My child seems to hate the bright light

Chapter 99 My child seems to hate the bright light

Charlotte L. Funnell

Although mild photophobia is fairly common in normal young children, photophobia must be taken seriously as there are a wide variety of conditions including serious disorders such as infantile glaucoma and anterior visual pathway tumors which may present with photophobia.

Presentation

A variety of behavioral patterns suggest a child is sensitive to light. Babies and young children may get upset and close their eyes when outside, in the car, or under fluorescent lighting, but play happily under natural light indoors. Photophobic children are often thought of as shy or sad as they have a tendency to look down, furrow their brows, and screw up their eyes. Frequent blinking, watering, and rubbing of the eyes are common. Children may complain of pain in their eyes, blurred vision, and headaches, especially when it is bright.

The approach to a photophobic child

It is critical that a good rapport is built with the child and as much information as possible gathered before formal examination is attempted. The lighting in the examination room should be lowered to aid the child’s comfort. The differential diagnosis for photophobia is considerable. Taking into consideration the age of the child (see Table 99.1) and getting a good history (see Table 99.2) help to focus the examination toward finding the diagnosis.

Table 99.1 Important causes of photophobia in each age group

Table 99.2 Questions and considerations in photophobia

Severity?	If severe photophobia, consider infantile glaucoma, corneal surface disease, acute CNS pathology (e.g. meningitis or migraine), achromatopsia, oculocutaneous albinism, or aniridia
Recent onset or present since very young?	Acquired corneal pathology is common in children New onset photophobia with a normal ocular examination may be due to acquired CNS pathology Long-standing problem more likely to be due to an inherited corneal or retinal disease
Associated watering?	Infantile glaucoma, keratoconjunctivitis, keratitis, and epithelial dystrophies have associated epiphora In retinal and CNS disorders epiphora tends to be less prominent
Associated redness of eyes?	Suggests corneal pathology
One or both eyes?	Acquired corneal disease is often asymmetric
Constant or intermittent?	Consider migraine or fluctuating corneal pathology
Reduced vision?	Most corneal and retinal pathologies causing photophobia also reduce visual acuity
Squint?	Monocular eye closure and photophobia are common in intermittent exotropia
Family history or history of consanguinity?	Meesman’s corneal dystrophy, aniridia, and many congenital cataracts are dominantly inherited Cystinosis, tyrosinemia type II, and achromatopsia are recessive Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Related Related posts: Visual electrophysiology: how it can help you and your patient My child could see perfectly but now the vision is weak Strabismus: non-surgical treatment Retinopathy of prematurity Stay updated, free articles. Join our Telegram channel Tags: Pediatric Ophthalmology and Strabismus Jun 4, 2016 \| Posted by admin in OPHTHALMOLOGY \| Comments Off on My child seems to hate the bright light Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access