Paediatric ophthalmology at Cardiff and Vale Hospitals

What is paediatric ophthalmology?

Paediatric ophthalmology is the term used to describe the speciality that focuses on the identification, diagnosis and treatment of eye conditions affecting children and young people. In many cases, these are childhood-specific vision problems such as lazy eye (‘amblyopia’), squint/strabismus or congenital cataracts that require specialist input to diagnose and manage.

You may also hear paediatric ophthalmology referred to as paediatric eye care, and you’ll typically see a consultant paediatric eye surgeon, who may also be called a children’s eye specialist or paediatric ophthalmologist.

Childhood eye conditions are very common, with studies estimating that 6 in every 100 children will experience at least one issue with their vision before the age of three.

What conditions can paediatric ophthalmology treat?

Paediatric ophthalmology covers a wide range of eye conditions including but not limited to:

• Amblyopia/lazy eye: a condition characterised by the eyes not working properly together, causing blurred vision in one or both eyes. It’s estimated to affect around 1 in 30 children in the UK.
• Allergic eye disease: an inflammatory condition of the eyes that tends to affect children more severely than adults. It causes eye discomfort and redness and is often found in those who also have hay fever, asthma or eczema.
• Strabismus/squint: this is where the eyes are misaligned and so don’t look in the same direction at the same time. Squint is believed to affect around 2 in every 100 children. Some children experience double vision due to squint/strabismus.
• Ptosis: a condition where the upper or lower eyelid droops excessively, which can affect your child’s vision as well as their appearance.
• Childhood cataracts: while cataracts usually develop with age, childhood cataracts (clouding of the natural lens of your eye) can develop because of eye trauma, infections during pregnancy or genetics. It’s quite uncommon.
• Nystagmus: characterised by rapid, involuntary eye movements, nystagmus can develop in babies or later in life and cause a range of symptoms, from balance issues to sensitivity to light.
• Myopia: short-sightedness (where objects are clearer when held close). This is an increasingly common problem and there are now evidence-based treatments available to slow the progression of myopia in children.
• Eyelid lesions: children can have many different types of lumps or bumps that appear on their eyelids. Most are harmless, but they can be unsightly.
• Watery eyes: Many babies are affected by recurrent discharge from one or both of their eyes. This is due to a blockage of the tear drainage system.

What causes eye problems in children?

Eye problems in children can be caused by a wide range of factors, including:

• Genetics. Some types of paediatric eye issues run in families or are more likely to affect specific types of children.
• Development problems during pregnancy. For example, amblyopia is more common in babies who are born prematurely.
• Lack of time outdoors. Research has shown that children who don’t spend much time outdoors could be more likely to develop myopia (short-sightedness).
• Diet. Some children with restrictive diets develop specific eye issues, especially affecting their optic nerves.
• Underlying medical conditions, for example, diabetes in children significantly increases the risk of developing eye problems, including diabetic retinopath.
• Neurological. Children require both healthy eyes and a healthy brain to develop good vision, so conditions affecting the brain can cause eye issues.

How are paediatric eye conditions diagnosed?

Like any eye condition, paediatric eye conditions are diagnosed using a combination of an evaluation of your child’s symptoms, physical examination and a range of tests that assess everything from how your child’s eyes look to how well they work together. There are many different types of tests, and your ophthalmologist will be able to explain to you which tests are required and what to expect.

Why choose Nuffield Health Cardiff and Vale Hospitals for paediatric ophthalmology?

Patients across South Wales can access specialist paediatric ophthalmology services through Nuffield Health Cardiff and Vale Hospitals, bringing together the expertise, facilities and services available at both The Vale Hospital and Cardiff Bay Hospital. Children with vision concerns or diagnosed eye conditions can benefit from assessment and treatment from experienced consultant ophthalmologists, with the flexibility of accessing care across two connected hospital sites.

Families benefit from a welcoming private hospital environment designed to make visits as straightforward as possible. From an initial eye assessment through to treatment and follow-up appointments, our ophthalmology team works closely with children and their parents to provide expert care, clear guidance and ongoing support at every stage of their journey.

What paediatric ophthalmology treatments are available?

There are a wide range of different paediatric ophthalmology treatments, and which is recommended for your child will depend on the issues that they are diagnosed with and the recommendation of your consultant ophthalmologist.

Non-surgical treatments for children's eye conditions

• Prescription eyewear: glasses and, in some cases, contact lenses are one of the first choices of treatment for many eye conditions, including myopia and astigmatism.
• Patching: also known as occlusion therapy, patching is used to treat amblyopia. It involves covering the stronger eye, forcing the weaker one to work harder, strengthening the visual pathways to your child’s brain.
• Eye drops: dilating eye drops can be used as an alternative to patching, blurring the vision in your child’s stronger eye so that the weaker one must compensate. They can also be used to help manage conditions such as progressive myopia. Steroid eye drops can be used to treat inflammation.

Surgical treatments for children's eye conditions

Surgical treatments for children’s eye conditions include but aren’t limited to:

• Squint/strabismus surgery: a surgical treatment for strabismus; it involves altering the muscles of your child’s eye(s) to correct the misalignment. Sometimes Botox injections are used instead of strabismus surgery.
• Cataract surgery: this procedure removes the cloudy natural lens of your child’s eye and replaces it with an artificial alternative.
• Ptosis surgery: a surgical process to remove excess fat/muscle/skin from a heavy or weak eyelid. Sometimes the muscles are strengthened to help the eyelids remain in position.
• Eyelid lesion removal: surgical removal of unsightly or dangerous eyelid lumps and bumps.
• Tear duct surgery: surgery to open up the tear drainage channels for those affected by watery eye(s) or recurrent eye discharge.

