Your Child’s Eyes: What Parents Need to Know

Clear and comfortable vision is essential to a child’s ability to learn, develop, and play. Any number of issues with the eye health or vision can limit their ability to learn in school, participate in sports, and their ability to navigate the world around them.

The biggest issue is that children do not understand what clear and comfortable vision is suppose to feel like. They don’t volunteer these things or complain, which is why it is recommended children be evaluated with a comprehensive pediatric eye exam. As optometrists, we have the opportunity to limit progression of eye diseases and learning related vision issues that can become difficult to treat later down the road.

To help parents identify eye issues early on, here is a guide to some of the most common eye issues that affect pediatric patients.

Focusing Issues

What to Look For:
You may see your child squinting, straining, or closing one eye. Sometimes, you may notice them moving a book/computer/tablet/phone closer or further from their face in an effort to focus. In extreme cases, your child may appear excessively clumsy (e.g. bumping into walls or furniture). Less commonly, you may notice excessive blinking and rubbing of the eyes during focusing tasks.

What to Do:
It is recommended the child have a complete pediatric eye exam. This will include but is not limited to checking the refractive error (nearsightedness, farsightedness, and astigmatism), checking the focusing abilities and alignment of the eyes. These issues can be resolved with properly prescribed and balanced eyeglasses that can provide strain-free clear and comfortable vision.

Crossed Eyes

What to Look For:
Crossed eyes, or strabismus, is a condition in which both eyes do not look at the same place at the same time. Vision may be worse in the consistently deviating eye. Strabismus is sometimes accompanied by a head tilt and a tendency to close one eye.

If uncorrected, it may lead to a condition known as amblyopia, which is visually weaker eye. This sually occurs in children who have poor eye muscle control or are very farsighted.

What to Do:
The child needs to be evaluated for eye alignment and uncorrected refractive error (e.g. nearsightedness, farsightedness, etc) Small deviations may be corrected by glasses and/or vision therapy. Large deviations and constant deviations, especially if they result in double vision may be corrected with strabismus surgery.

Poor Eye Coordination

What to Look For:
Children with poor eye coordination might cover one eye, skip lines or lose their place while reading, avoid tasks that require close work and tire easily, and underperform in sports. Pay attention to your child's complaints of double vision, headaches, eye fatigue, and dizziness.

Eye coordination is the ability of both eyes to work together as a team. This is a complex task that involves many different abilities of the eyes: sharpness of vision, focusing ability, eye alignment. In addition, if your child’s eyes are improperly aligned, their depth perception may be affected. Children with poor eye muscle control often subconsciously exert extra effort to maintain proper alignment of the eyes.

What to Do:
Poor eye coordination is often successfully treated with eyeglasses and/or vision therapy. Sometimes, eye coordination will improve when underlying vision conditions like nearsightedness, farsightedness, or eye turns are corrected. It is recommended your child see an optometrist for a complete pediatric eye exam.

Pink eye / Conjunctivitis

What to Look For:
Pink/redness of the white part of the eyes, excessive tearing, discharge or crusting of the eyes, swollen eyelids, itching or burning sensation

Often called "pink eye," conjunctivitis is a common eye disease, especially in children. It may affect one or both eyes and some forms are highly contagious and can easily spread in schools and at home. A viral or bacterial infection can cause conjunctivitis. It can also develop due to an allergic reaction to air irritants such as pollen and smoke, and chlorine in swimming pools.

What to Do:
It is recommended you see your optometrist for a ocular health examination. The main goals will be to increase patient comfort, reduce or lessen the course of the infection or inflammation, and to prevent the spread of the infection in contagious forms of conjunctivitis.

Eye bump or Stye

What to Look For:
Look for a small bump along the upper or lower eyelids. It is common to have some redness and swelling around the bump.

These bumps are commonly known as styes and occur in two main forms.

• Inflammation of the small oil glands near the eyelashes results in a chalazion.
• Infection of one of the small oil glands near the eyelashes results in a hordeolum.

Depending on the type of lesion your child has can result in different treatments and healing time.

What to Do:
First of all, please do not attempt to squeeze or drain the stye yourself. This may inadvertently cause more damage and delay healing.

It is recommended the child see an optometrist for an ocular health exam which will include the following: External examination of the eye, lid structure, skin texture and eyelash appearance, lid margins using bright light and magnification.

Treatment may include lid and hand hygiene, warm compresses and gentle massage, antibiotic or steroid drops/ointments, or in severe cases, surgical removal of the lesion.

Drooping Upper Lid

What to Look For:
Look for a eyelid that droops down compared to the other eye. This is called a ptosis and it occurs in two forms. It may occur as a child is born (congenital ptosis) or later in life (acquired ptosis).

With congenital ptosis, you may notice the child’s head in the chin-up position as it allows them to see beneath the edge of the drooping upper lid. This may also be accompanied by contraction of the forehead muscles to further elevate the upper lid. This is a risk factor for developing a condition called amblyopia due to deprivation of proper vision to the young eye.

Acquired ptosis can be caused by neurological conditions that affect the nerves and muscles of the eye.

What to Do:
It is recommended the child have a complete pediatric eye exam. This will include but is not limited to checking the refractive error (nearsightedness, farsightedness, and astigmatism), eye turns, amblyopia of the eyes.

Color blindness

What to Look For:
There are several behaviors that result from abnormal color vision:

• Reading issues with colored pages or work sheets produced with color on color
• Using the wrong colors for an object – e.g. coloring tree leaves purple
• Problems in identifying red or green color pencils
• Low attention span when coloring in worksheets

Color vision deficiency is the inability to distinguish certain shades of color. The most common form of color deficiency is red-green color deficiency. These patients simply have a harder time differentiating between the two colors. Early detection of color deficiency is vital since many learning materials rely heavily on color perception or color coding.

What to Do:
Color deficiency can be diagnosed through a comprehensive pediatric eye examination. The child is shown a series of specially designed pictures composed of colored dots as seen below.

The patient is asked to look for numbers among the various colored dots. Individuals with normal color vision see a number, while those with a deficiency do not see it. There is no cure for inherited color deficiency.

Traditionally, your optometrist recommended special tinted eyeglasses to increase some patients ability to differentiate between colors. Today there are more advanced technologies such as the EnChroma lenses to increase color perception. You can read more about it here in Dr. Rosemary Melrose’s blog post here.

White Pupil

What to Look For:
Look for the appearance of a white pupil in a photograph taken with a flash. Keep in mind, a red reflex in the pupil is very common in normal eyes that are exposed to flash. Here is a picture guide for comparison: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194850/

This symptom is commonly a sign of retinoblastoma, the most common cancer involving the eye in young children. In the United States, this fast-growing cancer occurs in 1 in every 20,000 children, making it the 10th most common pediatric cancer.

What to Do:
It is highly recommended that the child have a dilated evaluation as soon as can be scheduled. Early detection of cancer can greatly reduce the severity of the illness and increase life expectancy.

If you suspect your child suffers from any of the above conditions, be sure to discuss them with your optometrist at your next appointment!

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References

“Glossary of Common Eye & Vision Conditions.” American Optometric Association, www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions.