The Eyes Have It!

You might wonder why we place such an emphasis on looking

at your baby and toddler’s eyes.  It’s not just about vision!


Birth: black and white, no clarity, envision us as aliens. Eye muscles work poorly together.

By 2 months:  best vision at 8-10 inches, can see details of face. No distance vision. Muscles still peter out, when tired, eyes go a little wonky. Can focus for several seconds, starts to track.

By 4 months: color vision starts to come in. Objects at a distance come into play. Baby looks out, very excited as world goes from the B&W of Kansas, to the full color of Oz. Muscle coordination great, follows over 180 degree arc

By 6 months: Riveted on the world. More clarity. Distance vision great.

By 9 months: with crawling, develops more depth perception, hand/eye coordination. Can see small objects across the room, and starts to pursue them.

By 12 months: can start to throw, judge distances pretty well, as they are on the move.

12-24 month: well developed hand-eye coordination (holding utensils, neat pincer grasp) and depth perception (can navigate without injury). Explores environment constantly, recognizes familiar objects (visual memory great), scribbles with crayon or pencil.

What happens commonly to the eyes of babies? What do you see in the office?

1.     Nasolacrimal Duct Stenosis – the tear ducts are formed as solid tubes and hollow out during the last stages of pregnancy. Often a bit of tissue clogs the duct, leading to tears overflowing in one or both eyes. 95% of kids will outgrow this condition by age 12-24 months. Ophthalmologists can open the tear duct if necessary by age 2.

2.     Amblyopia/Strabismus – eye muscle weakness that leads to a lazy eye. Because visual input to both eyes is necessary for the development of both vision and depth perception, a lazy eye that doesn’t focus consistently loses out and can underdevelop. If we see a lazy eye, a referral is made to ophthalmology to follow, and often the strong eye is patched several hours/day to force the weaker eye to  work harder. Sometimes corrective surgery is necessary.

3.     Injury – irritable child, rubbing eye, corneal abrasion

4.     Infection – conjunctivitis (bacterial or viral) with pus/redness

5.     Allergy – swollen pale or cobblestoned appearance to conjunctivae, often with other allergy symptoms.  Base of lashes can be crusted as well.

6.     Lens cloudiness – can indicate the presence of corneal opacities/cataracts

7.     Light hypersensitivity – can indicate glaucoma

8.     Blindness – no response to light pointed directly at eye. Wandering response to stimulus

9.     Abnormal eye movements – can point to seizure activity, be a sign of tumor (neuroblastoma) or increased pressure within the brain (hydrocephalus)

10.  Abnormal red reflex – something blocking the retina and reflecting back a white color – retinoblastoma – a rare tumor of the eye, typically arises in the retina, blocking the blood vessels that give the “red reflex” when taking a photo. The eye may appear larger, the color different, and may affect how the eye moves. 

11.  Infant Botulism - a baby or child suddenly has droopy eyes, most often accompanied by constipation that is acute.


·      Early on: look and speak to baby at 8-10 inches – best focusing distance

·      Make visual environment interesting…early – black and white geometrics, by 4-6 months – lots of clear, bright color

·      Encourage floor time early

·      Change baby’s visual environment – move from room to room, point out objects, and name them, touch them, narrate what baby is seeing

·      Change baby’s position in crib – sleep north one day, south the next – different viewpoints

·      Encourage crawling

·      Toys that build hand-eye coordination great – building blocks

·      Play games with gestures – patty cake, itsy bitsy spider, hide and seek

·      When old enough, play ball – rolling, then throwing

·      Read and tell stories frequently


·       Excessive tearing - this may indicate blocked tear ducts

·       Red or encrusted eye lids - this could be a sign of an eye infection

·       Constant eye turning - this may signal a problem with eye muscle control

·       Extreme sensitivity to light - this may indicate an elevated pressure in the eye

·       Appearance of a white pupil - this may indicate the presence of an eye cancer

For a video link to this episode featured on Hallmark Home & Family go to: