Pediatric Ophthalmology at Tri-County Eye

Children with vision problems often do not complain about trouble with their eyes, and many exhibit no outward signs of impairment. Tri-County is proud to offer a full-service Pediatric Ophthalmology practice for the greater Philadelphia area. Drs. Sheryl Menacker, Emily DeCarlo, and Scott Goldstein completed their fellowship training at the Children’s Hospital of Philadelphia. Drs. Menacker and DeCarlo provide eye care for children of all ages, beginning in infancy, for problems large and small, including eye muscle issues like crossed or out-turned eyes, poor vision due to “lazy eye,” the need for glasses, and routine eye exams. Dr. Menacker has an interest in individuals with disabilities, and Dr. DeCarlo has expertise in treating adults with eye muscle problems, in addition to children. Dr. Goldstein specializes in pediatric oculoplastic surgery, treating children with droopy eyelids, tearing problems, congenital anomalies involving the eyes and surrounding facial structures, skin lesions like hemangiomas, and traumatic orbital and facial injuries.

At Tri-County Eye’s two locations in the Philadelphia area, children can be seen in a caring, comfortable and fun environment to ensure the health of their eyes is being maintained.

What is a pediatric ophthalmologist?

An ophthalmologist is a medical doctor who has attended four years of medical school, followed by a year of internship and then at least three more years of hospital based residency training. Ophthalmologists provide total eye care, from routine examinations to complicated eye surgery, and are licensed to prescribe all types of medication. Pediatric ophthalmologists have chosen to specialize in treating children’s eyes, and have taken at least one additional year of training.

When and why should my child’s eyes be tested?

Very early detection of treatable eye problems in infancy and childhood can have far reaching consequences for vision and, in some cases, for general health. Vision screening in children can detect important eye problems such as poor vision in one or both eyes and misalignment of the eyes. Primary care doctors begin screening children even in the newborn nursery and continue assessing eye health throughout childhood. Formal vision screening evaluations should begin by 3 to 4 years of age. An ophthalmologist is able to perform a full eye examination on any child at any age if there is any question of an eye problem.

Frequently Asked Questions

What are the main reasons why children wear glasses?

Blurry vision – Glasses are prescribed when nearsightedness, astigmatism, or significant farsightedness causes blurry vision which interferes with daily activities such as seeing the blackboard or reading. They are also prescribed to prevent and treat amblyopia in the case where there is a large difference in power between the eyes, such as when one eye is very nearsighted or farsighted and the other is not.

Straightening the eyes – For children who have crossed eyes, glasses correcting their farsightedness will often straighten ocular alignment. In this case, glasses must be worn full time, since when they are removed, the eyes will usually turn inward. Over time, gradual changes in the prescription may allow good alignment even without glasses.

Protection – Children who have good vision in only one eye should wear safety glasses for protection of the better eye at all times. A Joint Policy Statement from the American Academy of Pediatrics and American Academy of Ophthalmology strongly recommends appropriate polycarbonate protective lenses in eyewear for all athletes.

What should I look for when buying glasses for my child?

Glasses that are uncomfortable are not likely to be well tolerated, so make sure you choose from an assortment of frames that are designed for your child’s age and size. Including children in the selection process makes getting glasses more fun and also improves the likelihood they ultimately will be happy with the pair chosen. Polycarbonate lenses are strongly recommended for children because of their safety and light weight. The eye care professional helping you should be experienced in fitting children with glasses; do not hesitate to ask for advice.

When can my child wear contact lenses?

There is no set answer to this frequently asked question. Contact lenses can be worn, physically, by children of any age. Infants often wear them after surgery has been done to remove congenital cataracts. Contact lenses have to correct vision, but must do so without causing eye discomfort, infections, or disease. Therefore, they require closer monitoring by the doctor than eyeglasses. In general, it may be a time to consider contact lenses when your child expresses the desire to wear them and is mature enough to master the hygiene and skill required for their insertion and removal.

Who should wear protective eyewear for sports?

All individuals who only see well out of one eye and athletes who have had surgery or trauma and whose ophthalmologists recommend eye protection must wear protective eyewear. It is also strongly recommended for all other athletes due to the high frequency of sports-related eye injuries in children and adolescents. Basketball, baseball, swimming/pool sports, racquet/court sports, and football are among those associated with the highest incidence of eye injuries. When properly fitted, appropriate eye protection has been found to reduce the risk of significant sports-related eye injury by at least 90%.

What is strabismus?

Strabismus is the condition where the eyes are misaligned. Different types of strabismus include crossed eyes (esotropia: the most common type in children), out-turned eyes (exotropia), or vertical misalignment (hyper or hypotropia). The problem may be present intermittently or constantly. Treatment options depend upon the type of strabismus, and may include glasses, prism lenses, and/or surgery.

Do people who are color blind see colors?

People with ordinary colorblindness do see colors and aren’t blind. In fact, 8% of males and less than 1% of females are born with the inherited condition of faulty color perception. There are three types of color receptors in the eye: blue, green, and red. Most people born with colorblindness have a faulty gene on the X-chromosome for the red or green pigment. Red-green colorblindness@ does not result in poor vision, and people with this condition do see the colors red and green. However, they will confuse reds, browns, olives, and golds, many pastels will appear similar, and purples will be confused with blues.

Can cataracts occur in children and even newborns?

