Vision Guide for Children & Families With Cerebral Palsy

Cerebral palsy (CP) is a group of conditions that affect the development of movement, muscle tone, and posture. There are many different factors that can damage the brain of a child before birth or cause abnormal brain development that can lead to CP. 

Although there is currently no cure for cerebral palsy, several treatments are available to help with muscle functionality and speech.

Vision issues and abnormal eye movements are common among children with cerebral palsy. Eye problems are usually caused by damage to the brain’s occipital lobe, which is the visual processing area of the brain. 

Common vision issues associated with CP include strabismus (eye misalignment), involuntary movements of the eye, cataracts, refractive issues, and blindness. However, proper treatments, therapies, and hard work can help manage a child’s CP and concurrent optical issues.

How Does Cerebral Palsy Affect Vision?

Children with cerebral palsy often develop vision issues. Since most cases of cerebral palsy are caused by damage to the brain, most vision problems associated with CP are also related to brain injury. Particularly, the occipital lobe in the back of the brain can undergo trauma or be subjected to other ailments that cause cortical or cerebral visual impairment (CVI). 

Symptoms of CVI include the following:

• Extra sensitivity to bright lights (photophobia)
• Compulsively staring into lights
• Decreased ability to express emotion through the face and eyes
• Blurry vision and visual field loss
• Unable to clearly distinguish shapes and details of an object
• The inability of making fast eye movements

CVI can also occur in children who do not have cerebral palsy. However, the neurological effects of CP in children can often make the symptoms of CVI worse. 

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Things to Know About Cerebral Palsy & Vision

Aside from issues caused by damage to the occipital lobe, cerebral palsy is also associated with vision health in other ways.

• Over 60 percent of children with cerebral palsy have some sort of visual impairment. This is often caused by CP-related CVI, but other complications from CP can also contribute to vision loss.
• Around 10 percent of children with CP are completely blind. Total blindness is somewhat rare compared to other vision issues associated with CP, but it can still occur depending on the severity of CP and other factors.
• Not all children diagnosed with cerebral palsy experience vision problems. Mild cases of CP typically do not affect the eyes and allow the person with CP to perform most everyday activities without assistance.
• For every 1,000 live births recorded, two to three babies have CP, making it the most common motor disability in childhood. The eye health problems that are a result of cerebral palsy, such as amblyopia (lazy eye) and strabismus, are among the leading causes of vision issues in children. 

What Types of Vision Problems Can People With Cerebral Palsy Have?

CVI is one of the most common optical issues that a child with CP will have. However, there are more vision problems that a person with CP can potentially develop, such as these: 

Strabismus

Strabismus is a condition where one eye remains focused, but the other eye looks in another direction. Both eyes can be misaligned in certain cases. 

There are different types of strabismus depending on the direction the misaligned eye is facing.

• Esotropia: This is when one misaligned eye faces inward.
• Exotropia: This occurs when the misaligned eye faces outward.
• Hypertropia: This is when the misaligned eye faces upward.
• Hypotropia: This occurs when the misaligned eye faces downward.

Esotropia is the most common ocular misalignment. Esotropia, along with the other types of strabismus, can typically be treated by wearing glasses or an eye patch. For children with strabismus, the lenses of the glasses feature contoured prisms that help focus the eyes. Wearing an eye patch over the stronger eye also helps focus the misaligned eye by making it stronger. 

Refractive Issues

A refractive issue refers to an eye condition that makes it difficult to see clearly. One of the most common refractive issues children with CP have is farsightedness (hyperopia), which makes things close up difficult to see. Nearsightedness (myopia), which makes things far away difficult to see, is much rarer among children with CP. 

Other refractive issues include the following:

• Astigmatism: This is when the eye’s cornea or lens is incorrectly curved and causes blurred vision with things that are both close and far away.
• Presbyopia: This is when the lens of the eye loses its elasticity and causes farsightedness.

More than 150 million Americans have a refractive issue that is hindering their vision, but many children with CP do not even realize that they could be seeing better with glasses or contact lenses. In more severe cases, a refractive surgery such as LASIK may be utilized to change the shape of the cornea, which helps to restore clear vision.  

Cataracts

A cataract is the clouding of the eye’s lens. Most cataracts are caused by regular changes in the eye as a person ages. However, initial trauma that causes cerebral palsy in children can also cause cataracts.

Common symptoms of cataracts include the following:

• Clouded or blurred vision
• Difficulty determining colors
• Extra sensitivity to light
• Double vision

Wearing prescription glasses may be able to alleviate some of the cloudiness caused by cataracts. In other cases, the eye’s lens may need to be removed and replaced with an artificial lens. Without proper treatment, cataracts are the leading cause of blindness in the world.

