Common vision and eye problems in children

by | Jun 26, 2020

This content has been archived. It may no longer be relevant

Children are not just small adults. They cannot always articulate what is bothering them. Therefore, it is important to pay careful attention to your toddler’s eye health and take them to a specialist if needed, writes paediatric ophthalmologist Dr Claire Cullen.

Good vision is key to a child’s physical development, success in school and overall well-being. Even if your child might still be relatively young, it’s so important to start thinking about this as early as possible.

An eye screening by a paediatric ophthalmologist or optometrist, is an important way to identify possible problems with his/her vision. When it comes to vision problems and successful treatment, it’s always better when problems are picked up early.

There is a wide array of doctors and specialists who work specifically with eyes. These include:

  • Ophthalmologist: This is a medical doctor who has specialised in the diagnosis and treatment of eye conditions. They are able to prescribe medication, glasses and even perform eye surgery.
  • Optometrist: An optometrist works mainly with glasses and focusing problems. They are able to perform eye examinations and prescribe glasses.
  • Orthoptist: An orthoptist can evaluate and manage childhood and adult alignment problems. Their primary focus is on the diagnosis and non-surgical management of squints, amblyopia (decreased vision) and eye movement disorders.


Why should I bring my child for an eye screening?

Your baby’s visual system is not fully developed when he is born. It continues to develop as he  grows. This means that abnormal changes in the correct functioning and structure of your child’s eyes can affect the future development of the entire visual system.

Good vision is essential for a child’s physical, social and physiological development. If a visual problem is not picked up early enough, it could not only impair their ability to see, but also profoundly affect other areas of growth.

Without screening, conditions that could be easily treated (and thus prevent permanent vision loss) go undetected.


How will you test my child’s eyes – she can’t even read yet?

Fortunately, there are several tools at the healthcare professional’s disposal. These help to test your child’s vision, without them being able to read. Instead of identifying letters or the alphabet, your child is encouraged to identify pictures such as an animal or a fruit. These tests will determine how far your child can see (visual acuity).

The ophthalmologist also shines a specially designed light or retinoscope across and into your child’s (or infant’s) eyes. This helps to determine if your child’s vision needs correction with glasses. With the addition of free lenses held up by the doctor in front of your child’s eyes, they work out what strength of lens is required. The ophthalmoscope is also used to look at the back of your child’s eyes to make sure everything is healthy.

Sometimes parents are concerned that their child might fake bad eyesight, just to get eyeglasses. Fortunately, there are certain tests that can be carried out, such as retinoscopy, that do not need the child’s verbal involvement or co-operation. This means that normal vision will be easily established, and the risk of glasses being prescribed for normal eyes, avoided.


Common eye issues

There are many different eye conditions and diseases that can affect a child’s vision. Some of the most common ones are:

  • Allergies
  • Refractive errors
  • Squints
  • Lazy eye (amblyopia)
  • Infections


Condition What is it? When it starts Possible treatment
Allergies An allergy describes the “over excited” way in which the body reacts to something in the environment which it sees as foreign. This foreign substance is called an allergen. Eye allergies are surprisingly common in children in South Africa and unfortunately, this phenomenon appears to be on the increase. Some children will experience eye allergies as young as infancy but luckily many of them will outgrow it as adults. Others however will unfortunately continue to battle with it right into adulthood. Once a diagnosis of an allergic eye disease has been made by your eye specialist, there are a variety of management protocols that can be followed. The simplest of these is to avoid the possible triggers. Many allergens that cause eye allergies are difficult to identify, but there are a few general procedures that can be helpful.
Refractive errors These occur when the shape of the eye does not bend the incoming light rays correctly, resulting in a blurred image. The main types of refractive errors are myopia (near-sightedness), hyperopia (farsightedness), presbyopia (loss of near vision with age) and astigmatism. Children who have parents with refractive errors are more likely to have them too. It can affect both adults and children. Refractive errors can be corrected with eyeglasses, contact lenses or surgery. Eyeglasses are the simplest and safest way to correct most refractive errors.
Squints This is when the eyes are not aligned correctly. The eyes could be turned inwards (esotropia), outwards (exotropia) or up/down. Squints affect about one in 20 children, including babies. Most squints develop before the age of three years, although they can develop in older children, and in adults. If eyeglasses, eye patching and/or atropine drops can’t fix a squint, eye muscle surgery might be needed. Surgery involves loosening or tightening the muscles that cause the eye to wander.
Lazy eye (amblyopia) Amblyopia, also known as lazy eye, is a vision development disorder in which an eye fails to achieve normal vision, even with prescription eyeglasses or contact lenses. In most cases, only one eye is affected. It could begin during infancy and early childhood. Applying a patch or special eye drop to the “good” eye. Other treatments commonly used include glasses.
Infections There are many different types of eye infections. Your eye doctor needs to determine the particular type of eye infection your child has in order to prescribe the proper treatment.


Conjunctivitis, also called “pink eye” is one of the most common infections. It’s highly contagious and often spread among children in day care centres, classrooms and similar environments.


Several different viruses or bacteria may cause eye infections. If your doctor feels the problem is caused by bacteria, antibiotic eye drops or ointment is usually the best treatment. However, viral conjunctivitis is not treated with antibiotics.


Should I really take the risk of paying for a screening, if nothing might be wrong?

The lifetime cost for your child of missing out on a serious, but treatable eye condition, is high.  If you have been referred by professionals such as a nurse, orthoptist, optometrist, GP or teacher to have your child’s vision tested comprehensively by a paediatric ophthalmologist, do not delay in booking the appointment.

There are certain warning signs that you as a parent can also look out for:

Under 6 months of age:

  • Your child not being able to look directly at you
  • Not responding to a light shone into their eyes
  • Constantly rubbing their eyes
  • Their eyes roving around or shaking
  • Eyes turning in towards or away from their nose
  • A white cloudy pupil in the centre of your child’s eye
  • Bulging eyes
  • Drooping eyelids
  • Chronic tearing, redness or swelling of an eye


In older children:

  • As above.
  • A change in your child’s behaviour. For example, your child now sits close to the TV, or they can no longer catch a ball or copy notes down from the board.
  • A suspected learning disability or developmental delay.

If you are at all concerned, take that first step to have their eyes tested.