Online Health Chat with Julie Hill, OD, and Elias Traboulsi, MD

July 24, 2014


As quickly as kids grow and change, so can their vision. Regular eye exams are important to make sure your child's eyes are developing normally, and early diagnosis of eye problems in children can be crucial for performing better at school or during play.

As a parent, you may have many questions and concerns about the proper eye care for your child or about eye conditions your child might have. Cleveland Clinic optometrist Julie Hill, OD, and Cleveland Clinic pediatric ophthalmologist Elias Traboulsi, MD, will answer your questions about eye care for your child, including:

  • How do I know if my child needs glasses?
  • What are common warning signs of vision problems?
  • When should my child have an eye exam?
  • What are the symptoms of complex pediatric eye problems or eye infections such as conjunctivitis?
  • What are treatment options for genetic eye problems my child might be experiencing?

Cleveland Clinic pediatric optometrists and ophthalmologists offer comprehensive eye care for children and adolescents, from annual well-care visits to the diagnosis and treatment of eye diseases including lazy eye, nearsightedness/farsightedness, congenital cataracts and genetic eye diseases.

About the Speakers

Julie Hill, OD, is a Cleveland Clinic optometrist. She treats both adults and children, and is certified and licensed through the state of Ohio. Dr. Hill received her optometry degree from The Ohio State University College of Optometry. Dr. Hill sees patients at the Wellington Medical Office in Lorain.

Elias Traboulsi, MD, is Head of the Department of Pediatric Ophthalmology and Director of the Center for Genetic Eye Diseases at Cleveland Clinic's Cole Eye Institute. Dr. Traboulsi received his medical degree from American University of Beirut in Lebanon and is board-certified in ophthalmology and clinical genetics. His clinical and research interests include the management and genetics of strabismus and congenital cataracts, and the nosology of ophthalmic and general medical genetic disorders and syndromes. He has a special interest in ocular developmental biology and ocular malformations, retinal dystrophies, childhood glaucoma and other common and rare ocular diseases of children.

Let’s Chat About Caring for Your Child’s Eyes

Moderator: Welcome to our chat today with Cleveland Clinic Cole Eye Institute specialists Dr. Julie Hill and Dr. Elias Traboulsi. We are thrilled to have them here with us to share their knowledge and expertise about children’s eye conditions.

Vision Essentials

Carlton: If my child has 20/20 vision, does that mean their vision is perfect?

Julie_Hill,_OD: Twenty/twenty vision does not mean perfect vision. Children can have eye coordination issues and focusing fatigues that can cause problems with reading and learning. In addition, even children can have eye diseases. It is important to have yearly eye exams even if a child has 20/20 vision.

S.R.: My child is four and has 20/40 vision in both eyes. Should I be concerned or could this improve with time?

Elias_Traboulsi,_MD: I would not be concerned if the rest of the examination is normal. He does need a complete examination by an eye doctor if this has not yet been done.

Encore: Will sitting too close to the TV hurt my kids’ eyes? I swear sometimes they sit almost on top of it when playing their video games.

Elias_Traboulsi,_MD: We are not sure if it does or not. It is probably safer to keep a few feet of distance between the eyes and the television.

Jennifer: I have two kids going back to school, one in seventh grade and one in fifth grade. They haven’t mentioned having problems seeing in school, but should I have them get an eye exam just in case? When should children start getting eye exams? I think sometimes they do this for them in school, I just don’t know in which grade.

Elias_Traboulsi,_MD: If they have not voiced concerns, and if the vision screening examinations at their pediatrician and in school over previous years are fine, then it is not necessary to get them an eye exam. If you have any concerns, though, or if there is a history of any significant eye problems in the immediate family, then an examination is preferable.

Doctor Decisions

Turtline: How do I know whether my child should see an optometrist or an ophthalmologist?

Julie_Hill,_OD: Most of the time, you can start with an optometrist. An optometrist can diagnose and treat any eye condition that does not require surgery. If the optometrist thinks that your child's eye condition is beyond what he or she is comfortable with, the optometrist can then refer your child to an ophthalmologist.

Na'yir: Is it really possible for my infant or toddler to have a comprehensive eye exam? How can the doctor tell what my child is seeing—before she can even talk?

Julie_Hill,_OD: Infant eye exams are very common. There is a program called InfantSEE, which is an American Optometric Association public health program. The doctors are trained to assess the infant using methods that don't require any verbalization from the child. The doctors are even able to dilate the infant’s eyes to check for health issues such as tumors, glaucoma and cataracts. An uncorrected high glasses prescription can lead to lazy eyes and poor visual outcomes if left untreated. The sooner a problem is detected, the better the child's visual outcome will be. Infant eye exams are encouraged and worthwhile.

McNR: My son has autism. I have taken him to another eye doctor but the other doctor was unable to examine him. How are eye exams at Cleveland Clinic different?

