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
Trusted External Resources
Retinoblastoma is a cancerous tumor that grows in the retina, a layer of nerve tissue in the back of the eye that senses light and sends images to the brain.
A cancer of early childhood, retinoblastoma can affect developing fetuses in the womb, as well as newborns, babies, toddlers, and children up to 5 years old.
Many parents first see signs of retinoblastoma after noticing that their child's pupil (the dark circular area in the middle of the iris, the colored part of the eye) appears whitish in bright light. Some parents notice this effect in photographs. This happens because the pupil is translucent; so, retinal tumors that lie behind it may be noticeable.
While the majority of kids who develop retinoblastoma are born with it, most are not diagnosed at birth. The average age at diagnosis is between 12-18 months. When diagnosed, most kids are treated successfully and able to preserve their sight while maintaining good vision.
Like other forms of cancer, there is a genetic component to retinoblastoma. Kids who carry the genetic mutation (from either a parent or grandparent) usually get more than one tumor and are likely to develop the disease in both eyes. It also usually occurs at a younger age than kids without the mutation. This is called hereditary retinoblastoma.
The remainder of kids who develop the condition ― about 60% ― have no family history of the disease, and will usually get it in just one eye, with much less risk of developing retinoblastoma in the other eye. This is called unilateral retinoblastoma.
Kids with hereditary retinoblastoma in one eye could develop it later in the other eye, so regular checkups of the healthy eye should be done every 2-4 months for at least 28 months. After treatment is completed, follow-up exams should continue until a child is 5 years old.
Signs and Symptoms
A cloudy white pupil, which might look silvery white or yellow in bright light, is often the first sign of retinoblastoma. This is called leukocoria, or "cat's eye reflex." Other symptoms include:
- poorly aligned or "wandering" eye, known as strabismus
- reddish pupil, often with pain
- larger-than-normal pupil
- different-colored irises
- poor vision or decreased vision
Many of these symptoms are common side effects of other eye conditions, and don't necessarily mean a child has retinoblastoma. If your child has any of these symptoms, contact your doctor right away.
If retinoblastoma is suspected, the doctor will refer your child to a pediatric ophthalmologist, an eye doctor who will examine the retina by dilating the eye, sometimes under general anesthesia. He or she might 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.
If retinoblastoma is diagnosed, a pediatric oncologist (cancer doctor) will test to see if cancer is anywhere else in the child's body. He or she might perform blood tests, a spinal tap, or bone marrow biopsy. Live tissue samples, or biopsies, are rarely used to diagnose retinoblastoma because they can cause cancer cells to spread beyond the eye.
Once doctors have made a diagnosis of retinoblastoma, they use detailed staging systems ― including the St. Jude's Children's Research Hospital and Reese-Ellsworth staging systems ― to determine the extent of the cancer and whether it has spread to other parts of the body. Knowing the stage of the disease helps doctors decide how to treat it.
Staging categorizes retinoblastoma that is either intraocular (within the eye) or extraocular (outside the eye):
- Intraocular retinoblastoma is found in one or both eyes but does not extend beyond the eye.
- Extraocular retinoblastoma means the cancer has spread beyond the eye to tissues around the eye or to other parts of the body, such as the brain, spinal cord, bone marrow, or lymph nodes.
Under the St. Jude's staging system, intraocular retinoblastoma is classified into four stages:
- Stage I: the tumor is confined to the retina.
- Stage II: it is confined to the eyeball.
- Stage III: the cancer has spread to areas in the region around the eye.
- Stage IV: the cancer has spread through the optic nerve to the brain, or through the blood to soft tissues, bone, or lymph nodes.
The Reese-Ellsworth staging system (an older model of staging developed in the 1960s) classifies retinoblastoma from Group I (cases that are considered the most favorable for saving the eye) to Group V (these cases are unlikely to be controlled with chemotherapy or radiation).
Recently, the National Childhood Cancer Foundation's Children's Oncology Group adopted a more modern staging system that considers a child's disease severity and predicts what type of treatment will be most effective while still preserving the eye.
A pediatric ophthalmologist, pediatric oncologist, and radiation therapist will work together to treat a child with retinoblastoma. This team will individualize a plan for each patient based on the extent of the disease within the eye, whether it is in one or both eyes, and whether it has spread beyond the eye.
There are many forms of treatment for retinoblastoma ― all targeted at killing cancer cells. The following treatments, or a combination of treatments, may be recommended:
- Chemotherapy: Tumor-killing medications are given orally, through injection or intravenously (in a vein).
- Intra-arterial chemotherapy: In some cases, doctors are now injecting chemotherapy drugs into the blood vessel that feeds the eye to get the medication to the tumor more directly.
- External beam radiation: Beams of radiation are carefully focused onto the tumor to kill cancer cells.
- Brachytherapy: Radioactive material (little rods or pellets) is placed within the tumor to deliver beams of radiation to specific areas. This form of treatment minimizes the damage to surrounding healthy tissue.
- Radioactive plaques: A disk is implanted in the eye with a dose of radiation applied directly to the tumor site.
- Cryotherapy: Liquid nitrogen or argon gases ― two extremely cold substances ― are used to freeze and destroy diseased tissue.
- Transpupillary thermotherapy: Laser energy (through the use of infrared light) heats up cancer cells and surrounding blood vessels, which kills the cells.
- Photocoagulation: Laser energy is delivered to blood vessels surrounding the tumor, causing blood clots and depriving the cancer cells of nutrients.
- Enucleation: In severe cases of retinoblastoma, the entire eyeball is removed to prevent the spread of cancerous cells to other areas of the body.
During treatment for retinoblastoma, a child will need periodic examinations of the eyes (usually under anesthesia) to confirm the effectiveness of treatment.
Recurrent retinoblastoma is cancer that has returned or continues to grow after treatment. It may occur in the eye, tissues around the eye, or elsewhere in the body. Kids with hereditary cases of retinoblastoma are more likely to develop new tumors years after treatment. Therefore, close follow-up exams are important for these children, who also are at risk for other types of cancer later in life.
Caring for Your Child
Kids treated with chemotherapy might develop flu-like symptoms afterward. Some might feel nauseated, weak, or dizzy after treatment, or run a fever. Those who undergo radiation therapy might feel more tired than usual. Their skin can become reddened or dry in the area being treated. During this time, the doctor may prescribe pain relievers for your child.
Once treatment is over, kids can get back to normal activities if they feel well enough and if the doctor allows. Recovery periods vary, depending on the treatment and the child.
In many cases, kids with retinoblastoma retain the use of both eyes. Children with one eye removed have good vision and receive a prosthetic eye to replace the missing eye. Prosthetic eyes are of such good quality that most people can't tell which eye is natural and which is prosthetic.
The majority of children treated for retinoblastoma survive and go on to lead normal lives ― in fact, more than 80% of them will retain 20/20 vision. Still, because those with hereditary retinoblastoma have a significant risk of developing secondary cancers, frequent checkups are vital.
Reviewed by: Gregory C. Griffin, MD
Date reviewed: April 28, 2017