Our eyelids are designed to cover and protect our eyes. They help spread tears and other secretions on the eye surface to keep it moist, and our blink reflex helps to protect the eye from foreign bodies. Here are some of the most issues that affect the eyelid for pediatric patients:
Blepharitis, also known as granulated eyelids, is an inflammation or infection of the eyelids. It is a benign condition, but can be chronic and annoying. It is most frequently caused by a bacterial overgrowth on the eyelid, but there is no one cause.
Chronic crusting of the eyelids is the hallmark symptoms of blepharitis. Other common symptoms include redness of the eyelid margins, dry eye symptoms and chronic redness of the eyes. Treatment involves a diligent eye hygiene routine, which includes eyelid scrubs with a baby shampoo solution.
A chalazion is a bump in the eyelid that is usually about the size of a small pea.
Small glands lining the edge of the eyelids produce oil that helps lubricate the surface of the eye. When one of these glands becomes blocked, oil backs up inside the gland and forms a bump in the eyelid. If the gland ruptures, the oily materials can irritate the eyelid causing it to become red, swollen and painful.
Most chalazia resolve by themselves within several days to weeks, but sometimes can take months to completely disappear. Warm soaks of the affected area can promote drainage of the blocked gland. Anti-inflammatory eye drops, ointments or an injection into the bump may be needed. A large swollen or persistent chalazion might require oral antibiotics and/or surgical drainage. Although older children and adults can undergo the procedure in a doctor’s office under local anesthesia, general anesthesia is usually necessary to drain chalazia in young children.
Ptosis (Droopy Eye Lids)
A droopy eyelid or ptosis can be present at birth (congenital) or occur later in life (acquired). Poor development of the levator palpebralis muscle in the upper eyelid with resulting abnormal function is the most common cause of congenital ptosis. Acquired ptosis has many possible causes, including neurological conditions that affect the nerves and/or muscles of the eye.
A pediatric ophthalmologist diagnoses ptosis by asking about the time of onset, variability, and presence/absence of double vision, which may aid in determining the cause of the ptosis. A complete eye examination is performed with special attention given to the eyelid position, vision assessment, refraction and the head position.
Early surgery is usually indicated for a droopy eyelid that blocks vision (which may cause delayed vision development) or causes a significant chin up head position (which may cause neck problems and/or delay of developmental skills). Children are usually observed regularly to monitor for visual problems. Surgery may also be indicated during preschool years if facial maturation has not sufficiently improved the ptosis.
A capillary hemangioma (strawberry birthmark) is a non-cancerous tumor consisting of an abnormal overgrowth of tiny blood vessels. Capillary hemangiomas are usually not present at birth but appear in the first 6 months. They usually begin to decrease in size between 12 and 15 months of age. Most regress nearly completely by 5 or 6 years of age. Capillary hemangiomas are more common in premature infants and in girls.
Amblyopia can occur in an eyelid hemangioma if it causes undue pressure on the eye leading to astigmatism. This may blur the vision and result in a type of refractive amblyopia. Hemangiomas on the eyelid can also block, or occlude, the line of sight and result in occlusion amblyopia.
A capillary hemangioma in the eye socket can put pressure on the eye and result in amblyopia or strabismus. It can also press on the optic nerve which may cause optic nerve atrophy. Any of these conditions may damage vision.
Capillary hemangiomas can be treated with medication, laser treatment or surgery, depending on the location of the hemangioma, its severity, and whether or not it is causing vision problems.
Source: American Association for Pediatric Ophthalmology and Strabismus
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