Astigmatism in Children: Causes, Signs, Treatment & Do Kids Outgrow It?

What is Astigmatism in Children?

Astigmatism in children is a common refractive error in which the cornea (the clear front surface of the eye) or the lens inside the eye is curved unevenly, shaped more like a football than a round basketball. Instead of focusing light on a single point on the retina, the eye focuses it at more than one point, which makes vision blurry or distorted at all distances.

Most children with astigmatism are born with it or develop it in the first years of life. It is not caused by reading in dim light or sitting too close to the TV. Astigmatism can occur on its own or alongside nearsightedness (myopia) or farsightedness (hyperopia).

What Causes Astigmatism In Children and Infants?

Most astigmatism in children comes from the natural shape of the eye, which is largely inherited. Large population studies of preschool children have also linked several factors to a higher risk. Here are several factors that contribute to the development of astigmatism in children and infants.

1. 1. Family History

      If astigmatism runs in your family history, your child is more likely to have it. Genetics strongly influence the shape of the cornea.

   2. Refractive Error

      Children who already have refractive errors are more likely to have astigmatism. In the Multi-Ethnic and Baltimore Pediatric Eye Disease Studies (MEPEDS/BPEDS), nearsighted preschoolers were about 4.6 times more likely to have astigmatism, and farsighted preschoolers about 1.6 times more likely.

   3. Maternal Smoking

      In the same studies, children whose mothers smoked during pregnancy were about 1.5 times more likely to have astigmatism.

   4. Ethnicity

      MEPEDS/BPEDS found that Hispanic children (about 2.4 times) and African-American children (about 1.5 times) were more likely to have astigmatism than non-Hispanic white children. Separate research has also reported higher rates among preschool children in some East Asian populations.

   5. Young Age

      Babies are the most likely to have astigmatism. In MEPEDS/BPEDS, infants aged 6–12 months were about 3 times more likely to have it than children aged 5–6.

   6. Eyelid or Eye Conditions

      Less commonly, a droopy eyelid (ptosis), an eyelid lump that presses on the eye, or a cornea condition such as keratoconus in older children and teens can cause or worsen astigmatism.

How Common Is Astigmatism in Kids, and at What Age Does It Start?

Astigmatism is usually present from birth or appears in infancy, and it is very common in babies. Much of it decreases during the first few years as the eye grows. Astigmatism can also appear or change later in childhood, for example with keratoconus in the teenage years.

Signs of Astigmatism in Kids

Many children with astigmatism show no obvious signs, because they don’t know their vision should be clearer and rarely complain. That’s why routine vision screening matters. Between checkups, watch for these signs:

1. 1. Squinting or Tilting the Head

      Children often squint, partly close their eyes, or tilt their head to sharpen blurry vision, especially while watching TV, reading, or looking at something far away.

   2. Holding Things Too Close

      Bringing a tablet or book very close to the face, or sitting right in front of the TV, can be a sign that your child is working hard to see clearly.

   3. Eye Rubbing and Tired Eyes

      Frequent eye rubbing can signal eye strain. Encourage your child not to rub their eyes, as it can irritate the eye and surrounding tissue.

   4. Headaches or Eye Strain

      Older children may complain of headaches, tired eyes, or discomfort after reading, homework, or screen time.

   5. Covering or Closing One Eye

      A child who covers one eye to look at something may be seeing much better with the other eye. This can point to unequal astigmatism, which raises the risk of amblyopia (lazy eye).

   6. Trouble With Reading or Schoolwork

      Losing their place while reading, avoiding close work, or struggling to see the board can all be linked to uncorrected astigmatism.

   7. Discomfort With Bright Lights or Glare

      With astigmatism, lights can look streaky or smeared, especially at night. On its own, light sensitivity has many causes, so treat it as one clue rather than proof of astigmatism.

Signs of Astigmatism in Toddlers and Babies

Babies and toddlers can’t describe blurry vision, so signs are subtle: consistently tilting the head, squinting, closing one eye, or seeming uninterested in looking at faces or pictures. Instrument-based vision screening at well-child visits can detect significant astigmatism long before a child can read an eye chart. If you notice these signs, book an eye exam.

How Is Astigmatism Diagnosed in Children?

Children don’t need to read letters to be checked for astigmatism. An eye doctor can measure it accurately at any age using:

• Vision screening: photoscreeners and autorefractors used at pediatric visits flag children who need a full exam.
• Cycloplegic refraction: dilating drops relax the eye’s focusing muscles so the doctor can measure the true prescription using retinoscopy, a light reflected from the back of the eye. No answers are needed from the child.
• Corneal measurements: keratometry or corneal topography maps the cornea’s curvature.
• Visual acuity testing: picture or letter charts for children old enough to respond.

Astigmatism is measured in diopters (D). Higher numbers mean more astigmatism. The doctor also checks whether both eyes have similar amounts, because a big difference between eyes carries a higher risk of lazy eye.

When Does a Child Need Glasses for Astigmatism?

