Symptoms of eye problems in children can sometimes be obvious and other times may be more subtle. It’s important to detect and treat issues early, while vision is still developing. Regular screenings with a pediatric ophthalmologist can help protect your child’s vision as they grow.
Pediatric ophthalmologist Stephen Lipsky, MD, urges parents and caregivers to follow the “RSVP” rule. “RSVP stands for: redness, sensitivity to light, vision change and pain. If your child experiences any one of these, it’s a good idea to make an appointment with an ophthalmologist. If they have two or more of these issues, they may need more immediate medical attention.”
Here are other common children’s eye symptoms you may worry about, and how to handle them.
Blinking or Rubbing
Frequent blinking and rubbing of the eyes is most often due to irritation caused by pollen- or animal-related allergies. Allergies can be treated with over-the-counter or prescription drops.
Sometimes, a foreign body can get caught under the eyelid and cause irritation. Blinking can also be a habitual tic caused by allergies, stress, or anxiety.
Other times, repeated blinking and rubbing can indicate a refractive error, such as nearsightedness. Your ophthalmologist will need to check your child’s vision to diagnose this and prescribe corrective lenses if needed.
Rarely, excessive blinking can be a sign of a neurological condition. Your ophthalmologist will refer you to a specialist if they suspect this.
Spots on the White of the Eye
Spots in the eye can occur for many different reasons. Pay attention to the color and size of the spot.
- A bright red spot is usually a subconjunctival hemorrhage. This is a broken blood vessel that may look scary, but is normally harmless and resolves on its own.
- A gray spot may be an indicator of a benign condition, but should be checked by an ophthalmologist. Sometimes, it can be a sign of iron deficiency or anemia.
- A brown spot is usually a nevus, or eye freckle. It occurs more frequently in people with dark hair or eyes, because they naturally produce more melanin. A nevus by itself does not indicate a problem, but it should be monitored over time by an ophthalmologist for change in color or size.
If a spot appears after an injury to the eye, visit the ophthalmologist right away.
Dilated Eyes/Large Pupils
It’s very common for children’s pupils to appear larger (more dilated) than those of adults. Children with light-colored eyes tend to have noticeably larger pupils.
When exposed to bright natural or artificial light, pupils should respond by getting smaller. Certain medications can also affect pupil size. For example, medicine used to treat ADHD as well as certain sweat blocking medicines can stimulate pupils to enlarge.
If one pupil consistently looks larger than the other, or if you’re concerned about your child’s pupil reaction, see a pediatric ophthalmologist for evaluation.
Seeing Spots in Vision
Spots or floaters in vision can look like grey or black specks, strings or cobwebs. In otherwise healthy eyes, they are caused by the natural structure of the vitreous gel inside the eye that casts shadows on the retina.
Floaters are more common in older adults, but can also occur in children. Occasional floaters are usually harmless.
Multiple new floaters or floaters that are accompanied by flashing lights or a curtain of vision loss can signal a retinal tear or inflammation inside the eye. If this happens, bring your child to the ophthalmologist right away.
Discomfort or Itchiness
Itchiness and/or discomfort is often a temporary condition associated with seasonal allergies.
Eye allergies can also cause tearing and/or a burning sensation and/or puffy eyelids. People who have eye allergies often have nasal allergies as well, with an itchy, stuffy nose and sneezing. Pet dander, dust, pollen, smoke, perfumes and even foods can bring on an allergic reaction in the eye.
If discomfort is accompanied by redness and a sticky or gooey discharge, it can be a sign of viral or bacterial conjunctivitis, aka pink eye. The ophthalmologist can help diagnose allergies and all types of conjunctivitis and provide treatments for relief.
Sleeping With Eyes Open
When children go into deep sleep, it’s fairly common for their eyes to open a little bit and even move around. This is generally safe and not a cause for concern.
If children frequently sleep with eyes open in an air conditioned room or with a fan blowing, eyes may become dry, red and irritated upon waking. Your ophthalmologist can suggest an eye ointment or drops that will help keep eyes sufficiently moist and prevent damage to the cornea.
Crust or Goop in Eyes
Discharge from the eye can dry on the lids and lashes and lead to “crusty eyes.” Crusty eyes can be caused by blepharitis, or inflammation in the oil glands of the eyelid.
A blocked tear duct can also be associated with crusty eyes. This occurs when the eye’s drainage system for tears is obstructed and tears cannot drain normally. This can lead to a watery, irritated and/or chronically infected eye.
Pink eye can also cause goopy or crusty eyes. A pediatric ophthalmologist should evaluate eyes with dry or wet discharge and provide the correct treatment.
Misaligned Eyes
If an eye turns inward, outward, upward or downward, that is a sign of strabismus, a visual problem that occurs in 2% to 5% of American children.
Strabismus can impair vision development since both eyes must aim at the same spot together to see properly. Left untreated, strabismus can lead to amblyopia, a condition where the misaligned eye has weaker vision.
A pediatric ophthalmologist should diagnose strabismus and provide treatment as soon as possible.
Head Tilting or Covering One Eye
A number of different eye and developmental conditions can cause a child to tilt their head or cover one eye. They may be adjusting the angle of vision to try and increase clarity. This might be an indication that the eyes are misaligned or that the child has lazy eye, also called amblyopia.
A head tilt could also signal a refractive error. Some kids who have astigmatism turn their face to the side to see clearer. Children with nearsightedness may look at objects with their chin up to see better. Kids who are farsighted tend to focus with their chin down.
Fourth nerve palsy, a rare congenital disease which can paralyze a certain muscle in your eye, can also cause a head tilt. If you notice a child tilting their head or covering one eye, bring them to a pediatric ophthalmologist for evaluation.