Elias_Traboulsi,_MD: The pediatric ophthalmologists at Cleveland Clinic have extensive experience examining children with autism. Although some children with autism do not cooperate well with examinations, the ophthalmologist will be able to get enough information about the health of the eyes and the need for glasses.

charl: My daughter suffers from an autoimmune disorder that impacts her eyes. Can she be evaluated and/or treated at Cleveland Clinic?

Elias_Traboulsi,_MD: Absolutely. Our Cleveland Clinic ophthalmology team has extensive experience with such patients, and we have several ophthalmologists who have specialized in the management of patients, including children, with inflammatory conditions that affect the eyes.

heather: Recently, my preschooler has been bumping into things around the house. Could she have poor depth perception? Can an optometrist check for depth perception?

Julie_Hill,_OD: Yes. An optometrist can check for depth perception issues. The tests for depth perception are actually quite enjoyable for children to take. In addition, the optometrist will look for other issues that could be causing this problem, including an undiagnosed glasses prescription, lazy eye and eye disease.

Signs & Symptoms

SusieN67: My daughter is 10 and has been complaining lately that her eye has been twitching. What causes this and should I be concerned?

Elias_Traboulsi,_MD: Most often, eyelid twitching is a sign of tiredness. She probably needs more sleep and rest.

Camp8765: I’ve noticed that my three-month-old’s eyes water often, even when she is not actually crying. What could be causing this?

Elias_Traboulsi,_MD: It is common for very young infants to tear if their tear duct has not totally opened up. This may happen spontaneously in the next few weeks/months. Have your pediatrician evaluate this first. Pediatricians are familiar with the management of nasolacrimal duct obstruction. If the pediatrician feels that this needs to be evaluated by a pediatric ophthalmologist, he or she will make the referral.

GED57: My one-year-old daughter has red spots on the white of her eye. Is this something to be worried about and what causes it?

Elias_Traboulsi,_MD: Red spots on the white of the eye most often just represent normal blood vessels that are of no consequence. I suggest that your pediatrician take a look at them first, and if he or she cannot identify them as something benign, then you should get a complete eye examination by an eye doctor.

sccrmom: The pollen has really been affecting my son, and he rubs his eyes constantly until they’re swollen. Is there anything I can do to help him, before he starts to rub or after his eyes are swollen?

Elias_Traboulsi,_MD: The simplest way to deal with mild allergic reactions around the eyes is to use cold compresses. Many times, that is all that is needed. If the itching and swelling persists, then a visit to the eye doctor is in order.

Kresse: My 22-month-old daughter's pupils always seem to be dilated, even in bright light. When I compare her pupils to my husband's or son's in the same light, hers are always bigger. Could this be a sign of something?

Julie_Hill,_OD: Young children tend to have larger pupils in general. As we age, our pupil size decreases. However, if your child has extreme sensitivity to light, then this may indicate an elevated pressure in the eye. A difference in pupil size from one eye to the other may be a sign of a severe visual/neurological problem, and the child should be seen as soon as possible.

KarenG: I took my 10-year-old daughter for a routine eye exam, and her doctor said that her optic nerve is swollen. She is scheduled for an MRI. He said it is common in 10-year-old girls or sixth grade level. My question is, will eyeglasses help her or is it something that will go away over time?

Elias_Traboulsi,_MD: Swelling of the optic nerve head as detected on an eye examination can certainly be a non-serious consequence of an anatomic variation on how the optic nerve developed. However, it could be the sign of more significant and serious problems such as drusen of the optic nerve head (deposits inside the nerve head), which does not need treatment and can just be observed, or the result of elevated pressure inside the cranial cavity, which may need additional neurological work-up and interventions. Ultrasonography of the optic nerve, MRI of the brain and other diagnostic tests are usually performed depending on the type of optic nerve swelling observed and the clinical judgment of the ophthalmologist.

SJ0676: My daughter is one year old and has one pupil that is larger than the other. What is the cause? Her doctor says it should become normal.

Julie_Hill,_OD: There are simple tests that can be done by an eye doctor to confirm that the child does not have an underlying problem such as an optic nerve that is not functioning correctly or other neurological issues. Some people are just made that way and it is nothing to worry about, but an exam with an eye doctor is needed to make certain it is normal.

Timely Treatment

Kirsten45: My daughter’s eyes were a little crossed, and she just started wearing glasses to try to help correct them. She has to wear them all the time and she hates them. How long until we might start seeing a change?

Elias_Traboulsi,_MD: The response to glasses in the treatment of accommodative esotropia (what your daughter probably has) is variable. Give it some time and she will most likely get better. If not, and if the turning in remains significant, additional treatment such as surgery may be necessary.

