Eye Abnormalities in Infants: Causes and Solutions

Abnormal Eye Issues in Infants

Hello! I would like to ask you the following questions, and I hope you can help me with the answers.
Thank you! My sister-in-law gave birth to a baby boy on February 15.
During prenatal check-ups, it was noted that his kidneys appeared to be enlarged, but after birth, it was found that this was due to his ureters being narrower than normal.
It is expected that this may resolve on its own over time.
However, we have now discovered that the baby has abnormalities in both of his eyes; there is a thin, transparent, whitish membrane covering the cornea, which is quite noticeable.
We consulted an ophthalmologist at Chung Shan Medical University Hospital, who confirmed the abnormalities.
The doctor mentioned that the white spots could cause visual impairment, meaning that the areas obscured by the spots would not be visible, while the unobstructed areas would be visible, resulting in an incomplete view of people and objects.
The doctor stated that a corneal transplant could be performed when the baby is 2-3 years old, but it may not provide significant improvement, with vision potentially recovering to only about half of what is considered normal.
Is this true? Are there any other methods, or could it gradually disappear on its own? If that is the case, wouldn’t a corneal transplant also require a suitable donor to be effective? How can one obtain that? What could be the underlying cause of this condition? Some people say that kidney issues can affect the eyes; is that true? I really hope you can provide me with answers soon.
Thank you again for your help!

Dou Dou, 20~29 year old female. Ask Date: 2002/03/05

Dr. Wang Yuwei reply Ophthalmology

The presence of white spots on both corneas at birth is most likely diagnosed as congenital corneal dystrophy.
These white spots, as mentioned by the physician during your visit to Chung Shan Hospital, can cause visual impairment; however, the intensity of the spots can vary the degree of visual impairment.
If the spots are lighter, the resulting amblyopia may be milder, and the baby's vision may improve over time.
Conversely, if the spots are very dense, it can lead to severe amblyopia, necessitating early corneal transplantation.

When discussing corneal transplantation, it is essential to have a suitable corneal donor.
The corneas of infants differ significantly from those of adults, making it challenging to find an appropriate donor.
Even if a suitable donor is found, postoperative care and amblyopia training can be a significant challenge and burden for both the infant and the caregivers.
Therefore, these issues must be thoroughly evaluated and addressed before surgery to achieve the best possible outcomes.

Lastly, regarding the kidneys, it is possible for congenital corneal dystrophy to be associated with abnormalities in other body organs.
The physician will provide systematic examinations and genetic counseling based on the infant's condition.
Family members should heed professional advice and remain calm to provide the best care for the baby.

Reply Date: 2002/03/05

More Info

Understanding eye abnormalities in infants can be a complex issue, particularly when associated with other health concerns such as kidney abnormalities. In the case of your nephew, the presence of a transparent white film over the cornea, which is likely causing visual impairment, is a condition that requires careful evaluation and management.

Causes of Eye Abnormalities
The white film you describe on the baby's cornea could be indicative of several conditions, the most common being congenital corneal opacities. These opacities can arise from a variety of causes, including genetic factors, infections during pregnancy, or developmental issues during fetal growth. In some cases, conditions such as congenital glaucoma or corneal dystrophies may also lead to similar presentations.

Visual Impairment and Treatment Options
As the doctor mentioned, the presence of a white spot on the cornea can obstruct vision, leading to significant visual impairment. The prognosis for recovery of vision largely depends on the severity and location of the opacity. If the opacity is dense and covers a significant portion of the visual axis, it can lead to amblyopia (lazy eye) or severe visual impairment.

The recommendation to wait until the child is 2-3 years old for a corneal transplant is standard practice. This delay allows for the child’s eyes to grow and develop further, which is crucial for the success of any surgical intervention. However, it is important to note that even with a corneal transplant, the visual outcome may not always be perfect, and the child may only achieve partial restoration of vision.

Alternative Treatments and Prognosis
While corneal transplantation is a primary treatment option, there are other supportive measures that can be taken to enhance visual development. These may include:
1. Vision Therapy: Engaging in vision therapy can help improve visual skills and may be beneficial, especially if amblyopia is present.

2. Regular Monitoring: Frequent eye examinations are essential to monitor the condition and adjust treatment as necessary.

3. Protective Eyewear: Depending on the severity of the condition, protective eyewear may be recommended to shield the eyes from injury and further complications.

Kidney Issues and Eye Health
Regarding the potential link between kidney issues and eye abnormalities, it is true that certain systemic conditions can affect multiple organ systems, including the eyes. For instance, congenital syndromes that affect kidney development may also have ocular manifestations. However, the specific relationship between the kidney condition and the eye abnormality in your nephew would require further investigation by a pediatrician and a pediatric ophthalmologist.

Obtaining a Suitable Corneal Donor
If a corneal transplant becomes necessary, finding a suitable donor cornea can be challenging, especially for infants. The corneas of infants differ significantly from those of adults, which can complicate the matching process. The transplant team will work closely with eye banks to find the best possible match, but this can take time.

Conclusion
In summary, while the situation is understandably concerning, there are pathways for treatment and management of your nephew's eye condition. It is crucial to maintain open communication with healthcare providers, follow their recommendations, and ensure regular follow-ups. Early intervention can make a significant difference in visual outcomes, and supportive therapies can help maximize the child's visual potential as they grow.

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