Monday, December 13, 2021

Healthy Habits: When should your child have a first eye exam?


Your child’s first eye exam occurs in the newborn nursery at the hospital within the first few days of life.  The pediatrician first conducts a penlight exam, looking at the outer eye anatomy, and the red reflex test, where a light is shone into the eyes and the light reflected back from the eye is examined for symmetry, color, and brightness. These newborn evaluations give information on the child’s eye structure and anatomy.  

At each well visit with the pediatrician, your child’s doctor conducts age-appropriate eye exams. For younger children this consists of the red reflex test. You may not notice that the doctor is examining the eyes because it is a quick test to perform.  As children get older, the doctor will not only assess the red reflex, but also visual fixation, eye alignment and movement.

When children are old enough, the pediatrician may perform a vision screen using an automated machine.  These machines look like virtual reality goggles or binoculars. This measures the eyes for risk factors needing further evaluation by a pediatric eye specialist.

Finally, older, verbal children can perform a visual acuity test using letters or pictures.This is completed at the pediatrician’s office but is also performed in some school by the school nurse.


A child should be referred to a pediatric eye specialist for the following reasons:


  • Failed vision screen by the pediatrician

  • Failed vision screen at school

  • A family history of childhood eye diseases

  • A medical condition associated with eye problems

  • Learning disabilities or behavioral concerns

  • Prematurity

  • Eye trauma

  • Any other reason for concern from the parent, patient, teacher, or health care team


Pediatric eye specialists include pediatric ophthalmologists and optometrists with pediatric training.  


Why are eye exams important for kids?

Eye exams and vision screening are important for children because many pediatric eye conditions cause life-long vision problems. Early diagnosis and treatment can prevent or even reverse issues that negatively impact a child’s vision development and quality of life.

Kids eyes are not mini versions of adult eyes. A child’s visual system is unique due to the critical stage of vision development in early childhood. Children can have any eye disease that adults have, but they also have pediatric specific eye diseases that do not occur in adults.  

At birth, the pediatrician looks for congenital anomalies (abnormalities in eye structure at birth).  They also rule out problems such as congenital cataracts and congenital glaucoma which are cataracts or high pressure in the eyes occurring at birth. These are serious eye conditions that need urgent treatment in children.

Eye exams in older children look for risk factors of amblyopia (poor vision development) or strabismus (eye misalignment).  These are significant causes of life long visual impairment but can be treatable with early diagnosis.  Some people call these eye problems “lazy eye”. Finally, older children can have refractive error (near sighted, far sighted, or astigmatism) which cause blurry vision and are treatable with glasses.


What are the signs to look for if your child has vision issues?

Commonly there are no signs of a vision problem, which is why the vision screenings performed by your pediatrician and school nurse are so important. However, there are occasionally clues you may see at home.  Some signs that could indicate an eye problem include:


  1. Asymmetry between the eyes: Do the eyes look symmetric in color, shape, size? Are the pupils (the round black circle) equal? 

  2. Eye misalignment: Are the eyes straight? Do the eyes look misaligned or appear to point in different directions?

  3. Movement abnormalities: Do both eyes move together in all directions or do they move separately?  Does one eye appear stuck?

  4. Difficulty fixating on visual targets

  5. Wiggling or “jumping” eyes called nystagmus

  6. Drooping eyelids (ptosis)

  7. Sensitivity to light

  8. Abnormal red reflex: In photos that have the “red eye effect”, do the eyes have an abnormally dark, asymmetric, or white color instead of an equal, red or pink color?

  9. Squinting

  10. Head tilt


If you see any of these signs or symptoms at home, your child should receive a complete eye exam from a pediatric eye specialist. 


How often should you bring your child in for an eye exam?

The pediatric eye specialist will determine how often your child needs a follow up exam. If your child is found to be healthy after a complete eye exam, they can continue to receive vision screenings with the pediatrician and follow up with an eye specialist as needed. Some medical issues require frequent follow up. For example, young children with amblyopia (poor vision development) or strabismus (eye misalignment) may need to follow as frequently as every 3-4 months.  Children who have near sightedness (myopia) should receive an eye exam every year to check visual acuity, refraction, and ensure a healthy retina.


For reliable information on pediatric eye care and diseases, I recommend the American Association for Pediatric Ophthalmology and Strabismus at


Caroline N. DeBenedictis, M.D. – ReFocus Eye Doctors
Dr. DeBenedictis is a board-certified ophthalmologist specializing in pediatric eye care and strabismus. She has training and surgical expertise in treating and managing pediatric cataracts, ocular trauma and working with multiple specialists to manage pediatric ocular genetic conditions.

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