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admin | Natural Treatment Bacterial Vag | 14.12.2014
Ophthalmologist and Director of Training, CCBRT Hospital, Dar es Salaam, Tanzania; Honorary Senior Lecturer, London School of Hygiene and TropicalMedicine.
Co-director, International Centre for Eye Health, London School of Hygiene and Tropical Medicine; Clinical Advisor, Sightsavers,UK. Chairman, International Council of Ophthalmology Examinations, International Council of Ophthalmology, 11-43 Bath Street, London EC1V 9EL. Children are brought to us with a range of conditions, usually when their parents or carers notice something is wrong.
You should have realistic expectations about what a baby should be able to do by a certain age.
For example, if a baby of about three weeks old does not turn to a diffuse light, such as light coming from a window, you would not necessarily be worried – although you would still believe the parents if they are concerned.
Bear in mind that there can be a lot of variation in babies’ development; however, this table should be a helpful guide. In order to be able to do a more detailed examination in an infant, examine the child while he or she is being bottle fed or breast fed. Children in this age group should have steady eyes, no squint, no history of sight difficulties and, if in a good mood, show interest in colourful or interesting objects in the room. Children in this age group should also be able to see objects presented in their peripheral visual field by a colleague while you draw their attention to your face, perhaps by making a funny noise.
Many children can accurately name colours by the age of three years but many cannot until they are older; it is reassuring if they can. After the age of three, most children can participate in accurate visual acuity, visual field, and colour vision testing by someone trained and with age-appropriate equipment.
If you do not have that equipment or have not been trained to use it, you can still test a child’s functional vision using everyday objects as described above.
Observe children when they don’t know they are being observed, for example while you are talking to the mother or taking a history. The tip about wrapping up a baby will work for a younger child, but may be more difficult in an older child. For each problem, the article describes the likely causes, what you should ask the parents, what you should look for, what action you should take, and how you can talk to the parents. Is there a history of head injury or fever immediately before the difficulty with vision was noticed? Hint: In this age group, doing a red reflex test is often easier because you can turn it into a game. When a baby needs a referral, refer him or her to an ophthalmologist, preferably one trained in paediatric ophthalmology, whatever the suspected cause. It is important to persuade parents to take up their baby’s referral urgently – just as soon as they can.
Try to dissuade parents from seeking the advice of traditional healers or using traditional remedies. At the back of the eye: retinoblastoma (Figure 16), coloboma (Figure 17), ROP (unlikely in Africa). A white spot on the surface of the eye can be due to congenital abnormalities and is often bilateral.
Corneal scars, ulcers, or opacities can be due to ophthalmia neonatorum (usually bilateral), trauma, or the use of harmful traditional remedies.
At the back of the eye, additional causes can include CMV retinitis (a complication of HIV), late presentation of ROP, or other developmental abnormalities; all are serious.
Hint: Babies and young children can be difficult to examine and you may not be able to see a white reflex, particularly if the reflex is coming from the back of the eye. If there is an ulcer, start a topical antibiotic immediately, show the parents how to instil the antibiotic (every 30 minutes), and refer very urgently. In older children with corneal ulcers, this may be due to vitamin A deficiency, in particular if Bitot’s spots are also present. Refer all children when there is an obvious white reflex just inside the eye(s) or deeper in the eye(s). Refer all children whose parents say they have seen something white in the eye – even if you can’t see it. Try and dissuade parents from seeking the advice of traditional healers or using traditional remedies. If you suspect an ulcer, explain that parents must put the eye drops in every 30 minutes until they reach the hospital. If you can see something white just inside or at the back of the eye, say something like: “I agree with you that there does seem to be something white inside the eye. If you cannot see something white in the eye, say something like: “Even though I cannot see anything today, I believe you and you did the right thing to bring your child for examination. If measles is the underlying cause of a corneal problem, you need to be aware that more children may be affected. If you suspect vitamin A deficiency, be aware that there is likely to be more children affected in the community. An abnormality in the brain mechanisms or muscles which control the movement and position of the eyes can also lead to wobbly eyes or squint, even if the eyes themselves are entirely normal. Check for any obvious abnormality in one or both eyes, including something white in the eye (see above).
Refer any children with wobbly eyes or a definite squint, especially babies with recent squint or eyes that point outwards. If the child is under 28 days old, the eyelids are swollen, and the discharge is thick and yellow, it is most likely due to ophthalmia neonatorum.