Not every child with astigmatism needs glasses. Mild astigmatism that is similar in both eyes is often just monitored. The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) uses age-based levels to decide when astigmatism found in screening should be referred for a full exam:

These are general guidelines. Your child’s eye doctor will consider age, both eyes’ prescriptions, symptoms, and whether amblyopia is present.

Astigmatism Treatment Options for Kids

Astigmatism in children is very treatable. These are the main options to discuss with your child’s eye doctor:

1. Eyeglasses

   Eyeglasses are the standard first-line treatment for children of all ages, including babies. Children with significant astigmatism usually need to wear them full-time for vision to develop normally. Durable, impact-resistant polycarbonate lenses are recommended. See our tips on helping infants and children wear glasses.

Regular follow-up visits, typically once a year, keep the prescription up to date. If your child says they can’t see well with their current glasses, book an appointment right away rather than waiting.

1. Contact Lenses

   Contact lenses designed for astigmatism are called toric lenses and are available for a wide range of prescriptions. Rigid gas permeable and hybrid lenses are options for higher or irregular astigmatism. Contacts are usually best for older children who can handle them hygienically. Learn about contact lens types for astigmatism.

2. Amblyopia (Lazy Eye) Treatment

   If astigmatism has already caused amblyopia, wearing glasses consistently often improves vision on its own. Some children also need patching of the stronger eye or atropine eye drops to make the weaker eye work harder. Treatment works best when started early.

3. Refractive Surgery (Rarely Used in Children)

   Laser vision correction such as LASIK or PRK is not a routine treatment for children. The lasers are FDA-approved for adults, and a child’s prescription can still change as the eyes grow. In rare cases, pediatric specialists may consider surgery for children with severe problems that glasses or contacts cannot treat. Learn more about how age affects eligibility for vision correction surgery.

Can astigmatism in children be cured naturally? No. A balanced diet with vitamins A, C, and D supports overall eye health, but it cannot change the shape of the cornea or lens, and eye exercises do not correct astigmatism. Some childhood astigmatism improves naturally as the eye grows, but only an eye exam can tell whether your child needs treatment.
Also Read: How to Fix Astigmatism Naturally?

Do Children Grow Out of Astigmatism?

Many do, especially babies. According to the NEI-funded MEPEDS/BPEDS studies, about 23% of infants aged 6–12 months have astigmatism, but only about 9% of children aged 5–6 do. As the eye grows during the first few years, the cornea often becomes more evenly curved and the astigmatism decreases.

However, you shouldn’t count on it. Astigmatism that is high, different between the eyes, or still present at preschool age is more likely to last. Left untreated during the years when vision is developing, it can cause amblyopia (lazy eye), a loss of vision that can become permanent if not treated in childhood.

If your child’s astigmatism doesn’t go away, it can be corrected with glasses or contact lenses. In adulthood, laser vision correction may become an option.

Tips Parents Should Follow

Apart from the above treatments, these are some additional tips you can follow to protect your child’s eyes.

• Encourage your child to wear their prescribed glasses as directed, usually full-time.
• Keep up with vision screening at well-child visits and schedule regular eye exams.
• Book an exam sooner if you notice squinting, head tilting, covering one eye, or reading trouble.
• Build in outdoor playtime and regular breaks from screens and close work.
• Protect your child’s eyes from injury with safe toys and sports eyewear.
• Tell your eye doctor if astigmatism or other eye conditions run in the family.

Read more on detailed eye health tips – 6 Essential Eye Health Tips for Protecting Your Child’s Vision

Sources

• National Eye Institute. NIH releases data from largest pediatric eye study (MEPEDS/BPEDS).
• McKean-Cowdin R, et al. Risk factors for astigmatism in preschool children: MEPEDS and BPEDS. Ophthalmology, 2011.
• AAPOS. Uniform guidelines for instrument-based pediatric vision screen validation 2021. J AAPOS.

Get Your Child’s Eyes Checked in Fresno, CA

If you’ve noticed signs of astigmatism or other vision problems in your child, early detection is key to protecting their eyesight. Book a comprehensive eye exam with our experienced eye doctors at InSight Vision Center in Fresno, CA. Request an Appointment.

FAQs About Astigmatism in Children

Is astigmatism normal in kids?

Yes, astigmatism is fairly common in kids and often appears as their eyes grow and develop. In many cases, it can stay stable or even improve, but regular eye exams help ensure it does not affect their learning or vision comfort.

Does astigmatism run in the family?

Yes, astigmatism often runs in families because genetics can influence the shape of the cornea or lens. If parents have it, their children are more likely to develop it as well.

What does a child with astigmatism see?

A child with astigmatism may see objects as blurry, distorted, or stretched out at any distance. They might also struggle with reading, squinting, or seeing clearly in low light.

At what age does astigmatism develop?

Astigmatism can develop at any age, including infancy, childhood, or the teenage years. It often becomes more noticeable as a child’s eyes grow and their vision needs change.