Ophthalmology

We see infants and children with a variety of disorders that affect the eyes, including:

• Blocked tear ducts (Children 1+ Year Old)

  Many children are born with tear ducts that aren't completely developed. This problem can cause blocked tear ducts, infections and over-production of tears. Blocked tear ducts often clear up by themselves and require no treatment. If tear ducts become infected, call your child's doctor quickly because the infection can spread to other parts of the face. Signs of infection include redness, pus and swelling.

• Disease of the optic nerve and brain

  There are many conditions that affect vision by harming the vision centers of the brain, including the visual cortex (where vision is processed) and the optic nerves (where light signals are sent from the eye to the brain). Our program works with other specialists to provide comprehensive care for specific diseases such as tuberous sclerosis complex, optic pathway gliomas, and other brain tumors. We use visual evoked potential to look at signaling in the brain and test visual function, and have developed specialized imaging analysis of the optic nerve using optical coherence tomography.

• Eye movement disorders

  Eye movement disorders usually involve uncontrollable movements of the eye or eyes that are not able to focus properly. For example, your child’s eyes may cross in or drift out (strabismus), they may have decreased vision in one eye (lazy eye, or amblyopia) or they may have double vision. Our team includes an orthoptist who is specially trained to measure your child’s vision and eye movement issues. Our orthoptist works with our ophthalmologists or optometrist to diagnose and develop a plan for your child which may include eye muscle exercises, glasses for double vision, a temporary patch for the eye or other treatments for eye muscle issues.

• Strabismus (ocular misalignment)

  Strabismus is a type of eye movement disorder in which a child's eyes look crossed. Strabismus is usually caused by an imbalance in the muscles that help the eyes stay straight and move together properly. Surgery on the eye muscles can help the eyes look straight. Children may have lasting vision loss in the less-used eye (amblyopia) if the condition is not treated in early childhood.

• Cataracts

  Some children are born with cataracts, which are a clouding of the eye's lenses. The clouding prevents images from being seen clearly or at all. In babies and young children, cataracts must be treated to prevent lasting problems with development of vision.

• Eyelid abnormalities and tumors

  Children can have a wide range of eyelid problems. Some problems include swelling and redness (inflammation) and infection, tumors that may or may not be cancer, and problems with the structure of the eyelid itself. In most cases, eyelid disorders don't threaten a child's vision or life. But sometimes their symptoms can cause pain or discomfort. Less often, the disorders can be serious.

• Eye tumors

  As in other parts of the body, tumors can form in the eyes when cells grow uncontrollably and form a lump of tissue. Tumors can be cancerous (malignant) or without cancer (benign). Retinoblastoma is a disease in which cancer cells form tumors in the tissues that line the inside of the back of the eye (retina). Although the disease can occur at any age, it usually shows up in children younger than 5 years. Read more.

• Glaucoma

  Glaucoma is a disorder that causes fluid pressure to build up inside the eye. This can cause damage to the optic nerve. It can occur in infants and children, although it is much more common among older adults. Unless found early by routine screening tests, glaucoma usually goes undiagnosed until some vision is lost.

• Inherited retinal degeneration

  Some children are born with diseases that affect the retina (the part of the eye that senses light). These conditions include inherited retinal degeneration, which can cause blindness from birth or later in life. Our clinic works with Seattle Children’s Genetics Program to provide tools to diagnose conditions that affect the retina, including multifocal and full-field electroretinogram, handheld and tabletop optical coherence tomography (retinal imaging), and genetic testing.

• Low vision

  Children with significant visual impairment can be seen by our low vision specialist, Vivian Manh, OD, for a complete evaluation. Through our low vision clinic, Dr. Manh works with vision specialists in schools and the community to provide a comprehensive approach to functional vision, identifying the best tools to help children achieve academic success and improve quality of life.

• Uveitis

  Uveitis is inflammation in the eye that can lead to long term vision damage. It is commonly associated with rheumatologic conditions such as juvenile idiopathic arthritis. Our combined uveitis/rheumatology subspecialty clinic provides state-of-the-art care for children with uveitis, including medical and surgical treatments.

• Vestibular balance disorders

  Vestibular balance disorders are problems that occur in the sensory system of the inner ear. This system works with eyesight to help people maintain their balance. Vestibular balance disorders can cause dizziness and imbalance, as well as nausea, anxiety, changes in hearing and other symptoms that can affect your child's daily life.

Children with these conditions can be treated by an eye doctor outside of Seattle Children’s, including most children with developmental disabilities and underlying medical conditions. Please see our list of eye care providers (PDF) that has been vetted by our faculty.

• Failed or abnormal vision screening
  • Learn about Your Child’s Vision.
• Decreased vision of unspecified duration and cause
  • Learn about Your Child’s Vision.
• Refractive errors (astigmatism, myopia, hyperopia)
  • Learn more about Astigmatism, Myopia or Hyperopia
• Blepharitis
  • Learn more about Blepharitis (PDF) (Spanish)
• Blocked tear duct (in patients under 1 year old)
  • Learn more about Nasolacrimal Duct Obstruction (Blocked Tear Ducts) (PDF) (Spanish)
• Chalazion or stye (except for surgery)
  • Learn more about Chalazion (PDF) (Spanish)
• Squinting, blinking, eye-rubbing, floaters, visual disturbances
  • Learn more about Your Child’s Vision.  
• Children who only need glasses
  • See our list of ophthalmologists and optometrists (PDF) outside of Seattle Children’s who are available to see these conditions.
  • Read about Your Child’s Vision for information on common eye conditions and how to help your child have healthy eyes and vision.
• Baseline or screening exams

  Children older than 12 months who need baseline or screening exams for farsightedness, nearsightedness, reading problems, or tracking problems (not including crossed eyes, or strabismus) unless the patient is referred to us by an eye care specialist.

  • See our list of ophthalmologists and optometrists (PDF) outside of Seattle Children’s who are available to see these conditions.
  • Read about Your Child’s Vision for information on common eye conditions and how to help your child have healthy eyes and vision.

Our Ophthalmology program offers tests to identify eye disorders in children, including:

• Electroretinogram (ERG)

  An electroretinogram measures the electrical response of the cells in the eye that are sensitive to light (retina). The test helps doctors evaluate disorders of the retina. The retina is the lining in the eyeball that is sensitive to light. It transfers signals to the optic nerve, which sends them to the brain, where they are seen as images. An electroretinogram can help doctors decide whether surgery on the retina may help your child.

• Oculomotor testing (eye movement testing)

  Oculomotor means eye movement. These tests measure how and when your child's eyes move in response to images, light, moving objects and head motion. Doctors compare your child's eye movement with that of other children of the same age to see if your child shows the usual response.

• Visual evoked potential

  This test measures the electrical signals to the brain that happen when your child sees something. Simply put, the test records the amount of time it takes for these electrical signals to reach the brain. Doctors use visual evoked potential tests to check sight, especially in babies and young children.

• Rotary chair testing

  Rotary chair testing helps doctors understand the cause of balance problems. The test measures eye movements as your child sits in a chair that moves in precise circular patterns. The doctor compares your child's eye movement with that of other children of the same age to see if your child shows the usual response. Rotary chair testing can help doctors find out how your child's visual and inner ear (vestibular) systems are working together.