If the child is over 28 days old, there is no ulcer, and the eyes are watery and red, this could be viral or bacterial conjunctivitis – especially if the eyes are sticky. If you suspect ophthalmia neonatorum, start treatment immediately – clean the eyelids and instil topical antibiotics.
If there is an ulcer, start a topical antibiotic immediately, show the parents how to instil the antibiotic (every 30 minutes), and refer urgently. Allergic and vernal conjunctivitis can be treated with sodium chromoglycate drops or topical antihistamine drops, if available. Burns: If a chemical or other fluid entered the eye, wash the eyes as shown in ‘How to irrigate the eye’ (Vol 18 No 55, see Useful Resources on page 116) and refer immediately. Foreign body: Carefully remove it with the edge of a clean, folded cloth or a matchstick covered in cotton wool.
For any injury, the most important thing is to give frequent antibiotic drops and make sure that the child is taken to an ophthalmologist as soon as possible. If you think the baby might have ophthalmia neonatorum, the baby and both parents need to be investigated and treated. Suspected viral, bacterial, allergic, and vernal conjunctivitis: Tell parents that the infection should get better, but that you want to see the child again in a few days to make sure there is improvement. Whatever the cause of the redness or discharge, tell parents to avoid using traditional remedies or seeking the advice of a traditional healer. Explain that it is really important to instil eye drops as often as instructed, and in the correct way.
In case of a suspected penetrating injury, explain that an ophthalmologist needs to see the child urgently and parents should continue with the antibiotics until the child is seen. In case of a blunt injury, parents should come back if the eye does not settle within a few days of the injury. If a child presents with trachoma, it is almost certain that other children and adults living in the same village or community will also have trachoma. You can have a significant impact on reducing visual loss and blindness in children by examining and referring them.


Even if you suspect that there’s nothing that can be done to help the eye or vision, there is still a lot you can do to help the child and parents. The red reflex is much easier to see in a darkened room, so switch off the lights, draw the curtains or ask the parents to accompany you into a room which doesn’t have a window. Use a direct ophthalmoscope or a red reflex scope (both of these devices allow you to look directly down the light beam) and make sure the batteries are well charged! Stand between one and two feet away (around one third to two thirds of a metre) and direct the light to one eye at a time: you should see a bright red reflex from the pupil.
EYE DISEASE - Eyewear company in Atlanta providing contact lenses, vision test, optical health, sunglases and Vision test. How do you get pink eye?  Let us know more about the prescribed and over the counter  treatment for pink eye, causes and symptoms. Pink eye is categorized into three, according to their respective causes such as viral, bacterial and allergic. This type of pink eye infection is due to the viruses from several ailments such as sore throats, common colds and other respiratory infections. Viral conjunctivitis is usually characterized by watery eyes coupled with watery discharge. Medication is not necessary with viral pink eye infection except among children wherein it is treated with special conjunctivitis eye drops to relieve the inflammation. Bacterial conjunctivitis occurs when certain types of bacteria such as streptococci and staphylococci intrude the eye.
Bacteria-caused pink eye infection is characterized by watery eyes succeeded by greenish or yellowish discharge.
Bacterial conjunctivitis is usually treated with antibiotic eye drops and within the next several days, it will disappear. Allergic conjunctivitis is induced due to allergic reactions from typical substances like cosmetics, fumes, drugs, air borne chemicals, dust mites and the like. Allergic conjunctivitis is characterized by itchiness, discomfort and heavy tearing most likely on both eyes. The physician will usually prescribe a different kind of eye drop especially made for those with allergies. Even if pink eye does not pose any serious danger to vision, but some types are contagious like bacterial and viral conjunctivitis. Pink eye treatment consists of over the counter treatment medication and prescription medication.  For bacterial infection, there is a an antibiotic that can treat the bacteria. This article focuses on the more challenging complaints in babies and young children, who are the most difficult to assess.
The earlier the treatment starts, the better a child’s vision is likely to be after treatment. It takes time to let the parents tell their story and to examine a child properly, especially one who cannot or will not cooperate. Parents want what is best for their children, but because of lack of education or resources they may not always make the best choices.
If a child needs to be referred, it is very important to convince the parents that specialist testing and treatment will help their child. Advise parents about what support is available to help them take up the referral, such as transport, subsidies, and so on. If the baby is awake and attentive, there is a lot you can find out by asking the parents and simply observing the baby’s reactions. Table 1 shows when a baby is too young to show a visual response, when the response is likely to develop, and at what age you should be worried if a baby does NOT show the expected response. On the other hand, if a baby is eight weeks old and does not eventually turn to a diffuse light, then there may be a problem and you should investigate further. For each new toy, the baby will momentarily hold their eyes steady, allowing a quick examination.
