Eye problems affect more than 12 million children in the United States. Some eye problems may be present at birth (congenital) or related to conditions at birth, such as prematurity. Others include diseases, allergies and injuries. Left untreated, these problems can lead to permanent vision loss, or to less serious but still substantial problems such as learning difficulties that may be attributed to a disability.

Eye problems unrelated to allergies include amblyopia (also known as “lazy eye”), strabismus (also known as “crossed eyes”), refractive errors (such as myopia, hyperopia and astigmatism) and others. Many children in daycare or schools contract some form of conjunctivitis, the contagious eyelid inflammation also known as “pink eye.” Allergic forms of conjunctivitis are a hypersensitivity of the eye to certain allergens that may be seasonal or perennial.

Eye injuries in children typically result from sports injuries, misuse of toys, falls, damage from everyday tools and objects, exposure to harmful household products, car accidents and fireworks mishaps.

The symptoms that a child displays vary depending upon the underlying condition affecting the eye. Examples of symptoms that may indicate an eye problem in a child include abnormal alignment of the eyes, pupils that are white instead of black, watery eyes, itchiness and burning and redness. Behaviors that may indicate eye problems include frequent rubbing of the eyes, closing or covering one eye, and complaints of blurry vision.

Children may not always indicate that their eyes are bothering them. For this reason, parents should watch for certain physical or behavioral indicators of an underlying eye problem. Physicians rely on information from parents as a crucial factor in accurately diagnosing a child’s eye-related condition. Most eye problems are diagnosed through a vision test. This is a standardized examination used to evaluate and monitor a child’s vision and to detect potential diseases or disorders that may affect the eyes.

Treatments for a child’s eye problems may include glasses or contact lenses, medications or surgery. Conditions that cannot be treated effectively may involve teaching children techniques that can help them cope with their condition, such as learning Braille in order to read and write or using recorded books to enhance school performance.

Eye problems affect more than 12 million children in the United States. This includes 5 percent of preschoolers and 25 percent of school-aged children, according to the American Academy of Ophthalmology. Left untreated, these problems can lead to permanent vision loss, or to less serious but still substantial problems such as learning difficulties that may be attributed to a disability.

The eye is a complex organ. Its structure – a fluid-filled body exposed to the outside – makes it susceptible to injury. The mechanisms inside the eye responsible for producing visual signals are equally complex. Light enters the eye through the cornea, which sits in front of the opening of the pupil. The iris controls the amount of light that passes through the pupil by causing the pupil to close more in bright light and open more in dim light.

As light is allowed in, a thin layer of tissue at the back of the eye called the retina sends nerve signals along the optic, which are then transmitted to the brain to create an image. In addition, the structures and glands around the eye protect it and keep it functioning. These include the tear glands, eyelids and eyelashes.

Several different factors may cause eye problems. The shape of a person’s eye is often responsible for vision impairments. In addition, diseases or disorders, allergies or injuries can cause eye problems. Left untreated, eye problems can lead to long-term visual impairment, academic problems and social development problems.

In some cases, an eye problem is severe enough that vision cannot be corrected to normal level. This is known as a visual impairment, and it may involve the loss of visual acuity (where the eye does not see things as clearly as normal) or loss of visual field (where the eye cannot see as wide an area as usual without moving the eyes or turning the head). Visual impairment is uncommon in children, according to the Centers for Disease Control and Prevention (CDC). Most cases of visual impairment in children are associated with children with developmental disabilities such as mental retardation or cerebral palsy. More than 55,000 children in the United States are diagnosed as legally blind, according to the American Foundation for the Blind.

Contrary to popular belief, watching too much television or looking at a computer screen for many hours cannot damage your vision, and neither can reading in low light. Parents are urged to contact a physician if their child has red eye, persistent pain in the eye, foreign objects in the eye or any changes in vision. Parents should take their child to a hospital emergency department if their child’s eye is injured and there is bleeding, loss of vision or change in the eye’s appearance.

Children experience many of the same eye-related conditions as adults. Some eye-related conditions, such as vernal conjunctivitis, affect children far more often than adults.

Eye-related problems in children may involve congenital, infectious or allergic conditions or eye injuries. A physician must distinguish among these sources of eye problems to reach an accurate diagnosis and prescribe an effective treatment plan.

Many eye problems in children may be related to injuries or foreign bodies. Other eye problems in children include:

• Refractive errors. Occur when light entering the eye does not focus properly on the retina, causing blurring of sight. Examples include nearsightedness (poor distance vision, also known as myopia), farsightedness (poor near vision, also known as hyperopia or hypermetropia) and difficulty seeing well either up close or far away (abnormal or imperfect curvature of the cornea, also known as astigmatism). In some cases, refractive errors develop into eyestrain or amblyopia. Refractive problems typically are treated with eyeglasses or contact lenses.
  
  
• Amblyopia. Also known as “lazy eye,” it is the result of having crossed eyes or having a difference in refractive error (problem with the eye’s ability to bend light) between the two eyes. Amblyopia is a common and often reversible eye condition in children. It affects children younger than age 7, and 2 to 3 percent of the population has this condition, according to Prevent Blindness America. In amblyopia, the eyes send different messages to the brain. Eventually, the brain turns off the messages of the deviating or nondominant eye, which can lead to impairment of the eye’s development. When identified early – especially by a child’s preschool years – lazy eye can be successfully treated. Left untreated, it can lead to permanent vision loss in the affected eye, because the brain will begin to ignore signals coming from that eye.
  
  
• Strabismus. Also known as “cross eyes,” it involves a misalignment of the eyes that causes them to turn in, out, up or down. This misalignment may be constant, or it may come and go. It is normal for infants to exhibit this pattern, and strabismus typically is not suspected until a child is 4 months old. About 2 percent of children have this condition, with half having it at birth, according to Prevent Blindness America. When an eye is misaligned for a longer period of time, amblyopia may result. Placing a patch over the healthy eye can force the weaker eye to work harder, thereby strengthening it. Surgery or special glasses also are sometimes used to treat this condition.
  
  
• Ptosis. Involves a drooping of the upper eyelid caused by weakness of the muscle responsible for lifting the eyelid, damage to nerves associated with those muscles or looseness of the skin of the upper eyelids. It is often caused by an underlying condition that may be treated, or may itself be treated with surgery.
  
  
• Infectious conjunctivitis. Commonly known as “pink eye,” it is the result of a bacterial or viral infection. It is commonly found in children and usually does not present a major health threat.
  
  
• Giant papillary conjunctivitis. Results from eye contact with a foreign surface, usually contact lenses.
  
  
• Atopic keratoconjunctivitis. Frequently occurs in patients with eczema (noncontagious inflammation of the skin). Left untreated, it can lead to the formation of cataracts and, eventually, blindness. This can affect children, but usually affects those ages 20 to 50 years.
  
  
• Color vision problems. A deficiency in seeing certain colors (e.g., shades of red or green). About 8 percent of boys and less than 1 percent of girls have this condition, according to Prevent Blindness America. It most often is hereditary and is present at birth. There is no treatment.
  
  
• Kawasaki disease. An inflammation of the blood vessels in the body, including the eyes. This affects children exclusively.
  
  
• Retinopathy of prematurity. Disease in which changes in the blood vessels of the eye’s retina permanently impair a child’s vision. It primarily affects infants who are born prematurely and who spend a long time on a ventilator following their birth.
  
  
• Blepharitis. An infection of the eyelids that can cause a prolonged inflammatory response when combined with the overuse of eye drops. It most often affects adults, but can also affect children.
  
  
• Uveitis. Potentially sight-threatening swelling that may involve some or all inflammatory processes of the middle layers of the eye, also called the uveal tract or uvea. Usually affects adults, but the risk of blindness increases in children who have uveitis.
  
  
• Infantile cataracts. Clouding of the eye’s lens that sometimes occurs in newborns. Surgery typically is used to treat this condition.
  
  
• Congenital glaucoma. Rare, inherited form of glaucoma (high eyeball pressure that damages the optic nerve) that appears in newborns. It occurs when the eye drainage canals develop abnormally during a child’s prenatal period. Medications or surgery may be used to treat this condition.
  
  
• Retinoblastoma. Malignant tumor of the eye that usually appears by age 3. Loss of vision and whiteness of the pupil are typically associated with this disorder. Laser surgery, radiation and chemotherapy are all used to treat this condition.
  
