Common Causes Of Blindness In Children, Symptoms & Treatment

Legal blindness in children is defined when they can only see at six meters (20 feet) or less than a child with normal vision can see at 60 meters (200 feet) or if their visual field is lower than 20°, compared to 180° in children with normal vision (1). Intrauterine infections such as rubella and toxoplasmosis can cause childhood blindness.

According to the US Centers for Disease Control and Prevention, nearly 3% of children are diagnosed legally blind or visually impaired before 18 years since they have trouble seeing even after wearing contact lenses or glasses (2). Early diagnosis and treatment may prevent some cases of blindness in children. Experts also recommend beginning essential skill training and learning braille at a young age to help the child to become independent and seek education.

Read on to learn more about the early signs, types, causes, prevention, and treatment of blindness in children.

Signs and Symptoms Of Blindness In Children

In most children with vision impairment, the eyes may look healthy. However, their behavior and the way they use their eyes may indicate vision problems. The early signs and symptoms of vision impairment or blindness in young children and babies may include (3):

• Nystagmus, a rapid side-to-side eye movement or eye jerk
• Lack of eye contact with parents and other known people
• Inability to follow a face or an object
• Lack of response to bright lights turned on in a room
• Pupils appear cloudy or white
• Lack of red reflex in photos
• Eyes often turn toward the nose (inward) or the side of the face (outward)

Babies can focus on faces and objects from four to five months of age and start smiling at familiar faces or objects from around six to eight months. Inability to do these can indicate vision problems.

The following symptoms and signs may indicate vision problems in older children (3):

• Rubbing their eyes often
• Holding objects or books close to their face
• Covering one eye to look at something
• Tilting their head to see something
• Reduced vision at nighttime
• Tiredness after observing things closely, such as while playing handheld games, drawing, or reading
• Crossed eyes or a squint
• Clumsiness

Blindness in children is often detected during regular check-ups and eye screenings in infancy or at a young age. Alternatively, some children are evaluated due to suspected symptoms by parents or teachers. 

Signs Your Child Should Have An Eye Exam

Children undergo eye examinations after birth to identify any vision or congenital eye conditions. Premature babies with a family history of childhood vision problems and signs of eye conditions may undergo comprehensive eye examinations. Doctors may also plan follow-up examinations.

The American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Ophthalmology recommend the following eye examinations for children (4):

• The newborn eye examination includes blink and pupil response and a red reflex test, where a light shone into the eyes returns a reddish glow.

• At six to 12 months, a second screening is done, often during a well-child examination. The doctor may inspect the eyes and do similar tests as done in the newborn eye exam. They may also observe the alignment and movement of the eyes.

• At 12 to 36 months, the eye exam includes a photo screening test to look for focusing problems. It may help identify and prevent lazy eye (amblyopia) later in life.

• At three to five years, the eye examinations assess a child’s eye alignment and vision. Visual acuity and vision tests are conducted as soon as the child is old enough to read an eye chart.

• Children who are five years or older are often screened for alignment problems and visual acuity during regular visits. Myopia (nearsightedness) is common at this age and corrected with eyeglasses. Doctors may also recommend periodic eye screening for children on growth hormone therapy.

Vision screening tests help determine eye problems such as refractive errors (hyperopia, astigmatism, and myopia), strabismus (misaligned eyes), and lazy eye. Children with suspected eye disease should get a comprehensive eye examination for proper diagnosis. However, a vision screening test may be inadequate for diagnosing complex eye conditions. 

Types Of Blindness In Children

The term blindness includes both vision impairments or vision loss and legal blindness. Blindness can be of the following types (5):

• Partial blindness results in low vision that may limit the normal functioning of a child.

• Complete or total blindness is the inability to see anything, including light.

The following are some other terms related to types of blindness (6):

• Legal blindness is a term used by the US Social Security Administration to determine eligibility for disability benefits. A person is considered legally blind if their visual field is 20° or less in the better-seeing eye or their central visual acuity in the best-corrected eye is 20/200 (6/60) or less. 

