Common Childhood Eye Problems
Refractive Errors in Children
A refractive error means the eye has trouble focusing light correctly, which makes images appear blurry. Refractive errors are among the most common childhood eye conditions, and most are easily managed with glasses or contact lenses when caught early.
Myopia occurs when the eyeball grows slightly too long, causing distant objects to look blurry while close objects remain clear. A child with myopia may squint at the board at school, sit too close to the television, or complain that they cannot see far away.
Glasses or contact lenses correct myopia and help a child see clearly at all distances. Children who develop myopia at a young age often experience increases in their prescription as they grow, so regular eye exams are important to keep vision sharp and to monitor how the condition progresses over time.
Hyperopia means the eye has difficulty focusing on close objects. Most babies are born with a mild degree of farsightedness that naturally decreases as the eyes grow and develop. Moderate to high hyperopia, however, does not always resolve on its own.
A child with significant farsightedness may experience headaches, eye strain, or difficulty with tasks like reading and drawing. They may avoid close-up activities without being able to explain why. When farsightedness is causing these problems, glasses help reduce eye strain and support normal visual development.
Astigmatism occurs when the cornea, which is the clear front surface of the eye, has an uneven curve. Instead of focusing light to a single sharp point, an irregular cornea causes blurred or distorted vision at all distances.
Many children with mild astigmatism have no noticeable symptoms. When astigmatism is more significant, a child may experience blurry vision, headaches, or eye fatigue. Glasses can correct the condition effectively, and routine exams allow the eye care team to track any changes over time.
Amblyopia and Strabismus
Amblyopia and strabismus are two of the most important pediatric eye conditions to identify and treat as early as possible. Both conditions affect how the brain and eyes work together, and both can lead to permanent vision problems if treatment is delayed.
Amblyopia, sometimes called lazy eye, develops when one eye sends weaker visual signals to the brain than the other. Over time, the brain begins to favor the stronger eye and essentially ignores input from the weaker one. Amblyopia is the leading cause of vision loss in children in the United States, affecting an estimated two to three percent of the population.
The most common treatment is patching the stronger eye for several hours each day, which encourages the brain to rely on and strengthen the weaker eye. Some children use medicated eye drops or special glasses instead of a patch. Treatment is most effective when started before age seven, though older children can still benefit from intervention.
Strabismus means the eyes do not point in the same direction at the same time. One eye may turn inward, outward, upward, or downward while the other looks straight ahead. Strabismus affects approximately four percent of children and can be constant or come and go throughout the day.
Treatment depends on the cause and severity. Options include corrective glasses, prism lenses, patching, or eye muscle exercises. When these measures are not enough, strabismus surgery can reposition the eye muscles so the eyes align properly. Prompt treatment is important because both eyes must work together for a child to develop depth perception and full binocular vision.
These two conditions frequently occur together. When one eye turns away from its target, the brain may suppress the image from that eye to prevent double vision. If this suppression continues, amblyopia develops in the turned eye.
During a comprehensive pediatric eye exam, our team checks for both conditions at the same time. It is important to understand that treating strabismus alone does not cure amblyopia. A child may need patching or drops in addition to glasses or surgery to fully strengthen the weaker eye and restore balanced visual development.
Congenital and Structural Eye Conditions
Some eye conditions are present at birth or develop in early infancy. These structural problems can seriously affect visual development if they are not identified and treated quickly. Our pediatric eye care team is experienced in evaluating and managing these conditions in children of all ages.
A congenital cataract is a clouding of the eye's natural lens that is present at birth or appears in early childhood. The clouding can block or blur the light that the eye needs to develop normal vision. A pediatric ophthalmologist can detect a cataract during a red reflex test, which is performed shortly after birth.
Dense cataracts that significantly block vision typically require surgery to remove the cloudy lens. For a cataract affecting only one eye, surgery is often recommended within the first few months of life to prevent permanent amblyopia from developing. After surgery, the child wears a contact lens or glasses to replace the focusing power of the removed lens, and close follow-up is essential because strabismus is a common complication after pediatric cataract surgery.
A nasolacrimal duct obstruction, commonly called a blocked tear duct, prevents tears from draining properly from the eye. The result is persistent tearing, crustiness around the eye, and sometimes a sticky discharge. This is one of the most common eye conditions in newborns, affecting up to one in five babies.
Most blocked tear ducts open on their own before a baby's first birthday. Gentle massage of the tear duct area several times each day can help move the process along. If the duct remains blocked after twelve months, a brief outpatient procedure called tear-duct probing can clear the passage. In some cases, a small tube is placed temporarily to keep the duct open, a procedure known as intubation. Both approaches have a high rate of success and recovery is typically very quick.
Retinopathy of prematurity, or ROP, is a condition that can develop in premature infants when the blood vessels in the retina, which is the light-sensitive tissue at the back of the eye, grow abnormally. The retina relies on a network of healthy blood vessels to function, and premature birth can disrupt that development.
Infants born before 30 weeks or at a very low birth weight are at the highest risk and need regular retinal screenings in the neonatal period. Most cases of ROP resolve on their own, but severe cases require treatment to protect vision. Early identification is critical, and our team works closely with neonatology teams and parents to monitor at-risk newborns.
Warning Signs Parents Should Watch For
Children often do not realize their vision is different from anyone else's, so they may not complain even when something is wrong. Parents and caregivers play an important role in noticing early signs that a child's eyes may need attention.