  
• Diabetic retinopathy. Condition that occurs when diabetes causes damage to the tiny blood vessels in the retina. Symptoms are typically not noticeable until damage is severe, which may not occur for years.
  
  
• Congenital blindness. Involves blindness that is present at birth. It can be inherited or caused by an infection (such as measles) transmitted from the mother to the fetus during pregnancy. It may also relate to other conditions such as prematurity or developmental disabilities also present at birth.
  
  
• Other genetic or metabolic eye diseases. These are conditions that make certain eye problems – such as retinoblastoma or cataracts – more likely. If genetic or metabolic eye diseases are detected, it is likely that the child will be required to undergo more frequent examinations.

Allergies also can cause eye problems in children. Examples of eye-related conditions include:

• Allergic conjunctivitis. This is a hypersensitivity of the eye to certain allergens that may be seasonal or perennial (occurring throughout the year).
  

  

• Vernal conjunctivitis. An eye allergy that affects children far more than adults. This is a condition that arises in the spring and summer and occurs at least twice as often in males as it does in females. It is suspected that allergies trigger the condition. Vernal conjunctivitis tends to flare in the spring and fall in dry, warm climates, but lasts year-round in some children. It usually disappears during puberty.

In many cases, eye problems are the result of an abnormal curvature in the eye. For example, children with myopia have eyes that are longer than normal from front to back. This causes light to focus in front of the retina rather than on it. Meanwhile, children with hyperopia have eyes that are shorter than normal from front to back. This causes light to focus behind the retina. Astigmatism is the result of an uneven curvature of the cornea at the front of the eye.

In some cases, a child’s eye problem stems from an injury. Injuries during sporting activities are the leading cause of eye injuries in children, according to the American Academy of Ophthalmology. Eye injuries are most common in baseball, basketball and racquet sports. The academy recommends eye protection be used for all of the following sports:

• Baseball
• Basketball
• Football
• Hockey (all forms, including ice, roller, street and field)
• Lacrosse
• Paintball
• Racquet sports
• Soccer
• Wrestling

An injury also may occur when sand, dirt or other foreign bodies come into contact with the eye’s surface. In some cases, a foreign object may actually penetrate the globe of the eye. Exposure to chemicals (including those found in common household items such as cleaners, detergents, paints and glues) and blunt-force injury also can injure the eye.

A scratched cornea is one of the most common injuries in older children. It typically occurs as a result of wearing contact lenses or playing sports. Children who have this injury may feel like there is something in their eye when nothing is really there. The eye typically becomes red, tears excessively and is extremely sensitive to light.

Contrary to popular belief, a child’s eyes cannot be damaged from watching too much television (or sitting to close to the TV), looking at a computer screen or reading in low light. While these conditions may cause a child’s eyes to become fatigued, no long-term harm occurs.

Other sources of injury include:

• Misuse of toys
• Falls from beds, furniture and stairs
• Damage inflicted by misuse of everyday tools and objects
• Car accidents
• Fireworks mishaps

Allergies also can cause eye problems in children. Allergies affect the eyes because the mucous membrane covering the front of the eye and the inner eyelid (conjunctiva) contains an estimated 50 million mast cells. These are the cells that release histamine and other chemicals that trigger symptoms of an allergic reaction. Both indoor (e.g., pet dander, dust mites) and outdoor allergens (e.g., pollen, mold) can cause eye-related conditions.

The symptoms that a child displays will vary depending upon the underlying condition afflicting the eye. For example, children with distance-vision problems may squint a lot or seem inattentive when looking at far away objects, such as school blackboards. Meanwhile, children with close-vision problems may experience difficulty reading.

There are several general symptoms typically associated with eye-related disorders. They include:

• Abnormal alignment of the eyes, or unusual eye movement after 6 months of age.
  
  
• Watery eyes. Eyes can water either because tear ducts are blocked, or because something is irritating them, such as an allergen.
  
  
• Itchiness, redness and burning. Histamine and other biochemicals released during an allergic cascade produce these symptoms.
  
  
• Black circles around the eyes. Sometimes known as allergic shiners, they are the result of constant rubbing and scratching of the skin, which causes a darkening effect. This also can be seen in allergic rhinitis (hay fever).
  
  
• Cobblestone pattern of lesions on the conjunctiva under the eyelids.
  
