From what age should my child see an ophthalmologist?

Two answers, and both apply at the same time. As soon as something stands out, straight away — whatever the age: an eye that turns inwards or outwards, a tilted head posture, a very close reading distance, frequent screwing up of the eyes or eye rubbing, headaches towards evening, or an eye test at school that showed something. If nothing stands out, an ophthalmic check at pre-school age still makes sense, because a child does not notice a weaker eye itself and nothing stands out to anyone for as long as both eyes are open. If there is a marked squint, a high refractive error or weak sight in the family, come earlier. We examine children from kindergarten age; with babies and toddlers we clarify by phone whether a consultation specialising in paediatric ophthalmology is the better place, and help you find the way there.

My child says it sees well — is that enough to go on?

Sadly no, and that is no criticism of the child. Children do not compare: anyone who sees blurred with one eye from the start takes that for the normal state of affairs and has no reason to report anything. Added to that, the stronger eye covers the gap completely in everyday life — your child plays, reads and catches the ball, and nothing stands out to anyone. That is why each eye is tested separately at an eye examination, with the other eye covered. That is the real point of the whole examination, and the reason why a passed eye test in a school class does not replace an ophthalmic check.

What is orthoptics — and does it take place with you?

Orthoptics is the field that deals with eye position, the range of movement of the eyes and how the two eyes work together — that is, with the question of whether two images become a single, spatial one. 'Vision school' is the everyday word for the same thing, and slightly misleading, because what is practised there is not the recognition of letters. What is examined is the position of the eyes in different directions of gaze, the angle of the squint, spatial vision, and the question of whether one eye is being suppressed. Treatment afterwards is above all with a precisely determined pair of glasses, and with holding the stronger eye back for periods so that the weaker one has to work. We do not have an orthoptic consultation of our own: what takes place with us is the ophthalmic initial assessment — the acuity of each eye separately, the cover test, the range of movement and the spectacle values under drops — and where a full orthoptic work-up is needed, we say so and arrange the referral. Exercises on the internet, training programmes and food supplements expressly do not belong to it.

Why does my child get eye drops, and what does that mean for the rest of the day?

Children can adjust the lens of the eye so strongly that a long-sightedness is underestimated or masked entirely at an ordinary measurement — the eye corrects itself during the examination. That is why, where the question calls for it, we give drops that switch this focusing off for a time; only then does the measurement show the true value. In practice that means: the pupils stay wide, near vision is blurred, and your child is sensitive to glare — in children often until the next day, and considerably longer depending on the preparation used. What you have to expect we tell you beforehand and not afterwards. Plan the rest of the day without homework and without screen work, and send sunglasses or a cap with a peak along. Very rarely these drops make a child red in the face, restless or slightly feverish for a few hours; that passes by itself, and if it worries you, call us. Marked drowsiness, confusion, a high fever or unsteadiness on walking are a different matter: that is not waited out but assessed by a doctor — within consulting hours with us, outside them in an emergency department.

In a flash photograph one pupil glows white instead of red — what does that mean?

This is one of the few signs in childhood that is not watched. A whitish or absent red pupil reflex means that something in the path of the light is holding the light back — the causes range from a congenital clouding of the lens to rare but serious findings inside the eye. The great majority of photographs with a strange reflex are explained in the end by the angle of view or by the flash, and even so the rule is: call the same day. With a baby or toddler, do not call us first for this but go directly to a children's eye clinic or an ophthalmic emergency department; we help you find the way there if you reach us. Bring the photograph with you, it is a usable finding.

Can weak sight still be made up later?

Only to a limited extent, and that is exactly where all the time pressure in this field lies. Vision matures in the first years of life: an eye that does not get a sharp image in this phase does not learn to see fully, and the brain gets used to passing that image over. The earlier weak sight is recognised and treated, the more can be made up; once visual development is complete at school age it becomes considerably harder. Harder, though, does not mean hopeless: an attempt is worthwhile in an older child too — the gain is smaller and needs more patience, but it is no exception, and nobody is told here that it is now too late for that. This is no reason for panic and no statement about any individual child — it is the reason why the check at pre-school age is not a formality, and why we ask you not to wait until after the holidays with a finding that stands out.

Does health insurance cover eye examinations in children?

