Eye exams by your child’s doctor are an important way to identify problems with your child’s vision. Problems that are found early have a better chance of being treated successfully.
What are warning signs of a vision problem?
Babies up to 1 year of age:
Babies older than 3 months should be able to follow or track an object, like a toy or ball, with their eyes as it moves across their field of vision. If your baby can’t make steady eye contact by this time or seems unable to see, let your child’s doctor know.
Before 4 months, most babies’ eyes occasionally look misaligned (strabismus). However, after 4 months, inward crossing or outward drifting that occurs regularly is usually abnormal. If one of these is present, let your child’s doctor know.
Preschool age:
If your child’s eyes become misaligned, let your child’s doctor know right away. However, vision problems such as a lazy eye (amblyopia) may have no warning signs, and your child may not report vision problems. That is why it’s important at this time to have your child’s vision checked. There are special tests to check your child’s vision even if he cannot yet read.
All children:
If you notice any of the following signs or symptoms, let your child’s doctor know:
Eyes that are misaligned (look crossed, turn out, or don’t focus together)
White or grayish white color in the pupil
Eyes that flutter quickly from side to side or up and down
Eye pain, itchiness, or discomfort reported by your child.
Redness in either eye that doesn’t go away in a few days
A vision screening is a brief eye and vision check to help detect vision issues in children. It is an essential part of preventative eye care. Some eye problems in children first show up with squinting, blinking, red eye or other noticeable symptoms. However, other eye problems can have no symptoms and will only be detected during screening.Some eye problems can cause permanent vision loss if left untreated in childhood. That’s why it is important for your child’s pediatrician to physically examine the eyes at each well-check visit, and start formal vision screening tests once they’re old enough.
What happens in a vision screening?
Vision screenings may be performed in different ways depending on your child’s age. Some screenings need your child’s cooperation to read or match images in an age-appropriate way. Other screenings use special tools to measure the eye position, reflection of light off the back of the eye or focus of light into the eye.
What happens if my child fails a vision screening?
If your child fails a vision screening they usually are referred to an eye doctor. This should be an ophthalmologist or optometrist who is experienced in the evaluation and treatment of children.
It is important to follow up with the eye doctor even if you are not noticing any vision problems. The eye doctor should perform a full eye examination. This includes dilating the pupils with eyedrops, and then telling you if your child needs eyeglasses or some other treatment.
When should my child’s eyes get screened?
The American Academy of Ophthalmology and the American Academy of Pediatrics recommend that children have their eyes checked starting as newborns. After that, screenings are recommended during well-child visits.
Vision screening schedule for infants and children
Newborns: At birth babies should have their eyes checked by their pediatrician for birth abnormalities, infections, cataracts and glaucoma. Premature babies may need further specialized exams by an eye doctor when they’re born.
Birth to 6 months: This is a time to talk with your pediatrician about anyfamily history of childhood vision problems. The doctor will check the red reflex (light reflected through the pupil from the back of the eye), using a handheld device called an ophthalmoscope. They’ll also have a look at the size and shape of the pupil and external parts of the eye.
6 months and up: Your pediatrician will continue to check the red reflex, pupils, and external eye structures. In addition, they will check if each of your child’s eyes will look at and appropriately follow a toy or face. They will also look for signs of strabismus (eye misalignment or “wandering eye.”)
Starting at 1 to 2 years: At this age, instrument-based screening devices may begin to be used for vision screening. These may include photoscreeners and autorefractors, computer-automated devices that use light and cameras to gauge how well your child can see.
Starting at 3 years: Visual acuity screening is recommended at ages 4 and 5 years, as well as in cooperative 3-year-olds. This involves asking your child how well they can see the details of letters or symbols from a set distance.
A sty is a painful, red bump on the eyelid caused by an infected oil or sweat gland. Sties are not very contagious. However, once your child gets a sty, she is more likely to get one again.
Signs and Symptoms
Red, tender bump on the eyelid
Tenderness around the eye
Swelling around the eye
Redness on the eyelid
Sty Treatment
To ease the pain and discomfort of a sty, place a warm cloth on the eyelid 3 to 4 times a day until signs of the infection are gone. Antibiotics are generally not helpful with a sty.
