Eye health is an essential aspect of a child’s development, with various disorders potentially affecting their vision quality and overall well-being. Early detection and treatment are crucial for preventing long-term visual impairment.
This guide aims to provide parents and caregivers with an understanding of common eye conditions seen in children. By recognizing the signs and knowing when to seek professional advice, you can play a pivotal role in safeguarding your child’s eye health.
Amblyopia (Lazy Eye)
Amblyopia, commonly referred to as “lazy eye,” affects approximately 2-3% of children. This condition leads to poor vision in one or both eyes due to the brain favoring one eye over the other. This preference can result from a variety of causes, including significant differences in the refractive power between the two eyes (anisometropia) or physical obstruction of an eye’s vision (such as cataract). Amblyopia is particularly concerning because the affected eye can suffer from developmental delays in visual acuity and processing if not treated promptly.
Amblyopia may be inherited or caused by an uncorrected refractive error (nearsightedness, farsightedness, or astigmatism). It typically results in a difference in the quality of the images recorded by each eye and sent to the brain. The brain picks the better of the two images and disregards the blurry or cloudy image. When the brain disregards that image, the visual system develops more slowly for the eye that sent the discarded image than for the eye that sent the “good” image.
Parents usually cannot recognize a lazy eye by looking at it because the problem is in the brain as well as in the eye. The brain blocks vision from the lazy eye because the brain is unable to use both eyes together. An infant with normal vision learns to use both eyes together (binocular vision), and the pictures from the left and right eye are then combined (fused) into one picture by the brain. Because binocular vision permits us to tell how far away an object is in relation to other objects (depth perception), children with amblyopia have poor depth perception.
Signs of Amblyopia
Most babies with amblyopia show no obvious signs of the condition, which must be diagnosed by an eye doctor. In some infants, however:
- The weak eye wanders inward or outward
- The weak eye tends to close
- The eyes do not appear to work together
- The child constantly squints or rubs one eye
- The child has poor depth perception (e.g., difficulty catching a ball, judging how far away an object is, playing sports, etc.)
If you notice any of these signs in your child, let your eye doctor know right away.
Treatments for Amblyopia
- Patch Therapy – A patch is worn over the good eye so the weak eye will be used and will develop.
- Glasses – Glasses can help correct poor vision in one or both eyes.
- Eye Surgery – Surgery may be required in rare cases in which the child is born with a clouded crystalline lens (a congenital cataract) or if amblyopia is combined with strabismus.
If amblyopia is not treated before 4 years of age, it can become permanent and untreatable. This is one reason why a visit to the eye doctor before 14 months of age is so important.
Strabismus is the medical term for “crossed” or “turned” eye. This condition occurs in 2-4% of children.
Strabismus involves a misalignment of the eyes, where one eye may turn in (esotropia), out (exotropia), or up or down (vertical deviation) independent from the other eye.
Strabismus can lead to amblyopia if the brain starts ignoring the image from the misaligned eye to avoid double vision.
Signs of Strabismus
Strabismus can be indicated by all of the signs of amblyopia plus a constant or occasional turning of the eyes or tilting of the head.
- Consistent or intermittent eye-turning
- Difficulty focusing on objects or tracking movement
- Squinting or closing one eye in bright sunlight
- Head tilting or turning to look at objects
Treatments for Strabismus
When vision is normal, the images sent by each eye to the brain are fused so the brain receives one combined image. Strabismus is treated by training both eyes to work together to send one fused image to the brain for interpretation. Treatments include:
- Patching the dominant eye to strengthen the weaker eye
- Prescription glasses, particularly if the strabismus is related to an uncorrected refractive error
- Surgery to correct the muscles’ alignment around the eye
- Vision therapy to improve coordination and eye teaming
Strabismus can occur at any age, but early treatment is essential to prevent Amblyopia and ensure optimal visual development.
Pseudostrabismus is a condition that may give the false appearance of strabismus (crossed eyes) in infants and young children. This perception is due to the structure of a baby’s face and eyes.
The bridge of the nose in infants is flat and wide, and the presence of epicanthal folds—excess skin covering the inner corners of the eyes—can make the eyes appear crossed even though they are properly aligned. This “false” cross-eyed appearance (pseudostrabismus) gradually vanishes as the baby’s nose bridge grows out and separates the eyes.
There is no need to worry about this condition as it is not really an eye disorder at all but only seems like one. However, if you become concerned about your baby’s vision for any reason, you should contact an eye doctor.
Blocked Tear Duct (Nasolacrimal Duct Obstruction)
A blocked tear duct, or nasolacrimal duct obstruction, is a common condition in infants, affecting about 6% of newborns. It occurs when the tear duct that drains tears from the eyes into the nose is blocked or has not fully opened (as it normally would after birth).
Signs of a Blocked Tear Duct
- Too much tearing (tears may even run down the cheeks)
- Watery or cloudy liquid draining from the eyes
- Crusty eyelashes upon awakening
- Constant rubbing of the eyes
Treatments for a Blocked Tear Duct
Most cases resolve without intervention by the time the child is 1 year old. However, gentle massage over the tear duct may encourage opening, and antibiotic eye drops or ointment may be applied if there is an infection.
Tear duct probing, a minor surgical procedure, may also be recommended if the blockage does not resolve by the age of 1 year.