For children and adolescents the self-pay rule for examinations without symptoms does not apply without qualification: assessing a squint, a one-sided refractive error and weak sight is a medical question and is as a rule billed through basic health insurance. Children have no deductible in the standard model — unless an optional deductible has been chosen —, and the co-payment applies. For spectacle lenses and contact lenses there are separate statutory arrangements for children, with a limited annual contribution, and beyond that with certain eye conditions. What applies in your case we clarify with you before the appointment — not with the invoice.

Paediatric ophthalmology

Paediatric ophthalmology — because children do not say that they see badly

A child who sees blurred with one eye does not complain. It knows nothing else and takes that for normal — and because the second eye delivers a flawless image, often nothing stands out in everyday life for years. That is exactly why paediatric ophthalmology is one of the few areas in which an examination with no prompting at all changes something: vision matures in the first years of life, and what is not laid down in that time can only be made up to a limited extent later on.

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Why children's eyes are examined differently

In adults an eye examination begins with a complaint. Someone reports that distance vision has gone blurred, that the letters swim in the evening, that an eye is burning — and the examination establishes why. In children that beginning is missing. A child reports no complaint, because it has nothing to compare with.

Added to that is a second difference that separates paediatric ophthalmology from adult medicine: vision is not finished at birth. It matures in the first years of life, and it matures only if both eyes deliver a sharp image and the brain learns to make a single, spatial one out of those two images. If one eye lacks the sharp image in this phase — because of an uncorrected refractive error, a deviation in eye position or an obstacle in the path of the light —, then the brain passes over that eye more and more. Later on that can only be made up to a limited extent.

The whole way of working follows from those two sentences. What is examined is each eye separately, with the other eye covered, because a weak eye hides behind the strong one for as long as both are open. Where the question calls for it, the measurement is taken under eye drops, because Long-sightedness in children and the accommodative convergent squint are otherwise masked by the child's lens. And what is assessed is not only visual acuity, but the position of the eyes, their range of movement and how the two eyes work together.

Not least, the process itself is different. Instead of letters we show pictures, symbols or rings with a gap that a child may point out with a hand — that works long before a child can read. How such an examination proceeds step by step is set out under How an eye test in children actually works.

When to come first — and when earlier

The most honest version of this answer consists of two rules that apply at the same time. One hangs on the calendar, the other on what stands out to you — and the second always beats the first.

The first weeks and months of life

In this period the eye check runs through the paediatric preventive checks: the basic newborn examination includes assessing the red pupil reflex, and congenital clouding of the lens and other obstacles in the path of the light stand out in the process. An ophthalmic examination is not a routine step at this age but the consequence of a finding or a suspicion — promptly, in that case. We examine children from kindergarten age; with babies and toddlers we clarify by phone whether a consultation specialising in paediatric ophthalmology is the better place.

From crawling to kindergarten

In these years the second rule applies practically on its own: have it examined as soon as something stands out. A child whose eye deviates inwards or outwards at times, who holds their head at an angle when looking at something, who moves noticeably close to picture books and screens, or who seems unsteady on the stairs, does not need an appointment 'to be safe next year' but now. And the finding that stands out more is not automatically the more dangerous one: an intermittent outward squint, in which the eyes work together most of the time, is usually less urgent than a small but constant angle, always in the same eye — precisely because the small, constant angle stands out to nobody and the eye concerned is passed over permanently. Both should be examined.

At pre-school age, even when nothing stands out

This is the one appointment that needs no prompting. An ophthalmic check at pre-school age makes sense even when nothing has stood out to anyone at home or at kindergarten — because a one-sided weakness stays unnoticed precisely when the other eye sees well. What is tested is the visual acuity of each eye separately, eye position, how the two eyes work together, and the back of the eye.

School age and adolescence

From the start of school the question shifts. It is now less about the development of vision than about the course of a refractive error that is changing — in this phase of life above all a short-sightedness that is increasing. An eye test at school that showed something, a board that can no longer be read, or headaches towards evening are good reasons for an appointment.

Earlier than described come children in whose family a high refractive error, a squint, weak sight or a hereditary eye condition is known, and children with a history of premature birth or with a developmental delay. Here the findings set the pace, not the calendar. Which examinations come together in that case is set out in the Overview of our eye examinations.

Warning signs for parents

The list that follows is not a list of diagnoses. It is the answer to the question parents ask us most often: is this still normal, or should I call? It has three levels — and the top one is the only one that does not begin with a call to us.

