Eye Exams for Children

Guidelines for Childhood Eye Exams

The American Academy of Pediatrics and the American Association for Pediatric Ophthalmology and Strabismus agree that all children should have their eyes examined by the pediatric or family doctor at birth and at all regular check-ups before school. At the age of 3 to 4, the exams should include vision testing using acuity charts to help identify childhood eye disorders.

Children with certain medical or family risk factors should have comprehensive ophthalmic examinations. Please follow the direction of your pediatrician or family medical doctor.

Urgent or more frequent eye exams should take place if you see one or more of the following warning signs

Lack of eye fixation

A normal baby should be able to look at your face and follow your eyes as you move from side to side.

Misalignment of the eyes

As early as 2 to 3 months after birth a baby’s eyes should be aligned on interesting objects, near and far, left and right, and up and down.

Jerking eye movements

The eyes should rest steadily without jerking side to side or up and down.

White pupil

The pupil is the hole in the iris through which light enters the back of the eye and the retina. Under normal conditions, the pupil should be black.

Swelling around the eyelids

Lumps, changes in color or swelling around the eyes and lids can be caused by tumors or infections.

Excess tearing

Serious inflammations, blurry vision and nerve problems are possible reasons for excess tearing.

Drooping lid

Abnormalities of the brain or tissue around the eye may cause one or both lids to droop or retract. Some children have drooping lid at birth, which may cause vision loss as well.

Squinting or frequent blinking

Partially closed eyelids may produce temporary improvement of some types of blurry or double vision. Frequent blinking may occur with eye inflammation or allergies or with neurologic disorders.

Irregular pupil

Pupil should be round and reactive to bright light. Irregular pupil can signal an eye problem.

What to Expect During Your Child’s Eye Exam

Visual Acuity Testing

Visual acuity will be checked. This is possible even in children who are not old enough to speak. For older children, picture charts, letter games and letter recognition can be used.

Eye Alignment (Muscle Balance) Testing

Various methods are used to test the alignment of the eyes and to make sure the muscles that move the eye are functioning normally. This may be done using light reflexes or alternately covering each eye to make sure that they do not move from the straight-ahead position.

Binocular Vision Testing

These tests are used to make sure that the eyes are not only aligned correctly, but that the brain is using them together as well.

Refraction Testing

Refraction is used to measure the “power” of the eye. It determines if your child is nearsighted, farsighted or has astigmatism. This can even be performed in infants when they cannot cooperate to tell us how well they are seeing. In young children, the focusing power of the eye must be eliminated to allow an accurate measurement. Therefore, drops are placed into the eye to dilate the pupil and eliminate their focus mechanism. These drops often take 30–60 minutes to work and do not wear off for 8–12 hours.

Fundus Examination

During a fundus examination, the examiner uses a special light, often worn on his or her head, to look into the back of your child’s eye. The retinal blood vessels and the optic nerve, an extension of the brain, can be seen. Because this is an area where blood vessels and portions of the brain can be seen, it is very valuable in helping to diagnose many disorders that can affect the entire body. Once the examination is complete, your child may be prescribed glasses. Treatment for other problems may also be addressed.