Last updated 2026-02-17

What Happens During a Children's Eye Exam — A Parent's Guide

What Happens During a Children’s Eye Exam — A Parent’s Guide

⏱️ Quick Summary (30 seconds)

🟢 Urgency: Routine — but knowing what to expect helps everyone feel calmer.

The short version: Children’s eye exams are quick (usually 20-40 minutes), painless, and don’t require your child to know letters or even speak. Doctors have special tools and tricks for every age. Your child may need eye drops to widen their pupils — this stings briefly but is harmless and wears off in a few hours.

Bring: Your child’s health card/insurance information, any glasses they currently wear, a list of concerns or questions, a comfort item for young children, and sunglasses or a hat (in case dilating drops are used).

Why this article exists

Many parents (and children) feel anxious before an eye exam because they don’t know what to expect. Will it hurt? Will my child need to cooperate? What if they’re too young to read letters? What are those drops everyone talks about?

This article walks you through everything that happens, step by step, so there are no surprises. When you know what’s coming, you can prepare your child — and yourself — and the whole experience becomes much easier.

Before the exam: what to bring and how to prepare

What to bring:

• Health insurance card or information
• Any glasses or contact lenses your child currently uses
• Any previous eye exam records, if you have them
• Photos that concerned you (like a flash photo showing a white pupil)
• A list of your questions or concerns
• Your child’s favorite toy, book, or comfort item (for younger children)
• Sunglasses or a hat with a brim (the doctor may use dilating drops, and eyes will be sensitive to light afterward)

How to prepare your child:

For toddlers and preschoolers (ages 2-5):

• Explain in simple, positive terms: “We’re going to visit the eye doctor. They’ll look at your eyes with some special lights and ask you to point at some pictures. It’s quick and doesn’t hurt.”
• Practice at home: cover one eye and have them point at shapes or pictures from across the room. Japan’s 3歳児健診 actually sends families practice materials for this very reason. [Source: src5]
• If drops might be used, mention it casually: “The doctor might put some special drops in your eyes. They might feel a tiny bit tickly for a second, like getting a splash of water.”

For school-age children (ages 6+):

• Be straightforward: “The eye doctor is going to check how well each of your eyes can see, and make sure your eyes are healthy inside.”
• If they’re nervous about needing glasses, address it calmly: “If the doctor says you need glasses, that just means your eyes need a little help to see clearly. We’ll pick out frames that look awesome on you.”

For any age: Your own calm matters more than any words. If you’re relaxed and treat this as a normal, routine thing (like going to the dentist), your child will pick up on that.

What happens during the exam: step by step

Not every test below is done at every visit — the doctor will choose what’s appropriate for your child’s age and situation. Here’s what each test involves:

1. Medical history and questions

The doctor or assistant will ask about:

• Your child’s birth history (premature? complications?)
• Family history of eye problems (glasses, strabismus, amblyopia, eye diseases)
• Any concerns you’ve noticed (squinting, sitting close to the TV, etc.)
• Your child’s general health and development

This is your chance to bring up anything that’s been on your mind. No concern is too small. If you noticed a white glow in a photo, or your child’s been rubbing their eyes a lot, or their teacher mentioned they might need to sit closer to the board — say so. [Source: src2]

2. External eye check

The doctor looks at the outside of your child’s eyes — the eyelids, the whites of the eyes, the position of the eyes in the face, whether the eyes appear the same size, and whether the eyelids open fully. This is just looking — no touching, no instruments in the eye. [Source: src2]

3. Red reflex test

The doctor uses a small handheld light (ophthalmoscope) to shine light into each eye from about arm’s length. They’re checking for the red reflex — that red glow you see in flash photos. It should be present, even, and the same in both eyes. An absent, dim, or white reflex could indicate cataracts, retinoblastoma, or other conditions. [Sources: src1, src2]

What your child feels: Nothing at all, except seeing a bright light for a moment.

4. Eye alignment and movement test

The doctor checks whether both eyes are pointing in the same direction and can move together smoothly. They might:

• Hirschberg test: Hold a small light in front of your child and look at where the light reflects on each eye — the reflection should be in the same position on both eyes.
• Cover test: Cover one of your child’s eyes while they look at a toy or light, then uncover it and watch whether the eye moves to re-align. This is the gold standard for detecting strabismus. [Source: src3]
• Follow the toy: Move a toy or light in different directions and ask your child to follow it with their eyes (not their head). This checks how smoothly the six muscles around each eye are working.

What your child feels: This is usually fun for young children — they get to look at toys and lights. No discomfort at all.

5. Visual acuity test (how clearly each eye sees)

This is what most people think of as “the eye test.” How it’s done depends entirely on your child’s age:

Babies (under 1 year): The doctor can’t ask a baby to read a chart, so they use indirect methods — watching whether the baby can fix on a target, follow it, and whether the baby has a preference for looking with one eye over the other. A baby who strongly resists having one eye covered (but not the other) may have amblyopia in the covered eye. [Source: src3]

Toddlers (1-3 years): The doctor may use instrument-based screening — a handheld device that can detect significant refractive errors from across the room without requiring any cooperation from the child beyond looking at the device briefly. [Source: src3]

Preschoolers (3-5 years): This is when most children can do a simple visual acuity test. Instead of letters, they use:

• LEA Symbols — four shapes (house, circle, square, apple) that the child either names or matches to a card they’re holding
• HOTV letters — just four letters (H, O, T, V) that even children who don’t know the full alphabet can learn
• Landolt C (popular in Japan and China) — rings with a gap that the child points in the direction of

Each eye is tested separately by covering the other with a patch or special glasses. [Sources: src3, src5]

School-age and older: Standard letter charts (Snellen or LogMAR), each eye tested separately. [Source: src3]

If your child can’t or won’t cooperate: This is completely normal, especially for 2-3 year olds. A good pediatric eye doctor will have multiple approaches. They might try a different test, try again after a few minutes, or simply reschedule part of the exam. Don’t feel embarrassed or frustrated — doctors who work with children are used to this. The important thing is to keep trying, not to give up because one visit was difficult. [Source: src3]

6. Refraction (measuring the prescription)

This determines whether your child needs glasses and what prescription they would need. There are two ways to do this:

Without drops (non-cycloplegic refraction): A device measures how light bends as it enters the eye. This can give a rough estimate quickly.

