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Eye Problems in Babies

Congenital or Acquired

Congenital problems

Congenital problems may either be due to developmental problems, mainly secondary to genetic conditions, or to intrauterine damage from such factors as drugs or infection. There seem to be no common factors among mothers of babies with congenital eye problems. One study showed that cases with different isolated ocular congenital abnormalities had different maternal characteristics.

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Defects of the globe

  • Anophthalmos - complete failure of development of the optic vesicle.
  • Congenital cystic eye - failure of development of the globe.
  • Coloboma - failure of complete closure that can affect the iris, retina or choroid.
  • Nanophthalmos - small eye with normal function.
  • Microphthalmos - small eye without normal function (eg cataract, coloboma, congenital cyst).

Defects of the lids

  • Congenital ptosis - this is usually due to defective muscles of the upper lid but may also be due to Horner's syndrome and 3rd nerve palsy.
  • Eyelid colobomata - often associated with specific craniofacial syndromes.

Defects of the cornea

Corneal opacity can be partial or complete and caused by:

  • Congenital glaucoma (most common with abnormally large eye).
  • Damage from forceps.
  • Endothelial development abnormalities.
  • Persistent attachment of lens.
  • Intrauterine inflammation.
  • Interstitial keratitis.
  • Megalocornea - an X-linked inherited defect associated with an abnormally large but clear, cornea.


Acquired problems

Ophthalmia neonatorum.- This is a conjunctivitis occurring in the first 28 days of life. It is most commonly infective in origin: Neisseria gonorrhoeae, Chlamydia trachomatis, bacteria such as staphylococci, streptococci and viruses - notably the herpes simplex virus - but may also occur as a reaction to chemical irritants. Chlamydial and gonococcal infection can be life-threatening.

Retinopathy of prematurity.- This occurs when there is disruption of the vascularity of the retina. 80% of babies are less than 1 kg in weight and the condition is associated with prolonged administration of oxygen. Abnormal vessels develop in areas where vascular and avascular tissue meets. The condition sometimes resolves spontaneously but may require laser therapy or surgery.

Also known as squint, this occurs in less than 2% of babies. If it persists longer than three months of age, referral is indicated. It can be an early presenting feature of retinoblastoma (21% in one study).

This is defined as reduced visual function in one or both eyes, not improved by refraction or removal of pathological obstruction to vision. It is caused by sensory deprivation with or without abnormal binocular interaction during the sensitive or critical period of retinal development in the first 2-3 years of life. The longer the period of visual disability, the worse the prognosis in terms of visual acuity.

Source: patient

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