Vision Problems and Down Syndrome

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Down Syndrome affects the developing eye, which also affects proper vision development. Over half of people with Down Syndrome deal with some form of eye disease, and problems can be mild to severe. For people with Down Syndrome, it is particularly important to screen for and treat vision problems. 

From Dr. Danielle LeDoux, Ophthalmology Instructor at Harvard Medical School:

In addition to the need for eyeglasses, many children with Down syndrome have tear duct abnormalities. Family members will notice this as frequent discharge and tearing from the eyes, worsened by colds. We generally recommend firm massage over the space between the eye and the nose (tear sac region) 2-3 times a day to attempt to open the tear duct. If this continues beyond a year of age, the tear ducts may need to be opened by a surgical procedure.

Strabismus (eye misalignment) is also more common. Family members may notice that the eyes do not line up well with each other, but often the strabismus can be subtle, even to the pediatrician. The folds of skin I mentioned between the eyes and the nose can also cover up the underlying strabismus, or make the eyes appear as if they are crossing even if they are not. It is important to diagnose strabismus as a child, as crossed eyes can result in amblyopia (loss of vision also known as lazy eye) and loss of stereopsis (the use of the two eyes together, or depth perception).

In addition to the need for corrective lenses and the presence of strabismus, people with Down Syndrome can also experience congenital cataracts, amblyopia, ptosis, weak accommodation, myopia, loss of eyesight, and other issues. 


Children with Down Syndrome and Glasses

Refractive error, or the need for glasses, is more common for children with Down Syndrome than it is for other children.

Children with Down Syndrome may need glasses for:

  • Farsightedness (hyperopia)
  • Nearsightedness (myopia)
  • Astigmatism
  • Weak accommodation (difficulty focusing when distances change)
  • Eye alignment


Children with Down Syndrome sometimes have trouble adjusting to life with glasses, but it’s worth the effort. Once the child makes wearing corrective lenses a part of their every day routine, both vision and eye alignment improve drastically. 


Diagnosis and Treatment 

Like most children, children with Down Syndrome often do not complain about vision problems or seeing difficulties. Children often don’t have the words to describe what’s wrong with their vision, or have no idea what experiencing “good” vision is like. In some cases, communicating vision problems is even more difficult for children with Down Syndrome. 

There are, however, some signs you can look for:

  • Regularly or constantly closing one eye
  • An irregular head tilt
  • Crossing eyes
  • One or both eyes regularly wandering
  • Light sensitivity
  • Eyelid droop
  • Irregular amount of tears or eye discharge

Strabismus, amblyopia, and the need for glasses can be difficult for a pediatrician or non-pediatric eye doctor to diagnose in children with Down Syndrome. 

Even more rare and serious problems, such as cataracts, can be even more difficult for an untrained care specialist to detect. These difficulties are complicated by a child with Down Syndrome’s reduced ability to communicate their problems and discomfort. 

A child with Down Syndrome should undergo their first eye exam, conducted by a pediatric eyecare professional, at six months of age. This eye exam should be performed by a professional who has experience in working with children with disabilities. 

After that, the child should see a pediatric eye doctor every year. A pediatric eye doctor can detect vision problems that a non-pediatric eye doctor or a pediatrician cannot, and can diagnose seeing difficulties that the child cannot communicate themselves. 

Our pediatric eye doctors are specially trained in working with children who have developmental disabilities. If your child has Down Syndrome and needs an eye exam, glasses, preventative care, or treatment for vision problems, then give us a call today.