At what age can children receive paediatric eye treatment?

Children can receive paediatric eye treatment at any age. Your consultant ophthalmologist will be able to advise you if your child is suitable for treatment and will explain what that treatment might involve.

How should you prepare your child for their paediatric ophthalmology procedure?

Every surgery is different, so it’s essential that you follow the specific pre-operative instructions provided to you by your consultant and ophthalmology care team. Doing so can help reduce the risk of complications during the procedure and even accelerate how quickly your child recovers.

This may include things such as:

• Stopping regular medications your child takes if advised
• Explaining what will happen at the appointment to your child ahead of the day of treatment, to help reassure them
• Pack your child’s comfort items – favourite soft toy, blanket, book etc., to try and help them to feel as calm and relaxed as possible
• Following any fasting rules you are given (if your child is having a general anaesthetic).

If you have other children, it’s important to remember to make provision for them (such as school pickups, etc.) while you are at your child’s appointments.

What happens at the pre-operative assessment?

A pre-operative assessment is an opportunity to make sure that your child is fit and well enough for surgery. In addition to a physical assessment, your care team will take observations including your child’s temperature, blood pressure and oxygen levels. They may perform a swab to check for infections, and a blood test.

At this appointment you’ll also be given critical information about the day of your child’s procedure including what to expect and how to prepare.

What happens during paediatric ophthalmology surgery?

Exactly what will happen at your child’s surgery will depend on what procedure they are having. Your paediatric ophthalmologist will explain to you what your child’s surgery looks like, so that you know what to expect.

How long does paediatric eye surgery take?

Paediatric eye surgery usually takes anywhere from 20 minutes to 2 hours depending on the procedure. This doesn’t include preparation and initial recovery time.

Is paediatric eye surgery painful?

Every effort will always be made to ensure that your child is comfortable and pain-free throughout their eye surgery. This means that either numbing eye drops or a general anaesthetic will be used so that they don’t feel anything at all. In some cases, topical anaesthesia is combined with sedation to keep your child calm during treatment.

How long does it take to recover from paediatric ophthalmology surgery?

Again, it depends on the type of procedure they have had. If they’ve had a general anaesthetic, it will take around 24 hours for that to wear off. Blurred vision can last from several days to weeks, while healing can take several weeks to a few months.

You’ll be provided with a timeline that will explain what to expect at each stage of your child’s paediatric eye surgery recovery, which will be tailored to their specific circumstances.

How soon can my child return to school after eye surgery?

Most children can go back to school within one to two weeks of surgery.

Can my child watch TV or use screens during recovery?

Yes, your child should be able to watch television or use screens during their recovery, but you may be asked to limit the amount of time they are allowed to use them. This is done to help prevent eye strain and to give your eyes time to heal and recover.

What should my child avoid after eye surgery?

You’ll be advised that your child should avoid:

• Rubbing or touching their eyes, which could disrupt healing and increase their risk of developing an infection.
• Use any eye shields provided to you exactly as directed.
• Swimming and getting water in their eyes. Again, this is to help reduce the risk of infection.
• Getting shampoo or soap into your eyes.
• Wearing eye cosmetics or facial lotions.
• Rough play/contact sports.
• Extensive periods of time on screens.

Always follow the post-operative instructions provided by your Nuffield Health Cardiff and Vale Hospitals healthcare team.

When will my child's stitches dissolve after eye surgery?

If your child needs stitches as part of their eye surgery, these will typically dissolve in between two and four weeks. Some surgeries may require stitches that last longer. Your paediatric ophthalmologist will be able to advise you how long to expect them to last, and how to care for your child’s eyes while they heal.

What are the risks and complications of paediatric ophthalmology surgery?

As with all treatments, there are some side effects, risks and complications associated with those used in paediatric ophthalmology. The include:

• Infection
• Swelling or inflammation of the eye
• Temporary blurred vision
• Eye pressure changes, including glaucoma
• Scar tissue or clouding that may affect their vision
• Visual disturbances
• Continued eye misalignment
• Development or continuation of lazy eye.

Rarely, more serious problems such as vision loss or retinal detachment can occur. Your consultant ophthalmologist will explain the specific risks associated with your child’s paediatric eye surgery or treatment.

What happens if my child's eye condition is left untreated?

Again, it largely depends on the condition, but many paediatric eye problems do get progressively worse without treatment. For example, untreated myopia (short-sightedness) will cause your child’s vision to continue to deteriorate, meaning that they will need increasingly stronger prescription glasses to see clearly. Children who are very short-sighted are also more likely to develop complications such as squint or lazy eye.

We strongly advise that you always follow the treatment plan recommended by your paediatric eye doctor.

Find a paediatric ophthalmologist at Nuffield Health Cardiff and Vale Hospitals

Our paediatric ophthalmologists at Nuffield Health Cardiff and Vale Hospitals are specialists in children's eye care, supporting families with everything from routine eye assessments to the diagnosis and treatment of conditions such as squint (strabismus), lazy eye (amblyopia) and other vision problems that can affect a child's development and everyday life.

We understand that visiting hospital can feel daunting for both children and parents. That's why our consultants take the time to explain each stage of care in a clear, child-friendly way, helping your family feel informed and reassured throughout. Book an online appointment, call us on 02920 836700 or complete an enquiry form to arrange a consultation.