At birth, babies have limited vision but can see faces up close, even in the nursery. By around six weeks, a baby’s eyes should start to follow objects, and by four months, they should work together. Vision develops rapidly over the first year or two, and by age two, most children’s vision is around 20/30, nearly equivalent to that of an adult.

Parents should look out for signs of poor vision, such as:

One eye turning or crossing, which may indicate reduced vision in that eye.

Disinterest in faces or age-appropriate toys.

Eyes moving involuntarily or shaking (nystagmus).

Tilting the head or squinting. Since babies and toddlers tend to compensate for poor vision, they may not complain about it.

If a baby needs glasses, the prescription is determined by dilating the pupil and analyzing the light reflected from the back of the eye. A special instrument called a retinoscope allows for an accurate measurement, even in young or uncooperative children.

A blocked tear duct causes excessive tearing, as tears cannot drain properly. Symptoms include mucus causing eyelashes to stick together or tear accumulation in one or both eyes. If the duct becomes infected, it can result in painful swelling at the inner corner of the eyelid. In infants, the membrane causing the blockage typically opens by six months. If it doesn’t, treatment may be required to clear the obstruction.

Initial treatment involves massaging the affected tear sac (located between the eye and nose) to encourage tear and mucus drainage, which can help open the blockage. Parents should perform this massage frequently. If an infection occurs, antibiotic drops may be prescribed. In cases where the blockage persists, a procedure called probing may be performed between six months and one year of age to clear the obstruction. This procedure is highly effective (90-95%) after one treatment. If necessary, a small tube may be placed in the duct to keep it open for six to twelve months.

Amblyopia, or lazy eye, is a condition where one eye fails to develop normal vision during childhood. The stronger eye compensates, and the brain may suppress vision in the weaker eye. Early identification and treatment are crucial to improving vision in the affected eye.

Strabismus is a condition where the eyes are misaligned. It can manifest as:

Esotropia: Eyes turn inward (crossed).

Exotropia: Eyes turn outward (wall-eyed).

Hypertropia or Hypotropia: One eye is higher or lower than the other.

Strabismus can be subtle or constant and may shift between eyes. It can result from a variety of causes, including uncoordinated eye muscles, trauma, or brain tumors. Children with strabismus often hold their heads at a certain angle or cover one eye to improve vision. In contrast, adults may experience double vision and lose depth perception.

Strabismus is often treated surgically by adjusting the tension on the eye muscles to straighten the eyes and enable them to work together. Surgery is highly effective, but about 15-20% of patients may require additional procedures to achieve optimal results.