Place the baby on a blanket or sheet, hold the arms to the side and the legs straight, and wrap the blanket around the body and arms (Figure 8).
A healthy baby with good fixation.It is clear that he can see the camera and is reaching out for it. Cover one eye at a time if the child will allow it and ask them to identify different sized objects or, with older children, letters – make it a game.
For example, shine a light into the mother’s eye first, or pretend you are playing ‘hide and seek’ or ‘peekaboo’ when covering one eye.
If yes, this may simply be a blocked nasolacrimal duct, in which case the eye will probably also be sticky. If yes, suspect an inherited retinal problem or an environmental problem such as maternal ingestion of drugs or alcohol.
For instance, tell a child of two or three years old to ‘blow the light out’ (you switch it off!).
Children with visual loss from cataracts need urgent surgical treatment to prevent them from developing amblyopia (lazy eyes) which may not be reversible if surgery is delayed. The sooner the exact nature of the condition is known, the sooner they can be treated and the better the outcome is likely to be. All the time, or just when the light is coming from any particular direction – such as over your shoulder when you are feeding your baby or cuddling your child? If yes, this could indicate corneal ulcer or scarring as a result of measles or vitamin A deficiency. Parents often see the white reflex more easily than you do because they are with the child more and they are likely to see the eyes in different lighting conditions – such as when they are looking at the child with the light coming over their shoulder.
For babies, you may need two people to instil the antibiotic – one to hold the baby and the other to instil the drops (see article on page 17). Give a dose of 200,000 international units (IU) immediately if the child is over 12 months of age and also start a topical antibiotic.
It’s really important not to miss a retinoblastoma – if diagnosed and treated early, this can save a child’s sight and their life. These may be harmful, but just as important, they may cause a delay in the proper investigation and treatment of children.
To find out exactly what the condition is and what the right course of treatment would be, your child needs to be seen by a trained ophthalmologist who has more equipment than I do. If the loss of vision is in both eyes, the eyes can become wobbly; if the loss is in one eye, it can lead to squint. If you cover each eye in turn with your or the mother’s hand, does the baby object to you covering one eye in particular?
However, it is important that parents realise that a squint may be a sign of something more serious.
This might be due to an injury that became infected, traditional eye remedies, or infection with Gonococcus or another organism. Children with severe vernal conjunctivitis will need more aggressive treatment and should be referred to an ophthalmologist. If unavailable, use topical tetracycline eye ointment which will have to be applied twice a day for six weeks.
Refer children with hyphaema (blood in the anterior chamber) if it looks severe or has not improved after three days of rest. Even if the eye or eyes get better quickly, parents should still bring the child back so you can see them again, because there may be incomplete healing or there may be some damage that still needs treatment. In addition to referring the child to an ophthalmologist, make sure the family receives all the other services it may need, including support for the parents and low vision care, rehabilitation, and visual stimulation for the child.
It can alert you to large lesions in the retina but it cannot be used to identify causes of poor vision related to retinal or optic nerve damage, such as retinal dystrophy or optic nerve hypoplasia.


This is when the light beam is directed towards the optic disc which is normally pink, not red like the retina (see Figure 24). Unless otherwise stated, all content is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. The virus “adenovirus” is known to bring about viral conjunctivitis and this eye infection rapidly spreads out from person to person which may result to an outbreak.
In addition, itchiness and discomfort are felt even though these may be limited to one eye. Examination of an eye specialist is recommended for proper treatment of viral conjunctivitis in children. Irritation is also felt along with itching, and the infection may start with just one eye and may transfer to the other or may affect both eyes simultaneously.
Aside from eye drops, antibiotic ointment may also be used as an alternative for eye drops and usually prescribed by physicians for bacterial conjunctivitis in children. Medications may include anti-inflammatory, decongestants, steroids, mast cell stabilizers and antihistamines to relieve the symptoms. However, you do not have to worry, there are medication in the form of eye drops and also pills that can treat this problem. Good hygiene not just spares you from being affected with pink eye but it also helps in preventing the infection to spread out. Thus, visit your doctor right away if you’ve figure out that you have pink eye so that treatment will start right away.
