Children cannot always tell you when something is wrong with their eyes. They may not realise their vision is blurred, or they may hide discomfort to avoid glasses or eye drops. This makes regular, structured eye care, not just school screenings, essential from infancy onwards.
Early detection matters because several childhood eye conditions cause permanent, irreversible vision loss if missed. Amblyopia (lazy eye), childhood cataract, and childhood glaucoma are treatable when caught early. Left undetected, they can result in lifelong visual disability.
This article has been written by Dr Shibal Bhartiya. She is a fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator with over 25 years of experience. Her approach focuses on identifying risk before damage is irreversible, simplifying treatment decisions, and protecting vision long-term.
Why Children Need Dedicated Eye Care
Children are not small adults when it comes to the eye. Several features make their eye health uniquely vulnerable.
Their visual system is still developing until the age of seven to eight years. Any disruption, refractive error, cataract, misalignment, during this critical window can permanently impair visual development. Children also spend more time outdoors, increasing exposure to infections, allergies, and trauma. They are more likely to eat selectively, raising the risk of nutritional deficiencies that affect the eye.
Finally, they rarely volunteer symptoms. A child who has never seen clearly does not know what they are missing.
Nutrition and Eye Health in Children
A balanced diet is the foundation of healthy eyes. In India, dietary deficiencies remain a significant contributor to preventable childhood blindness.
Vitamin A deficiency is the leading nutritional cause of childhood blindness globally. It causes night blindness, dry eyes, and, in severe cases, keratomalacia — corneal melting that causes permanent scarring. Good dietary sources include sweet potato, carrots, dark leafy greens such as spinach and methi, mango, papaya, eggs, and liver.
Zinc supports night vision and retinal health. Deficiency can accelerate cataract formation and impair dark adaptation. Whole grains, legumes, pumpkin seeds, and dairy provide adequate zinc for most children.
Junk food and ultra-processed snacks displace nutrient-dense foods without offering meaningful nutrition. Children who eat poorly are at higher risk of deficiency-related eye disease, fatigue-related eye strain, and systemic conditions that affect the eye over time.
Screen Time and Myopia
Childhood myopia (short-sightedness) has increased sharply over the past two decades. Evidence consistently links excessive indoor screen time and reduced outdoor activity to higher myopia rates.
Outdoor time, particularly in bright natural light, is protective. Studies show children who spend at least 90 minutes outdoors daily have significantly lower rates of myopia progression. Encouraging outdoor play is not optional advice: it is evidence-based eye care.
For screen use, the 20-20-20 rule is a practical starting point: every 20 minutes, look at something 20 feet away for 20 seconds. Reducing screen time before bed also reduces eye strain and sleep disruption.
For more detail, see Tips for Computer Use and Screen Time.
Preventing Eye Injuries in Children
Eye injuries are a leading cause of unilateral blindness in children. Most are preventable.
Choose age-appropriate toys without sharp or broken edges. Avoid toys that shoot projectiles, pellet guns, bow-and-arrow sets, and similar items cause serious, often irreversible eye injuries. During Diwali and other festivals, ensure strict adult supervision around firecrackers. Protective goggles are essential for cricket, squash, badminton, and any racket or ball sport.
If your child has an eye injury, chemical splash, blunt trauma, or penetrating injury, do not rub the eye, do not apply pressure, and seek emergency care immediately.
See Eye Injuries: First Aid and When to Go to Emergency for detailed guidance.
Preventing Eye Infections
Children are prone to conjunctivitis, styes, chalazia, and keratitis, largely because they touch their eyes frequently without washing their hands.
Teach hand hygiene early. Discourage eye rubbing. In Indian households, the application of kajal or surma inside infants’ eyes is a common practice, but it carries a real risk of infection and chemical injury and should be avoided.
If your child develops a red eye with discharge, tearing, or crusting, do not self-medicate with eye drops. Have the cause identified — conjunctivitis can be viral, bacterial, or allergic, and treatment differs significantly.
Routine Eye Examinations: What Schedule to Follow
Vision screening at school or during a paediatric visit is not a substitute for a comprehensive eye examination by an ophthalmologist. School charts measure only distance acuity. They miss refractive errors requiring near correction, squint, amblyopia, and all internal eye diseases.
The following schedule is recommended:
High-risk infants — immediate ophthalmology examination for premature babies at risk for retinopathy of prematurity, and for infants with a family history of retinoblastoma, childhood cataract, or childhood glaucoma.
All newborns — red reflex examination at birth and at every subsequent well-child visit. Any abnormality requires urgent ophthalmology referral.
