What your child can’t tell you about their eyes Part 2

In part 1, I covered longsightedness, shortsightedness, astigmatism, squints, lazy eyes and why its important for your child to have a full eye examination rather than relying on the nursery screening programme. In this part I will explain some other aspects of your child’s vision.

Anisometropia is where the lens power required is very different in each eye. Children with Anisometropia don’t know they have a problem. The situation is a bit like having a short leg and a long leg. You can use the long leg or you can use the short leg but you can’t use them together. Let me use the example of a child who is a bit short sighted in one eye and longsighted in the other. They could see distance objects clearly with the longsighted eye and near objects clearly with the shortsighted eye. This child will not be aware of any problems but could have issues with the development of the visual system that deals with the two eyes work together (Binocular Vision). Anisometropia is responsible for problems with image size differences and it is one of the causes of lazy eyes (Amblyopia).

We all know children that excel at sports. Whether it’s football, badminton, netball or table tennis, these kids have got it nailed. We also know kids that couldn’t catch a tennis ball even if their life depended on it. So what’s the difference between these two groups of children. The main difference is often to do with their eyes and whether the have good stereopsis (3D vision). Although both eyes look in the same direction the viewing position of each eye is slightly different. The distance between the eyes is generally between 48 and 74 mm. As the visual system develops it learns to interpret the very slight differences in the images from each position as 3D vision. If your child has an issue, which stops the normal development of their visual system, they will have poor or no stereopsis. Without good stereopsis a child would be unable to judge how far away the tennis ball is, and would have difficulty catching it. If your child has difficulties catching a ball an eye test would be a good idea.

If you would like to experience what it is like to have no stereopsis try playing a game of catch with one eye covered.

Diplopia (Double Vision), needs to be investigated by an optometrist. The chances are high that your child will tell you they have double vision but some may not.

There are two types of diplopia. The first is when things are double when you look in one direction but not in others. Either something has damaged one of the ocular muscles that control the movement of the eyes or something has happened to the nerve that controls the muscle. A forceps delivery can result in this type of problem. Patients with this type of double vision will turn their head to the side to minimise effect of the diplopia.

The second type is when the diplopia is in all directions of gaze. This occurs because the eyes are not looking in the same direction ie a squint. If untreated the brain will do one of two things. It will either disregard the image from one of the eyes, which will result in the development of a Lazy Eye or split the visual system in two so that each eye can see independently but not together.

If found early enough treatment can ensure that each eye has good sight and the visual system develops with both eyes working together.

Patients often get confused about double vision. If you see two distinctly separate images of the same thing with almost equal clarity you have diplopia. The images can be side-by-side or one above the other. Diplopia occurs when both eyes are open. If you close one eye you will only see one image. If you look at something and see a ghost image of the same thing, which almost entity overlaps the first image it’s probably blurred vision and spectacles should sharpen up the image.

Nothing surprises a parent more than discovering that their child has a colour vision problem. The main reason for this is a lack of understanding of what the phrase “colour blind” means. People often assume that patients who are “colour blind” have black and white vision. The phrase “colour defective” is much more appropriate. Colour vision can be explained by comparing it to the computer screens. The first colour screens used 16 colours and the more modern screens have 256 colours. Colour defective patients are like the 16 colour version. They can see colours but lack the range of colours that everyone else can see and they may confuse lime green with lilac. Some patients have minor colour vision issues while others had more significant issues.

There is no treatment for colour vision problems, which are predominantly hereditary. About 90% of patients with colour vision issued are male and they pass the gene through their daughter to their male grandchildren.

The detection of colour defective patients by optometrist is essential to make sure that they choose a career that does not require good colour vision.

The pupil is the black hole in the middle of the coloured part of the eye (Iris). It gets bigger or smaller depending of the amount of light entering the eye. There are a couple of pupil problems that parents are not likely to notice. A difference in pupil size can be an indication of a problem and should be investigated. This sometimes occurs after the patient has been suffering from a viral condition. Small pupils could be due to exposure to certain substances and should also be investigated.

If your child bumps into things a lot more than their peers there may be an underlying cause. There are of course many reasons why children bump into things. Telling them that they should look where they are going may if the problem is just carelessness. It may however be because of issues with their peripheral vision. The big problem with peripheral vision is that you can’t see what you can’t see. If you have an area of your peripheral vision that is blind it doesn’t appear black. It just doesn’t appear. So you don’t know it is missing. A good way to demonstrate this is to use a pen. Cover your left eye and pick an object to focus on. Stretch out your arm in front of you with the pen. Place the top of the pen just to the right of the object you are looking at. Slowly move the pen about 6 or 7 inches to the right while watching the object. The top of the pen will disappear. You have just placed the pen in the blind spot created by your optic nerve and you didn’t know it was there.

You child will not be able to tell you that they have a problem either. Reduced visual fields could have a variety of causes, including genetic conditions, congenital problems, cerebral palsy, trauma and neurological issues. If you have any concerns about this get it checked out.

