We realize that you may have questions about your child’s vision or pediatric eye problems, so we’ve provided resources and extra information below that have been medically reviewed by our Nemours experts at KidsHealth.org or approved by our Nemours ophthalmologists who consult regularly with national organizations devoted to children’s visual health.
Get More Information on Pediatric Eye Problems
Find more details on some of the pediatric eye problems treated at Nemours.
What is amblyopia or "lazy eye"?
Amblyopia, (am-blee-o-pee-uh) or "lazy eye” is one of the most common vision problems in children and is responsible for more vision loss in children than all other causes.
With amblyopia, vision is decreased when one or both eyes send a blurry image to the brain causing the brain to “learn” to see blurry with one eye and to “turn off” that eye in order to favor the other eye.
What are the causes of amblyopia?
Underlying causes for decreased vision in a child’s eye may include refractive errors such as astigmatism or farsightedness, strabismus (a misaligned eye) or a cataract (cloudiness of the lens).
Amblyopia can be difficult for parents, and even pediatricians, to spot. A child’s eye and eye structure may look fine, and the one “good eye” may have normal vision, so the only way to detect the amblyopia is with a vision test.
What are treatment options for amblyopia?
Amblyopia treatment may involve prescription glasses, occlusion therapy (covering one eye with a patch) or blurring the vision in one eye with atropine drops.
Blocking or blurring the vision in the “good eye” with a patch or with eye drops (which don’t sting) helps stimulate the brain to learn to use the other the eye. It usually takes a few weeks for your child’s vision to improve and the best results may be achieved over several months depending on the child’s age and level of vision. Maintenance treatment until 9-10 years of age may also be necessary.
Surgery may be used to treat strabismus (only one cause of amblyopia), but it is often not performed before treating the amblyopia with patches, glasses, and/or atropine.
What are blocked tear ducts?
Blocked tear ducts, also known by the medical term nasolacrimal duct obstructions, are very common in children and infants. Children may be born with a tear-duct system that hasn’t fully developed and this can lead to blockage, excessive tearing, and infection. Many cases of blocked tear ducts clear by themselves during the first year of life.
What are symptoms of blocked tear ducts?
Symptoms of a blockage include an overflow of tears, as well as red, swollen eyelids and possibly a yellowish-green discharge from a build-up of bacteria in the tears.
How are blocked tear ducts diagnosed and treated?
Our Nemours pediatric ophthalmologists will perform certain tests in the office to confirm the diagnosis of blocked tear ducts.
If the tear duct obstruction does not resolve by itself, your Nemours physician may recommend one or more of the following treatments:
- tear duct massage
- topical antibiotic eye drops
- tear duct probing
- balloon tear duct dilation
- tear duct intubation
What are pediatric cataracts?
A pediatric or childhood cataract refers to any cloudiness or opacity (whiteness) in the normally clear lens of a child’s eye. A cataract can affect a very small part of the lens or involve the entire lens. Infantile and childhood cataracts occur in about three per 10,000 children.
What causes pediatric cataracts?
Cataracts in babies may be caused by abnormal development of the lens before birth. By interfering with the light ray path to the retina (back part of the eye), cataracts in children can cause abnormal vision development and may result in permanent loss of vision.
How are pediatric cataracts treated?
Cataracts that are small and/or off-center in the lens may not need to be removed because your child’s vision can develop normally, even with the cataract. Larger cataracts or those causing major visual loss should be removed as soon as it is safely possible to do so.
Nemours pediatric ophthalmologists are experienced eye surgeons and are highly skilled in performing cataract procedures in infants and children. Following pediatric cataract removal surgery, our team will work to restore and improve your child’s eye focus through the use of intraocular lenses placed during the surgery, or contact lenses and glasses designed specifically to help focus light rays and correct vision in infants and young children. Eye patching is also required in many cases of children with cataracts.
What is pediatric glaucoma?
Pediatric glaucoma is a rare condition characterized by damage to the optic nerve and usually caused by elevated internal eye pressure (intraocular pressure). The optic nerve is responsible for sending vision from the eye to the brain.
Infantile or congenital glaucoma may be present from birth and is caused by problems in the development of the eye’s drainage system. The elevation in intraocular pressure that results can damage the optic nerve and cause severe vision loss. Juvenile glaucoma occurs in children older than age three and is caused by other problems that can lead to increased eye pressure.
What are the symptoms of pediatric glaucoma?
Some of the most common symptoms of childhood glaucoma that our Nemours pediatric ophthalmologists look for are:
- excessive tearing
- sensitivity to light
- a dull-looking iris caused by clouding of the cornea
How is pediatric glaucoma diagnosed and treated?
Although parts of the examination for glaucoma can be done in our office, diagnosing babies with glaucoma usually requires an examination under anesthesia in order to evaluate the intraocular pressure and other aspects of the condition. For older children with glaucoma, the complete examination may be done in our office.
Taking care of pediatric glaucoma may require both surgical and medical treatment. As with most childhood eye conditions, the earlier the diagnosis and treatment, the more promising the outcome.
What is ptosis or "droopy eyelid"?
