What to Expect at Your Infant's First Eye Exam

An infant’s vision develops rapidly. In the first six months, a baby’s sight usually becomes their strongest sense, enabling them to develop important cognitive and social skills. 

That’s why it’s important for your pediatrician to check your child’s eyes regularly. It's also recommended that you take your infant for a complete eye exam with a specialist within the first year, whether or not they are showing signs of vision problems.

A healthcare provider will use specialized tests to screen for eye disorders or diseases, which will help keep your baby on track in all areas of development.

When Infant Eye Exams Should Be Done

Newborn babies usually have their eyes checked at the hospital shortly after birth. Pediatricians perform screening eye exams to check for infections or structural problems with the eyes, including:

• Malformed eyelids
• Cataracts
• Glaucoma
• Other abnormalities

Following that initial screening, pediatricians and eye doctors advise having your child’s eyes checked during regular well-child visits. In the first year, it’s recommended that babies have well visits in the first week after birth then at 1 month, 2 months, 4 months, 6 months, 9 months, and 12 months of age.

While these checkups are helpful, the American Optometric Association also recommends that babies see an eye specialist, an optometrist or an ophthalmologist, at around 6 months of age for their first complete eye exam. This more thorough examination can test for things such as:

• Nearsightedness
• Farsightedness
• Astigmatism
• Eye movement ability
• Eye alignment

After the first year, your child should have an eye exam at age 3, before starting kindergarten (around age 6), and every year or two. Children who are diagnosed with an eye problem or who are prescribed glasses should have their eyes checked once a year.

Signs of Vision Problems

Eye problems are not common in infants, but they can develop. If you notice any of the following issues with your child’s eyes or vision, you should consult a healthcare provider as soon as possible, and don’t wait until the next well visit.

• Crossing their eyes, called strabismus, after 6 months of age
• Quick back and forth or up and down movements of the eyes in which they seem to dance or jerk about, known as nystagmus
  
• Injuries to the eye or the eyelid
• Blocked tear ducts, which may cause an unusual amount of tears
• Signs of infection, such as conjunctivitis, which may include a red, swollen, or encrusted eyelid
• Unusual sensitivity to light 
  

How an Eye Exam Is Done on a Baby

Eye examinations can be specially designed to evaluate a young child who isn’t able to communicate or pay attention for long periods of time.

Your healthcare provider may recommend scheduling an eye exam in the morning when babies tend to be more alert. Ensuring your baby is not hungry or overtired can help the test go smoothly.

At the start of the exam, the healthcare provider will first evaluate your baby’s medical history. Tests cover specific areas including:

• Visual acuity, how well the baby is able to see
• Binocular vision and ocular motility, whether or not both eyes align correctly to focus on an object
• Refraction, which assesses prescription lenses for children who have received glasses
• Overall health of the eye
  

Although a baby can’t read an eye chart or provide feedback at this age, there are tests that can provide information about the child’s sight without their input.

Tests may include checking the following:

• Does the baby blink when a light is flashed?
• Does the baby’s pupil change when a light is shone into the eye?
• Will the baby follow with their eyes a moving toy or another object?
• Can the baby focus on a toy that's brought closer and then farther away? Will the eyes line up properly?

Additional Tests

For the six-month ophthalmologist exam or in cases where your healthcare provider thinks there's a risk of a problem, your child may need to have additional tests.

Visually evoked response test: A visually evoked response test requires a special monitor to be placed on the baby’s head. It allows doctors to record brain activity that occurs when lights and patterns are shown to the infant. 

Retinoscopy: An ophthalmologist will use an instrument called a retinoscope to test your baby’s eyes for errors, such as nearsightedness, farsightedness, or astigmatism. The ophthalmologist may temporarily dilate an infant's eyes with dilating drops, which makes it easier for the doctor to examine the eyes.

Most babies are slightly farsighted at birth. This usually goes away by 3 to 5 years of age. However, a baby can wear glasses if needed. Special eyeglasses are designed to fit very small faces.

Ophthalmoscopy: Similar to retinoscopy, this test allows an ophthalmologist to examine the inside of the eye. Dilating drops may be used again as the doctor uses a lighted instrument with a magnifying glass (ophthalmoscope) to look inside the baby's eyes.

Steps in Infant Vision Development

A baby’s eyesight begins to develop before birth and continues throughout the first year, reaching certain milestones along the way to becoming sharp and acute.

Birth to 4 Months

Babies are drawn to high-contrast images like black and white silhouettes. At around 3 months, they can begin to follow things with their eyes. However, they can only focus on items about 10 inches away.

5 to 8 Months

At around 5 months, babies begin to have depth perception, so they can judge how far away things are. Color vision and hand-eye or body-eye coordination improve.

9 to 12 Months

Depth perception improves, so babies can better grab for items and can throw with some accuracy. Better hand-eye coordination will help with pulling up, standing, and first steps. 

A Word From Verywell

Vision problems in newborns are rare unless you have a family history or certain genetic conditions.

Still, it’s important to watch for milestones in vision development and work with your healthcare provider to check for signs that your child may have weakness in eye muscles or issues with vision.

These problems can usually be addressed and corrected if your infant is treated early.