Paediatric Ophthalmologist: Children’s Eye Care

When should a child see an ophthalmologist for the first time?

A child’s first examination by a paediatric ophthalmologist should usually take place after the first three years of life. The reason is that from this age onwards the child is able to cooperate, so we can obtain objective findings about their vision. In other words, we can see whether the child really has good vision or not. This of course applies when the parents have not noticed anything abnormal, or anything that seems to them not entirely normal. In that case, a full examination with fundoscopy and refraction with retinoscopy should be carried out before the age of three as well.

Page contents

1. When should a child see an ophthalmologist for the first time?
2. What does a full eye examination in children include?
3. When should a child wear glasses?
4. What is lazy eye, or amblyopia?
5. When can a child wear contact lenses?
6. Signs parents should look out for
7. When an eye examination is needed before the age of 3
8. Refractive errors in children
9. Myopia in children: can we slow it down?
10. Amblyopia treatment step by step
11. Squint in children
12. Common eye problems in children
13. How to prepare your child for the eye examination
14. Vision and school performance
15. Glasses for children: practical tips
16. Children who need closer monitoring
17. Sun and eye protection for children
18. Sport and eye injuries
19. What we will ask you at the appointment
20. How often should a child’s eyes be checked?
21. Our approach to examining children
22. Contact lenses and adolescence: what parents need to know
23. Frequently Asked Questions about Children’s Eye Care

What does a full eye examination in children include?

The first and most important part is testing visual acuity and refraction, that is, measuring whether the child needs glasses and with what prescription. It is also essential to check eye movements and alignment, in other words whether the eyes move in all directions or whether there is a hidden squint. Colour vision is tested with the Ishihara plates and stereoscopic (3D) vision with a stereo test. We examine the front of the eye with the slit lamp, measure the pressure in the child’s eyes and put in drops for the last part of the examination, which is fundoscopy.

When should a child wear glasses?

Glasses are usually recommended for a child when their vision is not as good as it should be for their age. Also, when a child develops a squint, any refractive error present usually needs to be corrected.

What is lazy eye, or amblyopia?

Amblyopia is reduced vision in one or both eyes because the brain and the eye are not working well together. When the brain receives a blurred image, it does not develop properly and ends up ignoring one of the two images, which blurs the overall vision. The most common cause of amblyopia is a refractive error, that is, myopia, hyperopia or astigmatism. So the first step in treating amblyopia is wearing glasses continuously and then, if vision does not reach the desired level, occlusion (patching) of the “good” eye. This is done for a few hours at first and, if there is no improvement, the hours are increased.

When can a child wear contact lenses?

To start using contact lenses, a young person first needs to be mature enough to treat them with the seriousness they deserve. Contact lenses are a very useful tool, but they must be taken seriously because they carry many risks. From an anatomical point of view, physical growth should be complete before starting contact lenses, which means at least after the age of 16.

Signs parents should look out for

Children rarely say that they cannot see well. For them, the world as they see it is the only one they know. That is why observations by parents, grandparents and teachers are so valuable. Book an eye examination if you notice that the child:

• Has one eye that seems to look in a different direction, all the time or when they are tired
• Tilts their head or turns their face to look at something
• Sits very close to the television, tablet or book
• Screws up their eyes or closes one eye in the sun or to see in the distance
• Often rubs their eyes or complains of headaches after school
• Avoids reading, loses their place when reading or tires quickly
• Often trips or is clumsy in ball games
• Has constantly watery eyes or sticky eyelids since infancy

When an eye examination is needed before the age of 3

The first full examination usually takes place around the age of 3, but some children need to be examined much earlier, even in the first months of life:

• White pupil: If in flash photographs the pupil of one eye looks white or yellowish instead of red, an examination is needed immediately.
• A squint that persists after the third or fourth month of life.
• Premature babies, who need a special examination of the retina.
• A family history of childhood cataract, glaucoma, high hyperopia or severe squint.
• Nystagmus, that is, involuntary shaking movements of the eyes.
• Constant tearing or discharge, often due to a blocked tear duct.

For a detailed schedule by age, read when a paediatric eye examination is recommended.

Refractive errors in children

Most children are born with mild hyperopia, which decreases as the eye grows. However, when the prescription is higher than expected for the child’s age, or differs a lot between the two eyes, it needs to be corrected.

• Hyperopia: The child makes a constant effort to focus, gets tired with near tasks and may develop an inward-turning squint.
• Myopia: It usually appears at school age. The child cannot see the board or distant objects clearly.
• Astigmatism: It blurs the image at all distances and causes tiredness and headaches.

Myopia in children: can we slow it down?

Myopia in children is increasing worldwide, and the earlier it starts, the higher the prescription it can reach in adult life. High myopia is not just a matter of glasses, because it increases the risk of retinal detachment and other conditions later on.

Today there are ways to slow its progression in suitable children: very low-dose atropine drops, special spectacle lenses and special contact lenses designed for myopia control. The choice is made individually, based on the child’s age, prescription and rate of progression. Time outdoors is just as important: at least two hours a day outside, in natural light, is linked to a lower risk of developing myopia. See also our advice on children and screens.

Amblyopia treatment step by step

Amblyopia is treated successfully when it is addressed early, because a child’s brain is still “plastic” and can learn to use the weaker eye. Treatment usually has three stages:

1. Correction with glasses: Many children improve significantly with the right glasses alone, worn all day.
2. Patching the good eye: With a special adhesive patch for a few hours every day, so that the weaker eye has to “work”. The number of hours is set by the ophthalmologist.
3. Atropine drops: In some children they are used in the good eye instead of a patch, blurring it slightly so that the weaker eye is preferred.

The family’s consistency is the key. Activities that require close attention, such as drawing, puzzles and games, during patching hours make treatment more effective and more enjoyable for the child.

Squint in children

A squint (strabismus) is not only a cosmetic problem. When the eyes do not look at the same point, the brain ignores the image from one eye, resulting in amblyopia and loss of stereoscopic vision, that is, depth perception. Depending on the type, a squint is treated with glasses, amblyopia treatment or surgery. You will find more on the page about strabismus.

Common eye problems in children

• Blocked tear duct in babies: The eye waters constantly and has a yellow discharge. It often clears up by the first year with massage at the inner corner of the eye, as the doctor will show you.
• Conjunctivitis: Red eyes with discharge, often after a cold. It is contagious, so hand hygiene is important. Find out more about conjunctivitis.
• Stye and chalazion: Very common in children, they usually settle with warm compresses. Read about a stye in the eye.
• Allergic conjunctivitis: Itchy, red and swollen eyes in spring, often together with allergic rhinitis.

How to prepare your child for the eye examination

A calm, well-rested child cooperates much better. Choose a time when your child is not sleepy or hungry. Explain in simple words that they will look at pictures and little lights and that it will not hurt. Bring their glasses, if they wear them, and a favourite toy.

At the first examination, cycloplegia is almost always performed, using drops that relax the eye’s focusing. It is the only way to measure a child’s true prescription accurately. The drops sting for a few seconds, and for a few hours near vision is blurred and the pupils are large. So, if possible, avoid scheduling the examination before an important test at school.

Vision and school performance

A child who cannot see the board well or gets tired when reading may seem distracted, restless or uninterested. An eye examination before starting school rules out vision as the cause. Remember, however, that learning difficulties such as dyslexia are not caused by the eyes and are not treated with glasses or eye exercises. When vision is normal, assessment continues with the appropriate specialists.

Glasses for children: practical tips

• Choose a frame that sits firmly on the nose and has flexible hinges.
• Polycarbonate lenses are light and impact-resistant.
• For young children, a strap behind the head helps keep the glasses in place.
• Let your child choose the colour; they will wear them more willingly.
• Have the prescription checked every year, because it changes as the child grows.

