Ophthalmology (Eye Care)

Many pediatric vision problems and eye diseases can be corrected if detected and treated early. When it comes to your child’s eyes, high-quality pediatric ophthalmology care is of the utmost importance. Pediatric eye problems are often very different from adult eye diseases and pediatric ophthalmologists (eye doctors who are also surgeons) are specially trained to manage and treat children's eye conditions.

 
Common Pediatric Eye Problems
  • amblyopia (lazy eye: with one weak eye and one strong one)
  • blocked tear ducts and defects (from the ducts not forming correctly)
  • glaucoma (damage to the optic nerve from a build-up of pressure in the eye)
  • cataract (a clouding of the eye’s lens)
  • eye injuries
  • ptosis (drooping eyelid)
  • refractive errors (nearsightedness, farsightedness, astigmatism)
  • retinopathy of prematurity (a disease that occurs in premature babies and causes abnormal blood vessels to grow in the retina)
  • retinoblastoma (a type of tumor involving the retina)
  • retinitis pigmentosa (RP) and other retinal dystrophies (diseases that cause damage to the retina
  • strabismus (wandering eye or “cross eyes”)
 
When to Schedule Pediatric Eye Exams

Children whose parents or siblings have eye conditions, such as strabismus or amblyopia, are more likely to have these eye disorders themselves, even if they don't have obvious signs of pediatric eye problems.

If your child has a certain medical condition such as diabetes, or a genetic disease like neurofibromatosis, it's a good idea to have regular pediatric eye exams with a pediatric ophthalmologist.

Early signs of serious pediatric eye problems, which should be evaluated by a doctor, include:

  • poor vision
  • eye pain
  • changes in the shape or size of an eye
  • crossed or wandering eyes
  • abnormal appearance of the pupil of one or both eyes

Genetic conditions can often cause eye problems in children. In these cases, our pediatric ophthalmologists collaborate with multi-disciplinary Nemours teams who treat children with genetic syndromes.

If your child is healthy and has no known risk factors for pediatric eye problems, then age-appropriate screening examinations with your primary care provider should be sufficient. If further evaluations are indicated, your child can be referred to our ophthalmologists as needed.

Strabismus

What Is Strabismus?

Strabismus is when eyes don't line up or when one or both eyes wander. The eyes may turn:

  • inward (called esotropia or "cross-eyed")
  • outward (exotropia)
  • up (hypertropia)
  • down (hypotropia)

When eyes don't line up together, the straight or straighter eye becomes dominant. The vision strength (acuity) of this eye stays normal because the eye and its connection to the brain are working as they should. The misaligned or weaker eye, though, doesn't focus as it should and its connection to the brain doesn't form correctly.

Sometimes, strabismus is very noticeable. Other times, it might only be noticed when a child is tired or looking at something very closely.

Strabismus usually can be fixed when found and treated early. If it's not treated, the brain eventually will ignore the visual images of the weaker eye. This change — called amblyopia, or "lazy eye" — can make vision blurry, cause double vision, and harm a child's depth perception (seeing in 3D). These problems can become permanent if they're not treated. 

How Do Kids Get It?

Kids can be born with strabismus or develop it in childhood. Often, it's caused by a problem with the muscles that move the eyes, and can run in families.

Most kids with strabismus are diagnosed when they're between 1 and 4 years old. Rarely, a child might develop strabismus after age 6. If this happens, it's important for the child to see a doctor right away to rule out other conditions.

What Are the Signs of Strabismus?

Most kids with strabismus don't complain of eye problems or notice changes in their vision. Usually, it's a family member, teacher, or health care provider who notices that the eyes are not straight.

Some kids may complain of double vision (seeing two objects when there's only one in view) or have trouble seeing things in general. These problems also can affect reading skills and classroom learning. Younger kids who aren't talking yet may squint a lot and turn or tilt their heads in an attempt to see more clearly.

If your child has any of these signs or symptoms, tell your health care provider. He or she can refer you to a pediatric ophthalmologist for care, if needed.

How Is Strabismus Diagnosed?

It's normal for a newborn's eyes to wander or cross occasionally during the first few months of life. But by the time a baby is 4 to 6 months old, the eyes usually straighten out. If one or both eyes continue to wander in, out, up, or down — even once in a while — it's probably due to strabismus.

How Is Strabismus Treated?

The earlier strabismus is treated, the better. This is because key connections between a child's eyes and brain form by about 8 years old.

Treatment for strabismus may include:

  • eyeglasses
  • eye patching
  • eye drops
  • eye muscle surgery

Sometimes, wearing eyeglasses is enough to straighten out the eyes. If not, a child might be given an eye patch to wear over the straight eye for a few hours a day. This patch makes the weaker eye do the "seeing" work. Over time, the muscles and vision in the weaker eye become stronger.

Getting a baby or toddler to accept wearing an eye patch can be a challenge. But most kids get used to the patch. Wearing it becomes part of their daily routine, like getting dressed in the morning.

Sometimes, though, kids refuse to wear an eye patch. Then, eye drops (called atropine drops) might be used instead. Just as eye patching blocks the vision in the straight eye, the atropine drops temporarily blur out vision in that eye. This makes the weaker eye work harder so that eye muscles and vision get stronger.

If eyeglasses, eye patching, and/or atropine drops can't fix a child's strabismus, eye muscle surgery might be needed. Surgery involves loosening or tightening the muscles that cause the eye to wander. Most kids can go home the same day of surgery.

Looking Ahead

Regular eye exams are the best way to detect strabismus. Early diagnosis and treatment better a child's chances of having straight eyes and developing good vision and depth perception. But older kids and teens (and even many adults with strabismus) can still benefit from treatment.

Also keep in mind the social aspect to strabismus. Aligned eyes are important for a healthy self-image in adults and kids.

Reviewed by: Jonathan H. Salvin, MD
Date reviewed: September 05, 2017