Straight to an emergency department — do not call, go there:

Any injury to the eye and any chemical in the eye. With acid, alkali, lime or a cleaning agent, rinse immediately with clear water for at least 15 minutes — considerably longer with alkalis, lime and cleaning agents — and carry on rinsing on the way in for treatment rather than stopping in order to travel. With a suspected penetrating injury the opposite applies: do not rinse and do not press, cover the eye loosely, eat and drink nothing from that moment on — treatment is usually carried out under general anaesthetic — and go straight to the emergency department of an eye clinic.
A newly drooping upper lid together with a wide pupil on the same side, with double vision or with a restricted range of movement of the eye. This combination has a small number of possible causes, at least one of which tolerates no delay — it needs assessing that same night and not the next morning.
A newly squinting eye together with headache, vomiting, marked drowsiness, a new compensatory head posture or double vision. This combination can point to raised pressure inside the skull. It waits neither for an appointment nor for consulting hours — and certainly not for Monday.

Call the same day — nothing here is watched. The same qualification applies to every single point on the list that follows. If it is a baby or a toddler, do not call us first but go directly to a children's eye clinic or an ophthalmic emergency department. We examine children from kindergarten age and help you find the way there if you reach us — but at this age the detour via us costs a day that nobody has.

A whitish or absent red pupil reflex, on a flash photograph, for instance.
An eye that suddenly starts to squint, without the accompanying signs named above — including when it was visible only in a photograph.
A newly drooping upper lid with a narrower pupil on the same side. In a child that calls for a paediatric assessment and not only an ophthalmic one — tell us on the phone that the two appeared together.
A baby or toddler whose eyes water, who is sensitive to light and screws the lids shut — particularly if one eye looks larger than the other or the cornea looks dull instead of clear. This combination needs assessing the same day, at this age directly at a children's eye clinic.
Jerky, involuntary eye movements ('wobbly eyes') that are new — particularly together with head nodding.
A newly appeared tilted head posture, that was not there before.
A red, painful or purulent eye in the first weeks of life. At this age a red eye is never a matter for waiting.
A deterioration in vision within hours or days, flashes of light, a sudden swarm of black dots (a shower of floaters) or a shadow growing in from the edge of the field of vision — they can be signs of a Retinal detachment .

Book an appointment, but without the rush of the same day:

A squint, even only intermittently or only when the child is tired — known and unchanged for some time
A tilted head posture that has been there for some time when watching television, reading or playing
Wobbly eye movements that stood out in the first months of life and have been unchanged ever since — with a baby or toddler that too belongs in a consultation specialising in paediatric ophthalmology
A very close reading distance, screwing up the eyes, frequent blinking or eye rubbing
Headaches towards evening or quickly tiring when reading and doing homework
An eye test that showed something at school or at the paediatrician's
Unsteadiness on the stairs or at ball games, if it is new
A school-age child who screws up one eye when reading or in the sun or when concentrating

And the other direction, because it belongs here just as much: Not every red eye is an emergency. A red, watering eye that is stuck together in the morning, in an otherwise lively kindergarten child, is usually Conjunctivitis in children: day care, kindergarten and school — unpleasant, contagious, but rarely dangerous. It belongs in the consulting room when pain, light sensitivity, worse vision, fever or marked swelling of the eyelid come with it.

Straight to an emergency department — do not call, go there: after any injury to the eye and after any chemical in the eye, with a newly drooping upper lid together with a wide pupil on the same side, double vision or restricted eye movement, and with a newly squinting eye together with headache, vomiting, marked drowsiness or a new compensatory head posture. If clouding of consciousness or a seizure comes with it, call the ambulance (144).

Call the same day with a whitish or absent pupil reflex, with an eye that suddenly starts to squint, with sudden double vision, with a newly drooping lid and a narrower pupil on the same side, with newly appeared wobbly eye movements, with a watering and light-sensitive eye in a baby or toddler, and with a red, painful eye in the first weeks of life: +41 44 500 69 00. Outside consulting hours the ophthalmic emergency service applies; with a baby or toddler, the emergency department of an eye clinic, and directly.

A photograph is a usable finding. If a strange pupil reflex or a deviating eye position stands out to you in a snapshot: keep the picture and bring it to the appointment. It shows us something that is not happening in the consulting room just then.

