Which signs would prompt referral for vision concerns in a preschool child?

• A. Normal visual acuity
• B. Frequent headaches with normal vision
• C. Persistent eye misalignment (strabismus) or asymmetry
• D. Transient eye redness

Answer: (C)

In preschoolers, signs that require referral for vision concerns are those that point to a binocular alignment problem. Persistent misalignment of the eyes or a noticeable asymmetry between the eyes indicates strabismus, which can disrupt normal binocular vision and, if not treated early, lead to amblyopia (reduced vision in one eye). Early evaluation by a pediatric ophthalmologist allows targeted treatment—such as glasses to correct refractive error, patching or active optical therapy to encourage use of the weaker eye, or surgical options if needed—to prevent permanent vision loss. Normal visual acuity on its own doesn’t rule out vision issues, and headaches with normal vision or transient eye redness are not specific signs of a vision problem in a preschooler. The key warning sign is eyes that do not align consistently or show asymmetry.