Common eye problems in children
Common eye problems in children
Key points to remember
- common eye problems include turned eyes (strabismus), small swelling of the eyelid (chalazion), lazy eye (amblyopia) and needing strong glasses at an early age (refractive error)
- see your family doctor if you are concerned about your baby's eyes
Strabismus may be known as turned eyes, crossed eyes, squint, or lazy eyes. Strabismus happens when the eyes point in different directions. When one eye is straight the other may point in, out, up or down. This may be noticeable all the time, or it may come and go. It may be present at birth or appear later. In babies and children with strabismus, the vision in the turned eye will not develop normally. Children do not outgrow strabismus. Treatment is most effective when started at an early age and may include glasses, patching, exercises, or surgery and is usually a combination of these.
Treatment is carried out by an ophthalmologist (eye specialist) and orthoptist (specialist in the assessment, diagnosis and treatment of certain eye problems).
The aims of strabismus treatment are:
- good vision in both eyes
- good appearance
- coordinated eyes (that is, depth perception)
Amblyopia happens when one eye becomes lazy because it is not receiving as clear a picture as the other eye. The most common causes of amblyopia are strabismus, refractive error (incorrect focusing power), ptosis (droopy eyelid) and cataract (clouding or opacity in the lens). If left untreated it can lead to very poor vision. Treatment for amblyopia is patching and/or glasses. Vision can often be improved when treatment is started at an early age.
Chalazion is a small swelling of the eyelid when there is a blockage in the glands of the upper or lower eyelid. There can be swelling and redness of the eyelid and sometimes there can be yellowy ooze. Your child can have many chalazia on their eyelid at any one time, and it can happen in one or both eyes.
Take your child to your family doctor who will suggest initial treatment. If there is no improvement after 3 to 4 months of treatment, you will need to see an ophthalmologist (eye specialist).
If the chalazia is so large it is covering the centre of your child's pupil (the black central part of the eye) it may affect your child's vision. Your family doctor will need to refer you to see an ophthalmologist.
Blocked tear duct (epiphora)
Epiphora or watering eyes may happen if the duct that drains tears from the eye to the nose becomes blocked. In many cases, blocked tear ducts get better by themselves, but if this doesn’t happen within 12 months, or frequent infection becomes a problem, a small surgical procedure may be necessary. Blocked tear ducts are not the only cause of watering eyes so it's a good idea to have an eye examination.
Signs to watch for
Occasionally, serious conditions can have signs and symptoms similar to those described above. For this reason children with suspected eye problems should be examined.
See your family doctor if you are concerned about your baby's eyes, particularly if:
- one or both pupils have an unusual or white appearance - this may be noticed in photographs
- there is persistent watering or discharge from your child's eyes
- one eye appears to be turned frequently or the eyes do not seem to move well
- there is extreme sensitivity to light or glare
- your child's head is always tilted/turned to one side
- your child sits close to the television and holds books/puzzles at very close range
- your child's eyes do not look the same (for example, one eye is larger than the other)
In New Zealand, screening for some vision problems occurs soon after birth and then at around 4 years of age as part of the B4 School Check. If your child missed their screening, it's important they have this screening in their first year at school. Contact your child's school to make sure the vision hearing technician screens your child on their next visit. This screening does not find all vision problems.
If you have questions about your child's vision screening, call the Ministry of Health's free 24-hour health advice service, Healthline (0800 611 116) or talk to the vision hearing technician who screened your child, an optometrist, ophthalmologist or your family doctor.
A full eye test is recommended for all infants and children when there is:
- turned eye (strabismus)
- lazy eye (amblyopia)
- strong glasses at an early age (refractive error)
- premature birth (30 weeks gestation or less)
- developmental delay
If none of the above apply to your child but there is a family history of turned eye, lazy eye or strong glasses at an early age, then the ideal time for your child to have an eye check is between the ages of 2 and a half and 3 years. At this age, your child will be old enough for a very accurate vision test and it is still early enough to manage any problems.
Remember to see your family doctor if you have any other concerns about your baby's eyes.
Starship Foundation and the Paediatric Society of New Zealand acknowledge the cooperation of The Children's Hospital at Westmead, Sydney Children's Hospital at Randwick, and Kaleidoscope - Hunter Children's Health Network in making this content available to patients and families. The content has been adapted for New Zealand families.