Children can suffer from a unique set of vision ailments. We are pleased
to offer a full range of pediatric eye care, from basic vision tests to advanced
treatment of eye problems. Whatever your child's needs, our doctors have the
training and experience to help. We are known for our excellent patient care
and for the rapport we maintain between patients and our doctors. You can
relax with the knowledge that your child will feel safe and comfortable during
his or her appointment.
Strabismus Surgery (lazy eye)
Patients with strabismus have eyes that are misaligned so when one eye focuses
on an object, the other may turn in, out, up, or down—confusing the visual image sent to the brain. If left untreated, strabismus (lazy eye) may cause the brain to ignore the messages it receives from the misaligned eye (a condition called amblyopia). Fortunately, strabismus can be treated with surgery. Surgery can adjust the muscles that hold the eye in place, ensuring that these muscles can contract or lengthen when the patient looks at a close or far object. Although strabismus is most commonly diagnosed in children, some adults have the condition as well. The earlier the problem is caught, the more successful treatment tends to be. Please contact us to learn more about strabismus (lazy eye) surgery or our pediatric ophthalmology practice.
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| Esotropia before surgery |
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Aligned eyes after surgery |
Even though the patient's left eye was not crossing, this patient required surgery on two muscles of her right eye and one muscle of her left eye.
Without operating on the left eye muscle there would have been some residual eye crossing after the surgery.
Decades of scientific research have produced surgical tables and graphs which let your eye surgeon know ho much to move each operated muscle, and how many muscles to operate depending on the amount of eye deviation present.
“My right eye was permanently turned in. I was having constant double vision and headaches. I was referred to Dr. Vicente at Eye Doctors of Washington for evaluation of my strabismus. He took the time to explain my problem. After a couple of office visits he had sufficient eye measurements to offer me eye muscle surgery to align my eyes. The surgery went well and after a few weeks, my eyes had healed and my double vision and headaches resolved. I am thankful to Dr. Vicente and his staff. ” |
"My parents have noticed my strabismus when I was four years old. In the beginning it was just one eye, but later in my twenties I have developed it on the second eye as well. I also started getting headaches and occasionally double vision.
I originally visited Dr. O’Neill and Dr. Vicente’s office with my baby son – his pediatrician recommended that I check him for signs of strabismus. I myself got so used to living with it that I was not even considering operation before that visit. I was also told by someone several years ago that adjusting it at my age might interfere with some brain functions (now that does not seem as a very professional opinion).
During my son’s check-up Dr. Vicente mentioned that not only is it possible for grown-ups, but that it is a routine operation performed by him on a regular basis and everyone’s brain remained fine so far ;-)
So after two more office visits and many of my questions answered in great details I went for the operation and do not regret it a bit. The procedure was very straight forward. I checked-in at the hospital early in the morning and was ready to go home around the afternoon. There was no pain whatsoever during the operation itself, as it was done under anesthesia. After the surgery I felt very nauseous, which is normal and I consumed quite a number of popsicles in the next 24 hours. My eyes were bloodshot for first 10 days after the surgery, so I was wearing dark glasses. My eyes hurt first couple of days after surgery but it was not a severe pain. I spent first 24 hours after the operation in bed with ice bag over my eyes.
Now, several months later all this seems just like a minor discomfort in comparison to getting my eyes straight. Not to mention physical discomfort, those who have strabismus know how embarrassing it can be sometimes when strangers either do not look you in the eyes or trying to figure out what are you looking at.
So to everyone who is considering strabismus surgery I highly recommend Dr.Vicente. He is a confident professional you can entrust yourself and I am very grateful to him." - A.L.
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BOTOX® injections
BOTOX®, a purified toxin widely used to treat facial wrinkles, has proven to be very effective in treating blepharospasm (eyelid spasms), spastic entropin (the inward turning of the lower lid), and strabismus (asymmetrical or crooked eyes) in children and adults. When injected in the treatment site, BOTOX® blocks nerve impulses sent to muscles, alleviating the condition. To find out if BOTOX® injections are right for you or your child, please contact us today.
 
 
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Blocked tear ducts
Blocked tear ducts are a common problem in children and newborns. Normally, our tears move toward the nose and drain into our tear duct system. But sometimes in children, the system becomes blocked and stops working. This can cause a child to develop a pain or redness under the eye and to develop a crust over the eye. If left untreated, blocked tear ducts can cause eye infections and other eye-related problems in children. We have the technology needed to probe and open any blocked nasal ducts, preventing the child from developing a severe infection.
"Dear Dr. Vicente: We never got to say thank you for the care you gave our daughter. You cleared her blocked tear duct last year and for some time afterward I was hesitant to email and jinx the wonderful results. She was a special case with a squiggly duct and we were fearful the procedure might not be successful. In any event, it was successful thanks to you. We can't thank you enough for your demeanor, skill and concern." - T.O.