With drops (cycloplegic refraction): This is the more accurate method for children and is considered the gold standard. Here’s what happens:

About those eye drops — a detailed explanation because many parents worry about this:

The drops serve two purposes: they widen the pupil (so the doctor can see inside the eye clearly) and they temporarily relax the focusing muscle inside the eye. In children, this muscle is very active and can “hide” the true prescription, making the child appear less farsighted than they actually are. Without drops, significant farsightedness can be missed.

What it feels like: The drops may sting or burn for about 10-30 seconds after being applied. Many children say it feels like getting water or soap in their eyes — uncomfortable but brief. The sting passes quickly.

Tip for younger children: If your child is anxious, ask the doctor about applying the drops with the child’s eyes closed, letting the drops pool at the inner corner, and then having the child open their eyes so the drops roll in. Many families find this much easier.

After the drops take effect (15-30 minutes): Your child’s pupils will be very wide. They’ll be sensitive to bright light — this is why you brought sunglasses or a hat. Close-up vision will be blurry (they won’t be able to read or look at a phone comfortably). This is all temporary.

How long the effects last: For the most commonly used drops (tropicamide), effects wear off in about 4-6 hours. For stronger drops sometimes used in younger children (cyclopentolate or atropine), effects can last 12-24 hours, occasionally up to 48 hours.

Are the drops safe? Yes. They’ve been used safely for decades. Serious reactions are extremely rare (about 1 in 10,000 children may experience temporary hyperactivity). The drops do not damage the eyes and do not affect the brain. If you’re concerned about any reaction, tell the doctor. [Sources: src1, src2, src4]

7. Looking inside the eye

Once the pupils are dilated, the doctor uses special instruments (an ophthalmoscope or slit lamp) to examine the internal structures of the eye: the retina, the optic nerve, the blood vessels, and the lens. This is how they check for conditions like retinoblastoma, cataracts, retinal problems, and optic nerve abnormalities. [Source: src2]

What your child feels: Bright light, which can be uncomfortable with dilated pupils, but no pain. The doctor works quickly.

8. Discussion of results

After the exam, the doctor will explain what they found. This might include:

• “Everything looks normal” — wonderful news, and the most common outcome.
• “Your child needs glasses” — they’ll explain the prescription and what it means.
• “We need to monitor something” — they’ll explain what to watch for and when to come back.
• “Your child needs treatment” — they’ll explain the plan (glasses, patching, drops, or referral).
• “I’d like to refer to a specialist” — for conditions that need more specialized care.

Ask questions. If you don’t understand something, say so. Good doctors expect and welcome questions. Here are some you might want to ask:

• “Is there anything I should watch for at home?”
• “When should we come back?”
• “Does my child need glasses? Can you explain the prescription?”
• “Is there anything I can do to help my child’s eye development?”
• “Should my other children be checked too?”

After the exam

If drops were used, your child’s eyes may be light-sensitive and their near vision blurry for several hours. Plan accordingly:

• Put on sunglasses or a hat before going outside.
• Avoid activities that need clear close-up vision (homework, reading) for a few hours.
• Some children feel a bit cranky or tired — this is normal.
• The effects will wear off completely. Nothing permanent has changed.

If glasses were prescribed, your eye doctor or optician will help you choose frames. Let your child have a real voice in this — wearing glasses they picked out and love makes a huge difference in whether they’ll actually wear them.

A message for parents

Eye exams are one of the simplest, most impactful things you can do for your child’s health. They’re quick, they’re painless (aside from a brief sting from drops), and they catch problems that are invisible from the outside but highly treatable when found early.

If your child is anxious, your calm makes all the difference. If you’re anxious yourself — that’s okay too. Now that you’ve read this article, you know exactly what’s going to happen. There are no surprises waiting.

And remember: the most common result of a children’s eye exam is “everything looks great.” You’ll walk out reassured, your child will get a sticker, and you’ll wonder why you were worried in the first place.

But the one time something is found — a refractive error that can be corrected with glasses, an amblyopia that can be treated before the window closes, a condition that can be managed before it becomes serious — you’ll be profoundly grateful you went.

Your child’s eyes are worth 30 minutes of your time.

⚕️ Medical Disclaimer: This article is for educational purposes only and describes a typical children’s eye exam. Exact procedures may vary depending on your child’s age, their specific concerns, and the practices of your eye care provider. If you have questions about what to expect at your child’s specific exam, don’t hesitate to call the office beforehand and ask.

Sources

1. NHS (UK). “Eye tests for children.” 2024. https://www.nhs.uk/tests-and-treatments/eye-tests-in-children/
2. AAO. “Pediatric Eye Evaluations Preferred Practice Pattern.” Ophthalmology, 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10680450/
3. “Pediatric Vision Screening.” Pediatrics in Review, 2018. https://pmc.ncbi.nlm.nih.gov/articles/PMC6317790/
4. 国家卫生健康委. “0～6岁儿童眼保健核心知识问答.” 2021. https://www.gov.cn/zhengce/zhengceku/2021-06-24/content_5620637.htm
5. 日本弱視斜視学会. “3歳児健康診査における視覚検査について.” 2023. https://www.jasa-web.jp/general/about-3sai