The retina is a very delicate, but extremely complex structure that lines the inner wall of the back of the eye. It contains the light sensitive elements – the rods and cones that allow us to see in dim and bright lighting conditions. It also contains numerous other cells and nerve fibers that are required for information processing. The vitreous is a jelly-like mass that fills up the back of the eye and has shock absorbing and nutritional functions.

• Horseshoe retinal tear

• Tear surrounded by laser treatment

• Retina

What can go wrong with these structures?

In premature children with low birth weight, retinal changes affecting sight can develop – retinopathy of prematurity. These and other developmental abnormalities of the retina and vitreous can also affect vision and need early care. Some infections can also affect these structures in children. The most serious lesion however, is a tumor termed retinoblastoma, arising from the retinal cells, threatening the eye and life of the baby.

In young adults, injuries can cause significant changes that affect sight. Sometimes however, there can be changes in the structure of the vitreous gel that are seen as floaters in front of the eye. These are usually harmless, although it is wise to have an eye exam to rule out serious retinal problems.

In older people, changes in the vitreous can result in pulling forces on the retina that can cause either a vitreous bleed, or a retinal detachment. A sudden increase in floaters without flashes of light is a matter for concern. Other aging changes can affect the center of the retina – the macula, an area needed for fine vision – changes in this zone result in black shadows in central vision, blurring or distortion of straight lines metamorphopsia.

The retina is affected in other systemic diseases-notably, diabetes mellitus and systemic hypertension. Blockage of the retinal vessels can result in vision threatening changes unless treated promptly. Infections of the structures within the eye are a very serious problem – endophthalmitis, and may occur after eye surgery. Prompt care is often successful in restoring sight in these eyes.

How will I know if I have these problems?

Since the primary function of these structures is to provide vision, most diseases affect sight – blurring, loss of field, floaters, flashes, central black shadows, and total loss of vision may occur. However, changes in the peripheral retina can be silent and require a detailed eye exam for detection.

What are the common causes of these diseases?

Genetic causes, injuries, infection, tumors, systemic

conditions, high refractive errors, and ageing changes account

for most of these diseases.

How can these conditions be detected?

A detailed evaluation of the back of the eye after dilation of the pupil, using an instrument called the indirect ophthalmoscope is required. In patients with diabetes, an imaging of blood flow in the retinal vessels is helpful- fundus fluorescein angiography. In age related changes of the central retina, two other examinations coherence tomography may be needed. If there is bleeding in indocyanine green angiography and optical the vitreous, ultrasonographic examination can help identify retinal changes.

How can these conditions be treated?

In changes of the blood vessels, the use of retinal lasers is often helpful, and these are also used to prevent serious eye disease in diabetics. In patients with infections, antibiotics; and in those with inflammation, steroids can be used. If there is serious vitreous bleeding or retinal detachment, surgery is required to restore vision. In age related central retinal disease, in addition to laser therapy, the injection of medications into the eye can be helpful.

Recent advances in vitreous and retinal diseases

Instruments are now available that allow the diagnosis of these diseases at a very early stage. Newer treatment option include photodynamic therapy for subretinalneovascularization, the use of intravitreal triamcinolone injections for diabetic macular edema, and anti VEGF agents for age related macular degeneration, all of which have improved our ability to treat retinal diseases.

General information

High myopes may be prone to central and peripheral retinal changes and should have a routine yearly eye exam. Similarly, diabetics and hypertensives should have a yearly eye exam in addition to good control of the systemic condition to protect their eyes and sight.

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Disclaimer: These are just our views expressed here. Please ensure to always contact your doctor for exact instructions and process to follow. In case of queries feel free to reach us. This article is in no way promoting or suggesting any procedure or treatment and is purely for educating oneself and or for academic interests as an individual. No information in this site is intended to be a substitute for actual professional medical advice, diagnosis or treatment. Always seek the consultation and or guidance of a qualified doctor / healthcare provider with any questions you may have regarding a medical treatment, procedure, and or before undertaking a new medical health care regimen in any manner whatsoever and never disregard or take specific action or professional medical advice or delay in seeking it just because of what you have read in this website or any of our communications, online or otherwise. Any and all images used here are for representation purposes only

Although structures in the child’s eye are similar to that in adults, the visual pathways continue to develop in a child. Hence, any obstruction to vision at a young age can cause permanent damage to the system that cannot be corrected later. Since small children often may not notice such changes, it is very important that all children undergo a screening eye exam at an early age.