Romero22: What do I do if my children get eye injuries while playing outside this summer? They are very active in the neighborhood, especially with sports and swimming with friends. Should I make them wear protective eyewear?

Elias_Traboulsi,_MD: Protective eyewear is essential for contact sport activities. If you suspect a direct eye injury in your child, especially if there is a vision change, a thorough examination is necessary.

Jennmom: What is the treatment for pink eye? Does the child need to see a doctor if I think they have it, or can this be treated at home? And when is it no longer contagious?

Elias_Traboulsi,_MD: There are a variety of causes of pink eye. The more common ones are viruses or bacteria. The viral causes usually occur in the setting of upper respiratory tract infections and do not need treatment with antibiotics. They get better when the cold is gone. They are contagious and children should stay at home until signs of the infection are gone. Bacterial conjunctivitis is characterized by more purulent discharge and responds well to antibiotics that can be prescribed by the pediatrician. It usually resolves within a few days, during which the child also needs to stay home. Allergic conjunctivitis is characterized mostly by itching and some swelling and with no "pus" coming out of the eye. This is treated by cold compresses or anti-allergy drops.

WorriedNell: How is conjunctivitis (or pink eye) in infants treated?

Elias_Traboulsi,_MD: See my previous posting. Thank you.

bluejeanlady: I have heard that vision therapy can help correct messy handwriting. Is this true?

Julie_Hill,_OD: Vision therapy has many uses in eye tracking and focusing conditions, but not all eye-coordination issues have a high success rate with vision therapy. However, some conditions are very treatable with it. Before committing to a vision therapy program, it is important that you ask the doctor what the research says about the success rate for the condition you will be treating. The one condition that does very well with vision therapy is convergence insufficiency. Messy handwriting, however, is not likely going to improve with vision therapy.

Specific Disorders

Jjunlci: Can cataracts occur in children? If so, how is this treated?

Elias_Traboulsi,_MD: Cataracts can certainly occur in children. They can even be present at birth. Their treatment is surgical if they interfere significantly with vision, but sometimes if they are small, they can just be observed. Other causes of cataracts in children include trauma and metabolic problems. There is often a family history of childhood cataracts in the parents or siblings of those who have them.

D2pak: My daughter has one eye that seems to drift outward sometimes. Will this correct itself?

Elias_Traboulsi,_MD: This condition is called exotropia. About one percent to two percent of people have some degree of it. If it is happening quite infrequently, then it is probably well-controlled and will not need active treatment. All children with exotropia or other types of ocular misalignment (strabismus) need complete and detailed eye examinations by eye doctors. Depending on the type of exotropia and its control, and depending on the presence or absence of other eye problems, the appropriate management can then be instituted.

BenTMore: My daughter has cataracts from steroid treatments. Will they keep getting worse?

Elias_Traboulsi,_MD: They may or may not. If the steroid treatment has been stopped for a long time and the cataracts are stable, then they probably will continue to be stable. If she is still on steroids, then they may get worse.

HalieJ: My daughter, age three, has Stickler syndrome. Her main medical problem is severe myopia, and she was diagnosed with -25 in both eyes. My ophthalmologist says glasses are of no use to her, but she is too young to keep the contacts in her eyes. She takes them out and throws them away. Is there a surgical procedure I can check into to better her vision?

Elias_Traboulsi,_MD: Very young children with Stickler syndrome can certainly be managed with glasses, even when the power is very high as with your daughter. Because of the high risk of retinal detachment and other problems associated with Stickler syndrome, I would urge you to try glasses again or contact lenses before any surgery is considered.

owens77: My 15-year-old daughter has been diagnosed with uveitis. Is this a common eye problem for someone so young to have? How is this generally treated?

Elias_Traboulsi,_MD: This is not a common problem. There are numerous causes of uveitis, and children and adults with uveitis are usually investigated to identify any underlying causes. The treatment varies from topical steroid drops to systemic steroids or other medications (pills or injections) that modulate the immune system.

bwhethers: My seven-year-old son's teacher thinks he has a convergence insufficiency. What is that and what can I do about it?

Julie_Hill,_OD: When we look up close, our eyes are wired in such a way that they turn in slightly to keep a single clear image. Some people have an eye coordination issue called convergence insufficiency. This is where the eyes struggle to converge or turn in when looking up close. This is one condition that can often be helped with home exercises that strengthen the muscles that allows the eyes to converge. Convergence insufficiency is a condition that can be diagnosed in a routine exam, and the doctor can give you home exercises to strengthen those muscles.

pamela: My teenage daughter once had a sty under her upper eyelid that was so big it caused her eye to shut slightly. She was told she had blepharitis and to just use lid scrubs. What exactly is this, and is there something more that she should be doing? She often complains that her eyes feel dry, but I've noticed they often water (almost like she's crying) when she's in the sun. Any advice you could give would be appreciated.

