Pediatric ophthalmology is a medical subspecialty dedicated to the prevention, diagnosis, and treatment of eye diseases in children. Visual development occurs mainly in the first years of life, and early identification of changes is essential to ensure adequate vision maturation. Several eye diseases can affect children, the most common being amblyopia, strabismus, refractive errors, and obstruction of the nasal tear duct.

Amblyopia, also known as “lazy eye,” is the main cause of preventable visual loss in childhood. Its prevalence varies from 1% to 5% of school-age children. Amblyopia occurs when there is inadequate visual stimulation for one of the eyes during visual development, which leads to a reduction in visual acuity, even in the absence of anatomical changes.

Diagnosis is usually made during a routine eye examination, especially when there is a difference in visual acuity between the eyes or family history. Treatment involves correcting the causal factor, such as refractive errors with the use of glasses, and occlusion therapy, which consists of covering the dominant eye to stimulate the weaker eye.

Refractive errors, such as myopia, hyperopia, and astigmatism, are very common in the pediatric population. The prevalence varies according to age and environment. Myopia, for example, has become increasingly common. It is estimated that one in three children in the world already have myopia. This trend is observed globally, with a notable increase in prevalence, especially after the COVID-19 pandemic. Several factors can contribute to this increase, including increased time spent on near activities, such as the use of electronic devices, and reduced exposure to natural light.

Diagnosis is made through a refraction exam, often with the use of cycloplegic eye drops to relax the eye muscles. The standard treatment is the use of glasses or contact lenses. In cases of progressive myopia, the use of low-concentration atropine eye drops, and special lenses has shown good results in reducing progression.

Strabismus is the misalignment of the eyes, identified in approximately 2% to 4% of children. It can be congenital or acquired and, if left untreated, can lead to the development of amblyopia.

Diagnosis is clinical and includes tests such as red reflex, cover test, and ocular motility. Treatment depends on the type of strabismus and may include glasses with or without prism, vision therapy, botulinum toxin injections, or surgery of the extraocular muscles.

Congenital obstruction of the nasal lacrimal duct affects approximately 5% to 20% of newborns. It is characterised by constant tearing and ocular secretion, usually unilateral. In most cases, the condition resolves spontaneously by the first year of life.

The diagnosis is clinical, based on the presence of tearing without signs of eye infection. Initial treatment is conservative, with massage of the lacrimal sac (Crigler maneuver) and hygiene measures. If there is no resolution by 12 months, a lacrimal duct probing procedure may be indicated.

Early and regular ophthalmological monitoring is essential to prevent and treat eye diseases in childhood. Many conditions, such as amblyopia and strabismus, can be completely reversible if identified and treated in time. Parents, pediatricians, and educators should be alerted to altered visual signs, as early intervention is key to healthy visual development.

At the Advanced Ophthalmology Centre of the HPA Institute in Faro (Montenegro), we have specialists dedicated to pediatric ophthalmology, with extraordinary results in terms of diagnosis and intervention.

For more information, please contact Grupo HPA Saude (+351) 282 420 400.