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Nasal lacrimal tubes 
Plugged tear drains can cause infection as well as discomfort and pain. The condition—which develops if the tear ducts do not drain well, causing a back-up of fluid—is marked by excessive watering, swelling in the corner of the eye, mucus buildup, and sometimes, general discomfort. There are a number of treatments available to treat this condition. Narrow, silicone tubes are used if simple probing and irrigation did not help. They are placed in the ducts for four to six months, eliminating the obstruction and preventing reclosure. Risks associated with nasal lacrimal tube insertion are relatively minimal, including infection, and bleeding. The tubes may be easily removed in our office without anesthesia. To learn more about this option, please contact us today
 Right blocked nasal lacrimal duct.
Note the white of the eye is not red; this is not contagious pink eye or conjunctivitis. |
 The nasal lacrimal system lies just under the skin. It drains tears and debris away from the eye and into the nose. |
 If the nasal lacrimal system is blocked, the tears cannot drain away properly, and they back up into the eye, overflowing over the eyelid.
Because the debris and bacteria are not drained away, the stagnant tears become infected. This leads to chronic mucus and pus buildup. |
 Surgical treatment of blocked lacrimal duct.
A thin probe can be used to open this blockage. This simple procedure may sometimes be performed in our office with topical anesthesia in babies up to 7 months of age. Babies 11 months or older operate under general anesthesia. If this is not successful, sometimes we may need to repeat this procedure and place a small tube stent to hold open this passageway. |
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Anterior eye segment surgery for removal of lesions or masses on eye lids or surfaces
We can perform anterior eye segment surgery to remove or treat a number of masses or lesions on the eye lids or surfaces. These include the chalazion (also called styes), nevi, scar tissue, cataracts, and other growths or imperfections that may be present. To learn more about anterior eye segment surgery,please contact us today.
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Laser surgery for Retinopathy of Prematurity
Once a baby begins to grow and develop in his/her mother’s womb, the blood vessels in the eye also begin to grow, moving from the back central part of the eye toward the front. In most babies the entire process ends just around the normal time of delivery. But in the case of premature babies, the process is interrupted and a baby can lose sight , resulting in blindness several weeks after birth if not properly treated. This unfinished growth of blood vessels and resulting scar tissue is called Retinopathy of Prematurity (ROP), and it is commonly found in babies who are born very premature, at less than 31 weeks. We prefer to treat ROP with a laser. If indicated by strict scientific guidelines, the laser can be used to create scar tissue on the anterior, peripheral retina that is not fully developed with blood vessels. By doing this, our doctors are able to save as much as possible of the central retina, keeping the best part of the eye’s vision intact. Patients who have the surgery can expect to have some of their side vision to be lost after laser treatment. However, the good news is that the central retina is what we use to help us drive, see and read, making it the best part of the eye to save. To learn more about laser surgery for retinopathy, please contact us today.
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Frontalis sling surgery
Congenital blepharoptosis, or droopy eyelids present at birth, can now be safely corrected with frontalis sling surgery. During this procedure, an incision is made in the drooping eyelid,and the muscles of the forehead and/or brow are incorporated into the elevation of the lid, ultimately lifting it to the same height as the other lid. Once in the correct location, the incision is stitched closed. To learn more about frontalis sling surgery, please contact us today.
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Pediatric cataract surgery
A cataract is the clouding of the eye’s crystalline lens. It is characterized by blurred vision not improved with glasses, glares, and difficulty reading. Most common in older adults—a cataract is a natural degeneration—cataracts sometimes form prematurely in children. Sometimes, children are born with cataracts, which to date can only be treated with surgery. During this surgery, the cloudy lens is removed and replaced with a synthetic replica if the child is old enough, typically after age one or two. Many patients reporting improved vision soon after surgery. To find out more about pediatric cataract surgery, please contact us today.
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Placement of secondary intra ocular lens implants in patients who have had previous cataract surgery
If your child has had previous cataract surgery and did not have a lens implanted in his or her eye, the placement of secondary intraocular lens implants is the next step. During this surgery, a second intraocular lens is inserted into the eye. This is an effective, safe, viable solution for children who have had previous cataract surgery and are experiencing problems with thick glasses or contact lenses. To learn more about secondary intraocular lens implants, please contact our practice today.
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What to expect after surgery
| • Your eye surgeon will call you the evening after the surgery to make sure all is well. |
| • Eye patch after surgery: |
| Most patients do not require an eye patch after pediatric or eye muscle surgery. |
| • Stitches: |
Most stitches used in eye surgery are thinner than human hairs. They will dissolve on their own over 6 weeks. They may make your eye feel scratchy for the first few weeks. The antibiotic ointment and a cool compresses will alleviate this symptom if it occurs.
