Vision Concerns

By Carmen Willings
teachingvisuallyimpaired.com
Updated June 20, 2025
The referral process for school-based vision services begins when there are observable concerns about a student’s vision or visual functioning. If a concern arises, the first step is to refer the student to an optometrist or ophthalmologist for a comprehensive eye exam.
💡 While medical information alone does not determine eligibility for vision services under special education, it plays a critical role in identifying the cause, diagnosis, visual acuity, prognosis, and possible educational implications of the visual condition. 

​Finding the Right Eye Care Specialist

  • For young children, choose a doctor who specializes in pediatric vision care.​
  • For children with multiple or complex disabilities, it is particularly important to work with a provider experienced in assessing students with special and complex needs.
  • The eye care specialist should:
    • Identify the cause of vision loss
    • Provide a formal diagnosis
    • Estimate visual acuity
    • Indicate prognosis and recommendations for support or further evaluation
It is also beneficial to share vision concerns with the student’s pediatrician, as some vision-related issues may stem from underlying medical conditions or side effects of medications.

​The ABCs of Vision Concerns

​Use the following indicators to screen for potential vision problems. These concerns may warrant a referral for further assessment.
A – Appearance
  • Eyes that turn inward, outward, or one positioned higher/lower than the other
  • Drooping eyelid(s) (ptosis)
  • Constant, rapid eye movement (nystagmus)
  • Red, crusty, or irritated eyelids/eyes
  • Unequal pupil size or inconsistent reaction to light
  • Enlarged or inflamed glands
  • Excessive tearing, light sensitivity, or eyelid spasms
B – Behavior
  • Avoids or shows minimal eye contact
  • Appears to have poor eye muscle coordination
  • Covers or closes one eye for visual tasks
  • Tilts or turns head to see objects
  • Pushes head forward to view distant items
  • Rubs eyes or blinks excessively during near tasks
  • Squints or frowns when focusing on distant objects
  • Frequently stumbles or bumps into objects
  • Holds materials too close or too far
C – Complaints
  • Reports of light sensitivity or photophobia
  • Burning, itching, or discomfort in the eyes
  • Experiences double vision or blurry images
  • Frequent headaches, especially after visual tasks
  • Reports of dizziness or nausea
  • Describes eyestrain or visual fatigue
S – School-Related Indicators
  • Difficulty copying from the board
  • Struggles with handwriting or letter/number formation
  • Confuses similar-looking words or letters
  • Requires more lighting than peers
  • Reading comprehension declines over time
  • Moves head instead of eyes when reading
  • Loses place or skips lines while reading
  • Uses finger to track words while reading
  • Difficulty with visual puzzles (e.g., mazes, word searches)
  • Makes frequent math errors due to misalignment of numbers
By knowing what signs to look for, educators and caregivers can help ensure that students with visual impairments are identified early and receive the appropriate services to support their learning and development.

Downloadable Resource

A printable checklist is available free for download on the Program Printables page. It can be used by teachers, parents, school nurses, and other school personnel to help identify when a vision referral may be necessary.

Printable Resource

The following handout is located on the Premium Printables page.
Vision Concerns Handout
Vision Concerns Handout
History of Visual Impairments
Professional Practice
Vision Professionals
Professionalism
Teacher Resources
Professional Publications
VI Book Resources
Family Resources
VI Referrals
Medical vision exams
visual diagnosis
fvlma
other evaluations