Eyesight & Down Syndrome

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People with Down syndrome are more likely to experience eye problems than the general population, and 50 percent of people with down syndrome have some type of eye disease.

Eye issues commonly seen in people with Down syndrome include refractive errors, weak accommodations, tear duct abnormalities, and eye misalignment.

There are many ways to treat the eye issues commonly seen in people with Down syndrome. Depending on the problem, treatment may include prescription glasses, proper eye hygiene, or surgery.

Identifying eye problems in a child with Down syndrome can be challenging because they may not complain about any vision problems. Recognizing the signs — such as squinting, an unusual head tilt, and sensitivity to light, among others — will help you determine if your child might be struggling with a vision issue.

Since people with Down syndrome are at an increased risk for eye problems, it is important to get their vision checked early and often. Babies with Down syndrome should have their eyes checked by a pediatric ophthalmologist by 6 months old and then at least once a year after that.

Are Eye Issues Common in People With Down Syndrome?

According to the National Down Syndrome Society (NDSS), over half of people with Down syndrome are diagnosed with some form of eye disease. Down syndrome impacts the developing eye, which in turn affects proper development of vision.

Variations in the eyes of people with Down syndrome may explain some of their susceptibility to eye disease. These characteristics include:

• Noticeable folds of skin between the eyes and nose.

• Upward slanting of the eyelids.

• Tiny white spots of the iris (Brushfield’s spots).

People with Down syndrome can exhibit the above characteristics and not experience any vision problems. However, these characteristics can make children and adults with Down syndrome more susceptible to vision problems.

Common Eye Issues

As NDSS explains, many people with Down syndrome experience vision problems. Eye issues that are seen in people with Down syndrome can range in severity from tear duct abnormalities to cataracts that threaten vision at an early age.

Dr. Danielle Ledoux of Children’s Hospital Boston explains that refractive errors of the eye are more commonly seen in children with Down syndrome than the general population. Common eye problems affecting children with down syndrome include:

• Myopia (nearsightedness).

• Hyperopia (farsightedness).

• Weak accommodation (focusing power).

• Tear duct abnormalities.

• Strabismus (eye misalignment).

The above conditions are common eye problems that can be addressed relatively easily. If left untreated, however, some of these conditions can lead to serious complications.

More severe eye problems that can develop in children with Down syndrome include:

• Amblyopia (loss of vision or “lazy eye”).

• Deprivational amblyopia.

• Loss of stereopsis (depth perception).

• Congenital cataracts.

• Severe ptosis (eyelid droop).

• Nystagmus (rhythmic shaking of the eye).

• Problems with the optic nerve and retina.

Diagnosing and treating the above conditions as early as possible is essential for developing healthy vision. For example, cataracts that go undetected and untreated can result in a lifetime of poor vision for a person whose brain never “learned” to see properly. Properly addressing these common eye conditions can prevent some of the serious complications from ever developing.

Ways to Treat Common Eye Issues

Most of the eye and vision disorders faced by individuals with Down syndrome can be treated with mild to moderate interventions. Proper diagnosis and treatment of eye problems is essential for improving quality of life.

These common eye problems are seen in people with Down syndrome. The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) explains how they are frequently treated.

• Refractive errors: Myopia, hyperopia, and astigmatism are most commonly treated with prescription glasses or contact lenses. Once children and adults who are born with or develop refractive errors get used to wearing their glasses or lenses, they are an effective way to achieve clear vision.

• Strabismus: About 20 to 60 percent of people with Down syndrome have misaligned eyes. Glasses, use of an eye patch, and eye muscle surgery are three effective treatment approaches, depending on the severity of the problem.

• Cataracts: People with down syndrome are at an increased risk of being born with cataracts and developing them later on. Cataracts get progressively worse and can only be treated through cataract surgery.

• Glaucoma: Babies born with Down syndrome are at an increased risk for infantile glaucoma, which causes elevated pressure in the eye. Most cases of glaucoma in babies and children are treated with surgery to lower intraocular pressure.

• Blepharitis: Inflammation and redness of the eyelids accompanied by crusting of the lashes and a sense of dryness or burning is called blepharitis. It is often observed in people with Down syndrome. Proper eyelid hygiene and topical antibiotics are the two most common ways to treat it.

• Tearing: If tear drainage channels are blocked or too narrow, excessive tearing or watering of the eyes can occur. Treatment options include massaging the tear ducts or surgical intervention.

• Nystagmus: This rapid, involuntary, shaking, or back-and-forth movement of the eyes has multiple treatment options. Glasses or contact lenses may be enough to fix nystagmus caused by severe refractive errors. Eye muscle surgery can also be used to improve vision, though it will not eliminate nystagmus completely.

Knowing the treatment options for common eye problems seen in individuals with Down syndrome will help you determine the safest and most effective treatment approach. Depending on the severity of the vision problem, glasses may be enough to achieve clear vision, while other conditions may require surgery.

Identifying Eye Problems in a Child With Down Syndrome

Identifying eye problems in a child with Down syndrome can be challenging, explains NDSS. A child with Down syndrome may not be able to tell you they cannot see well. They may not even complain about any vision problems.

To help you identify potential vision problems in your child, look for nonverbal signs that they may be struggling with their vision, which may include:

• Frequent squinting.

• Closing one eye.

• Uncommon head tilt.

• Wandering or crossed eyes.

• Sensitivity to light.

• Eyelid droop.

• Daily tearing and discharge.

In addition to the above symptoms, a regression of overall functioning or developmental milestones can be a sign of vision loss or problems. If you have recognized any of these signs in your child, contact your child’s pediatrician or ophthalmologist. Routine eye care is the best way to ensure your child’s eye and vision health.

Vision Care for People With Down Syndrome

According to AAPOS, children with Down syndrome should receive their first exam by a pediatric ophthalmologist by the age of 6 months. Following their initial exam, regular vision exams should happen at least once per year. For children with identified vision problems, more frequent exams may be warranted.

Although children and adults with Down syndrome are at a greater risk for eye problems than the general population, early identification and treatment of any problems can ensure healthy vision and high quality of life related to eyesight.

REFERENCES

1. Down Syndrome. (April 2020). American Association for Pediatric Ophthalmology and Strabismus.

2. Vision Deficits in Adults With Down Syndrome. (June 2019). Journal of Applied Research in Intellectual Disabilities.

3. Spatial Vision Deficits in Infants and Children With Down Syndrome. (May 2004). Investigative Ophthalmology and Visual Science.

4. Facts About Down Syndrome. (December 2019). Centers for Disease Control and Prevention.

5. Vision & Down Syndrome. National Down Syndrome Society.

The information provided on this page should not be used in place of information provided by a doctor or specialist. Reproduced with permission from NVISION, a free online resource dedicated to helping people live better by seeing better.