A cataract is a clouding of the lens inside the eye, which causes obstruction of the normal visual pathway to the back of the eye and onto the brain. Because pediatric cataracts can cause permanent blindness if they are not treated early enough, those causing very blurry vision must be surgically removed. Once the cloudy lens has been removed, another focusing device must take its place. This may involve a contact lens worn on the eye or an intraocular lens implanted inside the eye. Glasses are an option when both eyes have had surgery.

My baby’s not crying, so why all the tears?

The nasolacrimal system drains the tears from the eye to the nose. That’s why our nose runs when we cry. Blockage of the tear drainage system occurs in approximately 6% of newborns, resulting in tearing and often mucous or crusting of the eye. Initially, treatment involves a regimen of massaging the tear sac combined with antibiotic drops or ointment if infection is present. In most infants, the obstruction within the tear drainage system will clear spontaneously. If this has not resolved by at least your baby’s first birthday, then the blockage may need to be opened with a probing procedure by your ophthalmologist.

Why do some children need eye surgery?

Eye surgery may be necessary in children with conditions such as misalignment of the eyes, blocked tear ducts, cataracts, and glaucoma. It has the best chance of a successful outcome when performed by ophthalmologists and anesthesiologists with special training in pediatric procedures.

Should my child wear a hat or sunglasses outside?

Definitely yes! Did you know that just wearing a hat will reduce exposure of the eyes to sunlight by approximately one-half? Sunlight is the main source of ultraviolet (UV) radiation, which may cause damage over time to the eyes, inside and out. A good general rule of thumb is that if your exposure to sunlight will be enough to cause sunburn, then a hat and sunglasses with a UV filter are advised. A favorite hat will reduce UV exposure in those children who cannot or will not wear sunglasses.

What to do if there is an eye injury?

Don’t panic. Appropriate treatment of an eye injury immediately following trauma can prevent loss of sight Assess the situation, administer first aid to the best of your ability, and then seek prompt attention from an ophthalmologist or emergency room. Never apply pressure to the injured eye or rub any speck that is in it. If something has splashed or squirted into the eye, the most important thing to do first is irrigate copiously under a water faucet before sending for other treatment. For serious injuries, protect the eye from further trauma by taping a styrofoam or paper cup over it as a shield before sending the child for emergency care.

What major eye infections will you see in school?

Conjunctivitis (pink eye) – Conjunctivitis is an inflammation of the conjunctiva, a transparent, thin membrane which covers the white part of the eye (the sclera). The conjunctiva contains many fine blood vessels which become very prominent when they are inflamed, making the normally white part of the eye appear pink or red. The most common causes of conjunctivitis are infections, allergies, and environmental irritants. Infections causing conjunctivitis are usually quite contagious, while allergies and irritants are not. Bacterial infections often are associated with considerable amounts of pus. Viral infections usually produce a watery discharge. The typical kind of conjunctivitis seen in the school setting is viral. A common misconception is that viral conjunctivitis is no longer contagious after twenty-four hours of antibiotic eye drops. This is not true! Like a virus which causes colds, antibiotics by mouth or eye drops will not resolve this infection, which usually lasts from one to two weeks. Frequent hand washing and avoiding contact with infected tears are the best ways to prevent spread of infectious conjunctivitis. Of course, any red eye which does not resolve, or is associated with significant pain, blurred vision, or severe light sensitivity may represent a more serious eye condition which should be evaluated by an ophthalmologist.

Chalazion (stye) – A chalazion is an inflammation of an eyelid oil gland which appears as a lump on an eyelid. A stye is actually an inflammation of a different type of gland on the eyelid, but also looks like a cystic swelling. While they may be tender and red, chalazia and styes are not contagious and often resolve on their own. Treatment may involve warm compresses, eye drops, or surgical drainage.

What Should Parents Know About Their Child's Eyes and Amblyopia?

Amblyopia is a condition in which poor vision is present in one eye. Commonly referred to by many people as a “lazy eye,” amblyopia affects over 2% of the general population and causes loss of vision in more people under age 45 than all eye diseases and trauma combined. Therefore, early recognition and prompt treatment of amblyopia is very important.

In early childhood, the connections between the eyes and the brain are developing. The brain must learn how to put together information sent from both eyes and make one picture. However, if the image from one eye is clear and the other blurry, or if the eyes are misaligned and send two different pictures, the brain will ignore the picture sent from one eye. A condition called amblyopia results when the brain consistently ignores the information from the same eye. Using the analogy of the eye as a camera and the brain as the photo processing machinery, the problem causing amblyopia is not that the camera (eye) is defective, but that the photo processor (brain) is not properly developing the “film” it is receiving.

Amblyopia can only be treated in early childhood, when the brain is learning to pay attention to the input from each eye. Usually, treatment will consist of patching the eye that sees better, forcing the brain to pay attention to the eye with poor vision. Glasses also may be needed to help the eyes see more clearly or straighten alignment. Children are most sensitive to developing amblyopia during the first 2 to 3 years of life, after which this sensitivity gradually decreases. After age 9, it is unusual for treatment to significantly improve visual acuity in an eye with amblyopia. Therefore, vision screening is very important in early childhood in order to determine whether amblyopia is present, since often there are no clues. As long as one eye sees well, you may not find out that the other doesn’t until it’s too late.

Ask your child’s physician or pediatric ophthalmologist if there is any sign of amblyopia. Don’t wait until it’s too late for your child’s eyes.