Children’s Services
As a parent and physician Dr. Gross understands the concerns and questions that confront you. He and his staff take the time to educate you about your child’s condition and treatment options.
Dr. Gross creates a customized plan for each pediatric patient which provides peace of mind for parents and enables them to explain the medical situation to their child in a reassuring manner.
Making parents and children comfortable – while providing the best treatment possible – is the top priority of Dr. Gross and his staff. The comfortable, child-friendly atmosphere of his Palm Harbor office, Dr. Gross’s patient manner, and his knowledgeable, compassionate staff will put even the most nervous patient (and parent!) at ease.
Medical Services & Evaluation
Surgical Services
Pediatric eye exams (back to top)
The American Optometric Association and American Ophthalmological Association recommend that all children have their first examination between 9 months and one year of age. (If a problem is noticed, the child should be examined before 9 months.) The ability to see 20/20, focusing ability and eye muscle coordination (aiming or alignment) are all developed by 6 to 8 months.
Surprisingly, young babies are easy to examine. By age 2 it is “neurologically late” and often difficult to examine a toddler. If everything is normal at that 9 month examination, the next exam should be in kindergarten.
Dr. Gross can evaluate a child for visual acuity for distance and near (with or without correction), intraocular pressure, pupil function, external and internal infections, disease or defect, extraocular muscle function, inspection of lens and retina through dilated pupil and more. As a pediatric specialist Dr. Gross is able to perform exams on “reluctant” or scared patients and put his young clients at ease.
Strabismus (eye muscle problems) (back to top)
Strabismus, more commonly known as cross-eyed, is a condition in which a person can not align both eyes simultaneously. One or both of the eyes may turn in, out, up or down. An eye turn may be constant (when the eye turns all of the time) or intermittent (turning only some of the time, such as, under stressful conditions or when ill). Whether constant or intermittent, strabismus always requires appropriate evaluation and treatment. The majority of children do not outgrow strabismus. It is estimated that up to 5 percent of all children have some type or degree of strabismus. Eyeglasses may be prescribed to eliminate the eye turn and/or eliminate any optical difference between the eyes. When the two eyes are not aligned, the brain is forced to ignore one of the images to prevent double vision. This can lead to loss of vision in the deviated eye. Dr. Gross might recommend a patch to stimulate one eye, which was suppressed or turned off.
Tearing in children (back to top)
Tears are made from the lacrimal gland located under the upper outer part of the eyelid and orbit. They drain down across the surface of the eye and are collected by the lower lid into a very small opening at the inner area of the lid near the nose. From there, the tears drain into a duct that penetrates though a canal in the bone of the nose where drainage occurs in the lower part of the nasal cavity. That is why we find ourselves reaching for a tissue when we cry…the extra tears drain into our nose and irritate it. Blockage of this normal flow can cause epiphora, the excess overflow of tears onto the face. Sometimes, this blockage can lead to infections in the sac beneath the skin at the nose that collects the tears causing redness, pain and discharge. In children, this can occur commonly due to a membrane that fails to open during development. In many cases, correction can be achieved with a simple ‘probing’ procedure.
Reading disorders (back to top)
Learning to read requires coordination of the eye muscles to follow a line of print, spatial orientation to interpret letters and words, visual memory to retain the meaning of letters and sight words, sequencing ability, a grasp of sentence structure and grammar, and the ability to categorize and analyze. The brain must integrate visual cues with memory and associate them with specific sounds. The sounds must then be associated with specific meanings, which must be retained while a sentence or passage is read. Reading disorders occur when any of these processes are disrupted. Dr. Gross can work with you and your child, in a cross-disciplinary educational approach, to help alleviate the visual problems associated with reading disorders.
Headaches (back to top)
Eyestrain or diseases of the eye can often lead to headaches. Some eye diseases cause pain around the eye, forehead or temple region, often mimicking the symptoms of migraines. Should your child have frequent or severe headaches, his/her eyes should be evaluated by Dr. Gross to check for a medical condition or general vision impairment.