Orthoptics and vision school: what that is — and which of it takes place with us

orthoptics is the field that deals with the position of the eyes, their range of movement and how the two eyes work together. It answers a question that an ordinary measurement of visual acuity does not even ask: do the two eyes work together — and do their two images become a single, spatial one? It is a field of its own with a training of its own, and we do not run an orthoptic consultation ourselves: what takes place with us is the ophthalmic initial assessment, and the referral into orthoptics is something we arrange.

In everyday speech the same thing is called vision school. The word has become established and is slightly misleading, because what is practised there is not the reading of letters, and certainly not 'wanting to see better'. A vision school is not a training room but a consultation with a repertoire of examinations of its own.

What is examined

The position of the eyes in different directions of gaze — looking straight ahead, to the side, up and down
The angle of the squint, measured and not estimated, and whether it stays the same in all directions of gaze
How the two eyes work together and the question of whether one eye is being suppressed in the picture
Spatial vision — the ability to perceive depth, which arises only from two eyes working together
The range of movement of the eye muscles, particularly with a tilted head posture or with double vision
The visual acuity of each eye separately, with symbols suited to children instead of letters

What follows from it

The treatment that follows from such an examination is less spectacular than the word 'school' suggests. In first place, almost always, comes the precisely determined pair of glasses — with an accommodative convergent squint it is not a visual aid but the treatment itself. In second place comes the Favouring the weaker eye: the stronger eye is covered for a few hours at a time, or held back with drops, so that the weaker one has to work. Added to that are follow-up checks at fixed intervals.

Supervised orthoptic exercises have a narrow but genuine place alongside this: with a weakness in how the two eyes work together at near, of the kind that shows up during longer reading as blurring or doubling of the letters. They are supervised at an orthoptic consultation and not with us; where they come into question, we say so and arrange the referral. On a refractive error and on weak sight, by contrast, they have no influence — what is needed there is the correction and the deliberate favouring of the weaker eye. These two things are regularly confused, and the confusion costs treatment time while the time frame is still open.

What does not belong to it at all we say just as plainly: eye training from the internet, commercial vision-exercise programmes and food supplements change neither a refractive error nor weak sight, and they do not replace supervised orthoptic treatment. Where a specialist assessment of how the two eyes work together is needed, we say so and arrange the referral rather than attempting it ourselves — that holds particularly with babies and toddlers, with a pronounced squint and with complex forms of weak sight. Which of it takes place with us and which in a specialist consultation we tell you before the appointment and not afterwards.

Weak sight (amblyopia) and the time frame

Weak sight means: one eye sees worse even though there is nothing wrong with the eye itself. The medical name for it is amblyopia. It did not arise in the eye but in the brain — because this eye delivered no usable image during the phase in which vision was maturing, and the brain learned to pass it over.

The routes to it are manageable in number, and there are essentially three:

An uncorrected refractive error, above all a one-sided one, or a marked long-sightedness or astigmatism. That is the most treacherous variant, because the healthy eye delivers a flawless image and so nothing stands out to anyone.
A deviation in eye position — the squinting eye delivers an image that does not match the other one, and is suppressed so that no double vision arises.
An obstacle in the path of the light, such as a congenital clouding of the lens or a permanently drooping lid.

What is decisive about amblyopia is not its severity but its Time frame. Vision matures in the first years of life, and in this phase the system is malleable: if the weaker eye gets a sharp image and is deliberately made to work, it catches up. As visual development is completed at school age this window gradually closes; after that a lag can only be made up to a limited extent. That is the whole reason why this field talks so often about appointments for which there is no acute prompting.

Treatment as a rule proceeds in two steps, and the first is the most important: the exact correction. Only once both eyes can get a sharp image does the second step make sense — covering the stronger eye for a few hours at a time, or holding it back with drops, so that the weaker one has to work. That is checked at fixed intervals, because dose and duration follow the progress measured and not a fixed scheme. Weak sight that does not catch up along this route belongs in a specialist consultation — we say so as soon as it becomes apparent.

Once the goal is reached, the treatment does not stop on a single day but is tapered off — and the check-ups carry on for a while afterwards. The reason is unspectacular and important: some of the children treated successfully fall back again in the first year after the end, and you only notice that if you look. Anyone who has achieved a good result is therefore not sent on their way but given a next appointment — and if nothing more is really needed, we say that too.

A word about your part in it: the success of this treatment depends less on the prescription than on whether it actually happens at home. We would rather plan it realistically together with you than write it down ambitiously.

