Stroke may affect a child or young person's vision in a number of ways. In many children vision does improve over time, but even where a child's vision does not fully recover, there is a lot that can be done to help.
How can stroke affect vision?
A stroke can affect a child's vision directly and indirectly:
Directly
Stroke can affect the parts of the brain that control the eyes and vision, as well as the parts that process the images that you see.
Indirectly
Loss of sight can be very traumatic for a child or young person and may have a major impact on their emotional wellbeing and confidence. In practical terms, it may be much harder for them to do many daily activities, from schoolwork to sports.
Types of vision problem after childhood stroke
Visual field loss
A stroke can damage the vision areas of the brain and lead to a loss of part of the field of vision. Losing part of the visual field is called peripheral visual field loss, and includes hemianopia (half loss) and quadrantanopia (quarter loss). It usually affects the same side of the visual field in both eyes, known as homonymous hemianopia. It usually affects the opposite side of the vision from where the stroke took place in the brain.
Visual field loss can improve, and some children will make a complete recovery. For those with a permanent vision loss, an eye specialist can advise on how to get help to make the most their vision.
Problems with eye movement
Stroke can cause problems with moving the gaze from one thing to another or following a moving object with your eyes, known as saccadic eye movements.
Stroke can cause a problem with coordinating both eyes, which is known as squint or strabismus. Strabismus may affect the vision in one eye, known as amblyopia. It can cause double vision (diplopia).
Stroke can also cause a constant movement of the eyes which can affect vision, known as nystagmus. Sometimes the eyes look like they are wobbling, but it may not always be obvious. For more information visit the Nystagmus Network.
Problems with processing visual information (visual inattention or neglect)
These affect the parts of the child's brain which interpret the information being received by the eyes. Their eyes are working, but the brain cannot make sense of the visual information. This may lead to the child being unaware of anything on one side. They might ignore people or bump into things because they are not aware of them. It can happen alongside a visual field loss.
Cerebral visual impairment (CVI)
Post-stroke visual impairment in children is sometimes referred to as cerebral visual impairment (CVI), and can be common in children after a stroke and those with cerebral palsy. It can include several types of vision problem including neglect and visual field loss. For more information visit the Perkins School for the Blind page on CVI.
Light sensitivity
Your child might be more sensitive to light and glare such as bright lights or reflections on shiny paper. This is more likely soon after a stroke and it often improves. It can make it hard to read screens, and you might need to adapt lighting or use sunglasses.
Dry eyes
If your child has muscular or nerve problems affecting blinking, you need advice on taking care of their eyes. They might need to use some lubrication drops or ointments, or tape the lid closed at night if it does not close fully.
Visual hallucinations
Sudden sight loss such as visual field loss after stroke can lead to visual hallucinations, also known as Charles Bonnet syndrome. These are due to the brain being deprived of visual input and generating images to fill the 'blank space'.
It is not a sign of mental health problems.
The hallucinations can look very real and may appear as either patterns and shapes or complex images of people and objects. It might seem very strange or even scary to your child, but you can reassure them that it is due to their brain trying to make up for the lack of sight. It usually improves as time goes by.
Speak to your GP or eye specialist if you think your child is having visual hallucinations. They need to check for other causes such as epilepsy or migraine. Read more about Charles Bonnet syndrome on the RNIB website and on Esme's umbrella.
[My son] had to have lots of eye tests checking his visual field, so he found that quite hard, as it was very lengthy.
Parent
What are the signs of difficulties with vision?
Babies tend to focus on faces and objects by around four to five weeks, and make eye contact by around six to eight weeks. If this doesn't happen, this may indicate a problem. Particularly for those with milder vision difficulties or at earlier developmental stages, some children or young people may be unaware that their vision is incomplete. Others may not mention their difficulty because they don't want to think about it.
You might notice an older child squinting, screwing up or rubbing their eyes, avoiding activities requiring close-up vision, tilting the head to one side when trying to focus. Some might complain of blurred or double vision, headaches or eye strain. You might also notice a child bumping into things or tripping over a lot or not noticing people. If this seems to happen more on one side, this could indicate hemianopia or visual inattention. If you notice a child's eyes appearing to jerk or tremble this could be a sign of nystagmus.