• Vision impairment or low vision means the best-corrected vision is poor and not enough for normal functioning in children.

• Cerebral visual impairment, cortical visual impairment (CVI), or cortical blindness is vision loss or blindness caused by damage to the brain area processing vision. Some children with CVI have normal eyes but see everything as a swirling mass of colors. This brain-based disorder can also coexist with ocular (eye) conditions causing vision impairment. However, some children regain some degree of vision with special training (7).

Conditions such as color blindness (inability to perceive colors), night blindness or nyctalopia, and inability to see in poor light are not included under the term legal blindness if the central visual acuity is more than 20/200.

Causes Of Childhood Blindness

The World Health Organization (WHO) classifies the causes of blindness in children based on anatomy and etiology. These classifications are helpful in understanding and planning the best management strategies.

Structural anomalies of the eye can cause problems in focusing and processing vision. The following conditions are included in the anatomical classification of childhood blindness(8):

• Whole eye globe defects: Anophthalmos or anophthalmia is a birth defect where one or both eyes are absent from Microphthalmos is a developmental disorder where one or both eyes are too small.

• Defects of the cornea: Keratoconus is an eye disorder where progressive thinning of the cornea leads to a cone-shaped bulge in the cornea. Corneal scarring can also affect vision since the irregularity or opacity of the cornea could affect focus. However, corneal scars on the outer edges of the cornea may not cause blindness in children.

• Lens defects: Aphakia is the absence of a lens in one or both eyes due to congenital disabilities or acquired conditions such as surgical removal. Clouding of the lens, called cataracts, can also affect the vision.

• Uveal defects: Uveitis is the inflammation of the uvea, the middle layer of the eyes, and can cause blindness if left untreated. Aniridia is the complete or partial absence of the iris (colored part) in the uvea.

• Retinal defects: Retinal dystrophies (RDs) are degenerative disorders of the retina that may affect retinal function.

• Optic nerve problems: Optic nerve atrophy (ONA) damages the optic nerve, causing central and peripheral vision loss and color blindness.

• Glaucoma: Structural abnormalities impeding fluid drainage in the eyes can result in glaucoma and high intraocular pressure, damaging the optic nerve and affecting

• Refractive errors: Hyperopia (farsightedness), myopia (nearsightedness), and astigmatism (incorrect curvature of the cornea)

• Cortical blindness (CB): In this condition, blindness is caused by the brain’s occipital lobe that controls vision. Light and pupillary reflexes may be normal in CB.

• Lazy eye: This condition often occurs in children with refractive errors, resulting in poor vision development.

The following conditions are included in the etiological classification of blindness in children (8):

• Retinitis pigmentosa is a genetic condition that affects night and peripheral vision due to the gradual breakdown of the retinal cells. It affects one in 4000 people in Europe and the US and often begins in early childhood, leading to total blindness later in life.

• Stargardt Syndrome is a rare genetic eye disorder resulting in fat deposits in the eye’s macula that often look like macular degeneration, a leading cause of blindness that is rare in children. Stargardt syndrome may begin in childhood and lead to total vision loss in adulthood.

• Intrauterine factors including rubella, toxoplasmosis, and other infections during pregnancy” under causes of blindness,

• Perinatal factors such as birth injury, retinopathy of prematurity, and neonatal conjunctivitis or ophthalmia neonatorum (eye infections from bacteria and viruses occurring in the first 30 days of life) can lead to blindness in young children. Chlamydia, bacteria, and certain viruses can cause eye infections in newborns. Sexually transmitted infections can spread to the child from the infected mother during vaginal delivery.

• Retinopathy of prematurity (ROP) is an eye disease that causes bleeding in the retinal vessels of preemies. Vessel scars after bleeding can lead to retinal detachment in babies.

