Refractive errors in childhood and adolescence

Presentations

The signs and symptoms of refractive errors in children and adolescents are many and varied, and are said to include excessive blinking, frowning, eye rubbing, head tilting, closing of one eye, clumsiness, photophobia, red eye and epiphora (an excess of tears). In practice, however, these features are only rarely explained by refractive errors. In infants and younger children, the errors are most likely to present as a squint; in older children, they may cause problems at school, such as an inability to read a blackboard or visual fatigue on prolonged close work. Headaches in children are rarely caused by a refractive error unless there is a clear association between visual effort and the onset of the headache.

The types of refractive errors that are seen in children and adolescents are shown in the box on page 88.