Must-Ask Questions About Kids’ Eye Health

Concerned about eyes that are askew or squinty? Here are some typical reasons for those problems—and why you shouldn't wait if your child has them.

Eye exam

There’s no need for every healthy child to have an eye examination by an ophthalmologist, but if there is a family history or a specific concern, it may be a wise move.

Most children receive vision screenings during routine medical checkups as well as in school. But parents, teachers and pediatricians should still be on the lookout for signs of eye problems as children develop—and should consult an ophthalmologist when they do. 

“These issues usually need to be addressed as soon as possible,” says Martha Howard, MD, a pediatric ophthalmologist and strabismus surgeon at Yale Medicine. “We often don’t have the luxury of saying, ‘Oh, we can correct that later.’” 

If you answer "yes" to any of the following questions, here is what it might mean and how your ophthalmologist might address it:

Are my child’s eyes crossed or wandering?

About 3 percent of children have strabismus, meaning their eyes are not aligned. The eyes might turn inward, each might turn outward, or they might be vertically misaligned. “Sometimes parents will report that when they look down at their toddler, they’ll see an eye turning up,” Dr. Howard says. “It’s not moving together with the other eye.”

Adults with strabismus frequently have double vision, seeing two images if their eyes are not aligned. However, children do not experience double vision from strabismus. “Their brains suppress the second image,” Dr. Howard says. But waiting for treatment can cause long-lasting problems, so the condition requires prompt attention. “In order to develop the ability of the eyes to work together, it’s best to correct the alignment within a year after they start crossing,” she says.

Stereoacuity (when the eyes work properly together) is especially important for activities requiring depth perception, such as navigating stairs, stepping off a curb or pouring something into a glass. Children with stereoacuity problems may have trouble stacking blocks or catching a ball.

An ophthalmologist may be able to remedy the condition. Sometimes glasses will do the trick. Some kids will need bifocals, but they usually grow out of them by middle school. Sometimes surgery is necessary.

Strabismus may return or worsen when the child is an adult, but treatment options are available then. If you answer "yes" to any of these questions, make an appointment with an ophthalmologist who can evaluate your child's eye health:

Can my child see well out of both eyes?

About 3 percent of children have amblyopia, or “lazy eye,” which occurs when the brain does not work well with one eye. “We can assess whether the children have an optical preference of one eye through ‘cover and uncover’ testing,” Dr. Howard says. “And when they are old enough to read pictures on a chart or match letters, we can measure better how they’re seeing.”

A doctor might prescribe glasses, which even newborns can wear. An eye patch over the better-seeing eye may also be a solution. “We usually have kids wear a patch for two to four hours a day while at home, so it doesn’t become a social issue,” says Dr. Howard. Another option is Atropine eye drops, which “blur the vision in the better-seeing eye, so the vision in the amblyopic eye will improve,” Dr. Howard says. In each case, the goal is to force the child’s brain to use the amblyopic eye.

Does my child tilt his head to see things better? 

Parents or a pediatrician will occasionally notice a child’s tendency to tilt his or her head to one side. Sometimes this is a signal that the eye muscles are not working properly. It can be the result of a palsy, or type of paralysis, that affects the superior oblique muscle, which acts to rotate the eye down and inward. The problem may be congenital. “The babies compensate by tilting their heads in order to align their two eyes, because they want to use their eyes together,” Dr. Howard says. This condition is typically corrected surgically and should be addressed as soon as possible.

Does my child have a bump near his eye or on the eyelid?

A lump or bump in this area can have a number of causes. “A lump could be a dermoid cyst, which is a developmental anomaly that is benign but can cause inflammation if a child falls and the cyst ruptures,” Dr. Howard says. “Older kids might develop a chalazion, an inflammatory lesion on the lid, or a stye, which is an infection in the eyelid margin.” 

Blepharitis is a common condition causing inflammation of the eyelids. It can be treated with antibiotics, steroid drops or ointments.

Does my child have a droopy eyelid?

A drooping eyelid is called ptosis (pronounced toe-sis). About 8 in 100,000 children are born with it, and it is more likely to affect the left side than the right. “It’s unlikely to go away on its own,” Dr. Howard says, and it can cause [amblyopia|], where vision in one eye is reduced because the eye and the brain are not working together properly. “These children need to be examined,” Dr. Howard says. Surgery may be the required treatment.

Can my child see things that are far away?

Nearsightedness, or myopia, is a big concern for many parents. “They may themselves have myopia and are worried that their kids may have the same problem,” Dr. Howard says. Children may initially have mild nearsightedness, but it can progress quickly.

Atropine eye drops have been shown to slow the worsening of nearsightedness when given on a daily basis over two years. An even simpler tactic: sending a child outside to play. “Studies have shown that spending more time outdoors can slow the progression of myopia,” Dr. Howard says.

Can my child see things close up?

Farsightedness usually affects both eyes, and the decrease in vision is detected when a child has difficulty with a vision screening. Glasses can correct this problem.

In rare cases, when a child is severely nearsighted or farsighted in one eye but not the other, a laser surgery technique also used in adults may correct the error. “Clinical studies are ongoing that are looking to determine the safety and efficacy of this procedure,” Dr. Howard says.

Not every healthy child needs to be examined by an ophthalmologist. But if you have a specific concern about your child’s vision of if there is a family history of eye problems, an exam may be the right move.

To connect with a Yale Medicine pediatric ophthalmologist, click here.