Congenital Cataract

What is Congenital Cataract?

Congenital cataract is, clouding of the lens of the eye, that is present at birth. The white opacity seen in a childís eye may be due to several reasons; however the most common reason is cataract. If such opacity is seen in a childís eye since birth, it is called congenital cataract.

What causes Congenital Cataracts?

Most common reason for a new born baby to have cataract is maternal infections acquired during pregnancy called TORCH group of infections. Out of these, rubella, also known as German measles is an important cause for congenital cataracts in India.

Other causes are:

  • Heredity: Approximately one eighth of bilateral cataracts are inherited. Families with history of congenital cataracts should seek genetic counseling.
  • Metabolic disorders and syndromes: Cataracts are also seen in children with abnormalities of other systems of the body and eye.
  • Injury to the eye: A blunt or penetrating injury to the eye can lead to this condition.
  • Steroids: When used for a long time, either systemically or through eye drops, steroids can cause cataract in one or both eyes in young children. Children often are steroid responders and are more prone to various side effects of steroids taken for a long time.

What are the symptoms of Congenital Cataract?

  • Gray or white cloudiness of the pupil (which is normally black)
  • Infant may not be able to see (if cataracts are in both eyes)
  • No ìRed eyeî glow of the pupil in photos
  • Unusual rapid eye movements (nystagmus)

What are the implications of congenital cataract?

Cataract surgery involves removing the cataract and replacing with an artificial lens implant.

Cataracts in infants or children are not uncommon and can lead to moderate to severe visual impairment. Infants with complete cataracts in both eyes often show very little ëvisual interestí and have delayed development. Lazy eye can develop in some cases, called ìStimulus deprivation amblyopiaî, because due to the presence of cataract, the brain receives no visual information thereby making the eye ëlazyí. Such lazy eyes are difficult to treat due to the severity of amblyopia. Unsteady gaze or nystagmus also develops which indicates poor vision.

What are the treatment options for congenital cataract?

Moderate to severe cataracts that affect vision, or a cataract that is in only one eye, will need to be treated with surgery. Significant cataracts whether present in one eye or both eyes, should be removed urgently if the baby is too young. In slightly older children, timing of surgery depends on the duration of visually significant opacity.

Babies who are younger than 2 years of age are given glasses or contact lenses after surgery, till they attain 2 years of age, after which intraocular lenses can be implanted in the eye. Parents are first taught how to insert and remove contact lenses and also how to maintain hygiene, which is of utmost importance. Once they master the insertion and removal process, the lenses are handed over to them with clear instructions to consult the doctor if they face any difficulties in handling the lens or if the baby does not seem comfortable with lenses on.

Finally, once the child crosses 2 years of age, lens implantation is performed as a second stage procedure. If the cataract is seen in a younger child but only in one eye, usually intraocular lens is inserted inside the eye irrespective of the age of the child, after which the child will require glasses.

Patching of the normal eye, to force the child to use the weaker eye, is often needed to prevent amblyopia. The infant may also need to be treated for the inherited disorder that is causing the cataracts.

What care should I follow after the surgery?

  • Your baby will be given a short course of steroid eye drops. Please use them only as advised and for the stipulated time period. Children tend to have steroid-inflammatory reaction hence these eye drops are very important.
  • Keep the eyes clean and do not miss out on the timings of eye drops.
  • Use of glasses or contact lenses is mandatory and should be followed meticulously.
  • Patching of the good eye as prescribed should be followed.
  • Children are often uncooperative for all these post-operative necessities. Parents must cajole them and coax them into following all the above instructions.
  • If there is discharge from the childís eye, the child is rubbing the operated eye all the time, or the eye is looking reddish, please consult your pediatric ophthalmologist immediately.
  • One must remember that even though there are newer techniques of cataract removal and good quality intraocular lenses, management of this condition does not end with surgery only. Proper postoperative care, use of glasses, and therapy for lazy eye, is extremely important for actual rehabilitation of the affected children. They must be followed years after surgery as some complications may arise and early detection and treatment is the key to tackling theses complications.NIO is one of the best eye care hospitals in Pune for cataract surgery, where experienced doctors provide patients with quality health care services and new technological advancements.