Nystagmus

Nystagmus is the rapid and involuntary movement of the eyes. The eyes will uncontrollably move from side to side, up and down, or in a circular motion, all of which can negatively affect vision. Nystagmus can be the result of many factors, including brain injuries and CP. 

Children with cerebral palsy who experience nystagmus are usually treated by slowing the rapid eye movements with corrected vision from glasses or contact lenses. There are also several surgical options to help manage nystagmus.

Blindness

Permanent blindness can occur in more severe cases of cerebral palsy. However, total blindness is rare among children diagnosed with CP.

Signs to Look for to See if Your Child With Cerebral Palsy Has Vision Issues

A child with cerebral palsy may not know that they are experiencing vision issues. It is important for the parent or guardian to look for signs that help indicate if the child is experiencing any type of vision problem. 

The most common signs that children with cerebral palsy might show that are associated with vision issues are as follows:

• Continual eye rubbing
• Periodic headaches from eye strain
• Red or dry eyes
• Frequent squinting
• Closing one eye when focusing on an object or reading
• Difficulty keeping track of moving objects
• Fully moving the head around instead of moving just the eyes
• Having to get up close to read something
• Poor hand and eye coordination
• Difficulty determining colors

If a child with cerebral palsy consistently exhibits any of these signs, a visit to an eye clinic is necessary to get properly diagnosed. 

Diagnosing Vision Problems in Children With Cerebral Palsy

Since most eye disorders have no initial symptoms or detectable early warning signs, an ophthalmologist or optometrist may be able to properly diagnose a child with CP who has vision issues. Diagnosing an eye issue during the early stages usually furthers the chances of being able to treat the issue. 

An eye health professional will typically test the following:

• Visual acuity: Lower levels of clarity and sharpness are easy indicators of vision issues.
• Smooth-pursuit eye movements: The voluntary eye movements used to track moving objects may be different among the visually impaired. 
• The correlation between the brain and the eyes: Brain sensory testing may need to be performed by a specialist, and it can also indicate a disruption between the brain and vision.

What to Expect During an Eye Exam

It can be overwhelming for a child to undergo an eye exam. However, eye exams are perfectly safe and will only help a child with CP who may have potential vision issues.

Step 1: Exam Preparation

A parent or guardian of the child should put together a list of questions for the doctor as well as a detailed record of family health history.

Step 2: Measuring Visual Acuity & Eye Pressure

Testing visual acuity is typically done by determining the smallest letters a person can make out on the standardized Snellen chart. Testing eye pressure is done by using a slit lamp, which emits beams of light into the eye. Eye drops are used to dilate the pupils for a better view. 

Step 3: Further Evaluation

Children 3 years old or younger are typically tested for common eye issues associated with that age and with CP. These issues include amblyopia (lazy eye) and strabismus. If the onset of either issue is detected, treatments such as corrective lenses or eye patches may be recommended.

Step 4: After the Exam

If a child has had their eyes dilated during the exam, an eye doctor usually provides the child with disposable sunglasses to shield their eyes from the sun on the way home. Dilated pupils gradually go away within four to six hours. If any potentially serious conditions are found during the exam, further blood work may be requested. 

Can Parents Do Anything to Prevent Vision Problems in Children With Cerebral Palsy?

Parents cannot completely prevent vision issues from occurring in children with cerebral palsy. However, keeping up with regular eye exams and following up on advice from medical professionals can help to reduce the effects of certain vision issues and stop them from developing into other, more serious eye conditions. If your child has cerebral palsy, it’s important to have a doctor managing their care and assessing for any issues that occur throughout their life.

References

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2. Dilating Eye Drops. (April 2020). American Association for Pediatric Ophthalmology and Strabismus.

3. Eliminating Cataract Blindness: Are We on Target? (December 2017). Indian Journal of Ophthalmology.

4. Factors That Influence the Receipt of Eye Care. (September 2017). American Journal of Health Behavior.

5. Ocular Findings in Patients With Spastic Type Cerebral Palsy. (November 2016). BMC Ophthalmology.

6. Profile of Refractive Errors in Cerebral Palsy: Impact of Severity of Motor Impairment (GMFCS) and CP Subtype on Refractive Outcome. (June 2010). Investigative Ophthalmology and Visual Science.

7. Refractive Errors. (June 2022). National Eye Institute.

8. Strabismus in Cerebral Palsy: When and Why to Operate. (2014). American Orthoptic Journal.

9. Surgical Management of Nystagmus. (May 2002). Journal of the Royal Society of Medicine.

10. Test Distance Vision Using a Snellen Chart. (September 2007). Community Eye Health Journal.

11. Visual Disorders in Children With Cerebral Palsy: The Implications for Rehabilitation Programs and School Work. (2012). Eastern Journal of Medicine.

12. Visual Impairment in Children With Cerebral Palsy: Croatian Population-Based Study for Birth Years 2003-2008. (October 2019). Croatian Medical Journal.