is important that the eyes be examined to look for other causes of tearing in a child such as allergies or even childhood glaucoma.

How is a blocked tear duct treated?

Fortunately, the majority of children will improve on their own by the time they are 12 months old.  If an obstruction is persistent, treatment options include tear duct massage, topical antibiotic drops, or ointment.  If the blocked tear duct is persistent beyond 1 year of age, some children may need tear duct surgery.

What does tear duct surgery entail?

Tear duct surgery entails a brief outpatient surgical procedure.  A smooth probe is gently passed through the tear duct and into the nose internally to open up the membrane that has caused the blockage.  Sometimes a tube or a balloon stent is added to the tear duct probe under anesthesia to improve success of the procedure.

Congenital Ptosis (droopy eyelid)

What is congenital ptosis (pronounced TOH-SIS)?

A droopy eyelid, also called ptosis, occurs when the muscle that elevates the eyelid is weak.  The most common cause in children is poor development of this muscle. This is often present at birth and is called congenital ptosis. Ptosis can affect one or both eyes.  If the ptosis is mild and does not interfere with visual development, it does not require any treatment. However, an eye exam by a pediatric ophthalmologist is recommended to evaluate if the ptosis interferes with vision and if treatment is warranted.

How is congenital ptosis diagnosed?

A complete eye examination is performed with focus on history, eyelid position, eye alignment, vision assessment, need for glasses, and the head position.  Often, photos are taken to monitor progression.

How is congenital ptosis treated?

Congenital ptosis is treated by eyelid surgery, which is usually an outpatient surgical procedure under general anesthesia. It should be done as soon as there are signs of interference with the child’s visual development. If it does not interfere with vision, surgery can be delayed to a later time, most commonly performed in the preschool years.  Children with ptosis need to be monitored frequently for vision abnormalities.

What surgical options exist for congenital ptosis?

Congenital ptosis may be corrected by connecting the droopy eyelid to the frontalis muscle in the forehead using different materials like sutures or silicone.  The function of the eyelid will therefore depend upon the use of the frontalis muscle in the forehead.  Surgical correction prevents visual impairment and improves the cosmetic appearance of the eye. In congenital ptosis, however, the surgery cannot reestablish a normal eyelid muscle function. As such, it is normal to notice asymmetry in up and down gaze and to see a small gap between the eyelids when the child is asleep.

Pediatric Cataracts

What are pediatric cataracts?

Young smiling girl with eye patch and glasses

Most people are familiar with the term cataract and associate it with a clouding of the lens as adults age.  However, children can get cataracts as well.  A pediatric cataract is a clouding of the lens of the eyes in a child.  Children can be born with cataracts or develop them at a young age, either in one or both eyes.  Because some pediatric cataracts can be small and may not interfere with vision, they do not require treatment.  On the other hand, some may be large or change with time and cause vision loss.  Often, pediatric cataracts can be associated with genetic or metabolic disorders, medication use, or trauma.

Why are pediatric cataracts different from adult cataracts?

In adults, cataracts develop after the eyes and vision have fully developed and matured.  In a child, if a cataract is not diagnosed or treated, it can lead to permanent effects on vision, as their visual systems may not develop or mature fully.  This is why it is critical to diagnose and treat a pediatric cataract in a timely fashion.

A pediatric cataract can cause decreased vision in one or both eyes.  Parents or caregivers may also note a white or dark pupil reflex on photographs.  Some children may present with strabismus (a crossed eye) or light sensitivity.

How are pediatric cataracts treated?

Treatment depends on the size, cause, and severity of your child’s cataract.  Small cataracts may be monitored by our pediatric ophthalmologist or may be treated with glasses or patching.  

Larger cataracts or cataracts that are compromising a child’s vision are removed surgically.  Unlike adult cataract surgery, children are often put under general anesthesia and specialized instruments are used to remove the cataract safely.

Depending on the age of the child, an artificial lens may be placed inside the eye (similar to adult cataract surgery).  If a child is too young, an artificial lens is not utilizied. It can, however, be safely implanted at a later age.

What does follow up care entail for pediatric cataracts?

Because a child’s eye is still developing, good follow up care is critical after pediatric cataract surgery.  Often, after cataract surgery, children need specialized contact lenses or glasses so they can see clearly and maximize their visual potential.  Frequent follow ups to the pediatric ophthalmologist are also required to monitor for amblyopia (lazy eye), strabismus (crossed eyes), and glaucoma.

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