Dyslexic children struggle with reading and writing. We have had children brought in for their first eye test, where the parents tell me that their child is dyslexic. Many attend learning support where they are taught useful strategies to help them cope at school. School can also allow extra time for exams, and other additional facilities. There are numerous specialist clinics that assess whether coloured overlays would help a child. Unfortunately they never thought that part of the problem might be that their child needed glasses. If you think that your child might be dyslexic get their eyes tested first. It is important to have good balanced vision without any eyestrain, as a starting point for a with child with potential processing issues.

I have had a patient bring in special coloured lenses (to assist him with his dyslexia) to be glazed into a frame. The assessment clinic had spent a lot of time refining the colour to maximise this teenager’s ability to read. The specialist lenses had and expensive tint but no optical power. I spoke to the parents and discovered that the teenager had never had his eyes tested. We tested his eyes and found that he required spectacles to correct a significant amount of astigmatism. We provided the clinic with the correct power of lens and they sent us a set of the tinted lenses with the astigmatic correction.

While I encourage all parents to take advantage of everything that is available for dyslexic patients at school, further education and in the workplace, it is important to remember that regular eye tests to ensure that the patient has good balanced vision without any eyestrain is the foundation upon which everything else rests.

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What your child can’t tell you about their eyes – Part 1

When young children watch television they believe everything they see. They also believe that everything they see at Disney World is real. On that basis it would also seem reasonable to assume that if a child’s vision is blurred for distance objects that they will accept that this is how it’s supposed to be. They will also assume everyone else sees the world the way they see it. When they look at things which are up close everything is clear so they think that their eyes are working properly.

This is why children who are a bit myopic (short sighted) don’t know they have a problem. If a child has blurred distance vision they will avoid tasks that require clear vision. Rather than sitting on the sofa to watch the television they would sit close to the television on the floor. They would be more interested in tasks involving close work like reading and computers. Some children with myopia will also screw their eyes up to try and see more clearly. As a parent you should be aware of these signs and should make sure your children have regular eye tests.

An amblyopic eye (lazy eye) looks perfectly healthy from the outside but the vision is poor, even when spectacles are worn. The question I am often asked is why a child wasn’t aware of the problem. Firstly the child may assume that it is normal to have one good eye and one bad eye. The other reason is that the visual system does not separate the images from each eye so the child may not have noticed the difference between the eyes. The brain takes all the visual information from each eye creates a single picture of the world. It doesn’t matter if most of that information comes from one of the eyes or they both contribute equally. Amblyopia occurs when the image at the back of an eye is not clear or when the image in one eye is very different to that in the other. This is often because of a squint where the eyes are not looking in the same direction. The early detection of an amblyopic eye is critical for the development of your child’s eyes.

A squint often occurs when a child is long sighted. The method used by the eyes to change their power from distance to near is called accommodation. It is linked to the muscles the make the eye move closer to the noise when you read. This process is called convergence. Children who are very long sighted use their accommodation to correct for the long sightedness. Unfortunately because it is linked to convergence the eyes will also converge. Although convergence is normally equal in both eyes, the child will keep one eye straight and let the other one do all the converging. The result is an accommodative squint where one eye looks straight ahead and the other one turns into the nose. An eye that turns in will lose its ability to see small objects and become lazy (amblyopic). The accommodation in children’s eyes is so strong that it can mask large amounts of long sightedness. You optometrist may feel it necessary to put drops in your child’s eyes to relax the accommodation. Doing this will tell us if there is any hidden long sightedness that could result in a squint or amblyopic eye.

As your child’s eyes develop there is a plastic period where an amblyopic eye can with the correct spectacles and treatment regain good vision. The plastic period is generally thought to between the ages of 4 and 8. This is why is important to have all children’s eyes examined before they start school. Many parents tell us that their child is fine because the nursery tested their eyes. The important thing you need to understand about this is that NURSERIES DO NOT TEST YOUR CHILDS EYES. In the nursery they conduct vision screening. They set a side an hour or so and ask 20 or 30 children to identify the shapes on a chart. This screening will only pick up children with the most severe visual issues. An optometrist will spend 20 minutes (more if drops are required) examining your child’s eyes. The nursery screening has it’s place but it is not a substitute for a full eye test.

If your child has a squint or amblyopic eye they will be referred to the orthoptics unit in your local hospital eye department. Treatment may include wearing a patch or various exercises. The patch is worn over the good eye to force the poor eye to relearn how to see.

On occasions surgery is required to straighten an eye with a squint. The surgeon will often only corrected part of the squint by surgery because part of the squint is accommodative and part isn’t. If the squint was fully corrected by surgery the child would still have to accommodate to correct the long sightedness and the convergence would start to pull the eye in.

When a child has a squint the main push is to improve lazy eyes and help the eyes develop a visual system that uses both eyes (binocular vision). Some patients develop two visual systems. One for each eye which means the vision is good in each eye but when they use one eye the other is switched off and vice versa.

Some patients have one eye looking straight ahead and the other moved out towards the ear. Some have one eye higher than the other and occasionally the squint is only in one direction of gaze due to one of the muscles that controls the eye being damaged.