Short-sightedness in children: what can be influenced

In adults a short-sightedness is above all a question of correction. In children it is a question of pace: the readings rise fastest during the growth phase, and the longer an eye ends up being, the higher the risk over a whole lifetime of a Retinal detachment, of changes at the point of sharpest vision, of glaucoma and of a cataract that appears earlier. This risk rises gradually, not in jumps — which is why every dioptre a child ends up not having counts.

This pace can be influenced in many children, and that is summed up by the term myopia management: low-dose atropine, rigid night lenses (ortho-K) and specially constructed spectacle lenses or special soft contact lenses. The second sentence belongs with it just as plainly: None of these measures cures. A short-sighted eye does not become normally sighted again, and no method stops the growth completely. What is at stake is a slowing down, on average and over years.

The precondition for all of it is a number, not a supposition: the increase measured over time, supplemented in children by the contactless measurement of the length of the eye. Without that course, there is no way either to justify starting a treatment or to tell whether it is working. Which measure is supported by evidence for what, what it means in everyday life and where its limits lie is set out in full under Short-sightedness in children and myopia management.

Two things you can do without us, and which are among the few that are well founded: Time outdoors in daylight — around two hours a day is the order of magnitude usually named, best supported by the evidence for delaying the onset — and a sensible reading distance instead of a nose on the exercise book. That tablets and phones in themselves make a child short-sighted, by contrast, is not supported by evidence; what can be supported is the setting: screen time happens indoors, at close range and without a look into the distance. Anyone who takes their child off the tablet and sits them in front of the television has gained little.

And the worry we hear most often we can take from you: there is no such thing as glasses 'too early', and glasses deliberately prescribed too weak slow nothing down — that has been studied and was not confirmed. A child who sees badly does not get used to the glasses; it gets used to seeing badly. Whether there is a short-sightedness behind the blur at all, or an Astigmatism, which is corrected earlier in children, the measurement decides.

Squint — even when it only stands out sometimes

A squint means that the two eyes are not looking in the same direction. That can be conspicuous and catch the eye of everyone in the room; it can also be so slight that it becomes visible only in photographs, only when the child is tired, or only on looking in a particular direction. For the question of how urgently it needs assessing, that size makes astonishingly little difference: even a small angle, visible only at times, can lead to one eye being suppressed.

Two misunderstandings persist stubbornly, and both cost time. The first: 'They grow out of it.' A squint that lasts beyond the first months of life, or that appears anew, is not something a child grows out of, and it needs examining. The second: 'It only squints sometimes.' It is precisely the intermittent squint that is noticed late — and the clock running while it does is the clock of visual development.

Often an uncorrected long-sightedness lies behind it: the child has to focus hard, and focusing is coupled in the brain with the eyes turning inwards. With this form, correctly prescribed glasses often normalise eye position wholly or in part — the glasses are then not a visual aid but the treatment. What other forms there are, how the angle of the squint is measured and what follows in each case is set out under Squint: forms, assessment and treatment in children.

Whether a procedure on the eye muscles becomes necessary in the end is decided only after this phase, and never at the first appointment. Where it is necessary we tell you so directly and organise the referral to a specialist centre; the assessment beforehand and the check-ups afterwards we take on close to home. An overview with how to get here and opening hours can be found under Sehklinik locations, how to get here and opening hours.

What happens at a child's appointment

Children rarely come to the ophthalmologist of their own accord, and many arrive with an expectation fed by the dentist's chair. So here, concretely, is what happens — you may tell your child beforehand, which takes most of the tension out of it.

Listening. What have you noticed, since when, in which situations? Is there a squint, a marked refractive error or weak sight in the family? Photographs in which something stood out to you we will look at.
Visual acuity, each eye separately. Instead of letters we show pictures, symbols or rings with a gap whose direction your child may point out with a hand. One eye is covered while this happens — that is the most important part of the appointment and the reason it is not shortened.
Eye position and how the eyes work together. Your child looks at a light or a toy while we cover one eye and then the other and watch the movements. It takes seconds and does not hurt.
Measuring the spectacle values at the machine. Your child looks into a device at a picture; the measurement is contactless.
Eye drops, where the question calls for them. They sting briefly and then take effect: the pupils go wide and near focusing is switched off for a time. In between there is a wait — bring something to play with, or a book your child likes to look at, for as long as it still can do so easily.
Assessment of the back of the eye with the pupil wide, with a bright light and in a few minutes.
Discussion. What was measured, what it means, what follows from it — and when the next check-up makes sense. If there is nothing to do, we say that just as plainly.