Refractive errors are among the most common visual impairments in children. These errors occur when the shape of the eye prevents light from focusing directly on the retina. The main types of refractive errors are myopia (nearsightedness), hyperopia (farsightedness), and astigmatism.
- Myopia – This occurs in 4% of babies. A person is nearsighted when light rays are focused in front of the retina, rather than on the retina (specifically, light focuses toward the center of the eye rather than on the back of the eye). This can occur when the eye is too deep or the cornea or is too curved.
- Hyperopia – This occurs in 20% of babies. A person is farsighted when the light rays are focused behind the retina, rather than on the retina (specifically, light focuses behind the back of the eye rather than on it). This can happen when the eye is too shallow or the cornea is not curved enough. Most children can correct for farsightedness by flexing muscles inside their eyes. However, this constant flexing can cause headaches, eyestrain, and turning of the eye (strabismus).
- Astigmatism – This distortion occurs in 10% of babies. In this condition, the cornea is football-shaped rather than spherical and so reflects light in a distorted way. Two perpendicular sets of light rays focus at different points on or near the retina, so the image perceived by the brain is warped. Astigmatism can occur by itself or together with other refractive errors.
Prescription eyeglasses or contact lenses correct most refractive errors by adjusting how light rays focus on the retina. Note that regular eye exams are crucial for detecting refractive errors early, ensuring that children have the visual resources they need for academic and social development.
Less Common Eye Diseases in Children
While the above eye disorders are common and easy to correct if detected and treated early, eye diseases can be much more serious. Some of them can be treated and cured; others are incurable. Fortunately, these diseases are rare. Examples include:
- Retinopathy of Prematurity (ROP) – Babies born with a very low birth weight have an increased risk of developing abnormal peripheral retinal blood vessels that can cause the retina to come loose (detached retina), which can lead to blindness. Those babies who do not develop this problem in childhood still have an increased risk of retinal detachment later in life and should be seen regularly by an eye doctor to check for retinal detachments.
- Familial (Congenital) Blindness – If there is a history of blindness in the family of either the father or mother, parents may want to seek genetic counseling to help determine the risk of blindness in their children.
- Retinitis Pigmentosa – In this inherited disease, the retina in both eyes degenerates more and more over time (progressively). Children become unable to see at night (develop night blindness) and then lose their side (peripheral) vision. Tunnel vision (no side vision at all, as if in a tunnel) develops, followed by complete blindness.
- Leber’s Congenital Amaurosis – Blindness or near-blindness occurs in children with this disease because they lose nerve function in the retina of both eyes. A jerky movement of the eyes (nystagmus) may occur, as well as hypersensitivity to light and sunken eyes.
- Congenital Glaucoma – In this disease, high pressure of the fluid within the eye, together with an enlarged cornea, can cause nerve damage in newborns and infants. A common cause is malformation of some parts of the eye. Too much tearing (excessive watering) can be a warning sign of congenital glaucoma, but may also indicate less serious conditions, such as a blocked tear duct.
- Congenital Cataract – The crystalline lens, usually crystal clear at birth, is cloudy (opaque), so not enough light from the outside object reaches the retina. Vision is unclear or blocked. This disease can be cured by eye surgery, which is often necessary. Cataracts are common among the elderly.
- Dermoid Cysts – These are bumps usually found on the side of the head near the eyebrow. They are not cancer but are capsules containing skin tissue, hair, fat, or other body tissue. Dermoid cysts should be removed before the child begins to walk because they can break open during a fall and cause painful inflammation.
When Should My Child See an Eye Doctor?
Make an appointment with your child’s eye doctor if you notice any of the following in your child:
- Eyes flutter quickly from side to side (nystagmus)
- Eyes are watery all the time
- Eyes are always sensitive to light
- Eyes change in any way from their usual appearance
- White or yellow material appears in the pupil-the dark circle at the center of the iris (the colored area of the eye)
- Redness in either eye persists for several days
- Puss or crust appears in either eye
- Eyes looked crossed or “wall-eyed”
- The child constantly rubs his or her eyes
- The child often squints
- The child’s head is always tilted
- The child’s eyelids tend to droop
- One or both eyes seem to bulge
- One pupil is larger or smaller than the other (asymmetric pupil size)
- Baby does not make eye contact by 3 months of age
- Baby does not focus on and follow objects by 3 months of age
- Baby does not reach for objects by 6 months of age
- Baby covers or closes one eye
- One eye constantly or sometimes (intermittently) turns in, out, up, or down
From amblyopia and strabismus to less common yet severe conditions like retinopathy of prematurity and congenital glaucoma, the spectrum of eye disorders in children is broad.
This comprehensive overview underscores the importance of vigilance and proactive care in the early detection and treatment of eye disorders. Regular eye exams play a pivotal role in ensuring the healthy visual development of children, enabling timely intervention for conditions that, if left untreated, could lead to significant visual impairment or even blindness.
Remember that early intervention is key. Treatments such as patching for amblyopia, corrective surgery for strabismus, and glasses for refractive errors can correct or significantly improve visual problems, allowing children to reach their full potential in both academic and social settings. For the less common diseases, advances in medical science offer hope and increasingly effective treatment options, making early diagnosis more critical than ever.
As parents and caregivers, staying informed about the signs of eye disorders and ensuring regular eye check-ups can make a profound difference in a child’s life. Protecting and nurturing the gift of sight starts with understanding the challenges it may face and taking the steps necessary to maintain it through vigilant care and early intervention.