Why does my toddler complain for pain in eyes ?
The toddlers are the childeren aging between 1.5years-4 years. This age is full of growth and exploring new things. At the same time the childeren are learning to navigate the emotions and communicate their words. The screen time has been increased for the childeren of this age. So is the complain of eyestrain and headache. The toddlers often can not navigate the pain in eyes and strain as they experience this type of condition for the first time.
However, toddlers often struggle to express their discomfort accurately. They may not be able to describe pain in the eyes, blurred vision, or strain, as these sensations are new and confusing for them.
Why cycloplegic refraction is often needed
It has been clinically observed that toddlers presenting with eye pain or discomfort frequently require cycloplegic refraction to rule out underlying refractive errors. Since the visual system is still developing, any uncorrected refractive issue can cause excessive strain, leading to symptoms like headache, eye rubbing, watering, and avoidance of visual tasks.
Clinical examination: step-by-step
If a child presents with complaints of eye pain or discomfort, a thorough clinical examination is essential. Here’s how to proceed:
🔹 1. Detailed history
Start by taking a complete history of the child’s visual habits, screen time, overall health, and any recent changes in behavior, such as squinting, irritability, or lack of focus.
🔹 2. Eye alignment assessment
If history reveals no obvious systemic or ocular health issues, move on to assessing eye alignment. Perform cover-uncover and alternate cover tests for both near and distance fixation to detect phorias or tropias.
🔹 3. Examine the adnexa and ocular surface
Next, check the adnexa of the eye:
- Inspect the eyelids, meibomian glands, and ducts
- Examine for signs of discharge, dryness, allergies, or blepharitis
- Observe the cornea and conjunctiva for any abnormalities
If no signs of dry eye, infection, or neurotrophic corneal pain are present, continue with the internal eye exam.
🔹 4. Fundus examination
Conduct a fundus exam to rule out any posterior segment pathology, especially if the child has unexplained headaches or eye discomfort.
🔹 5. Cycloplegic refraction
Finally, perform a cycloplegic refraction using an age-appropriate cycloplegic agent (like cyclopentolate). This is a critical step, as latent hyperopia, accommodative spasm, or uncorrected astigmatism could be the root cause of the visual strain and headaches.
Management and follow-up
If a refractive error is detected, provide an age-appropriate prescription and advise the use of trial glasses for at least three months. During this period, observe changes in behavior, reduction in symptoms, and improvement in visual attention. After three months, schedule a follow-up visit to re-evaluate the refractive status and ensure that the correction is still accurate and effective.
Conclusion
In toddlers, complaints of eye pain or headache should never be ignored, as they might be early signs of visual strain due to uncorrected refractive error. Since children at this age cannot clearly express their discomfort, it becomes the responsibility of the eye care professional to assess their visual system thoroughly. Cycloplegic refraction remains the gold standard to detect hidden refractive errors in toddlers. By addressing these issues early and providing proper correction, we can significantly improve a child’s comfort, visual development, and quality of life.
Founder of EyesMatterMost- an optometry student who loves talking about eyes. I tend to cover topics related to optometry, ophthalmology, eye health, eyecare, eye cosmetics and everything in between. This website is a medium to educate my readers everything related to eyes.
