What are common eye conditions in children?

Common Eye Conditions in Children

Refractive error is the most common cause of reduced vision in children, affecting 5-7% of preschoolers and 25% of school-age children, followed by amblyopia which affects over 6 million Americans and causes more permanent vision loss in those under 45 than all other causes combined. 1

Most Common Conditions Causing Vision Impairment

Refractive Errors (Most Common Overall)

• High hyperopia, moderate-to-high astigmatism, moderate-to-high myopia, and anisometropia (asymmetric refractive errors between eyes) represent the most prevalent vision problems 1
• Affects 5-7% of preschool children in the United States 1
• 25% of children ages 6-18 years either use or would benefit from corrective lenses 1
• Incidence varies significantly by age, race/ethnicity, and socioeconomic status 1
• These are easily correctable with glasses but frequently go undetected without screening 2

Amblyopia (Leading Cause of Permanent Vision Loss)

• Affects over 6 million Americans and is responsible for more permanent vision loss in people under age 45 than all other causes of visual disability combined 1
• Prevalence varies by race/ethnicity: 2.6% in Hispanic/Latinx children versus 1.5% in African American children 1
• The most common causes are strabismus (mainly esotropia) and high refractive errors or anisometropia 1
• Risk increases 6.5-26 times with anisometropia and 2.7-18 times with strabismus 1
• Children with developmental delay have sixfold greater prevalence than full-term healthy children 1
• Best treated in early childhood for optimal outcomes, though treatment can improve vision even in teenage years 1

Strabismus

• One of the four most common childhood ocular problems causing vision impairment 1
• Esotropia is the primary type associated with amblyopia development 1
• Intermittent exotropia rarely causes amblyopia 1

Vision-Threatening Conditions in Infancy

In High-Income Countries (Including United States)

Severe vision-threatening problems observed within the first year of life include: 1

• Congenital cataract 1
• Retinopathy of prematurity (ROP) 1
• Congenital glaucoma 1
• Retinoblastoma (vision- and life-threatening malignancy) 1
• Cerebral visual impairment 1
• Conditions of the optic nerve and higher visual pathways, frequently associated with prematurity 1

Premature Birth-Related Conditions

Premature birth is a major risk factor for severe visual impairment and blindness 1

• ROP frequency and severity inversely related to gestational age and birth weight 1
• Preterm infants have higher rates of amblyopia, strabismus, refractive error, optic atrophy, and cerebral visual impairment 1
• Even preterm children not meeting ROP screening criteria remain at risk for amblyopia 1
• Children with severe ROP have lifelong risk of glaucoma and retinal detachment 1
• Visual impairment from ROP often accompanied by cerebral palsy, epilepsy, and other motor/intellectual disabilities 1

Less Common but Important Treatable Conditions

Uveitis

• Although uncommon, uveitis is an important and treatable cause of ocular morbidity in children 1
• Most frequent specific causes are juvenile idiopathic arthritis and toxoplasma retinochoroiditis 1
• Children with juvenile idiopathic arthritis should have ophthalmic examination within 1 month of diagnosis to rule out uveitis, with ongoing periodic examinations per American College of Rheumatology/Arthritis Foundation guidelines 1
• Prompt diagnosis and treatment are critical to preserving visual function 1

Keratoconus

• Commonly begins during puberty 1
• Corneal ectasia progresses most rapidly in young people 1
• If recognized early, treatment with corneal cross-linking stabilizes the cornea 1

Critical Clinical Pitfalls

At least 25% of children with visual impairment have a cerebral and/or optic nerve component contributing to vision loss 1

Anisometropic amblyopia shows left eye predominance (53-64% of cases), though strabismic amblyopia affects both eyes equally 1

Parents or caregivers are frequently unaware of eye problems in children or the consequences of delayed care, making screening essential 1