Important:Dr Manish Malhotra (Consultant Ophthalmology ) shall not be available on 25December 2017. Please do not schedule appointments during that time. Can take appointments from Tuesday 5.30pm
Paediatric Ophthalmology

Refractive Error In Children
Detection of Refractive error in children is itself a challenge, we at manna Clinic & Maternity Home & eyes Care make it a simple and a enjoyable experience for the child. Children below the age of 7 years require three visits in total & above 7 years till 16 require two visits, the procedure includes detection of refractive error, examination of the optic nerve & the retina, and to conclude with a post mydriatic test (PMT)

Congenital Nasolacrimal Duct Obstruction (CNLDO)

Overflow Tearing and Chronic Eye Infections in Infants

What Is Overflow Tearing?

Babies frequently develop infected eyes with overflow tearing. It has been reported that almost one-third of newborn infants have one or both eyes that water at birth. These eyes overflow with tears and mucus. Often the lashes are stuck together after sleep and the eye(s) may become chronically infected. Ophthalmologists refer to overflow tearing as congenital stenosis of the nasal lachrymal drainage system.

How Do Tears Drain From The Eye?

Tears drain from the eyes through two small openings, or pores, located on the upper and lower lids near the nose. These openings empty the tears into tear sacs which are located under the skin on each side of the nose. From the sacs, the tears are pumped by the blinking action of the lids, into tear ducts that go through the side bones of the nose into the back of the nose. Our nose runs whenever we cry because the tears flow from the eyes, down the tear ducts, and into the nose.

What Causes Overflow Tearing?

This condition is usually caused by a persistent membrane that blocks the lower end of the tear drainage canal inside the nose. Normally, this membrane stretches or pops open at or before birth. In many infants however, it is still closed at birth and the tear drainage system is clogged.

Are There Other Causes Of Overflow Tearing?

Very rarely, a baby may have congenital glaucoma. There are other signs and symptoms associated with this serious condition such as an enlarged eye, a clouded cornea, high pressure in the eye, light sensitivity, and infant irritability. Overflow tearing can also be caused by irritation of the eye from wind, pollen, smoke, and chemicals.

How Is Overflow Tearing Treated?

Initially, the ophthalmologist will recommend antibiotic eye drops or ointment to be used once or twice daily, along with pressure (or massage) over the tear sac.

How Is Probing Of The Tear Ducts Performed?

At Manna Clinic & Maternity Home & Eye Care, A thin, blunt metal wire is gently passed through the tear drainage system to open any obstruction. Fluid is then irrigated through the system into the nose to ensure that the pathway is open. Infants have no pain after the probing. Some blood-staining of the tears or nasal secretion is common after probing. There may be discharge in the eye for up to a week and antibiotics may be prescribed. Obstruction can recur and repeated probing may be required. If probing is not successful, plastic or silicone tubes can be placed in the drainage canals. This is a longer procedure than probing and requires general anesthesia. Rarely, further surgery is needed to bypass the blocked tear duct to create a new opening through the bone into the nose.

What Complications can occur with treatment?

As with any surgical procedure, there is the possibility of infection or bleeding, Scarring can re-obstruct the opening, requiring additional surgery. Chronic obstruction can lead to infections of the tear sac at any age.





What Is Nystagmus?

Nystagmus is an unintentional jittery movement of the eyes. Nystagmus usually involves both eyes and is often exaggerated by looking in a particular direction.

What Causes Nystagmus?

Many conditions are associated with nystagmus. Sometimes, the brain’s control of eye movements is poor, resulting in an inability to look steadily at an object. Some forms of nystagmus are associated with reduced vision, such as occurs in albinos, extreme near or farsighted people, or in those with scars in the retina or optic nerve. Rarely, nystagmus can occur as a result of brain tumors or in serious neurologic disorders. Nystagmus can be found in families as an isolated problem, not associated with other conditions.

What Should Be Done?

A thorough evaluation by an ophthalmologist and perhaps other medical specialists is very important. The cause can usually be determined. Important clues relate to age of onset, family history, general health of the patient, or the use of certain medications. Your ophthalmologist may examine the pattern of the nystagmus, its speed and direction and look for other eye problems such as a droopy lid, cataract, or an abnormality of the retina or optic nerves. Blood tests or special x-rays may be useful in determining the cause.

Can Nystagmus Be Cured?

Sometimes, removal of the cause may cure nystagmus. Often, however, nystagmus is permanent. The reduced vision may be improved with glasses and low vision aids. If the eyes are more stable looking in a certain direction, glasses with prisms or eye muscle surgery may improve the head position and allow better vision. Medications, biofeedback, and eye exercises have rarely helped control nystagmus.

What Are The Most Common Forms Of Nystagmus?

Motor nystagmus tends to begin between six weeks and three months of age. Other family members may have similar unusual eye movements. The motion is usually horizontal. Often focusing up close or looking in an odd direction reduces the nystagmus intensity and improves the vision. Fortunately, patients do not see the world moving as their eyes move. Vision may be reduced at distance, but is almost normal up close. There are usually no limits to the educational potential of one who has motor nystagmus.

Sensory nystagmus is associated with reduced vision of any cause. Sensory nystagmus usually begins at 6 to 8 weeks of age. The eyes appear to rove, sometimes slowly and sometimes quickly. Very often the eyes will also rotate upward, and the eyelids may flicker as well. As a baby becomes older, he may poke at his eyes or wave his hand in front of them. Sometimes the cause for the reduced vision is treatable, as in babies who are born with cataracts. Other conditions which lead to “sensory nystagmus” may not be treatable. Nevertheless, understanding the underlying cause is of great importance to predicting how the baby will do in the future.

What Are Other Causes Of Nystagmus?

Medications or drugs can cause nystagmus. Rarely, this nystagmus can be associated with double vision and is often worse looking to the side. Causes include excessive drinking of alcohol or use of medications such as those given for seizure control. Often, the nystagmus will improve if the medication is stopped. Voluntary nystagmus can be created by some people, much in the same way as ear wiggling. Fine, rapid, horizontal movements can be produced and sustained for a short period of time. Often, this kind of nystagmus is used to gain attention. Disease-induced nystagmus is less common. It is often associated with neurological signs and symptoms which indicate the seriousness of the problem.


If nystagmus is present, a full eye examination by an ophthalmologist is needed. Underlying causes which determine the effect on the patient’s life and vision vary greatly and we have a tailor made approach at Manna Clinic & Maternity Home & Eye Care for every person who has nystagmus to improve quality of life by providing low visual aids , glasses , and also perform nystagmus surgery in order to improve the head posture and shaking of the eyes


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