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Tips for Spotting Eye Issues in Children

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Tips for Spotting Eye Issues in Children

Jan 18, 2021

Newborns can’t always control their developing eyes and sometimes go cross-eyed. But if your child is older than two months and you notice her or his eyes looking in different directions, something else might be going on. Pediatrician Dr. Cindy Gellner describes how to tell if your child’s eyes are developing in a healthy way.

Episode Transcript

Your child's eyes, when do you think they need glasses? When do you think something's wrong? Is this something you can pick up or something your pediatrician needs to pick up? Eye problems, we are going to discuss them today on The Scope.

When Should Your Child Start Having Vision Exams

So when do you start worrying about kids: their eyes, glasses, things like that? The good news is that for most kids, they don't start needing to wear glasses until they are about elementary school age. And you notice they are squinting when trying to do their school work or they have to get moved up to the front of the classroom because they can't really see that well, or complaining of really bad headaches after reading. That's another sign that your child might need glasses.

We actually start vision exams at three and your child should have a vision exam by your pediatrician every year at a well visit starting at age three.

They have different eye charts. You can do letters or you can do ones that just have pictures and the kids can tell us what pictures they are until they are able to learn their letters.

But what about littler kids? What do we start looking for in littler kids when we start shining those lights in their eyes during exams? Well, we are looking for different things in terms of making sure that their eye balls are focusing properly.

So one thing that a lot of people start asking about is, "My newborn baby looks cross-eyed." Well, your newborn baby can't focus their eyes very well and they don't have good control over their eye muscles until they get about two months old. After that, you should be able to notice your child is able to move their eyes in the same directions.

What if your child can't? What if one eyeball is looking down or up or to the left or to the right and the other eyeball's looking forward? That's different.

Strabismus in Young Children

Strabismus is the fancy name for that. That is where your child's eyes point in different directions. One is pointed straight ahead, the other is pointed in a different direction. Sometimes you get what's called "walleyed" where one or more of the eyes turn outwards towards your child's ears. And then you got cross-eyes, which means they are looking towards your nose.

But both of them are forms of strabismus. Strabismus happens when the six muscles that work together to move your child's eyes don't work together. It can be caused by a problem with the muscles, with the nerves, or problem in your child's brain, but most people with strabismus are born with it and it does tend to run in families.

So when your child's eyes don't tend to work together to look at an object, the brain pays attention to the image from only one eye and ignores the image from the other eye. So what you need to do is to watch: does this happen more when your child is tired or sick? That's usually when we pick this up. When you can see they're getting tired and one of the eyes is just kind of wandering away, it's time to mention that to your doctor.

Methods for Testing and Treating Strabismus

A good thing is we don't normally see your children when they are tired and tiredness is usually when it happens. Take a picture. That's great because you'll often notice to the red eye reflex, you know when you take a picture and you've got to use that red-eye reduction thing on Photoshop because their child looks like they've got bright red eyes? Okay, those bright red eyes--that's actually good. That's looking at the back of the eye. It's called the retina, and you're looking at all the blood vessels in the back.
We like seeing that. That's what we are looking for when we use that ophthalmoscope and we look in your child's eyes. We are looking for that red reflex. If they are not the same, then you might have a problem with how the eyeball muscles are working.

So that's what we are looking for and if we find it, what do we need to do? Well we usually refer to an eye doctor because they will be able to help with actually managing this. They usually start with patching, or sometimes using eye drops, depending on the age of the child to force your child's brain to pay attention to the weak eye. And then the weak eye works harder and develops more normally.
In severe cases, your child may need surgery on their eye muscles to help re-position where the eyeballs go. They might need glasses, especially if your child has farsightedness from the eyeballs not being in the right direction. The glasses often do help this when started early. And eye exercises.

The eye doctors can tell you about some different eye exercises and what that does is that also helps with helping the eyeballs focus at the right spot. Unfortunately, a lot of the forms of strabismus do not improve with eye exercises, but it's always something that they try.