You can call our Healthcare team on 02025536369 / 41460100 if you have any queries regarding your childís eye.

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What is Amblyopia?

The word Amblyopia is derived from Greek. It means dullness of vision, or lazy eye.

In this condition, vision does not develop properly in one eye. If itís left untreated, a childís vision may never develop optimally in that eye.

What causes Amblyopia or Lazy eye?

When an image from one eye does not reach the brain frequently and distinctly over a period of months or years, the brain chooses to ignore that input from the eye. As the brain keeps ignoring that eye, it turns lazy.

Strabismus is the most common cause of amblyopia. There is often a family history of this condition. A large plus or minus cylindrical power in one eye or asymmetrical numbers in both eyes can also cause this condition to occur.

What are the symptoms of Amblyopia?

Usually, amblyopia or lazy eye does not cause symptoms. But the child may:

  • Have an eye that wanders or does not move with the other eye.
  • Have eyes that do not move in the same direction or fix on the same point.
  • Experience inability to judge depth correctly.
  • Cry or complain when one eye is covered.
  • Squint or tilt the head to look at something.
  • Have an upper eyelid that droops.

How is Amblyopia diagnosed?

Amblyopis can be detected with the help of an eye exam. If the exam shows that the child has poor vision in one eye, the doctor may diagnose amblyopia after ruling out other causes.

To help make the diagnosis, the doctor should be told about any symptoms, or if your child has trouble reading, seeing the board at school, or watching TV. It is recommended that children be made to undergo an eye checkup between the ages of 3 and 5, and earlier in some cases. If you worry about your childís eyes or vision, take him or her to an eye doctor. No child is too young for an eye exam.

What are the treatment options for Amblyopia?

Amblyopia can be cured fully provided it is detected early and the treatment regimen is followed faithfully. The treatment aims to achieve maximum visual acuity for an individual.

The treatment consists of removing any ambloygenic factors such as cataract, drooping of eyelids etc., and correction of significant refractive errors by giving glasses and encouraging the child to use the lazy or amblyopic eye. This is done by forcing the lazy eye to see. This can be done by the following treatment methods:

1. Patching

Patching of the good eye is the mainstay of the treatment. This compels the amblyopic eye to see, and the brain is left with no choice but to analyse the inputs from this eye. The treatment needs to be followed everyday for at least 6 months to a year, depending on the age of the child, the severity of the lazy eye and how much the child is able to cooperate. Presently, this form of treatment is easy, effective and inexpensive.

2. Penalization

This treatment is used for children who absolutely do not comply with patching. It involves blurring the vision of the good eye through the use of medications and/or spectacle manipulation, thereby encouraging use of amblyopic eye. However, this modality cannot be used long term due to obvious side effects of long term use of eye drops.

3. Synaptophore exercises

These are machine exercises in which flashes ofn light in the form of a fan are projected onto the patientís retina. This stimulates the use of the lazy eye.

What are the implications of Amblyopia?

The psycho-social implications of this condition are tremendous. The patient may have reduced vocational and socio economic opportunities because normal vision in both eyes is required for many jobs. Besides that, people suffering from Amblyopia also face more risk of blindness in case of accident or injury to the normal eye.

What happens after therapy?

Once vision is improved by treatment, we recommend maintenance therapy by continuing patching for a few hours every day to minimize risk of recurrence till 10 years of age. Participation of parents in understanding and execution of Amblyopia treatment is an important factor in improving your childís vision.

NIO is one of the best eye hospitals in Pune, and it can prove to be the perfect choice for treatment of Amblyopia.

You can call our healthcare team on 02025536369 / 41460100 to schedule an eye checkup for your child.

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Glasses And Children

Why does my child have glasses?

Children usually inherit glasses from their parents. If either parent has glasses, then there is a fair chance that the child may get it. If both parents have glasses, chances are that the children will have them too. However sometimes even when the parents do not have glasses the kids may still get it. This is also a possibility as heredity is not the only causative factor. Having glasses seems to be a multifactorial problem.

How do glasses help see clearly?

