Eye Problems

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.

 
Amblyopia (Lazy Eye)

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.

 
Blocked Tear Ducts

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
 
Pediatric Cataracts

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. 

 
Pediatric Glaucoma

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.

 
Ptosis (Droopy Eyelid)

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.

 
Retinoblastoma (Eye Tumor)

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.

 
Retinopathy of Prematurity

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 (Crossed Eye)

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.

Your Child's Vision

Healthy eyes and vision are a critical part of kids' development. Their eyes should be examined regularly, as many vision problems and eye diseases can be detected and treated early.

Eye Doctors

Be sure to make vision care and eye checks a part of your child's routine medical care.

Different kinds of doctors offer eye care, and the names can be confusing:

  • Ophthalmologists are medical doctors who provide comprehensive eye care with medicine and surgery.
  • Pediatric ophthalmologists are doctors who have additional special training to treat kids' eye problems.
  • Optometrists provide services that may be similar to ophthalmologists, but they don't perform surgery. Some optometrists specialize in kids' eye problems.
  • Opticians fit and adjust eyeglasses.

Eye Exams

Routine medical exams for kids' vision include:

  • Newborns should be checked for general eye health by a pediatrician or family physician in the hospital nursery.
  • High-risk newborns (including premature infants), those with a family history of eye problems, and those with obvious eye irregularities should be examined by an eye doctor.
  • In the first year of life, all infants should be routinely screened for eye health during checkups with their pediatrician or family doctor.
  • Around age 3½, kids should have eye health screenings and visual acuity tests (tests that measure sharpness of vision) with their pediatrician or family doctor.
  • Around age 5, kids should have their vision and eye alignment checked by their pediatrician or family doctor. Those who fail either test should be examined by an eye doctor.
  • After age 5, routine screenings should be done at school and the primary doctor's office, and if symptoms such as squinting or frequent headaches occur. (Many times, a teacher will notice that a child isn't seeing well in class.)
  • Kids who wear prescription glasses or contacts should have annual checkups by an eye doctor to screen for vision changes.

Spotting Eye Problems

Signs that a child may have vision problems include:

  • constant eye rubbing
  • extreme light sensitivity
  • poor focusing
  • poor visual tracking (following an object)
  • abnormal alignment or movement of the eyes (after 6 months of age)
  • chronic redness of the eyes
  • chronic tearing of the eyes
  • a white pupil instead of black

In school-age children, other signs to watch for include:

  • being unable to see objects at a distance
  • having trouble reading the blackboard
  • squinting
  • difficulty reading
  • sitting too close to the TV

Watch your child for signs of poor vision or crossed eyes. If you notice any eye problems, have your child examined right away so that the problem doesn't become permanent. If caught early, eye conditions often can be corrected.

Common Eye Problems

Several eye conditions can affect kids. Most are detected by a vision screening using an acuity chart during the preschool years.

  • Amblyopia ("lazy eye") is poor vision in an eye that may appear to be normal. Two common causes are crossed eyes and a difference in the refractive error between the two eyes. If untreated, amblyopia can cause irreversible visual loss in the affected eye. (By then, the brain's "programming" will ignore signals from that eye.) Amblyopia is best treated as early as possible, ideally before a child is 8 years old.
  • Strabismus is a misalignment of the eyes; they may turn in, out, up, or down. If the same eye is chronically misaligned, amblyopia may also develop in that eye. With early detection, vision can be restored by patching the properly aligned eye, which forces the misaligned one to work. Surgery or specially designed glasses also may help the eyes to align.
  • Refractive errors mean that the shape of the eye doesn't refract (bend) light properly, so images appear blurred. Refractive errors also can cause amblyopia. Nearsightedness is the most common refractive error in school-age children; others include farsightedness and astigmatism:
    • Nearsightedness is poor distance vision (also called myopia), which is usually treated with glasses or contacts.
    • Farsightedness (also called hyperopia), which is usually treated with glasses or contacts.
    • Astigmatism is imperfect curvature of the front surface of the eye, which is usually treated with glasses if it causes blurred vision or discomfort.

Other eye conditions need immediate attention, such as retinopathy of prematurity (a disease that affects the eyes of premature babies) and those associated with a family history, including:

  • Retinoblastoma is a malignant tumor that usually appears in the first 3 years of life. The affected eye or eyes may have visual loss and whiteness in the pupil.
  • Infantile cataracts can occur in newborns. A cataract is a clouding of the eye's lens.
  • Congenital glaucoma in infants is a rare condition that may be inherited. It is the result of high pressure in the eye from incorrect or incomplete development of the eye drainage canals before birth and can be treated with medication and surgery.
  • Genetic or metabolic diseases of the eye, such as inherited disorders that make a child more likely to develop retinoblastoma or cataracts, may require kids to have eye exams at an early age and regular screenings.

Be sure to talk to your doctor if your child is at risk for any of these conditions.

Glasses and Contacts

Kids of all ages — even babies — can wear glasses and contacts.

Keep these tips in mind for kids who wear glasses:

  • Let kids pick their own frames.
  • Plastic frames are best for children younger than 2.
  • If older kids wear metal frames, make sure they have spring hinges, which are more durable.
  • An elastic strap attached to the glasses will help keep them in place for active toddlers.
  • Kids with severe eye problems may need special lenses called high-index lenses, which are thinner and lighter than plastic lenses.
  • Polycarbonate lenses are best for all kids, especially those who play sports. Polycarbonate is a tough, shatterproof, clear thermoplastic used to make thin, light lenses. However, although they're very impact-resistant, these lenses scratch more easily than plastic lenses.

Babies born with congenital cataracts may need to have the cataracts surgically removed during the first few weeks of life. Some wear contact lenses after cataract surgery.

Around age 10, kids may want to get contact lenses for cosmetic reasons or if they play sports. To wear contacts, a child will need to know how to insert and remove lenses properly, take them out as required, and clean them as recommended by the doctor. Contact lens problems are almost always due to poor habits and bad hygiene.

Your eye doctor can help you decide what type of vision correction is best for your child.

Reviewed by: Jonathan H. Salvin, MD
Date reviewed: September 26, 2016