The eye in paediatric surgery

Abstract Paediatric surgeons must have a basic knowledge of a variety of conditions that affect the eye and eyelids. External angular dermoid cysts are common. Proptosis presents with lid asymmetry and fullness, motility disturbances, redness, and reduced vision. Meibomian cysts are benign and affect most children at some stage. Rhabdomyosarcomas may involve the eyelids or orbit. Intraocular retinoblastoma is the most common malignant head and neck tumour in young children. The survival rate is 96% when the tumour is confined to the eye. Children with subdural haemorrhage should have a dilated retinal examination by an ophthalmologist. Direct ocular trauma is common in children. Acute Horner syndrome presents with mild ptosis and a small pupil, and may be indicative of a neuroblastoma. Sporadic cases of aniridia develop Wilms tumour in over 70%. Premature neonates requiring surgery are often very unwell, but examination of their eyes must still be performed to avoid delay in diagnosing retinopathy of prematurity. Infants with nystagmus must be suspected of having visual impairment—check the pupil and red reflex. Congenital cataract requires microsurgical treatment by using vitrectomy techniques by 6 weeks of age. Early diagnosis and treatment of strabismus improve visual and alignment outcomes. Prompt treatment of esotropia can often restore normal vision. Constant exotropia may indicate a potentially blind eye.