Watching your baby’s eyes

Doctor and a woman with a newbornWhen dealing with eye conditions, it can be beneficial to start treatment early. But how can you tell if your three-month-old’s eyes are developing the way they should?

Dr. Annick Fournier, head of the Children’s Hospital of Eastern Ontario’s Ophthalmology Department, offers some helpful information and advice on normal eye development and which warning signs can indicate problems.

How your baby’s eyes develop

For the first two months after a baby is born, their pupils will respond to light, but their eyes will only follow faces and objects sporadically. At this point, your baby is still learning how to keep her eyes aligned, so sometimes they might seem to be pointing in slightly different directions. “Out-turned” eyes that point away from each other are common.

During these first few months, your primary care physician will assess your baby’s retinal reflexes as part of the physical examination. Something to keep in mind during these first weeks while you’re snapping pictures for the scrapbook – it’s natural for his eyes to reflect red when they’re flashed with light, just like you get “red-eye” in photos.  If your baby’s “red-eye” reflexes do not appear to be symmetric while looking straight on, you should bring this to your doctor’s attention.

From two to six months of age, your baby’s eyes will start to fix and follow on faces, usually their mother’s face first. Her eyes will begin to track more smoothly, and by six months, her eyes should be properly aligned, or aligned in the same direction. At this point, if you notice that her eyes still seem to be misaligned, you should let your primary care physician know, and they can refer you to an eye-care specialist.

What to watch for and common issues

“Parents can trust their instincts,” says Dr. Fournier. “If something seems wrong to you, you should feel comfortable mentioning your concerns to your primary care provider. He or she can assess your child’s eyes and recommend an eye exam with a primary eye care provider if it’s necessary.”

The most common eye problems referred to CHEO include:

•Blocked tear ducts.  Ninety-five per cent of which are resolved by the baby’s first birthday through conservative treatments like massaging the tear duct to help remove the blockage.

•Strabismus, or misaligned eyes. There are many types of strabismus, with eyes turned inward, outward or vertically. Although the exact cause of strabismus remains unknown, some forms are related to the need for eyeglasses for farsightedness.

• Amblyopia, or “lazy” eye, which involves decreased vision in one or both eyes. Amblyopia may also be associated with strabismus when a misaligned eye doesn’t develop properly and loses vision, or it may be present on its own.  Treatment may take several years of ongoing therapy to train the brain to regain vision from the weak eye.

• Eye problems related to a more complex health condition such as juvenile arthritis or diabetes.

Warning signs parents can look for include an asymmetrical “red-eye” from photo flashes, a persistent eye-turn after your baby is six months old, closing one eye in bright sunlight, and persistent tearing or watery eyes beyond one year of age.

Many childhood diseases are familial, so it’s also important to mention any family history of eye problems to your doctor.

Sarah Hartwick, Public Relations, CHEO