Preschool children (ages 3 to 5) — at least one comprehensive examination to detect amblyopia and strabismus before school entry.
School-age children — annual examination including visual acuity, refraction, squint assessment, and fundus evaluation where indicated.
See Routine Eye Examination for Children for a full guide.
Common Eye Conditions in Children
The following conditions are routinely seen in children and should be actively screened for:
Refractive errors (myopia, hyperopia, astigmatism) are the most common. Untreated, they cause amblyopia — permanent vision loss that cannot be corrected once the critical developmental window closes.
Strabismus (squint) causes the eyes to misalign. It can indicate refractive error, amblyopia, or, rarely, an intraocular tumour. Any squint warrants urgent assessment.
Amblyopia (lazy eye) develops when the brain suppresses the image from one eye, leading to permanently reduced vision in that eye. Early glasses, patching, and vision therapy can prevent this — but only if detected in time. Read Dr Bhartiya’s peer reviewed article on amblyopia published in the Delhi Journal of Ophthalmology here.
Conjunctivitis — allergic or infective — is the most common cause of a red eye in children.
Nasolacrimal duct obstruction causes persistent watering and discharge in newborns. Most resolve spontaneously; a small percentage require probing.
Ptosis (drooping eyelid) can obstruct the visual axis and cause amblyopia if it covers the pupil.
Childhood cataract may be congenital or acquired. It requires urgent surgical management to preserve visual development.
Childhood glaucoma is rare but serious. It presents with excessive tearing, light sensitivity, and enlargement of the eye in infants. Early surgery is essential to prevent permanent optic nerve damage.
Retinoblastoma is a malignant tumour of the retina. The classic sign is a white pupillary reflex (leukocoria). Any white reflex in a child’s eye is an emergency.
Vitamin A deficiency, retinitis pigmentosa, and other hereditary retinal disorders round out the list of conditions that may present or be detected in childhood.
When to Seek an Urgent Opinion
Bring your child to an ophthalmologist without delay if you notice any of the following: a white or unusual reflex in the pupil in photographs, one eye turning in or out, persistent watering or light sensitivity in a newborn, a drooping eyelid, a red or discharging eye that is not improving, or any eye injury.
Do not wait for the next scheduled visit if a concern arises between appointments.
Known for her structured approach to vision risk assessment and progression analysis, Dr Shibal Bhartiya provides trusted second opinions for patients seeking clarity before major treatment decisions for their children.
Frequently Asked Questions
At what age should a child have their first eye examination?
All newborns should have a red reflex check at birth. Children at high risk (family history of retinoblastoma, childhood cataract, or childhood glaucoma) need a formal ophthalmology examination as early as possible. For all other children, a comprehensive examination before age 3 to 4 is recommended, with annual checks through school age.
Can refractive errors in children cause permanent vision loss?
Yes. Significant uncorrected refractive errors — particularly in young children — lead to amblyopia, which is permanent visual impairment. Glasses prescribed early can prevent this. Delay cannot be recovered once the critical developmental window closes.
In case your child needs glasses, please discuss myopia progression strategies with your doctor. In Gurgaon, Dr Shibal Bhartiya works closely with parents for both amblyopia therapy, and prevention of myopia progression.
Is school vision screening enough?
No. School screenings detect only gross distance acuity problems. They miss near-vision deficits, squint, amblyopia, and all internal eye diseases. They are a useful first filter, not a replacement for a comprehensive examination.
My child rubs their eyes constantly. Should I be worried?
Frequent eye rubbing can indicate allergy, refractive error, or dry eye. In children with connective tissue disorders, habitual eye rubbing is also associated with keratoconus (corneal thinning). Have it assessed rather than dismissed.
Can kajal or surma be used in a baby’s eyes?
No. Traditional application of kajal or surma inside the eye is a common practice in India, but it carries a documented risk of infection, chemical injury, and lead toxicity in infants. It should not be used in children’s eyes.
Read the research articles
This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. This article was edited in April 2026.
She has published peer-reviewed research on glaucoma management, examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes.
As Editor-in-Chief of Clinical and Experimental Vision and Eye Research and Executive Editor of the Journal of Current Glaucoma Practice (Pubmed Indexed, official journal of the International Society of Glaucoma Surgery), Dr Shibal Bhartiya brings editorial and research depth to every clinical decision. Her 200+ publications, including 90+ PubMed-indexed publications and 28 edited textbooks span glaucoma biology, surgical outcomes, health equity, and emerging diagnostics.
Her work can be accessed on Pubmed, Google Scholar, ResearchGate and ORCID.
Dr Shibal Bhartiya
Glaucoma • Second Opinion • Advanced Care
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