  
• Light sensitivity (photophobia).
  
  
• Discharge. The characteristics of the discharge will vary based on the type of condition.
  
  
• Swelling, crusting or redness of the eyelid.
  
  
• Pupils that are white instead of black.

Symptoms of allergy-related eye conditions may occur alone or can appear in combination with nasal allergy symptoms (e.g., sneezing, sniffling, stuffy nose).

A child with an injury to an eye may display one or more of the following symptoms, which require immediate medical attention:

• Obvious pain or trouble seeing
• Cut or torn eyelid
• Lack of movement in one eye
• One eye that sticks out more than the other
• Unusual pupil size or shape
• Blood in the clear part of the eye
• Foreign object in the eye that cannot be removed

Children who may be developing refractory problems, such as nearsightedness, may feel dizzy or complain of a headache or nausea following work that requires close-up vision, such as reading. However, children may not always indicate that their eyes are bothering them. For this reason, parents should watch for certain physical or behavioral indicators of an underlying eye problem. Children can also reveal potential eye problems through their behavior. Parents should watch to see if their child:

• Rubs eyes often
• Closes or covers one eye
• Tilts head, or thrusts head forward
• Struggles with reading or other work that involves close-up vision
• Sits too close to the television
• Blinks more often than normal
• Mentions that things are blurry or hard to see
• Squints or frowns a lot while trying to see things
• Has difficulty following (tracking) objects visually

Most eye problems are diagnosed through a vision test. This is a standardized examination used to evaluate and monitor a child’s vision and to detect potential diseases or disorders that may affect the eyes. The exact nature of a vision test varies depending on the child’s age and any suspected vision problems.

A pediatrician, ophthalmologist (eye physician) or other trained eye specialist will regularly perform various tests of a child’s vision from the time a child is born until around the age of 5 years, with checkups every year or two years. These tests include:

• Visual acuity test. The child reads an eye chart that helps determine the strength of vision at various distances.
  
  
• Visual field test. Measures a child’s peripheral (or side) vision.
  
  
• Tonometry test. Uses a simple puff of air blown on the child’s eye to check the fluid pressure inside the eye.

Many eye problems – such as amblyopia, strabismus and refractive errors – are first detected during preschool vision screening, in which an acuity chart is used to test a child’s eyesight.

In other cases, parents may bring a child to a physician because of certain symptoms that are affecting the child. Parents who notice their child struggling with vision difficulties are urged to set up an appointment with a physician promptly. Early diagnosis of vision problems often can keep these disorders from becoming permanent.

A physician will conduct a physical examination. In addition to performing a vision test, the physician may observe a child’s eye motion, look for physical manifestations on the eyelids and test the reaction of pupils to light. Parents will be asked to provide information about the child’s medical history and list of symptoms. Parents who can present an accurate and complete account of a child’s symptoms will greatly aid in this process. This information is crucial to helping the physician distinguish the source of a condition.

In evaluating a newborn, a physician will ask the parent for a full prenatal history. Likely questions include those about developmental delays, maternal infections (e.g., herpes simplex virus, cytomegalovirus, chlamydia, human immunodeficiency virus), and any complications with delivery. Some medications given to infants at childbirth, including silver nitrate (an ophthalmic antiseptic used to treat chlamydial infection) and erythromycin (an antibiotic), also are known to cause eye irritation.

There are a variety of treatments for children who are diagnosed with eye problems. In many cases, children will require glasses or contact lenses to treat their visual disorder. Plastic frames should be used when glasses are prescribed for children younger than age 2, and an elastic strap may be used to help keep the glasses in place in very young children. Older children can wear metal frames.

Children with significant eye problems may benefit from high-index lenses, which are thinner and lighter than plastic lenses. Polycarbonate lenses are often recommended for young children because they are more durable than plastic lenses. However, they also scratch more easily than plastic lenses.

As children grow older (usually sometime after age 10), they may request to wear contact lenses for either cosmetic purposes or because they participate in certain sports. These lenses must be cleaned regularly to prevent eye infections. Parents are urged to consider their child’s maturity level when debating about whether to allow contact lenses to be worn.

Other forms of eye problems can be treated with medication. For example, a scratched cornea is treated with medicated eyedrops and usually heals within a couple of weeks. Eyedrops and ointments are used to treat amblyopia and strabismus.

