Your baby's first eye exam occurs right in the hospital nursery, when your pediatrician checks for general eye health. High-risk newborns, including premature infants and those with a family history of eye problems, should be examined by a pediatric ophthalmologist.
Otherwise, all children are screened at each well-baby visit for eye issues. The doctor checks baby's ability to fixate on and follow a light; the anatomy of the eye; and whether anything is clouding the lens. Then children will have their first complete vision exam around their third birthday, or between 12 months and 18 months if there's a family history of strabismus. If this is the case, ask your pediatrician for a referral to a pediatric ophthalmologist. Vision problems affecting newborns and young children include:
• Strabismus. This describes crossed or wandering eyes, which affects around 2 percent of kids. The misalignment may be constant or it can come and go, and it can affect one or both eyes. While it's normal for a newborn's eyes to cross or wander when they're tired, if you still see your baby's eyes cross after 3 months, or your child looks at you with one eye closed or with her head turned to one side, talk to your pediatrician.
• Excessive tearing. This may be a sign of a minor, common problem, blocked tear ducts, which occur in about 6 percent of babies. It happens when the normal drainage system for tears fails to open or becomes blocked, preventing the flow of tears from the eyes into the nose. Tears accumulate and overflow onto the cheek, even when baby isn't crying. Other symptoms include mucus discharge at the inner corner of the eye and swollen and red eyelids. Consult your pediatrician, who will show you how to massage the tear duct and apply compresses to encourage it to open. He may also prescribe antibiotics if the ducts get infected. Fortunately, 90 percent of babies outgrow this problem by their first birthday. If the problem doesn't clear up, surgery may be required to open the tear duct.
• Amblyopia (or "lazy eye"). Good vision requires both eyes to see the same clear image; this condition results when one eye has weak vision (usually due to crossed eyes, cataracts, or droopy eyelids) prompting the child to rely on the "good" eye for sight. Treatment usually involves wearing an eye patch over the stronger eye for several months until the weaker eye catches up.
• Cataracts. This is a clouding over the eye's lens, which prevents light from getting in and interferes with your child's vision. Though this condition is pretty rare among babies, it is important to diagnose and remove cataracts as quickly as possible, so your child's sight develops on schedule. Cataracts are generally removed surgically.
• Glaucoma. Also extremely rare in babies, glaucoma is a condition in which there's too much pressure built up inside the eye, due to the overproduction or poor drainage of tears. Warning signs include enlarged eyes, excessive tearing, and sensitivity to light. Since untreated glaucoma can lead to blindness, most children have surgery shortly after it's diagnosed. --Julie Evans
Originally published in American Baby magazine, November 2004. Updated 2009.