• Certain childhood issues such as trauma, measles, vitamin A deficiency

• Unknown causes and functional blindness (lack of vision without clear damage to the structural integrity of the vision system)

Hereditary factors such as chromosomal abnormalities or genetic disorders can also cause blindness in children. Inform your doctor and seek ophthalmological exams for your child if certain eye problems run in your family.

According to the WHO, the conditions included in the etiological classification of childhood blindness are more common in low-income countries. ROP and hereditary conditions are common causes of blindness in children from middle-income countries. Alternatively, central nervous system (CNS) disorders and retinal conditions cause the most cases in high-income countries (8).

Treatment For Blindness In Children

The treatment for blindness may vary depending on the underlying cause. Some children regain complete or partial vision after treatment, while a few may not. Discuss with your ophthalmologist to know the best treatment option and expected outcome based on individual factors.

Blindness caused by the following conditions are curable (8):

• Cataracts can be surgically treated by replacing the clouded lens with an artificial/intraocular lens (IOL).

• Glaucoma can be controlled with medications and treated with laser surgeries.

• ROP can be treated with laser ablation and injection of medication

• Uveitis can be treated with anti-inflammatory (such as corticosteroids), antibacterial, or antiviral eye drops according to the cause.

• Corneal diseases such as corneal ulcers and swelling can be treated with medications. In addition, corneal transplantation using an artificial cornea (keratoprosthesis) of a deceased donor may help restore vision in children with corneal opacities and scarring.

• Refractive errors can be corrected with eyeglasses, contact lenses, or LASIK surgery.

• Low vision can be managed with visual aids such as magnifiers to help with daily activities.

These treatments are primarily administered by pediatric ophthalmologists (eye specialists) along with other specialists if associated systemic conditions require medical treatment. Ask your pediatrician about clinical trials of new drugs and gene therapies, such as the transfer of the CRISPR gene to treat eye conditions (9). 

Blind And Low Vision Skills Training

Children with partial or complete blindness can benefit from blind skill training programs, which help the child develop life skills to cope with blindness. The earlier the training begins, the better the results are.

Experts train the children in the following skills in these programs (10):

• Orientation skills help children with blindness understand their location and intended destination. They can help them move inside the home or to a bus stop and other places.

• Mobility skills help them move safely from one place to another by using public transport, crossing streets, and walking without tripping or falling. They also teach the child to use smartphones and devices such as brain ports.

• Essential living skills, also called independent living skills or daily living skills, help them take care of personal hygiene, clothing, banking, shopping, and food preparation.

• Braille, a tactile (touch) reading and writing system for blind literacy, is taught.

Encourage your child to develop skills from an early age regardless of their visual ability. Appropriate support and encouragement from parents and dear ones can help children pursue their passions.

Prevention Of Blindness In Children

Although all cases of blindness in children are not preventable, good primary health care can prevent some cases.

The following measures may help prevent some causes of blindness in children (8) (3):

• Timely childhood immunization could prevent measles in children.

• Adequate vitamin A consumption through nutritious foods is essential for eye health. For high-risk groups, Vitamin A supplementation can help avoid blindness. It is often given during routine immunization in many countries to increase coverage.

• Treatment of systemic conditions such as juvenile arthritis could prevent ocular manifestations.

• Eye infection treatment and refractive error correction

• Providing health education to parents and children may help them learn eye care tips and do regular eye examinations.

• Adequate prenatal care reduces the risk of developing toxoplasmosis and rubella during pregnancy.

• Avoiding consanguineous marriage can help prevent the genetic causes of blindness in children.

• Avoiding alcohol and other teratogen exposure during pregnancy could prevent certain birth defects of the eye.

The WHO also emphasizes the importance of clean water and good sanitation for children’s eye health and general health and the prevention of many childhood infections.

Early identification and treatment of eye diseases in children may help prevent vision loss in some cases. In addition, good nutrition with ample vitamin A could promote eye health. Finally, interventions and training at the right time can help children with partial or complete blindness to achieve their life goals.

References

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