Detecting eye issues in babies

When your baby is born, it may be a while before you can study those little eyes. After birth, nurses usually put an antibiotic ointment in the newborn's eyes to prevent bacterial conjunctivitis, an infection of the outer layer of the eye. As a result, the infant's eyes may be shut for a while. In addition, you are not the only one exhausted after that delivery; your baby may need to get some shut eye too. While you may be eager to see if he inherited Grandpa's blue eyes or Dad's green eyes, you may need to wait a day or two.

Pediatricians also have trouble getting a good look at newborns' eyes. During the initial exams in the hospital, your baby's doctor will use a flashlight-like instrument called an ophthalmoscope, which magnifies the doctor's view of the eye. Often, the doctor cannot get the eyes open either, but if she does, she will be trying to get a "red reflex" which is a reflection from the eye that insures the doctor that the baby does not have cataracts, an opacity that completely or partially covers the lens of the eye and can block vision.

Sometimes there will be redness in the white of the baby's eye. This is called a subconjunctival hemorrhage, which sounds scary but is harmless. The trauma of birth can cause these superficial bleeds in both the mother's eye and the baby. The mother gets hers from pushing during labor, and the baby gets his from the trauma of getting through the birth canal. These bleeds take a few days to go away since the redness is pigment from red blood cells that needs time to be reabsorbed.

Once your baby has his eyes open, the doctor will also be checking to see if the pupils (the black circle in the center of the eye) are round and equal in size. Anisocoria or asymmetry of the pupils is seen in 20% of the normal population. It doesn't cause any problems with vision or anything else, but it's good to know if your child has it - that way, if he gets a head injury, you can tell the doctor that he always had asymmetrical eyes. The pupils should get smaller when a light is shined in the eye. Your doctor may also note whether the orbit, the bony encasement surrounding the eye, is symmetric. Many children have one eye that is slightly larger than the other. This is just an anatomic variant.

As the baby gets older, the doctor will check to see if your baby has a wandering eye. Detecting a wandering eye or crossed eyes is tricky in infants because they usually have a wide nasal bridge, which can give the appearance of crossed eyes. This is called pseudostrabismus and is more of an optical illusion rather than a medical problem. Sometimes an eye will wander or turn out or in only occasionally. In this case, your doctor may not observe this in the office, and it is important that you let the doctor know that you have seen it happen. If your baby has a true strabismus, or crossed eye, the condition may be treated in several ways. Strabismus is caused by a weakness in one of the eye muscles. A patch on the good eye, surgery, glasses, and observation are all possible treatment options. Be sure to see a pediatric ophthalmologist who has treated many children with strabismus if at all possible.

I'll leave you with two interesting facts about babies' eyes: One, eye color can change as the baby gets older; it is usually set by a year. Two, your baby will not acquire 20/20 vision until the age of three years. That does not mean those little hawk eyes will miss much, however.

Do you have any interesting eye stories? Any unique eye problems?

Dr. Victoria McEvoy graduated from Harvard Medical School in 1975 and is currently an Assistant Professor of Pediatrics at HMS. She is the Medical Director and Chief of Pediatrics at Mass General West Medical Group. She has practiced pediatrics for almost thirty years. She has been married to Earl for thirty six years and raised four children. She currently enjoys writing, traveling, reading, almost all sports, and spending time with her two grandsons.

Your Developing Baby
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