When to Call Your Child’s Doctor
Call your child’s doctor if the warm cloth treatments don’t work. In some cases, you may be referred to an eye doctor who can drain the sty surgically.
Myopia, or nearsightedness, is a common vision problem that often begins between the ages of 6 and 14. It affects an estimated 5% of preschoolers, about 9% of school aged children and 30% of adolescents.
Children are more likely to develop myopia if their parents are nearsighted. However, myopia is on the rise overall, especially in kids. No one is exactly sure why, but experts believe it could be related to more time doing closeup tasks indoors like using computers and playing video games.
Eye development & vision
Myopia happens when your child’s eyeball is too long from front to back. It can also develop when the cornea, the clear window at the front of the eye, is curved too steeply. When light enters your child’s eye, the rays fall just short of the retina, the light-sensitive tissue at the back of the eye. This makes distant objects blurry and close objects clear.
In hyperopia, or farsightedness, distant objects are clearer than near objects. It takes more work to focus on everything, but especially on close-up objects. Children’s eyes haven’t totally developed yet, so some farsightedness is normal in childhood. Most kids don’t experience blurry vision though because their eyes automatically focus. As they grow, children usually become less farsighted and may become nearsighted instead.
Myopia generally gets worse through adolescence, then starts to stabilize in the early twenties.
Myopia symptoms in children
Symptoms of myopia include:
Complaints of blurry vision (like not being able to see the board in school)
Squinting to try to see better
Frequent eye rubbing
Frequent headaches
Myopia and the COVID-19 pandemicThe COVID-19 pandemic prompted many schools to offer virtual learning. That means kids have been spending more time on screens and close-up work during the past couple years. Social distancing measures and staying home more also equals less time that many children spend outside. These factors have had doctors concerned about the potential for a big increase in myopia in children. To help lower the risk of myopia, especially during the pandemic, encourage your child to take frequent breaks from close-up work, spend daily time outside when possible and limit recreational screen time.
Diagnosing myopia
If your child doesn’t pass a vision screening at your pediatrician’s office or at school, they may have myopia. To get a diagnosis, your child will need to see an ophthalmologist or an optometrist.
Ophthalmologists have a degree in medicine (MD or DO). They do eye exams and prescribe glasses and contact lenses. They also diagnose and treat eye diseases and perform eye surgery.
Optometrists have a degree in optometry (OD). They give eye exams, prescribe glasses and contact lenses, and screen for and treat certain vision problems.
An optician is trained to make sure glasses that are prescribed by an ophthalmologist or optometrist fit correctly.
Treatment of myopia in childhood
Myopia cannot be reversed or cured, but it can be treated. The goals of treatment are to improve your child’s vision and prevent it from getting worse. This is important for protecting their eye health in the future, even if they still need glasses or contact lenses.
Glasses
Glasses for myopia can be used all the time or just when they’re needed so your child can see far away. It’s important to choose frames that fit well and that work for your child’s age and activities. For example, if you have a young child, it may help to buy glasses with a strap so they stay on more easily. Or if your child plays sports, getting sports goggles will keep their regular glasses from getting broken. An optician can help you figure out what your child may need.
Contact lenses
Contact lenses are an option if your child prefers them. They can be helpful for certain activities too, especially sports. While there’s no age limit for contacts, your child should be able to tolerate eye drops well and practice good hygiene. Contacts need to be cared for on a daily basis to prevent eye infections.
It’s important to always have glasses for backup, even if your child wears contact lenses most of the time. If your child has eye pain or redness while wearing contact lenses, contact your ophthalmologist or optometrist right away.
Treatments to prevent myopia from getting worse
Researchers are studying ways to prevent myopia from worsening in children. These potential treatments include:
Low-dose atropine eye drops
A low dose of the same type of eye drops that are used to dilate the pupils during an eye exam may help slow down myopia in children between 5 and 18 years old.
Specialized contact lenses
In some children, wearing a specialized multifocal contact lens that blurs their side vision may help slow their eye growth and limit myopia.
Another type of contact lens treatment called orthokeratology, or Ortho-K, is worn overnight to flatten the cornea. During the day, the reshaped cornea helps focus light properly on your child’s retina to improve blurry vision. The safety of this treatment is a concern because wearing contact lenses while sleeping increases your child’s risks of eye irritation and infection. It also increases the risk for more severe vision problems.
