Astigmatism In Children: Signs, Causes, Treatments & Risks

Astigmatism in children is a common ocular condition where the child has an imperfection in the cornea’s curvature or lens. This abnormality prevents the formation of a clear image on the retina, causing blurry vision. Several children are born with astigmatism and can have it in one or both eyes. The child may need eyeglasses, contact lenses, or surgery to treat the condition in some cases.

As per a cross-sectional survey conducted on 9,970 children, children between six and 12 months are approximately three times more likely to have astigmatism than children between five and six years (1). Therefore, prompt diagnosis and treatment are crucial to mitigate the risk of learning and development problems.

Read on to know more about the causes, symptoms, and treatment of astigmatism in children.

Types Of Astigmatism

Astigmatism can be classified into two main types (2).

• Corneal astigmatism: This type occurs when there is an irregularity in the shape of the cornea.

• Lenticular astigmatism: This results from the uneven curvature and differing refractive indices within the crystalline lens.

Astigmatism can also be classified based on the refractive errors.

• Myopic astigmatism: In this type, astigmatism is combined with near-sightedness (myopia), wherein an image of a distant object becomes focused in the front of the retina. Here, distant objects appear blurred.

• Hyperopic astigmatism: In this type, far-sightedness is combined with astigmatism, and the image of the distant object becomes focused behind the retina. This makes up-close objects blurry.

• Mixed astigmatism: When astigmatism is associated with both near-sightedness and far-sightedness, it is known as mixed astigmatism (3).

What Causes Astigmatism And Who Are At Risk?

The exact cause for astigmatism is not clear. However, experts believe that the following factors can lead to or increase the risk of astigmatism in children (1) (4).

• Genetics: Astigmatism is known to run in families and is usually present at birth.

• Astigmatism may also develop following an eye injury or eye surgery.

• Keratoconus, a condition in which the cornea becomes progressively thinner and cone-shaped, may also lead to astigmatism.

• Refractive errors. Children who have myopia or hyperopia are often found to have astigmatism.

• Maternal smoking. A baby exposed to tobacco smoke either through the mother or by secondary smoking has a higher chance of developing astigmatism.

• Other factors. Pressure of the eyelid on the cornea, extraocular muscle tension, gestational age, birth weight, and medical conditions such as cerebral palsy are also known to play a role in causing astigmatism in children (1).

Symptoms Of Astigmatism

The most common symptoms of astigmatism in children include (3) (5).

• Squinting

• Eye strain

• Frequent headaches

• Blurry vision

Diagnosis Of Astigmatism

If you find any of the symptoms mentioned above in your child, take them to an ophthalmologist for a complete eye exam. The doctor would check the child’s vision and eye alignment and administer the following standard tests (4).

• Visual acuity assessment test

In this test, the child would be asked to read letters from a chart at a distance. This would help in determining the type of astigmatism.

• Keratometry

The doctor would determine the curvature of your child’s cornea using a keratometer. This helps in determining the proper fit for the contact lenses.

• Refraction

Using a phoropter, the doctor would place a series of lenses in front of your child’s eyes and measure the focus of light.

Complications Of Astigmatism

If left untreated, astigmatism can cause visual problems in children and affect their ability to read or write. Severe forms of astigmatism can also lead to amblyopia (lazy eye) (6).

Treatment Of Astigmatism

Your child’s doctor would suggest any of the following treatment options based on your child’s condition (4).

1. Eyeglasses: Prescription eyeglasses that contain a special cylindrical lens, typically a single-vision lens, are given.

2. Contact lenses: Special toric soft contact lenses are recommended for astigmatism of any type. However, caution should be exercised while using contacts for children as they need regular cleaning and care.

3. Orthokeratology: In this method, a series of rigid contact lenses are fitted to reshape the cornea. These lenses are usually worn for a limited period and removed.

4. Laser and refractive surgery: Surgeries such as LASIK laser in situ keratomileusis) or PRK (photorefractive keratectomy) may be recommended to remove tissues from the superficial and inner layers of the cornea to correct astigmatism.

Prevention Of Astigmatism

As the specific cause for astigmatism is unknown, you cannot prevent astigmatism. In some children, it may get corrected on its own, while in others, treatment may be required.

References

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Reviewer

Dr. Dur Afshar AghaMS

   

Dr. Dur Afshar Agha is a consultant pediatrician with around 26 years of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association.

Read full bio of Dr. Dur Afshar Agha