|“My child’s eyes are irritated” but not red (bloodshot).|
|Idiopathic (general light sensitivity)|
|Ocular tic (blepharospasm)|
|Squint from strabismus|
|Worse in dry, cold weather|
|Atopic history (asthma, eczema)|
|Frequent forceful blinking|
|No eye redness, discharge|
|Possible other vocal, motor tics|
|History of attention deficit hyperactivity disorder|
|Crusts on eyelashes|
|Erythema of eyelid margin|
|Often minimal or no visible changes|
|May have mild conjunctival swelling|
|Frequent bilateral forceful blinking|
|Eyes may deviate upward and laterally|
The etiology of eye irritation (or pseudoirritation) in a child
whose eyes are not red (bloodshot) can often be identified by history.
The examination in most such children is relatively unremarkable.
Most of the disorders associated with this symptom are not dangerous.
If the etiology can’t be identified with reasonable certainty,
referral to a pediatric ophthalmologist is indicated.
Ocular tics are fairly common in childhood, and may present as
bilateral frequent forceful blinking. Hemifacial spasm is rare,
and is characterized by contraction of the periocular and facial muscles on only half of
the face. This may be associated with brainstem or posterior fossa lesions.
Imaging is indicated in these patients.
- 1. Idiopathic. Some children
are generally more light sensitive than others. They squint in bright
light and may want to wear sunglasses or avoid bright situations.
These patients tend to have fair skin and light-colored irises.
- 2. Blepharitis/dry eyes. Blepharitis
is a condition in which the meibomian glands of the eyelids do not
function normally. The eyelid margins are usually erythematous and
crusts are present (Figure 6–1). This results in an unstable
tear film. The tears tend to evaporate rapidly, creating symptoms
of eye irritation and frequent blinking. Blepharitis is a common
cause of dry eyes, although not all patients with dry eyes have
blepharitis. Paradoxically, some patients
with dry eyes may have symptoms of excess tearing. This is
because there are 2 types of tears: basal tears that keep the eyes
moist and comfortable, and reflex tears that are produced in response
to irritation. Patients with dry eyes have abnormal basal tears,
so they tend to have cyclic symptoms of eye irritation, reflex tears
that temporarily improve the symptoms, and then recurrent irritation
as the reflex tears evaporate.
- 3. Ocular allergy. The key historical
feature of ocular allergy is itching. If the child is old enough
to reliably articulate this symptom and differentiate it from nonspecific
ocular irritation, the diagnosis of allergy is very likely. Many
patients with ocular allergies will have other atopic problems,
such as reactive airway disease or eczema.
- 4. Ocular tics. Tic disorders
are frequent during childhood, occurring in approximately 10% of
children. Ocular tics present with frequent bilateral ...