Elias_Traboulsi,_MD: Children often have recurrent styes and, indeed, they can occur in the setting of blepharitis or chronic inflammation of the lids. The treatment consists of lid margin scrubs to keep the pores of the glands in the eyelid open and to improve the blepharitis. If this is unsuccessful, ointments and sometimes oral medications need to be utilized. Styes are treated with warm compresses and topical ointment applications.

zelfish: My daughter was recently diagnosed with juvenile diabetes. Does she need more frequent eye exams or special vision care because she is diabetic?

Elias_Traboulsi,_MD: She needs a good baseline examination with inspection of her retina for any diabetic changes. Diabetic retinopathy changes typically do not occur before 10 to 15 years of diagnosis in juvenile diabetes. There are specific guidelines for how often she needs an eye examination for retinopathy, and these can be provided to you by her endocrinologist.

Simi: My seven-year-old son is having trouble with reading. I have also noticed that he frequently reverses letters and numbers when he is writing. Could he have dyslexia?

Elias_Traboulsi,_MD: It is possible. A complete eye examination will rule in or out any physical abnormalities in the eyes or any vision problems. Many children, however, do reverse letters and have some difficulties with reading at first, but overcome them without a problem. Dyslexia is a significant diagnosis that should only be made by specialists in the field of pediatric psychology, learning or neurology.

Lens Advice

Jodieann: My daughter is going into seventh grade, and last year, she was complaining about not being able to see the board. When I took her for an eye exam, they said she will need glasses. What should I look for when buying glasses for her? Is there a certain kind of lens recommended for children?

Julie_Hill,_OD: Children should ALWAYS have an impact-resistant lens. Typically, that lens material is polycarbonate. Most offices will not allow you to purchase a lens for a child that is not the polycarbonate lens material or one with the same impact resistance. The frame is really a matter of personal opinion.

Maddiemom: When is it OK for a child to wear contact lenses? My daughter is only 10 and hates her glasses, but I feel that 10 is too young for contacts.

Julie_Hill,_OD: My rule for contact lenses in children is that they must be able to do everything on their own with them. Parents have enough responsibility with everything else that goes along with raising a child and don't need another thing to worry about. When the child is mature enough to be able to keep the bedroom clean and do good personal hygiene without being reminded, then it may be time. I have patients that are 20 years old and not responsible enough to wear contact lenses, and I have eight and nine year olds that do wonderfully. It is important to remember two things: one, contact lenses are a medical device that if not cared for appropriately can cause serious sight-threatening eye infections, and two, they are a privilege that can always be taken away.

paula: Is it safe for my child to wear contact lenses when playing sports? Can they hurt their eyes if they get hit?

Julie_Hill,_OD: Most kids do great with contact lenses for sports. The contact lens has no protective factor for the eyes with regard to sports. In addition, there are no additional risks with respect to sports.

H.M.: I have an 11-year-old son who is myopic. His doctor suggested that he be fitted for hard contact lenses and reading glasses. She also suggested that he wear bifocals. Are bifocals common in children?

Elias_Traboulsi,_MD: Myopic children do not need bifocals except in rare occasions. The choice between glasses and contact lenses is often a family choice. Your son would probably do quite well with simple myopic glasses. The use of bifocals in slowing down the progression of myopia has yet to be proven.


Moderator: I am sorry to say that our time with Dr. Hill and Dr. Traboulsi is now over. Thank you for sharing your expertise and time to answer questions today.

Elias_Traboulsi,_MD: I would like to thank all the participants for such important questions. I hope that I have been able to help you in understanding the subject of your questions. Remember that this is not medical advice and that your children need to be examined and treated by qualified eye doctors before any treatment is given. I thank my colleague Dr. Hill for her help.

Julie_Hill,_OD: Thank you for your time. I hope we were able to answer your questions. Have a great day.

For Appointments

To schedule an appointment with Dr. Hill at our Cleveland Clinic Wellington Medical Office in Lorain, please call 440.647.0004. Or call 216.444.2020 to find a Cleveland Clinic optometrist near you.

To schedule an appointment with Dr. Traboulsi or any of the other specialists at the Cole Eye Institute, please call 216.444.2020 or call toll-free at 800.223.2273, ext. 42020.

You can also visit us online at

For More Information

On Children’s Eye Conditions

There are a number of health articles that may help to clarify some common questions. You may also visit

On Cleveland Clinic

Cole Eye Institute is among the world’s most advanced eye institutes, ranked by U.S. News & World Report as one of “America’s Best” ophthalmology programs and number one eye care program in Ohio. Our Department of Pediatric Ophthalmology specialists offer care for children and adolescent eye diseases, including strabismus, retinopathy of prematurity (ROP), congenital cataracts, nearsightedness/farsightedness and genetic eye diseases.

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