Get an early start on eye health
2/7/2022 by Kara Fine, M.D.
One of the first tests a newborn undergoes is a check for eye health. Healthy eyes not only support good vision, but also success in school, sports, social activities and work.
Your health care team has the information you need to make sure your children's eyes remain healthy, no matter their age.
Routine childhood vision screening
Here are the recommended childhood vision screenings by age:
Starting after birth, your primary provider will routinely check the "red reflex" of the eye. With this check, he or she is looking to see if something, such as a cataract or mass, is blocking light reflection off the retinas.
Your primary provider will continue to check the red reflex at well-child visits and may ask about eye alignment. It's important to let your provider know if you notice your child has crossed eyes or a "lazy eye" because catching these problems early makes correction more effective.
At a well-child visit around age 3, your child will have his or her first vision screening using either an eye chart or a vision "spot screener" tool. This screening will help identify any problems with your child's ability to see things clearly.
Many schools will perform periodic vision screening for students, and your care team will continue to offer vision screening at well-child visits. If any of these screenings are abnormal, an optometrist or ophthalmologist should evaluate your child. Nearsightedness, or myopia (difficulty seeing objects in the distance), is the most common vision issue for school-aged children and can be corrected with eyeglasses.
Eye injuries are the leading cause of blindness in kids, and sports are the major source of eye injuries in school-age children. Baseball, basketball, soccer, football and hockey are the sports most associated with eye injury, so your child should wear eye protection during these activities.
In addition to injuries, it's never to early to protect eyes from the sun. The best sunglasses will block at least 99% of ultraviolet (UV) and and UV B rays. Look for glasses with large lenses that fit well and close to the eye surface for the best protection.
Red eye or pinkeye
Pinkeye, or redness of the white part of the eye, is a common infection in childhood. It can be caused by bacteria, a virus, or an allergy:
Viruses cause most cases of pinkeye, which is also called conjunctivitis. One way to think of viral conjunctivitis is an "eye cold." Viral conjunctivitis can be contagious, so good hand-washing is key to help prevent it from spreading.
It can sometimes be difficult to distinguish between viral and bacterial conjunctivitis. Most importantly, a bacterial infection will cause a thick, pus-like discharge that continues throughout the day. Within minutes of wiping the eyelids, more discharge appears. Antibiotic eye drops or ointment are prescribed.
Allergies also commonly cause red eyes. Children often complain of itchy eyes, or they may have a watery discharge. Their eyes may be crusted shut in the morning. They also can have associated symptoms such as sneezing or runny nose, or have a history of asthma or eczema. Treatment consists of antihistamine eye drops.
Symptoms of pinkeye include:
- Isolated redness of the eye.
- Fever, sore throat or respiratory symptoms.
- Burning, gritty or sandy feeling in the eye.
- Crusty discharge when waking up or a watery, mucous-like discharge throughout the day. If this happens, use warm compresses to clear the discharge. Antibiotic eye drops will not work for this type of infection and could cause additional irritation.
- The infection may worsen over the first three to five days, but it typically improves gradually and is gone within two to three weeks.
Newborn issues include:
- Eye color
Many parents wonder when their baby's permanent eye color will become apparent. Eye color is determined by the production of melanin, a pigmented protein. Melanocytes, the cells that make up melanin, respond to light, so many babies ill have gray or blue eyes right after both. Over the first year of life, the eye color may change with light exposure. Most of the time, these changes become apparent in the first six months, but the final color may not be clear until a baby is 1 year old.
- Blocked tear ducts
Parents may notice clear discharge from one or both of their baby's eyes. This often is caused by blocked tear ducts. A blocked duct is not dangerous, and it usually will go away over time. Parents may want to gently massage the corner of the eye to help open the duct. Ask your baby's health care team to show you how. If the watery discharge is still present by the time your baby is 1 year old, your health care team may refer you to an ophthalmologist to open the duct. Most blocked tear ducts go away by age 1 without any intervention. Contact your baby's care team if your baby's eyes appear red, or the discharge is yellow-green, since these can be signs of infection.
Between prevention and knowledge of some common eye issues, you and your family are well on the way to maintaining healthy vision.
Kara Fine, M.D., is a pediatrician in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine. In addition to general pediatrics, she is medical director for the newborn nursery and provider lead for the Pediatric Complex Care Coordination Program.