I. What is congenital cataract?
Congenital cataract is a partial or total clouding of the lens that occurs at birth or gradually within one year after birth, and can be familial or disseminated; it can develop in one or both eyes; and it can occur with or without other ocular abnormalities or genetic and systemic diseases. The morphological manifestations of congenital cataracts vary depending on the location, shape or degree of lens clouding, some of which are easily noticed by parents, while others require specialized examination equipment such as slit-lamp microscopy to be observed. Whitening of the pupil area is the most common clinical manifestation of congenital cataract. Congenital cataracts are an important cause of blindness and amblyopia in children.
II. What are the causes of congenital cataracts?
Various factors affecting the development of the fetal lens may cause congenital cataracts:.
1.Heredity: about 1/3 of patients are related to heredity.
2. Viral infections: Intrauterine viral infections in the first 3 months of the mother’s pregnancy, such as rubella, herpes virus infection, mumps, measles and chickenpox, can cause clouding of the fetus’ lens. This is due to the fact that the lens capsule is not fully developed at this time and cannot resist viral invasion, and the lens protein synthesis is active and sensitive to viral infection.
3, drugs and radiation: the mother’s pregnancy, especially during the first 3 months of pregnancy application of some drugs, such as systemic application of glucocorticoids, salicylic acid preparations, anticoagulants, some antibiotics (such as sulfonamides, tetracycline), or exposure to X-rays.
4, systemic diseases: the mother suffers from metabolic diseases during pregnancy, such as diabetes, underactive thyroid, extreme nutritional and vitamin deficiencies (such as vitamin D), etc.. There is also heart disease, nephritis, anemia, etc.
In addition, premature birth and intrauterine hypoxia of the fetus may also cause cataracts.
3. Is congenital cataract hereditary?
About 1/3 of patients with congenital cataract are hereditary related. It is commonly inherited as autosomal dominant. If it is accompanied by other congenital abnormalities of the eye, it is often determined by the mode of inheritance of the main abnormality, usually autosomal recessive or concomitant inheritance. Therefore, for those who have congenital cataract patients in their families or newborns who are found to have other congenital anomalies that may be accompanied by cataracts, they should have regular eye examinations and if the examination reveals congenital cataracts, they should choose to have early surgery or continue to be observed according to their condition.
4. Do all congenital cataracts require surgery?
The goal of treating congenital cataract is to restore vision and reduce the occurrence of blindness in.
1.For those who have little effect on vision, such as anterior pole cataract, coronal cataract and punctate cataract, treatment is generally not required and regular follow-up observation is required.
2. For those with obvious impact on vision, such as total cataract, nuclear cataract, or other types of cataracts located in the center of the visual axis with obvious degree of clouding, surgery should be performed as early as possible. The earlier the surgery, the greater the chance of the child to get good vision.
V. When should congenital cataract be operated?
For congenital cataracts that significantly affect vision, such as total cataracts and nucleus pulposus cataracts, surgery should be performed as early as possible. The earlier the surgery, the better the chance of the child to get good vision. For total cataracts in one or both eyes or cataracts located in the center of the visual axis with obvious degree of clouding, surgery should be performed as early as possible after birth (after 4 weeks of birth) and no later than 6 months. In patients with bilateral cataracts, after completion of surgery on one eye, surgery on the other eye should be completed after a shorter time interval. Premature surgery is not advisable for congenital cataracts caused by rubella virus. This is because in the early post-infection period, rubella virus still exists in the lens, and surgery may cause the release of these latent viruses in the lens and cause iridocyclitis, which may lead to atrophy of the eye due to inflammation.
VI. Why is it necessary to implant an IOL in congenital cataract surgery? When is the implantation done?
The shape and function of the lens in the human eye are similar to a convex lens. After removing the cloudy lens, congenital cataract surgery will result in high hyperopia, which requires refractive correction and vision training, treatment of amblyopia, and promotion of fusion function development. The commonly used correction methods are
1.Glasses correction
Simple and easy to adjust and replace, but the lenses are thicker, the whole glasses are heavier, and the imaging quality is relatively poor.
2.Corneal contact lens
Suitable for most children with aphakia in one eye, but it is more troublesome to remove and wear frequently, and is prone to corneal epithelial damage and infection.
3.IOL implantation
It is a refractive correction method that is closest to the physiological state. Due to the development of microsurgery technology and the improvement of IOL quality, serious complications after IOL implantation are rare, and IOL implantation in children has been accepted, especially in patients with monocular congenital cataract. There is now a consensus on the safety of IOL implantation after the age of 2 years, and an increasing number of ophthalmologists believe that IOLs can be implanted at the age of 1 year.