After the appointment the following applies where drops have been used: the pupils stay wide and near vision blurred, in children often until the next day — considerably longer depending on the preparation used, and in that case we tell you beforehand — and your child is sensitive to glare. Plan the rest of the day without homework and without screen work. Very rarely these drops make a child red in the face, restless or slightly feverish for a few hours; that passes by itself, and if it worries you, call us. With marked drowsiness, confusion, a high fever or unsteadiness on walking, on the other hand, do not wait: that needs assessing by a doctor, outside consulting hours in an emergency department.

Allow more time for a child's appointment with drops than for an adult's — the wait between putting the drops in and measuring is part of it and cannot be shortened. Experience shows it goes most calmly when the appointment does not fall at nap time.

When you are ready: Book an appointment for your child online — or call us on +41 44 500 69 00, Mon–Fri 08:00–12:00 / 13:00–17:30. Referring colleagues will find the details for registration for referring colleagues.

Costs & health insurance

What goes through basic health insurance (OKP) in children

In children the self-pay rule for examinations without symptoms does not apply without qualification: assessing a squint, a one-sided refractive error and weak sight is a medical question. What applies in your case we tell you before the appointment — not with the invoice.

Service	Coverage	What this means for you
Ophthalmic examination where a squint or weak sight is suspected	Basic insurance (OKP)	Assessment, refraction and the follow-up checks are medical treatment for this question. That holds even if the suspicion is not confirmed in the end.
Measuring the spectacle values under eye drops (cycloplegic refraction)	Basic health insurance where indicated	In children this step is regularly necessary, because the child's lens otherwise masks a long-sightedness. It is part of the examination and not an additional service booked on top.
Ophthalmic initial assessment of eye position and referral into orthoptics	Basic health insurance where indicated	A justified question — a squint, double vision, a tilted head posture, suspected weak sight — is medical treatment. The ophthalmic initial assessment we carry out ourselves; the orthoptic examination itself takes place at a specialised consultation, and the referral there is something we arrange.
Check at pre-school age with nothing standing out	Its own rules — not automatically self-pay	For children and adolescents the self-pay rule for examinations without symptoms does not apply without qualification. How an appointment with no specific suspicion is billed depends on the question behind it; we clarify that with you before you come.
Deductible and co-payment in children	Separate, lower rates	Children have no deductible in the standard model — unless an optional deductible has been chosen —, and the co-payment applies, capped lower than for adults. A service 'at the insurer's expense' is therefore rarely entirely free of charge in children either.
Spectacle lenses and contact lenses for children	Statutory arrangement with a limited contribution	For children there is a statutory arrangement with a limited annual contribution, and beyond that with certain eye conditions; the frame you as a rule pay for yourself. Some supplementary insurance policies contribute — settle this with your health insurer.
Congenital eye conditions (birth defects)	Responsibility lies elsewhere — please clarify beforehand	In children, certain congenital eye conditions run not through the health insurer but through invalidity insurance (IV); which ones is settled exhaustively in law. Whether your case falls under it we clarify with you, and not you alone at a counter — tell us the diagnosis before you submit anything anywhere.
Eye patches and materials for amblyopia treatment	Please clarify beforehand	How consumables are billed in your case depends on the insurer and on the model. We tell you what to expect, and with that same information you check with them.
Myopia management: special spectacle lenses, ortho-K lenses, compounded atropine	Mostly self-pay	Where there is a medical question, examination and measuring the progression are medical treatment; the measure itself is as a rule not covered by basic health insurance, and some supplementary insurance policies contribute. More on the page on Myopia.

Not sure which category your concern falls into? Call us — +41 44 500 69 00. We tell you on the phone what to expect, and with that same information you check with your health insurer. An invoice that comes as a surprise is an avoidable annoyance.