In some children, a mild problem may become more apparent when they are learning to read or write. Behaviour like being inattentive or fidgeting or a change in their handwriting might be due to them not being able to see properly.
Children should have their vision checked after a stroke, and all children should have eyesight checks during early years health screening.
If you have any concerns at all, take your child to the optician or the GP. Make sure they have a sight test every 12 months in any case. Even if your child is very young or has a disability or communication problems, vision can still be assessed by trained staff.
What could difficulties with vision mean for my child?
Vision problems can affect every stage of development, but with support children can thrive physically, at school and in their social lives. Support needs to be tailored to their visual impairment, their other skills and strengths, and their environment. Visual impairment could affect a child's development in many areas, such as physical skills, learning, attention, social skills and communication. It may also affect them emotionally.
For example, a baby may not start to crawl if they can't see anything interesting to move towards. It may affect their independence if they learn to rely on others for support. It may interfere with their social skills, if they can't see their friends or miss body language. It may also interfere with early language development, as much vocabulary is built by the baby pointing and adults telling them the name of things. It may interrupt their sleeping, if they cannot see light, which helps regulate our sleep cycle.
Where vision problems are due to visual processing problems, the child may find it hard to recognise or focus on objects or people, especially when combined with distractions such as busy backgrounds or noisy environments.
It may be helpful to introduce your child to other children with sight problems.
Frequently asked questions
What professionals can help support my child's vision?
Low vision and mobility specialists
A low vision assessment will look at the strategies and resources that can help your child. The assessment may be carried out by the visual impairment team in your local area. This might be called a sensory impairment or sensory support team. They can recommend gadgets, resources and mobility training for your child. You can ask your GP or eye specialist to refer you.
Find out more about children's mobility training including using canes on the Guide Dogs website.
Eye specialists
Depending on the difficulty, some visual therapies and techniques may help. For example, orthoptists or occupational therapists may do visual scanning activities to help a child with visual field loss or visual neglect get used to moving their eyes towards their blind side.
Teachers
If your child has a serious visual impairment they might need support from a qualified teacher of the blind (QTVI). Any child with vision loss should have a personalised support plan, which might be done by the school or could be an Education, Health and Care Plan (EHCP) for children with higher support needs. A child might need a scribe to help them in class, and they may be able to use technology such as text-to-speech software to allow them to access information.
What can I do to support my child?
If they are reluctant to wear their glasses, try giving some incentives like a reward chart. For children with special needs, there are frames available that are easier for them to wear.
Encourage them to use their vision, with activities like reading, painting or watching TV.
Think about contrast to make things easier to see, such as white plates on a dark table.
Make sure your home is well lit, uncluttered and free from trip hazards.
Arrange regular sight tests to check for changes in their vision.
What aids are available to help my child's visual impairment?
There are many different aids available to suit your child's stage of development and vision. A specialist teacher or low-vision professional can suggest things to try. For example:
Large-print books and resources.
Magnifiers to see print and objects, either mechanical or digital.
A laptop for use in school, with software to make the lessons accessible such as audio screen readers or text magnification.
Screen readers and text-to-speech software that read on-screen text aloud.
Voice recognition software that can convert spoken commands into written text or other outputs.
Minifiers can help the child focus on a specific area.
Prisms can be used to help double vision.
Some children will benefit from using a cane for getting around.
Many mobile devices now include as standard accessibility apps which allow you to do things like change text size, play text as audio and carry out voice activated searches.
Should I register my child's sight loss?
If your child has a long-term visual impairment, you have the option to register them with the local authority. This is not compulsory, and you are still entitled to support and benefits for your child without registering. However it can make it easier to get some types of help such as disability benefits or a Blue Badge. Read more about registering a child as sight impaired.
We feel overwhelmed by our child's visual impairment. What can we do?
Finding out that your child has a vision problem can be a big shock. Over time, you will gradually become more familiar with what your child needs and the strategies that help. Meanwhile, make sure you get plenty of support for yourself, including practical help and a chance to rest and adjust to the change. Other families who have been through a similar experience may offer useful tips and a listening ear.