Your doctor will discuss with you if the stitches need to be removed after surgery. |
| • Diplopia or double vision: |
| Some double vision is normal for the first few weeks after eye muscle surgery. |
Restrictions after eye surgery:
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| • Showering: |
| As with other surgeries we want the patient to keep the operated area clean until the surgical incisions heal, typically 10 days after surgery. This means no swimming and keeping the area dry during this time. Patients may shower with care to avoid dirty water entering the operated area. |
| • Eye Rubbing: |
| Because even the youngest patients realize the area around the eyes is tender after surgery, eye rubbing is almost never a problem |
| • Driving: |
| Most adult patients may drive on their own a few days after the surgery. The decision of when to drive again is often up to the patient. |
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Length of surgery
. Probe and irrigation of nasal lacrimal system: 10 minutes
. Lid mass removal: 10-30 minutes per lid.
. Strabismus, eye muscle surgery: 1-2 hours.
. Ptosis lid surgery: 1 hour.
. Pediatric cataract surgery: 1-2 hours.
. Expect an extra 20-30 minutes before and after the surgery to take into account the time it takes for the patient to fall asleep and wake up.
. All eye surgeries are outpatient procedures and the patient may go home typically 1-2 hours after surgery.
. Expect to spend half a working day at the hospital.
. Most patients may return to work or school 3-5 days after most procedures.
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| • To avoid the discomfort to the patient during surgery and to prevent the movement of the eyes during surgery a general anesthetic is required. |
| • When we perform pediatric surgery we only use anesthesia doctors who specialized in pediatrics. |
| • In a healthy child the risk of a complication from today’s general anesthetics is extremely small. It has been compared to the risks of riding a car in the US. |
| • To avoid the risk of the patient choking while under the effects of anesthesia, all patients must have an empty stomach the morning of surgery. This typically means no fluids 6 hours prior to surgery. Surgery will be cancelled or postponed if the patient consumes liquids or foods prior to the surgery. |
| • All patients must be cleared for surgery by their primary doctor prior to the day of surgery. If the patient develops a cold or other illness the surgery will be postponed to avoid any unnecessary risks. |
| • Parents in the OR: |
| Depending on the patient’s age, one parent may be allowed to accompany the patient and stay with them while the patient falls asleep. Once the patient is asleep the parent will be escorted back to the waiting area. As hospital policy parents are not allowed to stay in the operating room during the surgery because they would create a distraction to the surgical team. |
| • For further anesthesia questions, you may contact the anesthesia department at the hospital where you will be operated. |
| • Needles: |
If the procedure will take longer than 10 minutes, IV (intra-venous) fluid may be necessary for the anesthesia doctor to administer anesthesia related medicines.
In young children the iv is placed with a small needle after they are asleep to avoid discomfort while the patient is awake. The needle is then removed. The iv tubing is removed painlessly after the child awakes. |
| • Pain medicine: |
| This is available after the procedure but most patients do not require it. |
| • Nausea: |
| Some nausea may occur after eye surgery. If it becomes a serious problem anti-nausea medicines may be prescribed |
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Risk of surgery not related to anesthesia
| • Complications are rare. |
| • Infection: |
Because most eye surgeries are small, clean and very superficial the risk of infection is extremely low, less than 1/10,000.
It is normal for the eyes to be red, swollen and sore after surgery, however these symptoms should not worsen after surgery. If they do, you must notify your doctor because they may indicate an infection.
Antibiotic drops or ointment will be given to you prior to going home. These must be used as instructed to lessen the risk of infection. Antibiotic ointment is placed on the patient’s eyes after the surgery, prior to waking up from anesthesia.
Serious eye infections could lead to blindness or loss of the eye.
In our 40 years of practice no patient has lost sight because of this complication. |
| • Bleeding during surgery: |
Because eye surgeries are very superficial, bleeding is often minimal (as in a few drops of blood.) Our patients have never required blood transfusions. This fact decreases the risk of blood born infections such as AIDS, or hepatitis.
Because the eye has a very thin, transparent skin it is normal for the white part of the eye to be very red after surgery. This clears up after 1-2 weeks. |
| • Bleeding after surgery: |
| It is common to have some blood tinged tears the day after surgery. |
| • Blindness: |
| Loss of sight is extremely rare in strabismus or pediatric eye surgery. Your doctor can review this risk with you. This risk varies depending on the procedure that is required. As stated above no patient in our pediatric and strabismus practice has lost sight because of eye surgery. |
| • Scarring: |
| This is as well an extremely rare risk. Because eye surgery is considered micro-surgery, most eye surgeries leave scars that are only noticeable or visible with a microscope. Your eye surgeon often uses an operating microscope or special magnifying glasses called loupes to perform very delicate surgeries. The surgical incisions are often made behind and under the eye lid which covers any residual signs. |
| • Need for further surgery: |
The long term course of strabismus is usually very satisfactory but it may be difficult to predict what will be required to achieve the ideal goals.
In some instances more than one procedure is required to attain the expected long term surgical goal. This may be required months or decades later.
Your doctor will discuss the chances of requiring further surgery depending on your condition and the planned procedure. |
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