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SEVERE VISUAL IMPAIRMENT AND BLINDNESS IN INFANTS: CAUSES AND OPPORTUNITIES FOR CONTROL
Affilliation
Eye Clinic. Pune / Lions NAB Eye Hospital. Miraj, India.
International Centre for Eye Health. London school of Hygiene and Tropical Medicine. London, UK.
Fundação Oswaldo Cruz. Imstituto Fernandes Figueira. Rio de Janeiro, RJ, Brasil.
International Centre for Eye Health. London school of Hygiene and Tropical Medicine. London, UK.
Fundação Oswaldo Cruz. Imstituto Fernandes Figueira. Rio de Janeiro, RJ, Brasil.
Abstract
Childhood blindness has an adverse effect on growth, development, social, and economic
opportunities. Severe visual impairment (SVI) and blindness in infants must be detected
as early as possible to initiate immediate treatment to prevent deep amblyopia. Although
difficult, measurement of visual acuity of an infant is possible. The causes of SVI and blindness
may be prenatal, perinatal, and postnatal. Congenital anomalies such as anophthalmos,
microphthalmos, coloboma, congenital cataract, infantile glaucoma, and neuro-ophthalmic
lesions are causes of impairment present at birth. Ophthalmia neonatorum, retinopathy
of prematurity, and cortical visual impairment are acquired during the perinatal period.
Leukocoria or white pupillary reflex can be cause by congenital cataract, persistent
hyperplastic primary vitreous, or retinoblastoma. While few medical or surgical options are
available for congenital anomalies or neuro-ophthalmic disorders, many affected infants can
still benefit from low vision aids and rehabilitation. Ideally, surgery for congenital cataracts
should occur within the first 4 months of life. Anterior vitrectomy and primary posterior
capsulotomy are required, followed by aphakic glasses with secondary intraocular lens
implantation at a later date. The treatment of infantile glaucoma is surgery followed by anti-glaucoma medication. Retinopathy of prematurity is a proliferation of the retinal vasculature
in response to relative hypoxia in a premature infant. Screening in the first few weeks of
life can prevent blindness. Retinoblastoma can be debulked with chemotherapy; however,
enucleation may still be required. Neonatologists, pediatricians, traditional birth attendants,
nurses, and ophthalmologists should be sensitive to a parent’s complaints of poor vision in an
infant and ensure adequate follow-up to determine the cause. If required, evaluation under
anesthesia should be performed, which includes funduscopy, refraction, corneal diameter
measurement, and measurement of intraocular pressure.
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