Long sight (Hyperopia) Correction by a convex lens

What are the common problems in a child’s eye?

A common problem is a refractive error high myopia, hyperopia, or astigmatism may exist in one or both eyes, especially if these are also present in the parent. These may be associated with misalignment of the eyes, squint, which can however, also exist by itself. Other problems can be structural – cataracts, glaucoma, corneal or retinal disease, and these may be present from birth. A rare but very serious problem is a tumor of the retina retinoblastoma. If the normally black pupil appears white (white reflex) in the eye of a child, please arrange for an immediate eye exam, as also in the case of premature births.

What is a ‘lazy eye’?

Amblyopia, also known as ‘lazy eye’, is reduced vision that does not fully acknowledge the images seen by the amblyopic eye. This almost always affects only one eye but rarely both eyes can be involved. A simple vision screening test can detect this-condition, and should be performed in all children since amblyopia is best treated in the early stages.

What is a ‘squint’?

Strabismus or ‘squint’ is a vision condition in which a child cannot align both eyes simultaneously. One or both of the eyes may turn in, out, up or down. An eye turn may be constant (when the eye turns all of the time) or intermittent (turning only some of the time such as, under stressful situations or when ill). Whether constant or intermittent, strabismus always requires appropriate evaluation and treatment. Children do not outgrow strabismus!

What is nystagmus?

Nystagmus is an involuntary rhythmic shaking or wobbling of the eyes. The eyes move constantly in various directions, although horizontal movements are the most common. The presence of nystagmus in a child is often an indication of vision problems. Treatment will depend on the cause. Sometimes, the presence of a nystagmus can indicate neurological dysfunction, and rarely, it can be a side effect of medication use.

How can these conditions be detected?

Children may not complain of problems, and a detailed examination is needed. In infants, the examination is done under general anesthesia. Parents may notice peculiar head posturing, constant side-to-side eye movement, squinting. sitting very close to the TV, or a white reflex in the pupil. The eye exam includes assessment of vision, special tests for stereopsis, (ability to use both eyes simultaneously), eye alignment, pressure and thorough examination of the front and back of the eyes.

How can these conditions be treated?

If a refractive error is detected early, simply providing the correct glasses will correct the problem. If detected late, and one both eyes are already ‘lazy’, then in addition to glasses, other measures may be required – these include eye exercises, and patching or occluding an eye to force the child to use the other eye, thereby ‘strengthening’ that eye.

If there is a squinting of the eyes, in some types, glasses may be corrective, although quite often surgery may be required.

For other problems, like cataract, glaucoma, corneal and retinal disease, the doctor will discuss in detail the options for treatment these could include the use of laser treatment or surgery. If a retinoblastoma (eye tumor) is present, early care is necessary to save the eye and life of the child.

General information

Your child should have his or her first eye exam done during the first year of the child’s life. The next eye exam will be at the age of 3, and once again before entering kindergarten, or by age 5. Thereafter, your child should receive a comprehensive eye exam at least every two years. Since prevention is better than cure, it is better to detect these problems at an early stage.

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Disclaimer: These are just our views expressed here. Please ensure to always contact your doctor for exact instructions and process to follow. In case of queries feel free to reach us. This article is in no way promoting or suggesting any procedure or treatment and is purely for educating oneself and or for academic interests as an individual. No information in this site is intended to be a substitute for actual professional medical advice, diagnosis or treatment. Always seek the consultation and or guidance of a qualified doctor / healthcare provider with any questions you may have regarding a medical treatment, procedure, and or before undertaking a new medical health care regimen in any manner whatsoever and never disregard or take specific action or professional medical advice or delay in seeking it just because of what you have read in this website or any of our communications, online or otherwise. Any and all images used here are for representation purposes only