**13. Common eyelid and orbital diseases in children**

The most important issue in pediatric eyelid disorders is to identify whether the lesions affect the visual development or not. If it occludes the visual axis, the pathology must be treated promptly to prevent the development of amblyopia. Entropion, ectropion, distichiasis, epicanthal folds, and telecanthus (increased distance between the medial canthus of each eye) are common congenital anomalies of the eyelids. Although they are solely cosmetic problems in most cases, they may result in corneal changes secondary to corneal irritation and exposure due to mal-position of the eyelids.

**Congenital ptosis** is the most important disease of the eyelids in a child. It is usually unilateral and occurs sporadically in most cases. The underlying pathology is the dysplasia of the levator palpebralis muscle. Surgical correction during the preschool years must be performed. If the disease is severe, early surgery to prevent amblyopia may be performed.

Fig. 5. Stye at lower eyelid

Chalazion (Chronic inflammation of the meibomian glands), blepharitis (effects base of the eyelashes) and acute infection of the eye lash follicle (stye) are very frequent infections of the eyelids in children. The infections are mostly innocent and respond well to conservative therapies (Hughes, 2000).

### **13.1 Orbital infections**

16 Complementary Pediatrics

The most common one is the sixth cranial nerve palsy (abducens palsy), which is characterized by loss of abduction. Cranial imaging must be ordered in all forms of acquired

The angle of deviation in eyes with all types of deviations is measured objectively by using special prisms. The prism cover test is preferred if the child cooperates. In severe amblyopia and in very young children prism reflex test (Krimsky test) is performed. The patient fixates a light and the prism is placed in front of the deviating or bad eye to center the corneal

Associated amblyopia and refractive errors must be addressed initially in all cases of strabismus. Abnormal eye movements are frequently associated with pediatric eye deviations and they can influence the management of the cases. Accommodative types of esotropias may be completely cured with spectacles. Surgical correction is decided according to the angle of deviation, if the deviation is not corrected by the spectacles during follow-up. All types of strabismus must be referred to an ophthalmologist, since early treatment by spectacles or surgery is important for normal binocular visual development.

The most important issue in pediatric eyelid disorders is to identify whether the lesions affect the visual development or not. If it occludes the visual axis, the pathology must be treated promptly to prevent the development of amblyopia. Entropion, ectropion, distichiasis, epicanthal folds, and telecanthus (increased distance between the medial canthus of each eye) are common congenital anomalies of the eyelids. Although they are solely cosmetic problems in most cases, they may result in corneal changes secondary to

**Congenital ptosis** is the most important disease of the eyelids in a child. It is usually unilateral and occurs sporadically in most cases. The underlying pathology is the dysplasia of the levator palpebralis muscle. Surgical correction during the preschool years must be performed. If the disease is severe, early surgery to prevent amblyopia may be performed.

paralytic strabismus to exclude cranial masses (Harley, 1980).

**13. Common eyelid and orbital diseases in children** 

corneal irritation and exposure due to mal-position of the eyelids.

reflex.

**12.2 Management** 

Fig. 5. Stye at lower eyelid

The bacterial infections of the soft tissue anterior or posterior to the orbital septum are the most common diseases of the orbit in the pediatric age group. The infections occur in two clinical forms; preseptal cellulitis or orbital cellulitis. Orbital cellulitis is the most common cause of protrusion of the eyeball in children. It is a life-threatening disease of the tissues behind the orbital septum. On the other hand, preseptal cellulits involves tissues anterior to the orbital septum. Preseptal cellulitis usually responds to ampiric antibiotic treatment, whereas orbital cellulitis may be associated with serious complications requiring longer periods of treatment and surgical interventions (Kanski, 2011).

Protrusion of the eyeball, limitations of the eye movements and decreased visual acuity are signs of orbital cellulitis. Skin trauma, sinusitis, lacrimal sac infections and rarely remote infections may be the source of preseptal or orbital cellulitis. Preseptal cellulitis rarely progresses to orbital cellulitis.

#### Fig. 6. Left orbital cellulitis

Subperiosteal and orbital abscesses, intracranial complications (meningitis, brain abscess) and ocular complications such as optic neuropathy and endophthalmitis may complicate orbital cellulitis. Hospitalization and aggressive medical treatment to prevent lifethreatening complications is indicated in orbital cellulitis (Sullivan, 2004). Any painful periorbital edema or pain associated with eye movements should raise the suspicion of serious orbital cellulitis and referral to an ophthalmologist is indicated.