More time outside
By balancing screen time with outdoor time when possible, you may help limit your child’s myopia and protect their vision as they grow.
Remember
If you think your child is experiencing symptoms of myopia, talk with your pediatrician. They can give your child a vision screening and help you figure out next steps, if necessary.
Amblyopia, or lazy eye, is a fairly common eye problem (affecting about 2 out of 100 children). It develops when a child has one eye that doesn’t see well or is injured, and they begin to use the other eye almost exclusively. In general, amblyopia must be detected as early as possible in order to treat and restore normal vision in the affected eye. If the problem persists for too long (past 7 to 10 years of age), vision is often lost permanently in the unused eye.
How is amblyopia treated?
There are a couple ways amblyopia may be treated, including:
Eye patching therapy
Once an ophthalmologist diagnoses the problems in the weaker eye, your child may need to wear a patch over the “good” eye for periods of time. This forces them to use and strengthen the eye that has become “lazy.”
Patching therapy will be continued for as long as necessary to bring the weaker eye up to its full potential and keep it there. This could take weeks, months or even a few years.
Eye drops or ointment
As an alternative to an eye patch, the ophthalmologist might prescribe eye drops or ointment to blur the vision in the good eye. This can stimulate your child to use the amblyopic eye.
Glaucoma is a serious eye disorder caused by increased pressure within the eye. It may be due to either overproduction or inadequate drainage of the fluid within the eye. If this increased pressure persists too long, it can damage the optic nerve and cause loss of vision.
Although a child can be born with glaucoma (called congenital glaucoma), this is quite rare. More often it develops later. The earlier it is detected and treated, the better the chance of preventing permanent vision loss.
What are the signs of glaucoma in children?
If your child experiences any of the following warning signs, call your pediatrician promptly:
Excessive tearing that happens along with extreme sensitivity to light (your child will turn their head into the mattress or blankets to avoid light)
Hazy or overly prominent appearance of either eye
Increased irritability (typically because of persistent eye pain and discomfort)
How is childhood glaucoma treated?
Usually glaucoma must be treated surgically to create an alternate route for fluid to leave the eye. Any child who has this disease must be watched very carefully throughout their life so that the pressure is kept under control. The goal is to keep the optic nerve and cornea as healthy as possible.
Children spend more time than ever staring at digital screens—on computers, tablets, TVs, smartphones, and other devices. All that screen time can take a toll on children’s wellbeing, including how their eyes may feel.
Research shows that children begin zooming in on digital media devices, such as their parents’ tablets or smartphones, as young as 6 months old. By their teens, studies have found, kids spend nearly 7 hours a day using screened-based media, watching TV, playing video games, and using social media. Especially if they’re having fun, children might keep playing and watching to the point of eye-rubbing exhaustion.
This doesn’t include additional time spent using screens at school and for homework.
COVID-19 & online learning: watch children’s eye health With COVID-19 and a shift to online learning by many schools, children are spending even more time looking at screens. Screen time limits are also being increased in many families to help children stay entertained and socialize with friends virtually, as they spend more time at home to prevent the spread of the virus. All of this makes it especially important to take steps that can help prevent tired, sore eyes in children.
Why screen breaks are important
Staring at a screen for long stretches without taking breaks can cause symptoms such as:
Eye fatigue. Muscles around the eye, like any others, can get tired from continued use. Concentrating on a screen for extended periods can cause concentration difficulties and headaches centered around the temple and eyes. Children may also use screen devices where lighting is less than ideal, causing fatigue from squinting.
Blurry vision. Gazing at the same distance for an extended time can cause the eye’s focusing system to spasm or temporarily “lock up.” This condition, called an accommodation spasm, causes a child’s vision to blur when he or she looks away from the screen. Some studies also suggest computer use and other close-up indoor activities may fuel rising rates of myopia (nearsightedness) among children, although this is not yet proven. More time playing outside may result in healthier vision development in children.
Dry eyes. Studies show that people blink significantly less often when concentrating on a digital screen, which can leave eyes dry and irritated. Desktop and laptop computer use can be especially tough on children’s eyes, because they’re usually situated higher up in the visual field than a book, for example. As a result, the upper eyelids tend to be open wider—speeding up evaporation of the eye’s tear film.