One of the most important warning signs to watch for in photographs is a white, yellow, or absent red-eye reflection in the pupil. The normal red reflex, the familiar reddish glow seen in flash photos, occurs because light is reflecting off a healthy retina. An unusual glow or a missing reflex can indicate cataracts, retinoblastoma (a rare form of eye cancer), or other serious conditions and should be evaluated by a pediatric ophthalmologist right away.
Other signs to watch for in everyday life include:
- Persistent head tilting or turning to one side
- Covering or closing one eye frequently
- Squinting at distant objects or the television
- Avoiding coloring, reading, or other close-up activities
- Eyes that appear crossed, wandering, or not aligned
- Frequent eye rubbing or complaints of headaches
Any of these behaviors is a reason to schedule an eye exam, even if the child's last exam was normal.
Eye screening at key developmental stages helps catch vision problems before they affect learning or daily life. Current guidelines recommend a red reflex test at birth, a vision assessment between six and twelve months of age, photoscreening or automated refraction testing between twelve and thirty-six months, and visual acuity testing between ages three and five.
Photoscreening and handheld autorefraction technology can detect risk factors for amblyopia and refractive errors in infants and toddlers who are too young to read a standard eye chart. These tools are an important first step, but a comprehensive exam with a pediatric ophthalmologist provides the most complete picture of a young child's eye health.
Some children face a higher risk of developing serious eye conditions and need more careful monitoring from an earlier age. Premature infants, children with a family history of congenital eye conditions, and those with genetic syndromes or developmental delays all fall into this category.
Children with systemic health conditions including Down syndrome, cerebral palsy, or other neurological disorders should receive a comprehensive exam with a pediatric ophthalmologist rather than relying on standard vision screening alone. A general vision screening may not detect the full range of problems these children are at risk for, and early specialist involvement can make a meaningful difference in outcomes.
Pediatric Eye Care at Rhode Island Eye Institute
Our pediatric ophthalmology program is led by John Donahue, M.D., Ph.D., a fellowship-trained Pediatric Ophthalmologist who completed his fellowship at Children's National Medical Center. Dr. Donahue holds a doctoral degree in microbiology and immunology and serves as a Clinical Assistant Professor at Brown University. He has extensive experience treating the full range of childhood eye conditions, including strabismus, amblyopia, nasolacrimal duct obstruction, retinopathy of prematurity, pediatric cataracts, and congenital eye conditions.
Dr. Donahue also cares for children with developmental delays, prematurity-related eye concerns, and systemic conditions that affect the eyes. Our team provides strabismus surgery, patching therapy for amblyopia, tear-duct probing and intubation, pediatric cataract surgery, and contact lens fitting for children who have had lens removal.
We also co-manage pediatric patients with our optometry team for ongoing care including myopia management, routine vision monitoring, and contact lens follow-up. This collaborative approach means children receive continuous, coordinated care as their eyes grow and change.
Frequently Asked Questions
These answers address practical questions that go beyond what is covered above, including guidance on when to seek urgent care and how to navigate your child's treatment plan.
A comprehensive eye exam can be performed on infants of any age, including newborns. Specialized equipment and examination techniques allow a Pediatric Ophthalmologist to assess the health and function of an infant's eyes without relying on verbal responses. If your pediatrician has concerns at any point in infancy, a referral for a full exam is appropriate and should not be delayed.
School vision screenings test for basic distance acuity and are a useful starting point, but they do not catch every type of eye problem. Conditions like mild farsightedness, early strabismus, binocular vision problems, and color vision issues can be missed on a brief screening. If your child has any behavioral signs of a vision problem or a family history of eye conditions, a comprehensive exam with an eye doctor is the more reliable way to assess their visual health.
Treatment length varies depending on how severe the amblyopia is and how early treatment begins. Some children see significant improvement within a few months, while others need to continue patching for a year or more, with regular monitoring throughout. If patching is difficult, there are alternatives including prescription eye drops that temporarily blur the stronger eye. Our team works with families to find the approach that fits the child's needs and keeps treatment on track.
Strabismus surgery improves eye alignment, but it does not always produce a permanent fix. Some children need more than one procedure as they grow, and some degree of drift can return over time. Surgery is typically one part of a broader treatment plan that may also include glasses, patching, and ongoing monitoring. Regular follow-up appointments allow our Pediatric Ophthalmologist to catch any changes early and adjust the plan as needed.
Screen use does not directly damage the structure of the eye. However, spending extended time indoors focused on close-up screens is associated with faster progression of myopia in children who already have it. Spending time outdoors, even without structured activity, appears to have a protective effect. Encouraging outdoor time and following the 20-20-20 rule, looking at something twenty feet away for twenty seconds every twenty minutes, can help reduce eye strain and support healthy visual habits.
Updating a prescription corrects how well a child sees right now. Myopia management goes further by using specific treatments designed to slow the rate at which myopia progresses over time. Options include specialized contact lenses, atropine eye drops at low doses, and orthokeratology lenses worn overnight. The goal is to reduce the total amount of myopia a child develops, which may lower their risk of certain eye conditions later in life. Our team can evaluate whether myopia management is appropriate for your child based on their age, prescription, and rate of change.
Schedule a Pediatric Eye Exam
Early detection is the single most important factor in protecting your child's long-term vision, and our team is here to help every step of the way. Rhode Island Eye Institute brings together fellowship-trained specialists and advanced diagnostic technology to give children in Rhode Island and southeastern Massachusetts access to the highest level of pediatric eye care. If you have noticed any warning signs, received a referral from your pediatrician, or simply want to establish care, we welcome you to schedule an appointment with our pediatric ophthalmology team.