pediatric and teen cl care

Dispensing Contact Lenses to Very Young Children

BY CHRISTINE W. SINDT, OD, FAAO

Very young children (ages 0 to 5) wear contact lenses for a variety of reasons, generally medical in nature. Parents carry the burden of managing the contact lenses, and therefore a pre-application-and-removal discussion is warranted. Frequently, one parent (generally the mother) will take on this burden by herself. A common complaint is the need for more emotional support from the spouse and for more informational support from healthcare professionals.

Make it Routine

To help caregivers cope with managing lens wear for their children, we emphasize the importance of daily routine. We provide parents with information about their child's condition and contact lens(es) so that they can educate others. A number of support groups, including The Association of Parents Having a Kid in Contacts (APHAKIC) and LazyEye, are available through the internet, but I caution parents that these are for support only and they should not act on medical advice without talking to me.

There are a number of reasons to establish a daily routine. Most importantly, the caregiver becomes more proficient and the child becomes more cooperative. Reassure parents that while the child may scream, they are not hurting the child. Only through a consistent routine will the screaming abate—which, consequently, is also true for bedtime.

Managing Very Young Children

For young children, it is necessary to control the arms and head during application and removal. There are a number of one-person and two-person holds. Perhaps the easiest hold is to wrap extremely young children in a blanket or papoose board.

For toddlers, I typically lay the child on the ground and "sit" on (really just hover over) him, securing the arms with my legs and the head between my knees. Children rarely need to be restrained long-term, generally deciding to lay still after two to three weeks.

Probably one of the biggest differences with lens application for infants is that the eyes do not need to be open. First, make sure the lids are dry, as wet lids make lid control difficult. Next, using the lashes, pull the upper lid toward the brow bone (Figure 1). Rest the lens on the lower eyelid and then push it along the lower lid onto the eye. Finally, pull down on the lower lid to make sure the lens is on the eye.

Figure 1. To apply a lens on an infant, create a gap under the upper lid and slide the lens in along the lower lid.

To remove the lens, place thumbs at the lid/lash margins. Push in toward the globe and laterally to visualize the edge of the contact lens. If your thumbs are not exactly at the lid margins and inward pressure is not used before lateral pressure is applied, the lids will flip. Once you see both superior and inferior edges, apply pressure inward and under the lens to pop it out of the eye.

These techniques work for both soft and GP lenses. With practice, parents can become accomplished lens handlers. Application and removal for very young children requires conversations and resources not typical for older children, but when a child can see who otherwise would be blind, it is all worth it. CLS

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Dr. Sindt is a clinical associate professor of ophthalmology and director of the contact lens service at the University of Iowa Department of Ophthalmology and Visual Sciences. She is also the chair-elect of the AOA Contact Lens and Cornea Section. She is a consultant or advisor to Alcon, Ciba Vision, and Vistakon and has received research funds from Alcon.