What parents can do
Monitor screen time. The American Academy of Pediatrics (AAP) family media use plan and related reports target issues ranging from obesity to sleep problems linked with too much screen time. Although children’s screen time will understandably increase during the COVID-19 pandemic, the AAP encourages parents to do their best to help keep some balance between the digital and real world. Two especially important aspects of this are making sure screens don’t cut into:
Sleep. Not getting enough shut-eye leads to tired, sore eyes. The AAP recommends children not sleep with devices in their bedrooms, including TVs, computers and smartphones. In addition, the AAP recommends avoiding exposure to screens for 1 hour before going to bed. Using devices past bedtime, especially for violent video games or shows, can interfere with sleep. Studies also suggest the blue light given off by screens might also make it difficult to sleep.
Exercise. Putting down the device or stepping away from the computer or TV can help avoid eye and vision problems from too much screen time. The AAP recommends children age 6 years and older get at 60 minutes of physical activity each day. Active play is the best exercise for young children. Outside play can also be a great “workout” for children’s vision—giving them a chance to focus at different distances and getting exposure to natural sunlight.
Take frequent breaks. Children frequently get so absorbed in what they’re doing that they don’t notice symptoms of eye strain. Remind them to take breaks. The American Optometric Association recommends the 20/20/20 rule: look away from the screen every 20 minutes, focus on an object at least 20 feet away, for at least 20 seconds. In addition, children should walk away from the screen for at least 10 minutes every hour. A simple timer can help your child remember, and there are even software programs can help by turning off the screen in regular intervals.
Remember to blink. Research published in The New England Journal of Medicine says staring at a computer can cut blinking rates by half and cause dry eyes. Encourage your child to try to blink extra, especially when they take breaks. Your pediatrician or eye doctor may recommend moisturizing eye drops or a room humidifier if your child continues to be bothered by dry eyes.
Screen positioning. Make sure the screen on your child’s desktop or laptop computer is slightly below eye level. Looking up at a screen opens eyes wider and dries them out quicker. Some experts suggest positioning device screens based on the 1/2/10 rule: mobile phones ideally at one foot, desktop devices and laptops at two feet, and roughly 10 feet for TV screens (depending on how big the screen is). Adjusting the font size—especially on smaller screens—so it’s twice as big as your child can comfortably read may also help reduce eye fatigue.
Spotlight on lighting. To cut down on glare and eye fatigue, consider the level of lighting in a room when using a computer or other screen. Ideally, it should be roughly half what it would be for other activities such as writing on paper or working on crafts. Try to position computers so that light from uncovered windows, lamps and overhead light fixtures aren’t shining directly on screens. Decrease the brightness of the screen to a more comfortable level for viewing. Some optometrists recommend special computer glasses with orange lenses that may also help reduce glare. Children who wear prescription eyeglasses may have an anti-reflective coating added, as well. Computer monitor hoods or shades that attach to the screen may also be an option.
Get regular vision screenings. If your child is having blurry vision or similar eye problems, he or she may not speak up. That’s why regular vision screenings are important. The American Academy of Ophthalmology and the AAP recommend children have their eyes checked by a pediatrician at well-child visits beginning at birth. If a problem is found during one of these routine eye exams, your pediatrician may refer you to a pediatric ophthalmologist.
Does my child need blue-light filtering glasses?You may have heard about special glasses that help filter blue light given off from computers and other screens. Especially with more online learning during the pandemic, many wonder if these glasses should be on their child’s back-to-school supply list. Although there is no evidence that blue-light is harmful to the eyes, it can make it harder for children to fall asleep and contribute to eye strain, However, turning screens off an hour before bed, using the 20/20/20 rule and the other tips above can help prevent this—no purchase necessary!
Remember
Children, especially younger ones, will likely need help and reminders to use digital screen devices in an eye-friendly way.
If you have any questions about keeping your child’s eyes and vision healthy, talk with your pediatrician.