Eye glasses help bend the incoming light rays so that they are focused properly on the retina of the eye. Adults wear glasses to see more clearly, however children may wear glasses for a variety of reasons.

Rays of light form a point of focus on the sensitive part of the eye known as retina and the eye can see clearly without any aid. But in a myopic eye (short sightedness), the axial length of the eye being larger than normal do not let the rays of light form a point focus on the fovea, and thus objects are seen blurred. When a concave lens (minus number lens) is placed in front of the eye, the rays of light falling on the eye make a point focus on the retina thus enabling the eye to see clearly.

In a hypermetropic eye (long sightedness) the axial length of the eye is smaller and hence rays of light falling on the retina do not form a point focus on the retina (fovea). But when a convex lens (plus number glasses) is placed in front of the eye, the eye can see clearly.

What is astigmatism?

Astigmatism occurs when the cornea is not symmetrical. The cornea has 2 radii of curvature ñ horizontal and vertical. When these 2 are not balanced, i.e. one meridian is steeper than the other; the condition is known as astigmatism. The patient perceives seeing shadows around objects or straight lines appear slanting. This is remedied by adding ìCylindrical lensesî (eye glasses or contact lenses) which have power only in one meridian.

Will my childís number reduce if he/she wears glasses all the time?

The eyeís number usually does not disappear only because the child has been wearing glasses all the time. As illustrated earlier, having glasses is an optical phenomenon, related to the length of the eyeball. As the child grows his eye balls also increases in length and hence till he/she is 18 years (in some cases 21 years old), the number does not stabilize. As age advances, with growth of the child, the number may increase.

My child watches TV too much, does not eat carrots and vegetables properly. Is that why he/she has glasses today?

Just watching TV for a prolonged duration may not lead to glasses. Similarly, vegetables, carrots, though contain vitamins and essential nutrients do not contribute towards needing glasses or otherwise. Even if a child with glasses eats carrots regularly, the number will not disappear only because of this.

Is it necessary for my child to wear glasses, though he/she is not complaining of eye strain or headache?

Yes. Depending upon the power of glasses whether plus or minus, your doctor will advice you regarding the wearing schedule. Remember, by wearing glasses only, some types of lazy eye can be prevented/cured.

What do I do if the child refuses to wear glasses?

If your child refuses to wear glasses, consult an eye doctor to make sure the prescription is correct. If the prescription is correct, you may want to use positive reinforcement and explain why itís important to wear them.

How can I get rid of my childís glasses?

When the number stabilizes by 18-21 years (that is, there is no change in power atleast for a year or so) laser can be utilized to get rid of glasses. It is a very safe and effective method to get rid of glasses permanently.

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Ocular allergy

What is ocular allergy?

Allergic ocular disease or Vernal keratoconjunctivitis (VKC) is a common problem in children, often occurring in association with asthma, allergic rhinitis (sneezing and runny nose) and atopic dermatitis (itchy rash on body). The condition, which is also called spring catarrh, occurs on a seasonal basis and is seen getting aggravated in summer. It is a common self-limiting disease, seen frequently in males between ages 5 to 20 years.

What causes ocular allergy or Vernal keratoconjunctivitis?

Though the exact cause is not known, it is thought to be of allergic origin mostly sunlight & dust, pollens. This condition can be the result of an allergic response thatís triggered by an over-reaction of the bodyís immune system to allergens, or foreign bodies. The immune system releases histamines and other mediators, resulting in itching, burning, and runny eyes that may become red and inflamed.

What are the symptoms of ocular allergy?

Marked itching and redness of eyes of recurrent and chronic nature are hallmarks of internal ocular disease of allergic origin. Other non specific signs like watering, stinging, burning or inability to bear light are also seen.

How is Vernal Keratoconjunctivitis diagnosed?

The eye doctor will diagnose VKC by listening carefully to your childís complaints and keeping in mind factors as the childís age, the climate in which he or she lives, and seasonal changes. Along with this, the doctor will also examine the eye closely by magnifying the structures of your childís eye.

What are the treatment options for ocular allergy or Vernal keratoconjunctivitis?