Ptosis ("toe-sis") or droopy eyelid may involve one or both upper eyelids. Sometimes an eyelid can be so droopy that it blocks vision or causes a child to hold his or her head in an abnormal position in order to see well. Ptosis may be present at birth (congenital) or show up later in life (acquired).
What are some of the causes of ptosis?
One of the most common causes of droopy eyelids is poor development of the muscle in the upper eyelid, but ptosis of the eyelid can also be caused by neurological conditions that affect the nerves and/or muscles of the eyelid, or rarely by an eyelid mass.
How is ptosis treated?
Depending upon how the drooping eyelid is affecting your child’s vision and learning, Nemours ophthalmologists may recommend treatment for ptosis, possibly including prescription glasses or surgery. The American Association of Pediatric Ophthalmology and Strabismus (AAPOS) has excellent information about ptosis.
What is retinoblastoma?
Retinoblastoma is a cancerous tumor that grows in the retina, the light-sensing part of the eye that sends the images we see to the brain. This childhood cancer, which occurs most often in children under five, can be present in one or both eyes.
How is retinoblastoma diagnosed?
In diagnosing retinoblastoma, our pediatric ophthalmologist will examine the retina by dilating the eye, and also order imaging tests, like an ultrasound of the eye, a computerized tomography (CT) scan, or magnetic resonance imaging (MRI), as well as blood tests.
How is retinoblastoma treated?
If tests reveal that a retinoblastoma might be present, our doctors will work together with Nemours pediatric oncologists (cancer doctors) to look for any other signs of the cancer in the body, and determine the disease stage and best course of treatment.
At Nemours, we know that the discovery of a childhood cancer like retinoblastoma is overwhelming. We promise to give you and your child the resources you need to make informed decisions, to answer all your questions, and to help you cope every step of the way.
You should also know that majority of children treated for retinoblastoma go on to lead normal lives ― and more than 80% of them will retain 20/20 vision.
What is retinopathy of prematurity?
Premature babies can face a number of health problems and one of the more common is called retinopathy of prematurity (ROP). ROP causes abnormal blood vessels to grow in the retina, the layer of nerve tissue in the eye that enables us to see.
How is retinopathy of prematurity diagnosed?
Generally, the earlier a baby is born, the greater the risk of ROP. Because ROP has no signs or symptoms, the only way to detect it is through an eye examination by a pediatric ophthalmologist.
Nemours Advances the Screening and Treatment of ROP
In Florida, eye doctors at Nemours Children's Specialty Care, Jacksonville, have developed a single-use sterile exam kit for performing retinopathy exams. This kit, now used in 31 state and 60 Neonatal Intensive Care Units across the country, makes ROP testing safer and lessens the chance of infection.
And in Delaware, team members in the Division of Ophthalmology at Nemours/Alfred I. duPont Hospital for Children have published medical journal articles reviewing new guidelines on ROP screening and treatment, recent advances in therapies, and effective laser treatment options.
How is retinopathy of prematurity treated?
The results of your baby’s first eye exam will determine the need for and frequency of follow-up examinations. ROP is usually diagnosed according to stages that describe how far the blood vessels have grown into the retina.
Some cases of ROP are mild and correct themselves, but others require surgery to prevent vision reduction or blindness. Surgery involves using a laser or other means to stop the growth of the abnormal blood vessels, the goal being to prevent the vessels from pulling on and detaching the retina.
Because there are varying degrees of ROP, the surgical approach used can differ for each case. We will discuss your baby’s condition with you and which method we recommend. The most frequently used method of ROP surgery is:
- laser surgery, in which small laser beams are used to scar the peripheral retina (also called laser therapy or photocoagulation). This procedure lasts about 30 to 45 minutes for each eye.
For more-advanced cases of ROP where retinal detachment has occurred, these methods are used:
- scleral buckling, which involves placing a flexible band, usually made of silicone, around the circumference of the eye.
- vitrectomy, a complex surgery that involves replacing the vitreous, or the clear gel in the center of the eye, with a saline (salt) solution.
Babies who’ve required any kind of treatment for ROP will need regular, long-term follow-up care. You can count on us to be with you every step of the way, and, if necessary, to provide recommendations for any vision-related services your child may need in the years to come.
Strabismus ("struh-BIZ-mus") is a misalignment of the eyes in which both eyes are oriented in different directions.
What causes strabismus?
Sometimes called “crossed-eyes” or “walleye,” strabismus often begins when a child is very young and is usually the result of a problem with neuromuscular, including brain, control of eye movement, or less often, the actual eye muscle itself.
How is strabismus treated?
If your child has strabismus, your Nemours pediatric ophthalmologist may recommend glasses, patching (wearing an eye patch over the good eye in order to strengthen the weaker eye), or in some cases, surgery to straighten the eyes. The important thing is to begin treatment as soon as possible to help improve your child’s vision.
From Nemours' KidsHealth
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Amblyopia is a problem in the way the brain interprets visual images from one or both eyes. This makes it harder for kids to do things like read a blackboard from a distance or catch a ball. As a result, many kids with amblyopia report having trouble with schoolwork or participating in gym class.
