Checks for eye problems start in the newborn nursery, where babies as young as two days old are examined for the red eye reflex to rule out retinoblastoma or cataracts. Catching retinoblastoma, a form of intraocular cancer, may save not only a child’s vision, but his or her life. Babies born prematurely may also be at risk for retinopathy of prematurity, a condition where blood vessels develop abnormally and may cause retinal detachment, leading to blindness. The outcome of ROP depends on the stage of the disease, and laser treatments may prevent retinal detachment if it has not yet occurred.
Older kids who excessively squint when reading or looking at screens, are typically tested for refractive errors, and often need glasses to correct vision. An unequal refractive error called anisometropia can put a child at risk for amblyopia, or ”lazy eye.” Amblyopia results from a failure of development of vision in one eye despite the fact that the eye is physically normal. This abnormality is usually due to a severe refractive difference between the eyes resulting from either a refractive error or something blocking vision, like a cataract. The brain tends to favor the “good” eye, leaving the other one behind as vision develops. Amblyopia can be corrected with an eye patch or by administering atropine drops to blur the vision in the eye that registers normal vision to “train” the other eye.
Pediatric cataracts can be detected in the first few months of infancy by looking for the red eye reflex on the eye exam. If a red eye reflex is present, the coast is clear. Glaucoma is not limited to the elderly population. Childhood glaucoma results from excess pressure surrounding the optic nerve. If this pressure is not relieved, it can lead to blindness. Children who rub their eyes excessively, have larger than life cartoon-like eyes, or are very sensitive to light should be checked.
Neurological disease or a defect of the ocular motor system may be marked by nystagmus, a quick, back and forth rhythmical movement of the eyes that can be seen with the naked eye upon examination. This movement is involuntary and not consciously controlled, and in this case kids should be referred to a neurologist.