Why Does My Child See Things Shrink? Visual Disturbances

Objects appear smaller when viewed with the eyes?

Hello Dr.
Yeh,
My son is 9 years old and has hyperopia.
He is currently wearing an eye patch and undergoing corrective eyewear.
Recently, he has frequently reported that objects appear smaller for about 10 to 20 seconds, and then it resolves.
This mostly occurs when he is lying down at night, but it has also happened during the day.
The episodes come and go, with his vision fluctuating between normal and the smaller appearance.
We have consulted an ophthalmologist, and his optic nerve examination was normal.
I am unsure what could be causing this; could it possibly be psychological? He has experienced this after having nightmares.
If we go to the hospital, should we see a neurologist? Thank you!

Yingying, 30~39 year old female. Ask Date: 2001/08/02

Dr. Ye Boshou reply Neurology

To Yingying, regarding your son's chief complaint of experiencing fluctuations in the size of objects, it seems to be not closely related to the optic nerve.
It is recommended to first have an ophthalmological examination of the ocular structures before consulting a neurologist.

Reply Date: 2001/08/02

More Info

Dear Parent,
Thank you for reaching out with your concerns about your son's visual disturbances. It's understandable to be worried when a child experiences unusual symptoms, especially when it involves their vision. Based on your description, it seems your son is experiencing a phenomenon where objects appear to shrink or change size intermittently, particularly when lying down at night, but also during the day.

This type of visual disturbance can be perplexing, and there are several potential explanations. One possibility is related to the way the brain processes visual information. The phenomenon of objects appearing to change size can sometimes be attributed to a visual illusion, which may occur due to the positioning of the head and eyes, especially when lying down. When a child is in a horizontal position, the way light enters the eyes and is processed by the brain can lead to temporary distortions in perception.

Another consideration is the role of refractive errors, such as hyperopia (farsightedness), which your son has. While corrective lenses can help manage this condition, there may still be instances where the brain struggles to interpret visual information accurately, especially if the prescription is not perfectly suited to his needs or if he is experiencing fatigue. Additionally, if he is wearing an eye patch as part of his treatment, this could also contribute to temporary visual disturbances as his brain adjusts to the changes in visual input.

You mentioned that these episodes have occurred after nightmares, which raises the possibility of psychological factors influencing his perception. Stress, anxiety, or even fatigue can impact how the brain processes sensory information, including visual stimuli. If your son is experiencing nightmares or other sleep disturbances, it may be worthwhile to explore these aspects further, as they could be contributing to his visual experiences.

Regarding your question about whether to consult a neurologist, it may be a reasonable step if the episodes persist or worsen. A neurologist can evaluate for any underlying neurological conditions that might be contributing to these visual disturbances. However, since an eye specialist has already assessed his optic nerve and found it to be normal, it may also be beneficial to continue working with an ophthalmologist or pediatric eye specialist who can monitor his vision and ensure that his corrective lenses are appropriate.

In the meantime, here are a few suggestions that may help:
1. Monitor Symptoms: Keep a diary of when these episodes occur, their duration, and any accompanying factors (such as fatigue, stress, or specific activities). This information can be valuable for healthcare providers.

2. Visual Rest: Encourage your son to take regular breaks from screens and close-up work, especially if he is experiencing fatigue. The 20-20-20 rule is a good guideline: every 20 minutes, look at something 20 feet away for at least 20 seconds.

3. Sleep Hygiene: Ensure that your son has a consistent bedtime routine and a comfortable sleep environment. Addressing any sleep disturbances may help reduce the occurrence of visual disturbances.

4. Follow-Up: Schedule a follow-up appointment with his eye care provider to discuss these symptoms in detail. They may recommend further testing or adjustments to his treatment plan.

In conclusion, while the symptoms your son is experiencing can be concerning, they may be related to a combination of visual processing, refractive error management, and possibly psychological factors. Continued observation and communication with healthcare providers will be key in addressing these issues effectively. If you have further concerns or if the symptoms change, do not hesitate to seek additional medical advice.

Best wishes for your son's health and well-being.

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