Amblyopia can go undetected for months or even years because parents chalk up poor grades or athletic ability to a child not being academically or athletically gifted. But sometimes the solution is as easy as visiting the eye doctor.
Treatment for amblyopia can correct the way the brain processes visual images and, ultimately, strengthen vision. The earlier treatment starts, the better. Waiting or not getting a proper diagnosis for a child could lead to irreversible vision loss later.
From birth until about 6 years of age, vital connections are formed between a child's eyes and brain. Anything that blocks or blurs vision in one or both eyes may then inhibit or block the development of these connections. This can cause the brain to not fully recognize the images seen by one or both eyes.
When this happens, the brain begins to ignore or suppress the images seen by the otherwise healthy eye, and the eye becomes weaker, losing vision strength (acuity). This eye is then referred to as "amblyopic."
One of the most common causes of amblyopia is strabismus, or wandering of one or both eyes either inward (called esotropia), outward (called exotropia), up (hypertropia), or down (hypotropia).
When eyes are misaligned, the straight or straighter eye may become dominant. The vision strength (acuity) of the straight eye stays normal because the eye and its connection to the brain are working normally. The misaligned or weaker eye, though, does not focus properly and the brain suppresses or ignores its signal, eventually leading to amblyopia.
Not all kids with amblyopia will have crossed or wandering eyes — in fact many have eyes that are perfectly straight. If so, amblyopia is usually the result of an anatomical or structural problem that interferes with or blocks vision, such as a droopy eyelid or a cataract.
Another cause of amblyopia is severe far-sightedness (hyperopia), near-sightedness (myopia), or astigmatism (a form of blurry vision). These vision problems ("refractive errors") cause vision to be blurry, and it's these blurry images that are sent to the brain. Over time, the brain begins to ignore or suppress these unclear images, resulting in amblyopia in one or both eyes.
Another cause could be having different vision strengths in each eye — a condition known as anisometropia. When one eye sees more clearly than the other, the brain can ignore or suppress the vision of the blurry eye.
Genetics play a role, too. Amblyopia tends to run in families. It's also more common in children born prematurely or those affected by developmental delays.
Signs & Symptoms
Most children with amblyopia won't complain of vision problems. Over time, they become accustomed to having good vision in one eye and poor vision in the other.
It's usually a parent or teacher who notices that a child is struggling with a vision problem — whether it's noticing crossed eyes, frequent squinting, or tilting the head to see better. Some kids will demonstrate poor depth perception (stereopsis) and difficulty seeing in 3D.
Treatment for amblyopia involves forcing the brain to pay attention to the images of the amblyopic or weaker eye so that vision in that eye gets stronger. This is done through glasses, eye patches, eye drops, surgery, or a combination of these:
- Glasses. Glasses are prescribed when amblyopia is caused by severe refractive errors and/or anisometropia (when one eye sees more clearly than the other). Glasses help send clear, focused images to the brain, which will teach it to "switch on" the weaker eye. This allows the brain to use the eyes together and develop normal vision.
- Eye patches. In many cases, kids with amblyopia must wear an opaque eye patch over their stronger or unaffected eye. The patch is worn for 2-6 hours a day while the child is awake for several months or years, depending on the severity of the condition. There are two types of eye patches: the first type works like a band-aid and is placed directly over the eye. The second type, designed specifically for kids who wear glasses, is a cloth patch that fits securely over one lens.
For parents, enforcing the use of an eye patch might seem challenging. But kids usually adapt well after an initial adjustment period, and the patch simply becomes part of their day. In the meantime, distraction with a new or exciting toy, a trip to the park, or just playing outside can help kids forget they're wearing an eye patch.
- Atropine drops. Sometimes, despite parents' best efforts, some kids just refuse to wear their eye patch. In these cases, atropine drops may be used as an alternative to patches. Just as a patch blocks the vision in the unaffected or straight eye, atropine drops will temporarily blur out the vision in the strong eye, forcing the brain to recognize the images seen by the weaker eye.
- Surgery. If strabismus is the cause of a child's amblyopia and treatment with glasses, patches, or drops doesn't improve the alignment of the eyes, eye muscle surgery might be an option. Surgery also might be done if amblyopia is caused by a droopy eyelid or a cataract.
Surgery involves loosening or tightening the muscles that are causing the eye to wander. Although it is an invasive measure, surgery is considered safe and effective and usually does not require an overnight hospital stay.
Eye Exams Essential for Toddlers & Preschoolers
Kids reach visual maturity by about 8 years old; after that, vision problems can be harder to treat. The earlier amblyopia is diagnosed and treated, the better the chances to restore vision and avoid permanent vision loss.
Sometimes there are no apparent signs of a vision problem, so it's important for kids to undergo yearly vision screenings. These exams should begin in the toddler and preschool years so that problems are caught before a child reaches visual maturity.
Most vision screening exams are done at the pediatrician's office or at school by the school nurse. If problems are found, your child will be referred to a pediatric ophthalmologist for further evaluation and treatment.
If your child is due for a vision screening, call your doctor to schedule one./p>
Reviewed by: Jonathan H. Salvin, MD
Date reviewed: September 26, 2016