VII. Can I see after congenital cataract surgery?
Unlike senile cataracts, congenital cataracts generally improve vision after surgery, but due to amblyopia caused by congenital cataracts, vision cannot yet reach the level of normal children of the same age, and amblyopia training is required. For congenital cataract surgery without IOL implantation, or despite IOL implantation, there is an error in the prescription of the IOL, refractive correction is also needed, and the common correction methods are: wearing glasses, corneal contact lenses, etc.
VIII. What should I pay attention to after congenital cataract surgery?
Generally speaking, you can live a normal life. 1~2 weeks after surgery, you need to order eye drops to reduce post-operative reaction and prevent infection, and avoid rubbing your eyes. 3 months after surgery, you should have an eye exam and prescription for amblyopia treatment. Regular review is required.
9. Why do some congenital cataracts need laser after surgery?
The chance of posterior cataract after congenital cataract surgery in infants and children is much higher than that in adults. Nowadays, most congenital cataract surgeries will remove or tear the posterior lens capsule membrane and perform anterior vitreous cutting, which can make the incidence of posterior cataract decrease significantly, but there are still a small number of children with posterior cataract. For children over 6~7 years old who can cooperate, the posterior capsule membrane or mechanized membrane can be laser cut, but For infants and children who cannot cooperate with laser treatment need to be operated again.
Why do some congenital cataracts need to wear glasses after surgery?
For congenital cataract surgery without IOL implantation, glasses or other means of refractive error correction are required after surgery. For those who have an IOL implanted, but there is an error in the calculation of the IOL prescription, they still need to wear glasses to correct it.
XI. What are the causes of chalazion?
Chalazion is a common eye disease that occurs in children. It is a fatty granulomatous inflammatory disease caused by the blockage of the lid gland ducts and the retention of secretions in the lid due to chronic irritation of the surrounding tissues.
What kind of chalazion requires surgery?
A chalazion that has progressed to a certain point will break down on its own and produce localized granuloma-like tissue, known medically as a sarcoid. A granuloma that breaks down into the eyelid often causes a rubbing sensation in the eye; a granuloma that breaks down into the skin will leave a scar or even cause a deformity, such as an ectropion, where the lid margin flips outward and away from the eye. Therefore, most chalazia require surgical treatment. However, if the cyst is very small or the disease does not last long, conservative treatment can also be carried out first to observe the development of the disease. Some small chalazia on the conjunctival surface of the lid can be absorbed on their own, but due to the thin skin of the child, most of them break through to the skin surface without waiting for absorption and form skin scars, so surgery is still recommended for children with chalazia. If the chalazion is secondary to infection, anti-inflammatory treatment should be carried out first, and then surgery should be performed after the inflammation subsides.
XIII. How to prevent chalazion?
To prevent chalazion, you need to eat a light diet, not to be picky, eat more vegetables and fruits, eat less greasy meat and fish, keep your bowels open, pay attention to eye hygiene, and apply hot compresses to your eyelids regularly.
Is general anesthesia or local anesthesia better for chalazion surgery?
Although chalazion surgery is a very common surgery, but due to the young age of the child, chalazion grows out of the skin surface or more chalazion children, local anesthesia is difficult to cooperate with the child, the surgery must be carried out under general anesthesia. The advantage of local anesthesia is that it is convenient and fast, but because the child cries a lot during the surgery, it is difficult for the doctor to examine the child in detail. In addition, although the child is young, the fear of facing the surgery alone will stay with the child for a long time, causing a shadow to the child’s young mind.
15. Will chalazion surgery leave scars?
There are two types of chalazion, one is the conjunctival surface type, which is a dark red conjunctival surface, the swelling does not develop towards the skin surface of the eyelid, this child can be operated on through the conjunctival surface of the eyelid, a small incision is made on the conjunctival surface to scrape out the necrotic degenerative tissue from the chalazion cavity, no scar is left on the eyelid after the surgery. There is another type of chalazion that is skin-faced. In this type of child, the chalazion granuloma develops on the skin surface of the eyelid, the swelling gradually increases in size, and there can be a large amount of hemorrhagic necrotic tissue in the cystic cavity of the swelling. Therefore chalazion should be treated as early as possible, aiming to operate when the granules are not yet protruding from the skin surface, so that the skin of the child’s eye will not cause too much scarring after surgery.
