Q: I have a new baby. What signs of vision problems should I look out for? And how soon should I take my child to his first eye exam?

A:It’s great you want to be proactive about your new baby’s eye health. Obviously a baby can’t tell you that he has a vision problem, but certainly there are some signs that you can watch out for.

Refractive Error and Your Child

First, be alert if your child has little interest in his surroundings. A young baby should be especially interested in your face, and should make you feel special by smiling at you frequently. Any eye problem can cause a child to lose interest in his environment, but extreme near or far-sightedness (refractive error) is a possible reason that this happens. This problem can be present at any age.

Strabismus and Amblyopia

When your baby’s eyes work properly, they move together as a team so that they can focus on the same object. This allows your baby to have three-dimensional vision. Normally, babies develop this ability by the age of three months.

However, at any age most people will appear to cross their eyes when they look at something very close to them – this is a normal response to keep both eyes looking at the same object. But if your baby’s eyes appear crossed or misaligned after the age of three months even when looking at things that are not close up, this is a sign of strabismus.

Strabismus can be difficult to spot. If your child has strabismus, his eyes may be misaligned most of the time, but often this becomes obvious only when your baby looks in certain directions. If you notice that your baby has signs of strabismus, you should seek an appointment with your eye doctor as soon as possible in order to prevent further visual complications.

When your child has strabismus, he may briefly see two images instead of one. The brain gets confused by seeing double, so it suppresses the view from the eye that is not straight. Over time, this can lead to reduced vision in that eye (called amblyopia). Strabismus and amblyopia have many different causes. A breakdown in the brain’s vision control center or an imbalance of the eye muscles are two possible examples.

Luckily, most kinds of childhood strabismus and amblyopia can be treated. If your child is far-sighted, glasses will help hold his eyes straight. If your child has an imbalance of eye muscles and decreased vision in one eye, then your eye doctor may want to patch your child’s straight eye in order to exercise the other one (sometimes called the “lazy” eye). In some cases, your baby may need surgery to straighten his eyes, but this does not necessarily eliminate the need for glasses. Surgery does not treat the poor vision of amblyopia, which requires treatment by occlusion (patching) of the “good eye” and possibly glasses.

Infection Alert

A bacterial eye infection is another common problem in children of any age. If your baby’s eyes become red and/or full of a yellow pus-like discharge, you should see your eye doctor right away. While this condition can look horrible, antibiotics will cure the problem.

Rare Conditions

Very rarely, some parents may notice white or yellow spots in the pupils of their children’s eyes. If you notice this, see an eye doctor immediately, since this may mean that there is a cataract or cancer of the eye (retinoblastoma). Early detection will help in both of these cases.

Other very rare eye problems include birth defects that affect the eyes. You may notice that your child’s eyes have two different colors, or one eye may be larger than the other. An eye doctor can help to make the correct diagnosis and explain its significance.

In all cases, if you notice something about your child’s eyes that appears to be abnormal, seek a medical opinion from a physician or ophthalmologist.

Your Child’s First Eye Exam

When your child reaches three years, he should have a routine eye check-up even if he appears to be seeing normally.

At this appointment, your eye doctor will begin by asking you questions about your child’s visual behavior. Your doctor will also observe your child to see whether he looks around at things or follows the movement of objects. He will then check your child’s visual ability with an eye chart.

Your child will be asked to identify symbols like a hand, a cake, or a telephone, or to match or name letters or other symbols. Your doctor will also test your child’s ability to see in three dimensions using special 3D vision games.

For the second part of the eye exam, your physician will dilate your child’s pupils with medical eye drops and look into the interior of his eyeballs with a special magnifying machine (a slit lamp biomicroscope) and an ophthalmoscope. The drops might sting a little, and will also blur your child’s vision for a few hours. When your eye doctor looks into your child’s eyes with a retinoscope, he will be able to tell if your child is near- or far-sighted, and even prescribe glasses if necessary.

Most of the time your eye doctor will be able to examine your child without a problem. Rarely, if your child is very frightened and cannot cooperate for the exam, he may need to be sedated, or even put under general anaesthesia to allow a complete examination when it is especially important.

Good luck. And congratulations on taking steps to start your child on the path to good vision health – and a lifetime of routine eye exams to protect his vision.

J. Raymond Buncic

The Expert

Dr. J. Raymond Buncic is a Professor of Ophthalmology at the University of Toronto. He has served as past Ophthalmologist-in-Chief at the Hospital for Sick Children and is an active member of the American Association of Pediatric Ophthalmology and Strabismus as well as the North American Neuro-ophthalmology Society.​​​​