Keeping an eye on your kids’ vision

Just as with adults, childrens’ eyes are their window on the world around them. Which is why it’s crucial that you make sure your child’s eyes are healthy and functioning properly. That can be a challenge, because childhood vision problems are common, affecting one in 20 preschoolers and a quarter of all school-age children. On top of that, kids often aren’t aware that something is wrong with their eyesight.

Infections
Infections are the most common eye complaint in childhood. Conjunctivitis, also called pink eye, is an infection of the conjuctiva, the tissue that lines the eyelid to help keep the eyelid and eyeball moist. “In the spring and summer, allergies are usually the cause,” says Susan Unfer, MD, a pediatrician at Advocate Lutheran General Children’s Hospital in Park Ridge, Ill. “The rest of the year, bacteria can be the cause, and in winter, when flu is predominant, pediatricians see a lot of viral conjunctivitis.”

Symptoms include:
itchy eyes (in allergic conjunctivitis)
a pink color in the white of the eye
thick yellow discharge (in bacterial conjunctivitis)
green or white discharge
more tear production than normal.

“Only bacterial infections respond to antibiotics,” says Dr. Unfer. These drugs are either taken orally or applied as eyedrops or ointments. Viral conjunctivitis will usually go away on its own in four to seven days. Conjunctivitis caused by allergies may disappear when the allergy is treated.

A stye, a red lump that looks like a pimple on the edge or inside of the eyelid, is another common childhood eye infection. Styes form when normally harmless bacteria on the skin surface get trapped with dead skin cells along the eyelash line. A stye typically fills with pus, making it painful for a few days until it bursts.

Most styes go away on their own. To relieve pain and speed healing, apply a warm compress to the eyelid. If a stye interferes with your child’s vision or doesn’t disappear on its own, your doctor may prescribe an antibiotic cream for the eyelid or may lance the stye.

Occasionally a more chronic lump appears on the eyelid. It is called a chalazion and may need excision.

Vision problems
Other eye disorders can impair vision in children. Strabismus, or crossed eyes, occurs when the eye muscles don’t work together. In infants, symptoms include one or both eyes that turn inward or outward, or eyes that don’t appear to fix on the same point. Older children may also complain of double vision or difficulty seeing objects clearly. “The important thing is to detect strabismus and other vision problems in early childhood,” says Norman Medow, MD, director of pediatric ophthalmology at the Manhattan Eye, Ear and Throat Hospital in New York City. “If you find them later, you can still treat them. But the earlier the treatment, the more vision is likely to be restored to the child.” Treatment for strabismus may involve prescription glasses to improve focus or surgery to straighten the eyes.

Strabismus that goes untreated can lead to amblyopia, or “lazy eye,” which can also be caused by problems focusing. With amblyopia, the brain suppresses a blurred or double image from one eye, making the other eye stronger.

Children with amblyopia are usually given prescription glasses. The eye with better vision may be covered with a patch for weeks or months to strengthen the weaker eye. For the same reason, doctors sometimes recommend using daily eyedrops that temporarily blur vision in the “good” eye. In some cases, surgery is needed to straighten the eyes.

Children can have many of the same so-called refractive errors as adults. In myopia (nearsightedness), objects in the distance appear blurry. Hyperopia (farsightedness) causes blurriness close up. Astigmatism typically makes a child see vertical lines more clearly than horizontal lines.

“If a child doesn’t see objects that everyone else sees, or they rub their eyes or squint, it should prompt parents to have the child’s eyes looked at,” says Dr. Medow. If you suspect one of these problems in your child, a pediatric ophthalmologist can do an eye exam and prescribe glasses, if needed.