What to know about vision problems in babies

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Experts consider eye and vision problems rare for infants — their visual abilities gradually develop, usually without any complications. However, sometimes vision and eye health problems may develop.

The following can be signs of problems with the eyes in infants:

• red, crusty eyes
• excessive tearing
• extreme light sensitivity
• eye turning to one side constantly
• white spot in pupil or white pupil

For the first 2 months, an infant’s eyes are not well coordinated and may wander or cross. However, an eye evaluation may be necessary if an eye appears to turn in or out constantly.

The American Public Health Organization estimates that around 1 in 5 preschoolers in the United States have vision problems.

Parents and caregivers should also look out for visual problems in children since conditions, such as crossed eyes or a squint, known as strabismus, is common in infants.

It is also fairly common for babies younger than 3 months to have some signs of strabismus that comes and goes.

The early years are crucial for children to learn the visual abilities they need in school and throughout life. Therefore, it is vital to spot these problems early and consult with a doctor for diagnosis and treatments if necessary.

Many parents and caregivers may find themselves comparing their infant’s skills with another child’s visual abilities. However, babies’ eyes and visual systems continue to develop during the first few months of life, and the stages vary across infants.

For example, by 8 weeks, a baby may begin to more easily focus their eyes on the faces of a parent, caregiver, or another person near them. However, others may not yet focus on objects or shift their vision from one subject to another. Developmental milestones are guides, and each child may hit their milestones at different ages.

Babies might have vision impairment at birth, which is called a congenital issue. It can also happen later as a result of disease, injury, or a medical condition. These could be the causes for the delay in visual development.

Congenital causes

Congenital causes are primarily due to:

• Developmental or genetic disorders: Babies may have eye problems due to an atypical formation of their eyes during pregnancy or genetic conditions. Examples include:
  • retinitis pigmentosa
  • albinism
  • cataracts
• Alcohol: Excessive alcohol intake during pregnancy may cause fetal alcohol syndrome, a condition that causes developmental problems, including:
  • blindness
  • visual impairment,
  • droopy eyelid, or ptosis
  • nystagmus, which causes abnormal or involuntary eye movement
  • changes in the eyelids
• Infection: This can occur during pregnancy, including TORCH — toxoplasmosis, other agents, rubella, cytomegalovirus, and herpes — which causes inflammation and abnormalities of the eyes.
• Drugs: People who take certain drugs, such as cocaine and seizure medications, during pregnancy may cause ocular malformation in babies. A 2020 study found that infants with exposure to substances while in the womb are more likely to be hospitalized for eye disorders, such as strabismus, binocular movement disorders, and ocular muscle disorders.

Other causes

Infants may also develop acquired conditions due to a variety of causes.

• Retinopathy of prematurity (ROP): This eye disorder affects extremely premature babies and occurs due to the atypical development of blood vessels in the retina. It may resolve on its own or may require surgery. Low birth weight and gestational age are the most important risk factors for developing severe ROP.
• Ophthalmia neonatorum: This refers to any conjunctivitis that develops within the first 28 days of an infant’s life. It is most commonly due to bacterial or viral infections.
• Amblyopia, or lazy eye: This occurs when one or both eyes do not develop properly early in life. It can result from strabismus, refractive errors, cataracts, and ptosis. About 3 in 100 children have amblyopia, making it the most common cause of vision loss in children.
• Strabismus: This occurs if eye muscles are not able to work together. It can run in families or be due to factors such as prematurity, retinoblastoma, cerebral palsy, and spina bifida. Some people can also be born with it.
• Shaken baby syndrome: This can cause fatal injuries in the brain. Around 85% of these cases indicate retinal hemorrhages, a condition that can lead to permanent vision loss.

The underlying cause of the vision problem will dictate the treatments, which may include using eye drops, wearing eyeglasses, Botox injection, or surgery.

For example, to treat strabismus, doctors may recommend patching the stronger eye to increase the strength in the weaker eye, wearing eyeglasses, surgery to straighten the eyes, or performing eye exercises.

Several specialists can work with children with severe vision loss. These include:

• orthoptists
• orientation and mobility specialists
• occupational therapists
• counselors
• special education teachers

Parents and caregivers can also try age-appropriate activities at home to support their baby and their vision. These activities are not necessary for development but useful for babies to experience.

0–4 months

At 0–4 months, activities to support vision include:

• changing the child’s position in their crib
• placing toys within their focus, around 8–12 inches from them
• infants start tracking moving objects with their eyes and reaching for them, when eye-hand coordination begins to develop

5–8 months

At 5–8 months, activities to support vision include:

• placing toys and objects that the baby can grasp and kick
• giving them adequate floor time to play and explore
• giving toys that the baby can hold

9–12 months

At 9–12 months, activities to support vision include:

• naming objects and actions to help children associate words with them
• encouraging active exploration and movements such as crawling and cruising
• playing hide and seek games and games that develop visual memory

1–2 years

At 1–2 years, activities to support vision include:

• rolling a ball around to help the child develop visual tracking
• playing with blocks and balls of all shapes and sizes
• reading or telling stories

Aside from taking the steps above to support the development of a baby’s vision, parents and caregivers should also consider taking their children to screenings and comprehensive eye testing.

After a baby is born, a doctor or pediatrician performs a general eye health check. However, this does not mean that a baby will not develop problems as they grow.

In the infant’s first vision screening, a pediatrician inspects the newborn’s eye, pupil, and red reflex.

The examiner uses a flashlight to inspect whether the pupils have an atypical shape or structure. The pupil will constrict in light and dilate in the dark, and both pupils should be the same size.

The red reflex is a reflection of the inside of the eye that causes the pupil to look red in photographs. The red reflex should be bright and equal in both eyes.

After the initial screening, doctors recommend parents and caregivers take their child for a vision assessment during the first 12 months of a baby’s life. This will generally take place at each well baby visit. Doctors will refer an infant for further testing if any other signs of vision problems are found by parents, caregivers, or pediatricians.

Parents and caregivers can also utilize InfantSEE, a public health program from the American Optometric Association that provides a comprehensive eye assessment to infants between 6 and 12 months.

The optometrist will also check a baby’s overall eye health and look for common problems such as:

• refractive errors such as nearsightedness and farsightedness
• eye movement and alignment
• cataracts
• ptosis, or drooping eyelid
• astigmatism

All babies go through a series of screenings and tests to detect vision problems early on.

While treatment results may vary on the cause and type of condition, early detection and intervention can resolve most eye conditions.

Parents and caregivers of babies with vision problems can expect to have regular visits with their ophthalmologist for a detailed care plan. This may include working with other specialists who can help treat the child’s condition if necessary.

A parent or caregiver may worry that their infant will experience vision problems. However, an infant’s eye and visual skills are still developing until they are over a year old. Parents and caregivers can support their development through age-specific activities.

An infant should undergo screening several times within the first year of life. This starts with the newborn exam. These tests can help rule out any current eye conditions or abnormalities. If doctors do detect any visual problems early, they may be able to correct the vision and avoid future issues.