Resources for Educators

Teachers, school nurses, and childcare providers are often the first to detect symptoms of eye conditions in children. Some of these conditions affect how children play, learn, and see their world. Children who show the warning signs for visual conditions relate to their environment differently. Some of these signs include:

Bringing objects close to their eyes
Avoiding projects that require close vision (like books or puzzles)
Covering or squinting one eye when viewing an object up close
Complaining of headaches, blurred or double vision, or burning and itching eyes
Demonstrating poor hand-eye coordination

It’s crucial to identify and address vision concerns as soon as possible. The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) has developed a valuable resource to help school nurses and educators identify eye conditions and injuries. We recommend you familiarize yourself with these common eye conditions:

Dyslexia & Vision Therapy

If a child has difficulty at school, many people assume that the cause is related to vision. The reality is, learning disabilities are caused by the brain, not the eyes. A learning disability can still exist even when a child's vision is normal—with or without corrective lenses.

Various forms of "vision therapy” attempt to correct learning disabilities by improving visual function and performance with lenses, prisms, and other optical devices. There are many vision therapy methods, but none of them have been proven to improve or correct learning disabilities. Many have no medical basis and can even cause a delay in getting children the educational assistance they need.

As effective as orthoptics, or eye exercises, can be for poor eye coordination, they are NEVER recommended in the treatment of learning disabilities. Educational redemption is the only proven solution.

Learn more about learning disabilities and vision in this PowerPoint presentation from the Amercian Academy of Ophthalmology.

Read the offical policy statement about learning disabilities, dyslexia, and vision from the American Academy of Pediatrics, the American Association for Pediatric Ophthalmology and Strabismus, and the American Academy of Ophthalmology for more information.

Eye Injuries

Close to 50% of eye injuries occur in sports and recreational activities--more often in children and teens than any other age group. But proper prevention can eliminate many common eye injuries.

Sport Injuries

Sports with high velocity ball action are most dangerous (such as tennis, soccer, baseball, basketball, hockey, etc.). The best protection is a sports frame with polycarbonate lenses. Any eye injury should be examined by an ophthalmologist.

Chemical Spills

If there is a chemical injury, immediately flush the eyes and face with fresh water for at least 10-15 minutes. Follow up immediately with a trip to the emergency room or ophthalmologist.

Traumatic Injuries

If a sharp object has penetrated the eye (like a pencil), do not pull it out. Transport the person to the emergency room as soon as possible. Other blunt or sharp injuries should be examined by an ophthalmologist (the serious nature of the injury may not quickly identified).

Corneal Abrasion (scratched cornea)

A corneal abrasion refers to a scratch of the front clear surface of the eye (cornea). These abrasions are very painful and usually associated with light sensitivity and tearing. Protect the injuried eye until the child can see a pediatrician. Serious cases should be seen by an ophthalmologist.

Headaches

Children who experience frequent headaches should have an eye exam, depending on the type of headache they experience. Eye related headaches in children could be caused by an eye muscle imbalance, an eye disease, or conditions that need correction with eyeglasses.

For children with extreme farsightedness, reading can trigger headaches (either while reading or shortly after). Glasses can reduce the effort to see clearly.
Children with a difficult time pulling the eyes together when viewing near objects (while reading) also experience headaches. Double or blurred vision and eye fatigue are symptoms of convergence insufficiency, and the child should have an eye exam.
Acute infections and inflammatory diseases can cause headaches. Symptoms inclue red eye and/or eyelid and light sensitivity (photophobia). Some conditions (like Juvenile Idiopathic Arthritis), can unknowingly affect the eyes and require regular eye exams.
Acute glaucoma can cause headaches, but this condition rarely affects children. We recommend intraocular pressure checks for children who are at increased risk for glaucoma.
Migraine headaches are uncommon in children, but may cause blurred vision, perception of jagged lines, or partial loss of vision. A child experiencing migraine headaches should see their primary care provider and/or a neurologist.

Lazy Eye (Amblyopia)

“Lazy eye,” or amblyopia, is a loss of vision in one eye when the other eye is used more. It’s often caused by a condition that affects normal use of the eyes and visual development—such as strabismus (misaligned eyes), unequal focus casued by a refractive error, or cloudiness in the normally clear eye tissues (like cataracts).

Unless the child has a misaligned eye or other obvious abnormality, there is often no way to diagnose the condition. Amblyopia is detected by finding a difference in vision between the two eyes.

Poor vision in one eye does not always indicate amblyopia. Vision can often be improved with glasses. A carefully examination by the interior of the eye to see if other eye diseases may be causing decreased vision.

Amblyopia is usually treated with eye drops or patches that blur or block vision in the stronger eye to strengthen the weaker eye. In severe cases, surgery may be necessary. Early intervention will help strengthen the weak eye and restore vision.

Learning Disabilities

Learning disabilities are commonly diagnosed during childhood years and can have many causes. The eyes are often suspected, but are almost never the cause of learning disabilities. That doesn’t mean that children with LD cannot have vision issues. Like any child, they should see an opthamologist if they fail vision screening tests.

Treating LD includes changes to a child’s academic approach (such as one-on-one tutoring, multisensory teaching techniques, and emphasizing learning strengths). There is no scientific evidence that supports vision training, orthoptic exercises, visual perceptual training, or colored spectacle lenses as a viable treatment for children with LD.

Pink Eye (Conjunctivitis)

Pink eye (conjunctivitis) appears as a reddening of the white part of the eye. It is usually associated with excessive tearing, a discharge, and a foreign body sensation in the eyes.

Pink eye has many causes and can occur at any age. In infants and children, pink eye is usually caused by a viral or bacterial infection. In older children, it may also be caused by allergies.

Treatment depends on the cause of pink eye. Eye drops or ointment may help, but it’s best to contact a pediatric eye doctor and have a proper diagnosis. Regular and thorough hand washing helps prevent the spread of infection.

Refractive Errors

Refractive errors affect the eye's cornea–the part of the eye that focuses light onto the retina.

Nearsightedness (myopia) is common in school-aged children. Objects in the distance appear blurry, but become clearer closer to the eye. There is no cure, but eyeglasses or contact lenses will help. Nearsightedness generally increases until the mid-teenage years. Periodic follow-up examinations by an ophthalmologist is recommended.

Farsightedness, or hyperopia, is more common in infants and children. A small degree of farsightedness is normal in infants and children. It does not interfere with vision and requires no correction. However, when excessive farsightedness causes the eyes to cross, glasses are required.

Astigmatism occurs when an eye has an irregular corneal shape. It may result in blurred vision. If the amount of astigmatism is large, glasses or contact leses can help achieve clearer vision.

Vision Screening

Vision screening helps identify children with vision impairment or eye conditions. Multiple screenings over time can catch issues undetected in a comprehensive exam.

Vision screening methods include:

Inspection of the eye, pupils, and red reflex
Photoscreening
Corneal light reflex testing
Cover testing
Subjective visual acuity testing

Screening is used to identify children who have or are at risk of developing amblyopia. Amblyopia can lead to permanent visual impairment unless treated in early childhood. Screening can also catch other vision conditions and other issues, such as tumors or neurological diseases. If a child fails a vision screening, they should be referred for a comprehensive examination.

Learn more about school requriements for vision screening in your state.