Will chalazion recur after surgery?
The chalazion has a high chance of recurrence, which is closely related to the living and eating habits.
How to reduce the chance of recurrence after chalazion surgery?
According to the cause of chalazion, the main mechanism is the obstruction of the lid gland, so regular postoperative massage of the lid gland is a relatively effective method to remove the secretions and attachments from the obstruction of the lid gland to reduce the obstruction and reduce the chance of recurrence. For chalazia multiforme, systemic adjustments can also be made in Chinese medicine by toning the spleen and stomach. In some patients, there is local inflammation of the lid gland, so anti-inflammatory drugs can be applied for a certain period of time to alleviate symptoms and reduce the recurrence rate.
XVIII. What are the causes of blinking in children?
Under normal circumstances, children blink an average of 15-20 times per minute. Blinking normally distributes the tear film over the surface of the eye, protects the cornea, prevents the surface of the eye from drying out, and prevents damage from dust, etc. However, frequent blinking is a pathological phenomenon. The common reasons for frequent blinking in children are
1. Inflammatory irritation
This is the most common cause, which may be caused by bacterial, viral, or chlamydial infections such as conjunctivitis and keratitis. In addition to increased blinking, there are also manifestations such as red, itchy eyes, increased secretions, and tearing.
2. Congenital eyelid entropion and impingement
Some children have congenital entropion of the eyelids (medically called eyelids), which causes the eyelashes to fall back on the surface of the eye and irritate the cornea (the surface of the black eye) causing tearing. This condition is most common with lower eyelid entropion and can be detected by attentive parents.
3. Hyperactivity in children
Hyperactivity is a sudden, involuntary contraction of a part of the child’s body, such as blinking, wrinkling of the forehead, tilting of the mouth, shrugging of the shoulders, etc., inattention and change in hyperactive behavior. Some children also make strange noises and even curse and swear, which is medically called hyperactive obscene language syndrome in children. The cause of this condition is still unknown, but it may be related to psychological factors, such as mental stress and emotional instability. This disease seriously affects the normal life, learning and mental health of children.
4, eye fatigue blink
Including visual fatigue such as refractive error, especially farsightedness, myopia, astigmatism is not corrected causing eye visual fatigue and caused. This is a protective reflex, through constant blinking can adjust the curvature of the eye, so that visual clarity.
5, neurological blinking
This is caused by frequent contraction of the nerve fibers that govern the orbicularis oculi muscle after being stimulated.
6.Habitual blinking
Some children have a history of frequent blinking due to one of the above causes, and after the cause is removed through treatment, they still retain the habit of frequent blinking. Other children, because they don’t usually pay attention, like to imitate other people who blink a lot, resulting in habitual frequent blinking.
Once you find out that your child has the habit of blinking, you should go to the hospital as soon as possible to have the cause of the problem diagnosed and then get the right treatment. Of course, it is not only eye diseases that cause blinking symptoms, such as ADHD and facial twitching disorder, which require further examination and treatment at the neurology department.
Do children need treatment for blinking?
There are many causes of frequent blinking in children and treatment varies, so an experienced doctor is needed to diagnose and treat the problem. Parents should seek medical attention as soon as they discover that their child is blinking frequently to avoid aggravation of the disease. As long as it is discovered and treated in a timely manner the treatment is generally more effective.
20. How to treat blinking in children?
1. Inflammatory irritation
The treatment of frequent blinking caused by bacterial inflammatory irritation can be treated with tobramycin eye solution or 0.1% rifampin eye solution, 3-6 times a day, and erythromycin and other antibiotic eye ointment applied to the eyes once a night. In severe cases, the number of eye drops can be increased to once every 1-2 hours. If the inflammation is caused by a virus, use acyclovir or antabuse eye drops to spot the eyes every 1-2 hours. In severe cases, systemic medication is required for treatment.
2. Congenital eyelid entropion and ingrown eyelashes
In mild cases, the eyelid can be gently turned out to its normal position and fixed by traction with adhesive tape on the local skin, and the eyelid inversion is expected to heal itself as the child develops. In severe cases, surgery is required to correct the problem.
3. Hyperactivity in children
Parents should cooperate with the doctor to remind their children to help them control themselves, but they should not be too anxious and should not reprimand or scold their children, but should gradually induce and patiently persuade them.
4, eyestrain blinking
This situation should be properly arranged for the child’s study life, telling the child that the time spent reading books and watching television and computers should not be too long, urging the child to do eye exercises and, if necessary, to get an eye exam and glasses.
5, neurological blinking
Treatment can be local massage and hot compresses, internal sedatives such as Bachmann’s compound, tribromine tablets, etc. You can also use neurotrophic agents such as vitamin B1, B12, inosine and other drugs.
6.Habitual blinking
Too much parental attention can also trigger excessive blinking in children, and when children focus on playing or studying, the symptoms will be significantly reduced. In this case we need to observe the child more, reduce repeated stimulation of the child, and try to give the child a psychologically relaxed environment.
What’s wrong with my child’s recent loss of vision and his tendency to squint at things?
Myopic and astigmatic children squint to narrow their pupils, increase their depth of field, improve their vision, and try to see clearly by squinting with the help of their eyelids.
22. Why do children need astigmatism and can’t they get glasses directly from computerized optometry?
Children and adult optometry are not the same thing. The younger the child, the greater the adjustment ability, computerized optometry will make the adjustment force to cover the true refraction, so the child must be fully paralyzed ciliary muscle adjustment function based on dilated optometry, in order to get the true and accurate optometry.
Twenty-three, why is it necessary to retest after the dilated eye exam?
The refractive power of astigmatism is based on the relaxed adjustment of the ciliary muscle, but children do not use their eyes in a completely relaxed state in their daily lives, so after astigmatism, which is actually the recovery of the adjustment, you need to retest again, called primary optometry, the purpose of primary optometry is to subtract a certain amount of physiological adjustment, adjust the astigmatism of astigmatism, so that children get a more durable and more Comfortable visual experience.
What is myopia? What is astigmatism? What is farsightedness?
Myopia means that in a relaxed state, parallel light rays are focused in front of the retina after passing through the refractive system of the eye; farsightedness means that in a relaxed state, parallel light rays are focused behind the retina after passing through the refractive system of the eye; astigmatism means that because the refractive power of the eye is different at different meridians, parallel light rays cannot form a focal point after passing through the refractive system of the eye but a diffuse circle.
25. Can myopia be cured?
There is no cure for myopia.
26. Why do myopic children get deeper and deeper after wearing glasses?
First of all, once a child is truly myopic, with or without glasses, myopia will deepen to varying degrees from year to year as they learn to use their eyes and environmental factors; secondly, some children who wear myopic glasses have improper habits and posture when wearing glasses and use the wrong method to deepen myopia. A pair of myopia glasses only help children to see clearly in a certain period of time, but can not stop myopia deepening once and for all, many children do not have regular review, not timely replacement of the appropriate degree of glasses, long-term use of low-degree myopia glasses, but easy to increase visual fatigue, making myopia deepen faster, so children’s myopia is getting deeper and deeper is not caused by wearing glasses.
Can children with myopia be treated by laser?
No, you cannot. Because children’s eyes are not yet developed, early laser treatment is difficult to achieve the effect of curing myopia, and the risk is greater, and the refraction may still change after surgery.
Can astigmatism be cured? Can laser be used when they grow up? Do I have to wear frames for the rest of my life?
At present, astigmatism cannot be cured. Some low astigmatism may be cured by laser in adulthood, but moderate to high astigmatism is difficult to cure surgically. After the adulthood, low astigmatism can be considered according to the situation whether to wear frames for a long time, but medium to high astigmatism should insist on wearing glasses for correction, either frame glasses or toric RGP lenses without frames, which are more beautiful and clearer.
Twenty-nine, how to control myopia?
Pay attention to eye posture, avoid prolonged close eye use, avoid long-term practice and piano sheet music damage to the eyes, reduce the use of television, computers, cell phones and other electronic video time, increase the time for outdoor activities and sports, a balanced diet, regular eye examinations, children with true myopia can use corneal plastic lenses to effectively control myopia if they meet the conditions.
How is astigmatism formed?
Astigmatism can be caused by genetic factors, eye development factors, and frequent blinking and squinting factors.
Can myopia be lowered for children?
Myopia is generally prescribed in full, that is, according to the results of medical optometry to the full correction, artificially with low may lead to eye fatigue and the risk of myopia deepening faster.
Thirty-two, children with glasses, can be worn in class, but not during the day?
No. Nearsighted glasses are distance glasses, which are used to look at the distance clearly, in addition to class time to wear, walking, sports classes, life in general need clear distance vision, so they need to wear glasses.
Is it safe to wear keratomileusis?
From the user’s point of view, it is safe to wear keratoplasty lenses if the child passes a strict eye screening, excludes contraindications, has a strong will, has good compliance from himself or his parents, has strict hygiene and care, and is able to come to the hospital regularly for eye examinations and lens checks.
What is amblyopia?
Amblyopia is caused by monocular strabismus, uncorrected refractive error, high refractive error and form deprivation during visual development, and the best corrected visual acuity of one or both eyes is lower than the corresponding age; or the visual acuity of both eyes differs by 2 lines or more, and the visual acuity of the lower eye is amblyopia. Amblyopia is an eye disease that seriously endangers the visual function of children, and if left untreated, it can cause aggravation of amblyopia and even blindness.
How is amblyopia classified?
1. Strabismic amblyopia
Amblyopia formed by monocular strabismus.
2.Refractive parallax amblyopia
The difference in refractive power between binocular hyperopic spherical lenses 1.50DS, or column lenses 1.00DC, the higher refractive power of the eye formed amblyopia.
3.Refractive error amblyopia
It occurs in patients with high refractive error who are not wearing refractive error correction glasses. The refractive error is mainly high hyperopia or astigmatism in both eyes, and the best corrected visual acuity in both eyes is equal or close. Hyperopic refraction ≥5.00DS and astigmatism ≥2.00DC can increase the risk of amblyopia, which is usually diagnosed after 3-6 months of wearing refractive error correction glasses.
4.Shape deprivation amblyopia
The amblyopia caused by refractive interstitial clouding, ptosis and other form deprivation factors, can be monocular or binocular, monocular form deprivation amblyopia is more serious than binocular amblyopia consequences.
Can amblyopia be cured by wearing glasses?
The treatment of amblyopia includes wearing glasses, masking, fine work training and amblyopia therapy device, if there is refractive error, you need to wear the right eyes first. Amblyopia can be cured, the key is early detection and early treatment, the treatment of amblyopia is mainly before the age of 12, generally 3-6 years old is the best treatment effect.
Can strabismic amblyopia be cured by surgery immediately?
The treatment of strabismic amblyopia is related to the child’s age, the difficulty of amblyopia treatment, and the child’s training cooperation. If the strabismus occurs in the neonatal period, early surgery should be actively pursued and completed within 1~1.5 weeks of age. early surgery for neonatal strabismus is of great significance for establishing binocular vision and preventing amblyopia. if the strabismus occurs within 1~3 years of age, if the strabismus remains after wearing corrective glasses, surgery can be considered to correct the strabismus, which is beneficial to the treatment of amblyopia and the soundness and perfection of binocular vision function. After amblyopia training or treatment above the age of 3, the vision has returned to normal, you can consider surgery to consolidate normal vision and establish and improve binocular visual function, but if the strabismus is very serious, and amblyopia is difficult to improve in the short term, you can retreat to the treatment of strabismus first, the post-operative binocular position is parallel, which is also helpful for the treatment of amblyopia.
Why is amblyopia not completely cured even after years of treatment?
Amblyopia can be cured completely, but only before the age of 12. The treatment effect of amblyopia is related to age and the nature of fixation. Early detection is the key to treating amblyopia, which is best from 3 to 6 years old and worse after 8 years old; central fixation is better and paracentral fixation is worse. There are many ways to treat amblyopia in children, but no matter which one, there are indications and limitations, and the appropriate method should be chosen according to the nature of amblyopia, with the aim of improving visual acuity and restoring binocular vision. Once a child is found to have amblyopia, he or she should first have a dilated eye exam to understand the refractive state and wear appropriate glasses to correct his or her farsightedness, myopia or astigmatism. The treatment of amblyopia is not overnight, in addition to the doctor’s examination, guidance, but also the cooperation of the child and parents, otherwise not only half the effort, and may be halfway.
Can acupuncture and massage cure myopia?
Acupuncture massage may improve eye microcirculation and nerve stimulation function, thus short-term effect of vision enhancement, can be used as an auxiliary health care, but can not cure myopia.
Is farsightedness the same as presbyopia?
No, it is not. Farsightedness is caused by refractive error, but the adjustment function of farsightedness is normal; while presbyopia is caused by the physiological phenomenon of hardening and aging of the lens with age (after 40 years old), which causes a gradual decline in the adjustment function of the eye, making it difficult to read near, but clear to see far.
Do children with high myopia or high hyperopia have to wait until they are three years old before they can get glasses?
Early detection, early intervention, and early prescription of glasses.
What should I do if my child with refractive error cannot adapt to frame glasses?
You can wear RGP lenses to reduce binocular disparity and avoid difficulties in binocular vision.