Droopy eyelid (ptosis) may appear as an enlarged or heavy upper lid; or, if it is very slight, it may be noticed only because the affected eye appears somewhat smaller than the other eye. Ptosis usually involves only one eyelid, but both may be affected. Your baby may be born with a ptosis, or it may develop later. The ptosis may be partial, causing your baby’s eyes to appear slightly asymmetrical; or it may be total, causing the affected lid to cover the eye completely. If the ptotic eyelid covers the entire pupillary opening of your child’s eye, or if the weight of the lid causes the cornea to assume an irregular shape (astigmatism), it will threaten normal vision development and must be corrected as early as possible. If vision is not threatened, surgical intervention, if necessary, is usually delayed until the child is four or five years of age or older, when the eyelid and surrounding tissue are more fully developed and a better cosmetic result can be obtained.
Most birthmarksand growths involving the eyelids of the newborn or young child are benign; however, because they may increase in size during the first year of life, they sometimes cause parents to become concerned. Most of these birthmarks and growths are not serious and will not affect your child’s vision. Many decrease in size after the first year of life and eventually disappear entirely without treatment. However, any irregularity should be brought to the attention of your child’s pediatrician so that it can be evaluated and monitored.
Some children will develop lumps and bumps on their lids that can impair development of good eyesight. In particular, a blood vessel tumor called a capillary or strawberry hemangioma can start out as a small swelling, and rapidly enlarge. They will enlarge over the first year of life, and then start to spontaneously resolve over the next few years of life. If they become large enough, they can interfere with your baby’s development of good vision in the affected eye and will need to be treated. Because of their potential to cause vision problems, any child who starts to show any lumps or bumps around either eye should be examined by an ophthalmologist.
A child might also be born with a flat, purple colored lesion on their face called a port wine stain, because of its resemblance to a dark red wine. If this birthmark involves the eye, especially the upper lid, the child may be at risk for development of glaucoma (a condition where pressure increases inside the eyeball) or amblyopia (a weak eye muscle). Any child born with this birthmark needs to be examined by an ophthalmologist shortly after birth.
Small dark moles, called nevi,on the eyelids or on the white part of the eye itself rarely cause any problems or need to be removed. Once they have been evaluated by your pediatrician, these marks should cause concern only if they change in size, shape, or color.
Small, firm, flesh-colored bulges on your child’s eyelids or underneath the eyebrows are usually dermoid cysts.These are noncancerous tumors that usually are present from birth. Dermoids will not become cancerous if not removed; however, because they tend to increase in size during puberty, their removal during preschool years is preferred in most cases.
Two other eyelid problems—chalaziaand hordeolaor sties—are common, but not serious. A chalazion is a cyst resulting from a blockage of an oil gland. A sty, or hordeolum, is a bacterial infection of the cells surrounding the sweat glands or hair follicles on the edge of the lid. Call your pediatrician regarding treatment of these conditions. He probably will tell you to apply warm compresses directly to the eyelid for twenty or thirty minutes three or four times a day until the chalazion or sty clears. The doctor may want to examine your child before prescribing additional treatment, such as an antibiotic ointment or drops.
Once your child has had a sty or chalazion, she may be more likely to get them again. When chalazia occur repeatedly, it’s sometimes necessary to perform lid scrubs to reduce the bacterial colonization of the eyelids and open the oil gland pores.
Impetigois a very contagious bacterial infection that may occur on the eyelid. Your pediatrician will advise you on how to remove the crust from the lid and then prescribe an eye ointment and oral antibiotics.
There are many different eye conditions and diseases that can affect a child’s vision. If your pediatrician suspects an eye condition or if your child fails a vision screening, the doctor can refer you to a pediatric ophthalmologist for further evaluation and diagnosis.
Early detection and treatment is so important to avoid lifelong visual impairments. Below, see some of the more common eye disorders and eye diseases and how they may be treated.
Condition
Description
Treatment
Astigmatism
An irregularly shaped cornea that can cause blurred vision.
Glasses if it causes blurred vision.
Blocked Tear Duct
In babies with this condition, also called nasolacrimal duct obstruction, the eyes overflow with tears and collect mucus.
Gentle massage of the tear duct can help relieve the blockage. If that doesn’t work, a tear duct-probing procedure or surgery may be needed.
Cataract
A clouding of the lens of the eye. About 3 out of 10,000 children have a cataract.
Most cataracts must be surgically removed. Cataracts in babies and children are rare and usually not related to cataracts in adults.