It is difficult to tell which type is actually the one you are suffering from, but the allergic pink eye usually goes away in a short time, especially when the allergen is removed and the eyes are rinsed properly.
This bacteria is in the form of eye drops or ointments that should be applied to the eyes for some days. This is not an exhaustive list of presenting complaints or examination techniques, but it will give a starting point. Even if there is no treatment, a blind baby or child still needs help to develop as normally as possible and should also be referred.
If you don’t, they may get tired and irritable, which will cause stress for their parents or carers; it also makes children difficult to examine.
If you can, tell them what to expect at the hospital and what they should bring with them (such as the referral letter, clothes, or food). However, if the watering happens when the child is in bright light, or if the child also cannot see or is in pain, you should suspect congenital glaucoma (Figure 10). You don’t need to get very near: 30 cm (about 1 foot) will do, as long as the light is bright. They should not be told to “wait for the cataract to mature”; nor to “come back when your child is older”. If all the time, it’s likely to be due to corneal opacity or cataract, if only some of the time, then it could be cataract, retinoblastoma or coloboma. Note the typical white, foamy appearance on the surface of the conjunctiva, next to the iris. Err on the side of caution: refer the child with a letter explaining what you have seen or what the parents have reported and urge parents to take them to the hospital within two days.
Explain that it is important to find out the exact cause of the ulcer so that it can be treated properly; the antibiotic eye drops are just an emergency treatment.
Record the community the child is from and alert the people responsible for trachoma control in your district. By helping parents to understand the importance of a referral and supporting them to take up that referral quickly, you can improve the chances of a good visual outcome for their child. This eye infection is medically called conjunctivitis because the conjunctiva, a transparent film that covers the eyeball and lines under the eyelid, is infected and becomes inflamed. In adults, however, the virus is just allowed to proceed its course by up to three weeks; the condition will eventually clear out by itself.
This is especially beneficial to infants with bacterial conjunctivitis as it is very easy to apply compared to eye drops although vision may become blurred for 20 minutes after putting the ointment. Another effective way of reducing the gravity of symptoms of allergic conjunctivitis is by keeping away from whatever may trigger allergic reaction. This primarily involves not sharing face towels most especially to someone affected by conjunctivitis.
Besides, if the conjunctivitis symptoms do not subside after following the doctor’s advice, a further examination may be needed to figure out underlying problems. But in case of conjuctivitis caused due to viral or bacterial infection, the spreading is fast.  In fact, it is one of the fastest contagious diseases, that spreads through eye contact or even by using a thing that has been infected by someone who has this infection. If allergy is the reason for pink, then over the counter pink eye treatment includes eye drops like Patanol, which can be effective with just 2 drops in a day.
They spend a great deal of time with their children, and will observe how children behave and what their eyes look like. Either the parent or a helper can then carefully open one eye at a time for the examination (without putting pressure on the eye – see Figure 2 on page 17). Practise on an older brother or sister, or the mother, first; this reassures the child that the test is not frightening. After six weeks the eyes should be basically steady and point in the same direction most of the time.
With a co-operative patient, ask them to look slightly away from the light, for example at one of your ears (your left ear if you’re examining their left eye, and your right ear if you’re examining their right eye).
But if the doctor figures out that the pink eye is due to the virus herpes simplex, antiviral medications will be prescribed.
It is expected that after several days, the symptoms of bacterial conjunctivitis will subside.
For instance,  if someone who has pink eye rubs his eyes and then uses that hand on a computer mouse can infect someone who touches the mouse later. With careful explanation, you can help them to make the best decision for their child’s eyes and vision. Yet, there are plenty of over the counter treatment for pink eye available to treat viral conjunctivitis.
Remember to fully apply the prescribed dose of antibiotics recommended by the physician to prevent this type of pink eye infection to reoccur.
Crust and pus must be taken off by washing your eyes with tepid salt water which likewise lessens conjunctivitis symptoms.
So, this is the way, especially for kids, it is advised to stay at home till the infection is cured, before joining back to school. OTC medicines for conjunctivitis help in soothing symptoms.  Warm compresses can also help in remove crusty portion around the eye and sticky residue. When drying your watery eyes, wipe them with disposable tissue and throw them right away to reduce contamination. The other way in which Pink eye is spread is through bathroom wash clothes, towels,  eye makeup etc. This is especially important as some types of conjunctivitis are contagious and with prompt treatment, you can prevent it from spreading.
Better yet, never share make up essentials and even eye drops with a family member or friend.



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