Children who need closer monitoring

Some children need more frequent or more specialised eye examinations because they are at higher risk of eye problems:

• Children with type 1 diabetes: They need a fundus examination at regular intervals, usually from adolescence onwards. Find out more about diabetic retinopathy.
• Children with juvenile idiopathic arthritis: They are at risk of silent uveitis and need a slit lamp examination every few months.
• Children with Down syndrome or other genetic conditions, who often have refractive errors, squint, cataract or keratoconus.
• Children with developmental or neurological disorders, in whom vision has a major effect on learning and communication.

Sun and eye protection for children

The lens of the eye in children is clearer than in adults and lets more ultraviolet radiation reach the retina. A large part of a lifetime’s sun exposure happens in childhood. A hat with a brim and sunglasses with a certified UV filter are essential at the beach, in the snow and when the sun is strong. Cheap sunglasses without a filter are worse than no sunglasses at all, because they dilate the pupil without offering protection.

Sport and eye injuries

Many eye injuries in children happen during play and sport. In ball and racket sports, special polycarbonate protective glasses significantly reduce the risk. Keep fireworks, catapults and toys that fire projectiles away from children.

If a chemical, such as detergent or bleach, gets into the eye, rinse immediately with plenty of running water for at least 15 minutes and then seek medical help. If a child is hit in the eye and their vision is blurred, the eye stays red or there is blood inside the eye, they need an examination straight away. Do not press on the eye and do not try to remove an object that is stuck in it.

What we will ask you at the appointment

To make the examination as complete as possible, we will ask you about the pregnancy and birth, any premature birth, your child’s development, any family history of glasses from an early age, squint or “lazy eye”, and anything that you or the school have noticed. If your child has been examined before, bring their old glasses prescription. All this helps us see the full picture and plan the follow-up schedule together with you.

How often should a child’s eyes be checked?

If the first examination is normal and there are no risk factors, a sensible schedule is:

• Around 3 years: First full examination with cycloplegia.
• Before primary school, at 5 to 6 years: Check of vision and refractive status.
• At school age: Every 1 to 2 years, or every year if the child wears glasses or there is myopia in the family.
• In adolescence: A yearly check, especially when starting contact lenses.

If the child wears glasses for amblyopia or squint, visits are more frequent, usually every 2 to 4 months, until vision has stabilised. Between check-ups, any new concern, such as an eye that starts to “wander” or a child who suddenly sits close to the television, is a reason for an extra visit.

Our approach to examining children

Every child is different. Some cooperate straight away, while others need a little time to feel comfortable. We adapt the pace of the examination to the child, use pictures and games instead of letters with younger children and explain what we are doing at every step. The aim is for the child to leave with a positive experience, so that the next check-up is easy too. Parents are always in the examination room and receive written instructions for anything needed at home. If the child is tired or frightened, we prefer to complete the examination at a second, short visit rather than push them.

Contact lenses and adolescence: what parents need to know

In adolescence many children ask to replace their glasses with contact lenses, mainly for sport or for appearance. Contact lenses are safe when the young person is responsible enough to follow good hygiene: washing hands before every handling, never sleeping in lenses, never using tap water or swimming in lenses. Daily disposable lenses are usually the safest option at this age. Every teenager who wears contact lenses should also have a pair of glasses for days when the eyes are red or tired.

It is also important for them to know that pain, redness or sensitivity to light are a reason to remove the lenses immediately and be examined on the same day, because this may be an infection of the cornea. Before the first fitting, there is a full examination, corneal measurements and training at the clinic, so that the young person learns to put in and remove the lenses safely. A follow-up check takes place a few weeks later.

To book a paediatric eye examination, call +30 210 677 0007.

Frequently Asked Questions about Children’s Eye Care

Medically reviewed by: Dr. Vasileios Skouteris MD, FEBO