Parents often assume that a child who can see well with each eye doesn’t need spectacles. This assumption is untrue. Your child may be hypermetropic (long sightedness) and they maybe able to see well with each eye but they may also have difficulty finishing their school work. They may suffer from headaches or tiredness when the watch the television or use a computer. A child who has to constantly strain their eyes used to overcome hypermetropia can run into difficulties which on the surface do not appear to be connected to the eyes. Optometrists are happy to test children’s eyes even if the result show that no spectacles are required. Probably one out of every five children who appear to have good vision that come in for a routine eye test have a issue with their eyes.

Everyone knows a parent who’s child is a slow reader. It is possible that the child has a learning difficulty but what if that child is struggling to read for no reason other than the fact that he cannot see the print. We recently had a seven year old child in the practice for his first routine eye test. His mother was in tears at the end of the test when he said “Wow! Mummy I’ll now be able to see the small print in my book” he had completed almost 3 years of schooling before he was able to see the print in the books.

Your child may have astigmatism which would make close work difficult. There may be a large difference in image size between the eyes making it difficult for the brain to fuse them into one image. Your child may have difficulties moving his eyes inward towards nose when he wants to read (convergence problems). Take your child for an eye test – Nobody wants to be the parent with tears running down their cheek.


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Ever heard of Blepharitis? Chris Connolly from Connolly Opticians explains more…

Blepharitis is a common eye condition that can develop at any age, it often leads to itchy, red and sore eyes. At Connolly Opticians, we treat people for the condition, using fast, safe and cost-effective treatment methods to relieve any symptoms.

What is Blepharitis?

Blepharitis is inflammation of the eyelid margins. It is often split into two types, Anterior Blepharitis affecting the base of the eyelashes and Posterior Blepharitis, which affects the oil producing glands (Meibomian Glands) at the back part of the lid margin. Posterior Blepharitis is also known as Meibomian Gland Dysfunction. Blepharitis is a chronic condition which needs proper management.


eye lids with anterior blepharitis

Anterior Blepharitis

Anterior Blepharitis

Anterior Blepharitis usually occurs when the natural Staphylococcal bacteria found on the skin cause an infection of the eyelid margin at the bottom of the eye lashes. Sometimes it is caused by a form of dermatitis. The bacteria deposit debris at the base of the eyelashes. As the eyelashes grow, this debris appears to move up the eyelash and can be seen by the optometrist using a slit lamp.

Although the bacteria are harmless on your skin, they are troublesome. They can travel down the eye lashes into the hair follicle and cause a Stye. They can spread to the wet skin on the inside of the eyelid (Conjunctiva) and cause bacterial Conjunctivitis, which generally presents as a red sticky eye. The bacteria can also cause a corneal ulcer about 1mm in from the edge of the cornea, known as a Marginal Keratitis.


meibomian cyst in eye lid

Meibomian Cyst

Posterior Blepharitis (Meibomian Gland Dysfunction)

You have about 23 Meibomian glands on each eyelid. The bacteria can react with the oils produced by the Meibomian gland and form a clear waxy plug which blocks the gland. If they travel down into the gland a Meibomian Cyst or a Chalazion can form. A Chalazion is a hard lump inside the eyelid. The Meibomian Gland Dysfunction often causes dry eye issues. Patients with dry eyes report that it feels like they have sand in their eyes.

If left un-checked Blepharitis can lead to in-turned eyelashes, corneal inflammation and scarring.

Treatment for Blepharitis

There are a number of ways that Blepharitis can be treated.

1) Do nothing – if a patient has very low grade Blepharitis and is asymptomatic, we would advise that treatment was not required. Patients would be advised to return if symptoms start to occur.

2) Hot Compress – Applying a hot compress will help with the crusty collars that form around the eyelashes and relieve some of the discomfort. A drawback of this treatment however is that the heat doesn’t have much impact on the Meibomian Glands.

3) Baby Shampoo – Historically the baby shampoo method was developed by Ophthalmologists as a pre-op procedure for patients having cataract surgery. The technique became widely adopted as a method of controlling Blepharitis. The main issues with the baby shampoo method is that it is also not a sterile process and it destroys the oily layer of the tear film, creating a dry eye problems. This method would cost the patient around £3.50.

4) Lid Wipes and Lid Foam – These products are specifically designed to clear the bacteria from the lid margin without affecting the tear film. Each wipe is sterile, unlike the baby shampoo method, providing a safe and cost-effective means of treating the problem. This method would cost the patient around £13.00.

5) EyeBag – The EyeBag contains flax seeds and it is placed in a microwave for 30 seconds. The warm EyeBag is then placed on the eyelids for 10 minutes. This is repeated 3 times a day. The Eyebag retains the heat long enough to soften and clear the waxy plugs in the Meibomian Glands. This method is more often used in conjunction with Lid Wipes. The cost to the patient is about £20.00 plus the cost of the lid wipes.

If you have been experiencing any symptoms of Blepharitis, make sure you don’t let it go untreated. Get in touch with the friendly team at Connolly Opticians on 01698 824777 and we will be more than happy to help to relieve you of your symptoms or alternatively click here to book an appointment.