Related conditions

Strabismus (squint)Myopia (short-sightedness)Eye examinations

Medically reviewed by Dr. med. Annette Schumann

Your ophthalmologistDr. med. Annette SchumannView profile

Frequently asked questions from parents

: Two answers, and both apply at the same time. As soon as something stands out, straight away — whatever the age: an eye that turns inwards or outwards, a tilted head posture, a very close reading distance, frequent screwing up of the eyes or eye rubbing, headaches towards evening, or an eye test at school that showed something. If nothing stands out, an ophthalmic check at pre-school age still makes sense, because a child does not notice a weaker eye itself and nothing stands out to anyone for as long as both eyes are open. If there is a marked squint, a high refractive error or weak sight in the family, come earlier. We examine children from kindergarten age; with babies and toddlers we clarify by phone whether a consultation specialising in paediatric ophthalmology is the better place, and help you find the way there.
: Sadly no, and that is no criticism of the child. Children do not compare: anyone who sees blurred with one eye from the start takes that for the normal state of affairs and has no reason to report anything. Added to that, the stronger eye covers the gap completely in everyday life — your child plays, reads and catches the ball, and nothing stands out to anyone. That is why each eye is tested separately at an eye examination, with the other eye covered. That is the real point of the whole examination, and the reason why a passed eye test in a school class does not replace an ophthalmic check.
: Orthoptics is the field that deals with eye position, the range of movement of the eyes and how the two eyes work together — that is, with the question of whether two images become a single, spatial one. 'Vision school' is the everyday word for the same thing, and slightly misleading, because what is practised there is not the recognition of letters. What is examined is the position of the eyes in different directions of gaze, the angle of the squint, spatial vision, and the question of whether one eye is being suppressed. Treatment afterwards is above all with a precisely determined pair of glasses, and with holding the stronger eye back for periods so that the weaker one has to work. We do not have an orthoptic consultation of our own: what takes place with us is the ophthalmic initial assessment — the acuity of each eye separately, the cover test, the range of movement and the spectacle values under drops — and where a full orthoptic work-up is needed, we say so and arrange the referral. Exercises on the internet, training programmes and food supplements expressly do not belong to it.
: Children can adjust the lens of the eye so strongly that a long-sightedness is underestimated or masked entirely at an ordinary measurement — the eye corrects itself during the examination. That is why, where the question calls for it, we give drops that switch this focusing off for a time; only then does the measurement show the true value. In practice that means: the pupils stay wide, near vision is blurred, and your child is sensitive to glare — in children often until the next day, and considerably longer depending on the preparation used. What you have to expect we tell you beforehand and not afterwards. Plan the rest of the day without homework and without screen work, and send sunglasses or a cap with a peak along. Very rarely these drops make a child red in the face, restless or slightly feverish for a few hours; that passes by itself, and if it worries you, call us. Marked drowsiness, confusion, a high fever or unsteadiness on walking are a different matter: that is not waited out but assessed by a doctor — within consulting hours with us, outside them in an emergency department.
: This is one of the few signs in childhood that is not watched. A whitish or absent red pupil reflex means that something in the path of the light is holding the light back — the causes range from a congenital clouding of the lens to rare but serious findings inside the eye. The great majority of photographs with a strange reflex are explained in the end by the angle of view or by the flash, and even so the rule is: call the same day. With a baby or toddler, do not call us first for this but go directly to a children's eye clinic or an ophthalmic emergency department; we help you find the way there if you reach us. Bring the photograph with you, it is a usable finding.
: Only to a limited extent, and that is exactly where all the time pressure in this field lies. Vision matures in the first years of life: an eye that does not get a sharp image in this phase does not learn to see fully, and the brain gets used to passing that image over. The earlier weak sight is recognised and treated, the more can be made up; once visual development is complete at school age it becomes considerably harder. Harder, though, does not mean hopeless: an attempt is worthwhile in an older child too — the gain is smaller and needs more patience, but it is no exception, and nobody is told here that it is now too late for that. This is no reason for panic and no statement about any individual child — it is the reason why the check at pre-school age is not a formality, and why we ask you not to wait until after the holidays with a finding that stands out.
: For children and adolescents the self-pay rule for examinations without symptoms does not apply without qualification: assessing a squint, a one-sided refractive error and weak sight is a medical question and is as a rule billed through basic health insurance. Children have no deductible in the standard model — unless an optional deductible has been chosen —, and the co-payment applies. For spectacle lenses and contact lenses there are separate statutory arrangements for children, with a limited annual contribution, and beyond that with certain eye conditions. What applies in your case we clarify with you before the appointment — not with the invoice.

Not sure whether it is a case for us? Ask before you wait.

Describe to us on the phone what has stood out to you about your child, and since when. We tell you whether an appointment is needed and how urgent it is — and if a specialist paediatric ophthalmology consultation is the better place, we say that too.

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