Chalazion
A firm, painless bump on the eyelid due to a blocked oil gland.
May resolve on its own or be treated with eye drops or warm compresses. In some cases, minor surgery may be needed.
Droopy eyelids (ptosis)
When the eyelids are not as open as they should be. This is caused by weakness in the muscle that opens the eyelid.
If severe, it can cause poor vision development (amblyopia) and needed eyelid surgery.
Falsely misaligned eyes (pseudostrabismus)
Caused by a wide nasal bridge or extra folds of skin between the nose and eye. The eyes only appear cross-eyed.
None. The eyes should be monitored to be sure they remain healthy.
Farsightedness (hypertopia)
Difficulty seeing close objects. A small degree of farsightedness is normal in babies and children.
If it becomes severe or causes the eyes to cross, glasses are needed.
Glaucoma
A condition in which the pressure inside the eye is too high. Warning signs are extreme sensitivity to light, tearing, persistent pain, an enlarged eye, cloudy cornea and lid spasm.
Glaucoma in childhood usually needs surgery. If left untreated, glaucoma can cause blindness.
Lazy eye (amblyopia)
Reduced vision from lack of use in an otherwise normal eye. It’s often caused by poor focusing or misaligned eyes.
Applying a patch or special eye drops to the “good” eye. Other treatments commonly include glasses or eye muscle surgery for misaligned eyes.
Misaligned eyes (strabismus)
When one eye turns inward, upward, downward or outward. This is caused by eye muscles that do not work well together.
Glasses, patches or surgery, depending on the cause for the misalignment.
Nearsightedness (myopia)
Difficulty seeing faraway objects. Nearsightedness is very rare in babies but becomes more common in school-aged children.
Glasses are used to correct blurred distance vision. Once nearsighted, children do not usually outgrow the condition. Contacts may be worn when old enough.
Pinkeye (conjunctivitis)
A reddening of the white part of the eye, usually due to infections, allergies or irritation. Signs include tearing, discharge and feeling that there’s something in the eye.
Depending on its cause, pinkeye is often treated with eye drops or ointment. Frequent hand washing can limit the spread of eye infections to other family members and classmates.
Scratched cornea (corneal abrasion)
A scratch on the front surface of the eye (the cornea). It can be very painful. The eyes usually tear and are also sensitive to the light.
Antibiotic drops or ointment to promote healing and prevent infection.
Sty (hordeolum)
A painful red bump on the eyelid due to an infected oil or sweat gland.
Warm compresses and antibiotic drops or ointment.
Swollen eyelids (blepharitis)
An inflammation in the oily glands of the eyelid. This usually results in swollen eyelids and crusting of the eyelashes.
Warm compresses and washing the eyelids with baby shampoo. Antibiotics may be needed if there’s an infection.
If the white of your child’s eye and the inside of his lower lid become red, he probably has a condition called conjunctivitis. Also known as pinkeye, this inflammation, which can be painful and itchy, usually signals an infection, but may be due to other causes, such as an irritation, an allergic reaction, or (rarely) a more serious condition. It’s often accompanied by tearing and discharge, which is the body’s way of trying to heal or remedy the situation.
If your child has a red eye, he needs to see the pediatrician as soon as possible. Eye infections typically last seven to ten days. The doctor will make the diagnosis and prescribe necessary medication if it is indicated. Never put previously opened medication or someone else’s eye medication into your child’s eye. It could cause serious damage.
In a newborn baby:
Serious eye infections may result from exposure to bacteria during passage through the birth canal—which is why all infants are treated with antibiotic eye ointment or drops in the delivery room. Such infections must be treated early to prevent serious complications.
Eye infections that occur after the newborn period:
These infections may be unsightly, because of the redness of the eye and the yellow discharge that usually accompanies them, and they may make your child uncomfortable, but they are rarely serious. Several different viruses, or bacteria, may cause them. If your pediatrician feels the problem is caused by bacteria, antibiotic eye drops are the usual treatment. Conjunctivitis caused by viruses should not be treated with antibiotics.
Eye infections are very contagious!
Except to administer drops or ointment, you should avoid direct contact with your child’s eyes or drainage from them until the medication has been used for several days and there is evidence of clearing of the redness. Carefully wash your hands before and after touching the area around the infected eye.