Finally, some eye problems require surgery. Babies born with infantile cataracts will need to have them surgically removed and may have to wear contact lenses thereafter. Surgery also is sometimes used to treat amblyopia and strabismus if other techniques fail. In adults, refractive errors of myopia and hyperopia may be treated with laser surgery. However, for children this option is usually not acceptable until the refractive level of the eyes stabilize, which may not occur until adulthood.

Other techniques include treating strabismus and amblyopia by having the child wear an eye patch on a healthy eye to force a correction in the misaligned eye.

If a child has an eye problem related to allergies, prescription or over-the-counter medications may be used to treat the child. Often, eye symptoms can best be addressed by treatments that prevent or soothe allergic reactions.  If medications and avoidance do not alleviate eye-related symptoms, allergy shots (immunotherapy) may be considered. Allergy shots are a form of allergy and asthma treatment in which low doses of an allergen are injected into a patient over a period of time. The goal is to increase the patient’s tolerance to the allergen while reducing symptoms brought on by an allergic reaction. 

Eye injuries may or may not require medical attention, depending on the severity of the injury. If a foreign object enters a child’s eye, it often can be cleaned out by flushing the eye with water or a sterile saline solution. Parents should wash their hands thoroughly before touching the eyelid. The eye itself should not be directly touched, pressed or rubbed. The eye can be flushed for up to 15 minutes. A medical professional should be consulted if the object does not dislodge from the eye.

Black eyes caused by an injury can be treated with cold compresses that are applied in alternating cycles of five to 10 minutes on followed by 10 to 15 minutes off. If children experience pain, they should be given acetaminophen. Aspirin and ibuprofen can increase bleeding, worsening the situation. Medical attention should be sought for a child’s black eye if the eye becomes increasingly red or begins to drain. Changes in eyeball appearance, changes in vision, persistent eye pain and visible bleeding all require treatment.  

If an object becomes embedded in the eye or the eye is exposed to a chemical, emergency care should be sought.  

Although some eye problems cannot be prevented, others can. For example, taking proper precautions such as wearing protective goggles during athletics or science class can reduce the risk of eye injuries. Toys are another frequent source of injury. Buying toys appropriate for a child’s age level can reduce the risk of injury to a child’s eyes. Also, decorative contact lenses, such as those worn with costumes or to enhance appearance, may cause damage if they are improperly used. Improperly fitted or incorrectly used contact lenses can lead to eye pain, infection, damage to the cornea and other eye problems. Eye health experts urge children to consult an eye care professional for obtaining decorative contact lenses in order to receive proper fitting and instructions on usage.

In addition, children can learn protective techniques that can help prevent eye problems later in life. For example, encouraging children to wear sunglasses with ultraviolet (UV) protection can help prevent damage that leads to cataracts (clouding of the eye lens) and macular degeneration (degenerative eye condition that can lead to blindness).

Scheduling regular eye exams can help identify disorders in their early stages, when they are most treatable. Children with certain health conditions that can lead to eye problems – such as diabetes and juvenile rheumatoid arthritis – are especially urged to have regular eye exams.

The best way to prevent children from experiencing eye-related symptoms related to allergies is to make sure they avoid the allergens that cause the symptoms. This should be done when possible. For example, children should remain indoors when pollen counts are high and parents should make sure the home is as allergen-free as possible. Children also should be encouraged to frequently wash their hands to reduce allergen contamination and to avoid rubbing their eyes, which will only worsen their condition.

Preparing questions in advance can help patients and parents have more meaningful discussions with their physicians regarding their or their child’s treatment options. The following questions related to eye problems and children may be helpful:

1. How do I know if my child has an eye problem?
   
   
2. What methods will you use to determine the cause of my child’s eye problem?
   
   
3. What are some of the steps my child can take to prevent eye problems?
   
   
4. What are my child’s treatment options?
   
   
5. When can I expect my child’s symptoms to subside?
   
   
6. Is my child’s eye problem progressive or contagious?
   
   
7. Is my child’s eye problem dangerous?
   
   
8. Will the condition temporarily or permanently affect my child’s sight?
   
   
9. What signs should I look for that might indicate that my child’s eye problem requires medical attention?
   
   
10. What types of eye problems is my child most at risk for?