Paediatric Ophthalmology

Common Children's Eye problems

Strabismus (Squint)

A squint occurs when the two eyes are not pointing in the same direction. Most commonly, one eye will turn in or out, but sometimes one eye could be sitting higher than the other. A squint can be present since birth or develop later in childhood. In some children, the eye will turn all the time (constant squint), in others it will turn sometimes (intermittent squint). An intermittent squint is usually more noticeable when the child is tired or when looking far away or close up.

The turned eye could lead to amblyopia or 'lazy eye' because the brain may be underdeveloped for vision in the turned eye. The lazy eye is usually treated with patching the stronger eye to strengthen the vision in the turned eye.

Sometimes glasses could help straighten the eyes. Once the lazy eye is treated, the eye could be straightened by surgery. Surgery only improves the alignment of the eyes and does not improve the vision. Squint surgery is usually done under general anaesthetic as a day procedure. This is usually well tolerated even in young children.

Lazy Eye (Amblyopia)

Lazy eye (amblyopia) occurs when there is an interruption in the normal visual development during early childhood. This results in reduced vision in the lazy eye. The common causes include:

  • a squint, (a turned eye),
  • refractive error (the need to wear glasses),
  • or obscuration of vision by for example a droopy eyelid.

It is important to treat the lazy eye before the age of seven or eight as the outcome of treatment is better. The treatment is usually in the form of patching over the stronger eye, sometimes glasses are needed to sharpen the focus, and occasionally eye drops could be used to blur the vision in the better eye.

Refractive Error

It is normal for children to be long sighted. Long-sightedness means children need to strain to focus both at distance and near. Most children can see well despite long sightedness as they have a great ability to change focus with their eyes. However, some children have a significantly high degree of long-sightedness causing blurred vision. This could then lead to lazy eye. Glasses may then be required to assist normal visual development.

Sometimes children are short sighted and depending on age and the degree of short sightedness, glasses may be necessary.

Astigmatism occurs when the shape of the eyeball is more like a rugby ball rather than like a soccer ball. This results in blurred vision at all distances. Significant degrees of astigmatism can lead to lazy eye and once again glasses may be required.

To check refraction in children accurately, eye drops are required to dilate the pupils.

Blocked Tear Ducts

Blocked tear ducts are a common condition in the population. Children with blocked tear ducts have watery eyes since birth. The lids could be stuck together and often there is yellow discharge around the inner corner of the eye. However, the white of the eye should not be red. Most children with blocked tear ducts get better spontaneously without treatment by the age of twelve months. If the blocked tear ducts persist after the age of one year, a surgical procedure may be needed to unblock the tear ducts under a short general anaesthetic.


Within the eyelid, there are many small meibomian glands that produce an oily fluid that forms part of the tears. A Chalazion is formed when the draining ducts of the meibomian glands are blocked. This causes a localised swelling and inflammation in the eyelid. It is common to have multiple chalazia involving both the top and bottom eyelids. Most chalazia go away with warm compression over eyelids. If the lump persists, this can be excised surgically, usually under a short general anaesthetic.

Credibility Logos

  • 	Fellow of the Royal Australian and New Zealand College of Ophthalmologists
  • American Academy Of Ophthalmology
  • American Society of Retina Specialists
  • National Eye Institute
  • Glaucoma Australia
  • Macular Degeneration Foundation