Although there is no specific treatment it can be controlled with topical steroids. The lowest concentration for the least amount of time is used. Cold compressors and oral anti-histaminics may also be helpful. Although the course may last several years, the recovery is usually excellent. Being a self limiting disease, it cannot be completely cured during its course, but the symptoms can only be treated to give some respite for the patient.

How serious is ocular allergy?

VKC is not known to cause permanent blindness in the patient as such. However, there are certain complications which can be vision threatening. Constant rubbing of the eyes can render the cornea thin (outer surface of the eye) leading to a serious condition called Keratoconus. Indiscriminate use of steroids can cause ulceration (shield ulcer) which can have vision threatening consequences.

Word of caution about using steroids:

Steroids are the mainstay of treatment of VKC. Even though they are wonder drugs, sometimes they can act like a two edged sword. Too much &/or usage for too long can harm the eye due to increasing the intra ocular pressure leading to glaucoma, opacification of lens which can further lead to cataract, ulceration of cornea, and make the eye prone to infection. All these complications though remediable to some extent, can cause considerable harm leading to irreparable vision loss.

It is recommended that these simple ground rules be followed:

  • Never instill steroid drops without competent medical supervision.
  • Follow the schedule of dosage as prescribed by your doctor.
  • Maintain your follow up schedule as asked for by your doctor
  • In case of any untoward effect noted, contact you doctor immediately

You can contact our healthcare team on 02025536369 / 41460100 to schedule an eye checkup and have your queries answered.

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What is squint?

Normally, our eyes are straight while looking at any object. However, in some children, while looking straight, the eyes do not see in the same direction. While one eye looks straight ahead, the other eye is turned either inwards or outwards. This is called a squint.

Why does squint occur?

This can happen due to various reasons, letís take a look at some of them-

  • Sometimes a squint is seen right since birth or within first six months from birth, where in both eyes are turned inwards towards the nose.
  • The other frequent cause of squint is having high plus power glasses. Such children have glasses of + 4-5D or even higher.
  • The presence of any other eye problem which hampers vision can also give rise to squint, where in the eye deviates more commonly outwards towards the ear.
  • Some other causes are- spectrum of syndromes such as Duaneís retraction syndrome, Mobius syndrome, Brown syndrome which have squint as the main feature.
  • Over action or under action or restriction of muscles can also cause eyes to squint.

You can contact our healthcare team on 02025536369 to schedule an eye checkup and have your queries answered.

What are the types of squint?

There are three types of squint- convergent squint, essential infantile esotropia, and divergent squint.

  • Sometimes a squint is seen right since birth or within first six months from birth, where in both eyes are turned inwards towards the nose. This is called convergent squint.
  • The presence of some other eye problems which hampers vision can give rise to a squint, wherein the eye deviates outwards towards the ear. This type of squint is known as divergent squint. It can also develop if the patient has lost his/ her eye sight of one eye due to an injury, accident, or other causes.

What are the treatment options available for squint?

  • Initially a complete detailed eye examination is necessary. Whenever short sightedness is detected, wearing glasses is the treatment, as many a times the squint decreases or disappears once the person starts wearing glasses.
  • When other eye problems are noted in the patient, he/ she should be treated with medication for the concerned problem. Frequently, in such cases the squint may take care of itself once all eye problems are solved.
  • In case if there is no need for glasses or no underlying pathology leading to squint is noted, surgery for the squint is necessary.

When is it advisable to operate squint?

Many factors are considered before deciding the timing for a squint surgery.

  • If the patient is less then two years of age and squints since birth, or since sixth month of age with no other eye problem, he or she must be operated as early as possible.
  • If the patient is older than two years and squints with one eye most of the times, then that eye is prone to become a lazy eye. In such cases, patching needs to be instituted first, so as to train the lazy eye to see. Squint surgery can be performed after waiting for few weeks to months of patching.
  • Patients who have grown out of the lazy eye treatment amenable stage can be operated anytime.