The Differences between Strabismus and Amblyopia

What's the other kind of thing that we hear most with the eye balls not focusing right? Lazy eye. We hear this a lot too. Lazy eye, the fancy name is amblyopia, and that's also where the eyes just don't go in the right spot.
You see again, you'll notice both eyes normally straight but the one just sort of slightly drifts a little bit too. And the difference is in most kids when you find this early, you can still have normal vision in both eyes. After age eight, the treatment is less successful, so you want to try to watch for it early.

It works the same way in the fact that the brain is getting images from the good eye and not the bad eye and this is more due to the eye ball shape and also the eyeball muscles. So there's more things going on to try to cause amblyopia.
Babies don't often show any symptoms of lazy eye. They may have trouble following objects with their eyes or continue to have the crossed eyes after two months old. Toddlers, they may favor one eye. And if you cover the eye that's really strong, then they kind of fuss because they can't see as well.

Older kids, they'll complain that their eyes hurt, the headaches. The bottom line is, both of them you'll notice the wandering eye with both amblyopia and strabismus. And sometimes it's even hard for pediatricians to pick up which one is which and that's why an eye doctor is going to be your best bet, because they're going to help figure out which one is which.
Again, just like the strabismus, the treatment for lazy eye starts with patching, to make the weaker eye do a little harder work. And then if the eye patches don't help, then you move to glasses.


Helping Your Child Love Their Glasses

So you've tried the patching and the eye doctor says it's time for glasses. So how do you help your child adjust to wearing glasses? Well, that can be hard.
You all remember kids who wore glasses, they're called four-eyes and all sorts of things like that and it's really not very nice. So kids will sometimes "forget" to put them on, "forget" to take them to school because they don't like being teased, they don't want to wear them, they're uncomfortable, they think they look ugly, they can't play sports in their glasses.

You know, it's hard to transition to glasses, but if you help your child understand why they need to wear glasses, they'll be more likely to wear them. Make sure that your school-age kid understands wearing their glasses will help them read. If they get headaches from their vision problems, it will decrease their headaches, and actually a lot of people wear glasses, so it's not like they are alone. Point out people who do wear their glasses, because then you'll be able to say, "See, look at that person wearing their glasses, look how good they can see."
If your child continues to get teased by other students because they are coming to school with glasses now, talk to your child's teacher about it. They often are used to having to deal with situations like this and they can help your child.

Another thing, have your child involved in picking out what kind of frames they like. Have them pick their favorite color, what matches with their wardrobe, some of them have characters on them that they like. Make it something so it's more of a fashion statement than a medical device.
Make sure that the glasses fit properly. Any place that you get your glasses from will have someone who is qualified to make sure that the glasses fit properly around the ears and around the nose piece. And you can usually have them re- adjust them whenever you need them to at no charge.

Picking Safe Glasses

Again, you should also remember to keep safety in mind. Kids will break their glasses, I will guarantee you that one, so make sure that their lenses, instead of being made with glass, are made with something called polycarbonate. It's a safe material. It's lighter than other lenses and if your child plays sports, you can also get sports goggles made with the same material that will help protect them against eye injury.
Another big thing is to make sure you don't nag. Don't nag at your child if you see them taking their glasses off. Have your child remember to put them on and when you see your child wearing their glasses, compliment them. Just say, "Oh I see that you are wearing your glasses, thanks that really helps me to know that you can see well."

Make your child's glasses a part of the daily routine. Put them on when they are getting dressed, put them on when they are brushing their teeth, make it so that it is part of their daily habits, and pretty soon they might realize that they don't even remember putting them on because it becomes such a habit.


And make sure that your child is getting regular appointments with the eye doctor to make sure their prescriptions are up to date. Again, we check their eyes at every well visit, so we do every year and if we notice that their vision is off with their glasses on, then we can even say it's time, even though you saw the eye doctor six months ago, something has changed with your child's eyes and you should go ahead and get your eye doctor to check the prescription again and make sure it's the right one or that they don't need a different prescription.

So the bottom line is if you think you notice something wrong with how a child is looking at things, go ahead, have your pediatrician take a look at them. We can check out the eyes. We can do a vision exam, see how they are looking, if they are old enough to do a vision exam. The main thing is that for children, their eyes are still developing, so the sooner you get an eye problem identified and corrected, the better it will be for their overall vision health.

updated: January 18, 2021
originally published: July 15, 2014