Children’s eyes are particularly at risk from the sun’s rays. Their clear lenses allow UV radiation to reach the retina unfiltered, and exposure to the sun at a young age is considered an extremely high risk factor for later developing white and black skin cancer, including on the eyelids. Experts from the German Ophthalmological Society (DOG) explain why parents should therefore pay careful attention to sun protection for their children and which measures are sensible.
Up until the age of 20, the lenses of the human eye are very clear and still unclouded. “This makes it easy for UV rays to penetrate the eye almost unfiltered and cause long-term damage,” explains Professor Dr. med. Vinodh Kakkassery, head physician of the eye clinic at Chemnitz Hospital. By comparison: in the first year of life, 90 percent of UVA and over 50 percent of UVB rays reach the retina, while between 10 and 13 years of age, 60 and 25 percent reach the retina. “It is only between the ages of 18 and 20 that UV rays are almost completely blocked by the lens,” emphasizes Professor Dr. med. Dr. phil. Ludwig M. Heindl from the Center for Ophthalmology at Cologne University Hospital. The two ophthalmologists are delegates of the DOG and the Professional Association of Ophthalmologists in Germany in the UV Protection Alliance, an initiative to prevent UV-related diseases.
Long-term damage to the lens and macula
UV radiation can therefore particularly easily cause photochemical damage to the proteins in the lens of the eye in children, which can lead to clouding and thus the development of cataracts. “It is a cumulative process that takes decades to lead to visual impairment,” emphasises Kakkassery. “Nevertheless, intensive exposure to sunlight increases the risk of children’s eyes developing cataracts at an early age.” UV exposure generally promotes aging processes in the eye – including possible late damage to the retina and the macula, the point of sharpest vision. “UV light is suspected of contributing to the death of retinal cells through oxidative stress,” says Heindl. This can lead to age-related macular degeneration (AMD), the most common cause of blindness in industrialised nations.
40 years later, skin cancer grows
Because UV rays also genetically alter skin cells, too much sun also promotes the development of benign and malignant tumors on the eyelids or conjunctiva. “Childhood and adolescence play a decisive role here,” says Kakkassery. “Because we now know that the damage that one accumulates in early life is the main cause of later development of white and especially black skin cancer,” says the Chemnitz DOG expert. Experts assume a 40-year development period. In Germany, cases of basal cell carcinoma and melanoma are increasing by five percent annually – presumably because UV radiation exposure is increasing. “In Australia, where UV exposure is particularly high, one in two people aged 70 has been affected by white skin cancer at least once in their life,” reports Kakkassery. “Cases of black skin cancer have also increased significantly.”
From UV index 3: sun hat and well-covering sunglasses
Parents are therefore well advised to ensure that their children are adequately protected from the sun. “The UV index, which many apps display on mobile phones, provides guidance,” says Heindl. The rule is: measures should be taken when the UV index is 3 or higher. “It is best for children to wear a sun hat and sunglasses,” advises the Cologne ophthalmologist. Unless you are in the mountains, EU-certified glasses with a CE mark that protect against UV rays up to a wavelength of 380 nanometers are sufficient. “As long as the glasses cover the eyes and sides well, they prevent burns to the eye, cornea or retina,” emphasizes the DOG expert.
In bright sunshine, take it into the shade or into the house
In the two hours before and after the sun is at its highest, children and young people should avoid direct sunlight and stay in the shade. “If the UV index approaches eight, it is better for children to stay at home during this peak sun period,” says Heindl. “They should still go outside regularly to prevent the development of short-sightedness as much as possible – if the UV index is high, only in the afternoon and in the shade, protected by a sun hat and sunglasses,” says Kakkassery. It is very helpful to explain the purpose of UV protection to children in a child-friendly way.
Sunglasses when it’s cloudy? It depends on the UV index
As far as sunscreen is concerned, caution is advised when applying it to the upper and lower eyelids. “The cream should not come into contact with the conjunctiva or cornea,” warns Heindl. If in doubt, sunglasses are sufficient. In this context, both experts also clear up a misunderstanding: “Whether you should wear sunglasses when it’s cloudy does not depend on the clouds, but on the UV index – index 4 and above is recommended.” But be careful: sunglasses can put children on scooters or bicycles at risk due to reduced visibility.
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