Considerations before surgery

  • Squint surgery is a dynamic process. The over acting muscles are weakened and weak muscles are strengthened. The muscles have their own blood supply, and without compromising both, surgery is performed on both eye muscles. Hence, many a times, a second or third stage operation may be required.
  • Redness of the eye may persist for a month. There is no ìno stitchî surgery available for a squint yet.
  • The pressure inside the eye may increase in the post operative period needing medication and regular follow up.
    vTreatment, if required, should be performed on time, as psychologically, a squint in a patient saps away his/her confidence and self esteem.
  • In children, squint surgery is performed under general anesthesia. Thus, the risk of the same must be borne in mind.

Facts about Squint surgery

  • People suffering from a squint with very low vision in the squinting eye may have recurrence of the squint in that eye after surgery. There is no way to tell when the squint would recur.
  • Regular follow up after the surgery is important. Patching and exercises, if necessary, needs to be done as advised by your ophthalmologist.
  • A squint surgery does not improve the vision. It only corrects the squint.

NIO is one of the best hospitals for squint surgery in Pune, thanks to its experienced team of Doctors and latest surgery equipments.

You can call our healthcare team on 020 25536369 / 41460100 to schedule an eye check up

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Watering Eyes

Watering Eyes

What is ìwatering eyeî?

In this condition, tears flow out of the eye constantly. It usually happens if the childís tears donít drain away properly. (link is external)

How tears work?

Tears are produced to keep the eyes moist. They are produced in small glands (lacrimal glands) located underneath the upper eyelids. When a person blinks, tears get spread over the front of the eyes. The tears then pass into tiny channels known as canaliculi, before draining into a tear (nasolacrimal) ìsacî and flowing down the tear duct into the nose. Watering eyes are the result of problems with this process.

What causes ìwatering eyeî?

In infants, the most common cause of persistent watery eyes is a blocked or incompletely opened tear duct. Corneal diseases or congenital glaucoma may also lead to this condition.

How can it be treated?

Conservative management consists of waiting for spontaneous resolution with regular lid hygiene & massage and occasional use of antibiotic drops. Lacrimal sac massage is an important part of early treatment. The technique, which was first described by Creiger in 1923 is called Creiger maneuver. It consists of applying pressure over the lacrimal sac with the finger sliding down the nose towards the mouth. This attempts to break obstruction in the nasolacrimal duct by hydrostatic pressure. 10 strokes at a time should be applied, 4 times a day (=40 stokes/day)

For how many days should I continue Lacrimal sac massage?

Several studies have documented high success rate with Lacrimal sac massage continued till the infant become one year old. By one year of age, more than 96% cases get resolved with sac massage alone.

What is to be done if watering persists beyond one year of age despite sufficient massage?

A small procedure called probing is done under General Anesthesia, whereby a thin long metal probe is passed through the lacrimal drainage system in an attempt to break the obstruction. It is safe and a simple procedure and does not take much time. However, if watering persists, probing may need to be repeated second or the third time.

In cases where repeated probing does not resolve the problem, other surgical procedures like Ballon Catheter dilatation or dacryocystorhinostomy (DCR) may need to be deployed as directed by the doctor.

NIO is one of the best eye hospitals in Pune, and it can prove to be the perfect choice for treatment of your childís eye.

You can call our healthcare team on 02025536369 / 41460100 to schedule an eye checkup for your child.

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Children Eye care


There is a misconception among many people that children do not need regular eye care like elders. This misconception and ignorance can prove to be dangerous for kids suffering from eye infections or refractive errors. A child is equally prone to vision problems and eye diseases, which makes regular eye examinations extremely important.

  1. When child is 3 years old.
  2. When the child enters pre-primary school.
  3. When the child enters secondary school.
  4. Whenever the child complains of pain, or severe irritation in the eyes.
  5. In case of an external body/object entering the child’s eye.
  6. Regular checkups are recommended if the child’s family has a history of eye problems.
  7. If you find your baby developing unsteady eyes (Nystagmus) or starts squinting, or if you notice an abnormal ‘glint’ in your baby’s eyes, visit a pediatric ophthalmologist immediately.
  8. If your baby is premature, ensure that an eye checks – up is done during baby’s stay in the hospital, then after one year, three year and five years.


NIO is a super-specialty eye hospital in Pune committed to delivering high quality eye care with highly skilled and experienced doctors specialized in Pediatric Ophthalmology, Squint, General Ophthalmology.

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