Amblyopia management (back to top)
Amblyopia is the clinical term for lazy eye. An amblyopic eye is anatomically normal but vision is poor – even with glasses. Vision loss may range from very slight to severe. Amblyopia develops sometime between birth and 8 or 9 years of age. This problem must be identified and treated prior to 8 or 9 years of age, or the vision loss becomes irreversible. Generally, the earlier the treatment the more rapid and complete the recovery of visual acuity and development. The most rapid and successful treatment of amblyopia may be to patch the better eye, either full or part-time, until vision in the amblyopic eye recovers to the same level as the normal eye. Atropine eye drop therapy may also be used as it prevents focusing, thereby blurring the vision in the better seeing eye. The extent of the recovery depends on the age treatment is started and the underlying cause of the amblyopia. Many children also require glasses as part of their visual therapy. Surgery may be performed afterward to improve eye alignment.
Eyelid disorders (back to top)
Common eyelid disorders include blepharitis, blepharospasm, chalazion and hordeolum, entropion and ectropion, trichiasis and tumors. A wide variety of treatment options are available. Dr. Gross will work with you and your child to correctly diagnosis and treat your child’s condition.
Ptosis (back to top)
Ptosis occurs when the upper eyelid falls into a position that is lower than normal, or droops. The entire lid is too low, not just extra skin hanging down. If this condition occurs in one eye, it causes that eye to appear smaller than the other. Sometimes both eyelids can be affected. In severe cases, the drooping eyelid can cover part or all of the pupil and interfere with vision. Ptosis in children is frequently the result of poor development of specific eyelid muscles.
Neurological visual disorders (back to top)
Visual disturbances associated with neurological disorders often include double vision, moving or blurred vision, reduced visual acuity, reduced visual field, and partial or total loss of vision. Visual disturbances are often symptoms of other disorders, such as neurological disorders, but can also occur due to muscular disorders, vascular diseases, cancer, trauma or infection. Dr. Gross will work with you and your child to diagnosis the underlying cause of the visual disorder and find the best possible treatment.
Esotropia (back to top)
Esotropia is an inward turning of the eyes. There are many causes of esotropia. Detailed examination is required to properly diagnose this condition. Treatment may involve glasses and/or eye muscle surgery.
Exotropia (back to top)
Exotoropiais the outward turn of an eye which may occur while looking at distance objects, near objects or both. Luckily, most exotropia is intermittent, meaning the eye turn occurs only some of the time. The turn usually occurs during times of inattention, fatigue, or distance viewing. Treatment consists of vision therapy, patching, glasses and/or surgery.
Surgeries
Ptosis (back to top)
Ptosis is usually corrected surgically. The levator muscle, the primary elevator muscle of the eyelid, is shortened through a lid-crease incision. The incision is hidden in the existing lid fold or in a new lid fold created to match that of the other eyelid. Other techniques may be needed in children with Ptosis. Most patients experience only minor discomfort and require little, if any, pain medication.
Strabismus surgery (back to top)
Strabismus surgery involves changing the position and tension in the eye muscles to correction malposition of the eyes. The surgery is performed on an outpatient basis, usually under general anesthesia. The eye muscles are approached via small incisions, usually behind the eyelids, thus avoiding exposed scars. The surgery is done under high magnification using specialized instruments. Patients often ask whether lasers are used. lasers are not indicated for this type of surgery. Dr. Gross does use lasers for some types of surgery such as tumor resection or some cosmetic procedures involving skin incisions. However, skin incisions are not used in eye muscle surgery. The use of lasers in strabismus surgery would increase potential damage without any associated improvement in outcome or real benefit and thus are not indicated nor used. Eye muscle surgery is done with absorbable sutures. Dr. Gross utilizes a newer technique called the Hang-back operation when possible for eye muscle surgery. This advanced technique provides patients with the same outcomes as the older type of eye muscle surgery while reducing many of the risks involved with the more traditional procedure. Dr. Gross has performed thousands of strabismus operations and he tailors his surgeries to specifically address the particular type of ocular misalignment (strabismus) found.
Nystagmus surgery (back to top)
Nystagmus is an uncontrolled movement of the eyes, usually from side to side, but sometimes the eyes swing up and down or even in a circular movement. Nystagmus that appears in the first months of life is called early onset nystagmus or congenital nystagmus. The condition may also develop later in life and is called acquired nystagmus and may be the result of a stroke, multiple sclerosis or a blow to the head.
S urgery can be performed to alter the position of the muscles, which move the eye. Surgery may reduce the amount the head has to turn to try and see better. However, surgery (at this time) cannot cure nystagmus.
