Photophobia & Light Sensitivity in Children

Light Sensitivity Causes, Symptoms, and Treatment

Migraines, concussions, and other physical ailments can be difficult to deal with, and if your child suffers from photophobia — discomfort or pain the eyes as a result of exposure to light — they can be particularly debilitating.

A whopping 80% of the population suffers from photophobia, as reported by the American Academy of Ophthalmology. This means that approximately 9 million children in the U.S. suffer from light sensitivity.

Photophobia can lead to a great deal of pain and confusion. In many instances, these children may have comorbid conditions such as autism spectrum disorder or attention deficit hyperactivity disorder. When these children experience severe discomfort as a result of photophobia, they may exhibit seemingly inexplicable behavior, which can make the root cause difficult to assess and treat.

Considering the scope of this issue, it’s essential to have an understanding of the symptoms, risk factors, and complications related to photophobia in children.

What Is Photophobia?

The structure of the word might imply a cognitive issue is to blame — “photo-” meaning “light” and “-phobia” meaning “irrational fear of.” However, the word does not truly refer to a fear of light in this sense. Instead, photophobia refers to discomfort or pain in the eyes caused by exposure to light, including both sunlight and indoor light.

Photophobia isn’t a condition in and of itself; it’s a symptom of an underlying issue. This includes eye diseases, mental health conditions, and medication side effects. It is also a common symptom in the days following eye surgery. The discomfort or pain associated with photophobia is related to the connection between photoreceptors in your eyes and the optic nerve. A child with this symptom can experience pain as a result of inflammation, abrasions, and other complications.

Photophobia vs. Photosensitivity

People often use the term “photosensitive” instead of “photophobic” to avoid the impression of referring to irrational fear. While the terms are often used interchangeably in layman’s speech, photophobia and photosensitivity describe two different issues.

While photophobia is the medical term for discomfort in the eyes as a result of exposure to light, photosensitivity refers to an immune system reaction to sunlight (sometimes called a “sun allergy”) which affects the skin. There are many different types of photosensitivity disorders in children, but photophobia is an unrelated phenomenon to many of these.

Photophobia Symptoms

There are many signs of photophobia to be watchful for. Take note if the child exhibits:

• Indications of pain in the eyes, particularly if red or swollen;
• Persistent touching of the eyes due to itchiness;
• Complaints of blurred vision, headaches, or neck stiffness;
• Excessive squinting, especially in bright conditions;
• Dizziness or nausea.

These signs can vary greatly in terms of severity, leading to different reactions in affected children. They can react to this discomfort in a variety of ways, including complaints, increased stress, aggressive tendencies, and a predilection to tantrums. Such reactions can be heightened in areas with bright lighting, such as unshaded areas outdoors, schools, and stores.

Photophobia in children may be confused with other potential conditions. This is problematic, as it also has a high rate of comorbidity with mental and physical conditions.

Photophobia Comorbidity With Mental Illness

While the effects of photophobia can induce physical pain, it has commonly been found to accompany certain mental illnesses. This can make diagnosis difficult, as caretakers and instructors may interpret a child’s physical reactions to photophobia as being inexplicable or related to a known mental condition. Determining the underlying condition can be substantially more challenging in such cases.

Autism

Autism spectrum disorder (ASD) refers to a range of conditions characterized by repetitive behaviors and challenges related to social skills and development. According to Autism Speaks, ASD affects 1 in 59 children in the United States. Symptoms include:

• Abnormal body posture, facial expressions, or tone of voice;
• Social withdrawal and isolation;
• Issues with social skill development, including speech and language;
• An unwillingness to maintain eye contact;
• Behavioral concerns, including meltdowns after feeling overwhelmed;
• Repetitive movement or speech;
• Patterns of self-abuse.

Children who have autism are often sensitive to stimuli from the environment, and they may have very negative reactions to overstimulation. For children with both photophobia and ASD, it can be difficult to determine if a child’s negative response to his or her environment is related to general overstimulation or to physical discomfort as a result of excessive light exposure.

Sensory Processing Disorder (SPD)

While it is not a medical diagnosis, SPD affects an individual’s ability to interpret sensory information. SPD affects 5% to 16% of school-aged children, and the condition is more common in children than adults. Children with SPD may experience oversensitivity and discomfort from certain sounds, smells, tastes, and touches. They may exhibit the following signs:

• A general lack of coordination and refined motor skills;
• An unwillingness to engage in social interactions;
• Atypical reactions to environmental stimuli, including outbursts.

Though SPD is not a mental disorder, it is a common component of other disorders on this list, such as autism. Similarly to how ASD can compound issues related to photophobia, SPD can as well. Again, this can complicate diagnosing the root issue when comorbidity is present.

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a medical condition that impacts an individual’s brain development, affecting a child’s attention span and self-control. ADHD affects 9.4% of children in the U.S. Young people with ADHD can experience many symptoms that can impact their lives at home and school. ADHD can result in signs of inattentiveness, hyperactivity, and impulsivity, including:

• An inability to stay on task or concentrate — children with ADHD may daydream for long periods at a time;
• A disposition to frequently lose things;
• Excessive fidgeting and restlessness;
• Frequently doing or taking things without asking for permission.

There is a high prevalence of self-reported photophobia in individuals with ADHD. This is thought to be connected to the processing of dopamine and melatonin in the eyes and brain, though the exact nature of this relationship is uncertain.  When ADHD is comorbid with an underlying condition that causes photophobia, the impacts on a child’s personal and academic life can be exacerbated.

Obsessive-Compulsive Disorder (OCD)

OCD is an anxiety disorder in which the individual affected has repeated and unwanted obsessions or compulsions. Research concerning OCD’s prevalence in children and teens reveals that the condition affects approximately 1 in 200 children. Recurring thoughts, ideas, or urges to do specific actions can cause an individual intense stress and inhibit a person’s ability to function in daily life. OCD presents itself in children differently than in adults. Some examples of common obsessions and compulsions in children with OCD include:

• Persistent concerns about getting sick or dying;
• Unwanted and disturbing thoughts of hurting oneself or others;
• Very frequent requests for reassurance;
• Constant organizing and rearranging personal possessions.

OCD may be comorbid with photophobia. When combined with a condition that causes photophobia, OCD can have a dramatic impact on a child’s ability to function in day-to-day life. It can be difficult with OCD to describe their symptoms, particularly when they feel confusion or shame due to their symptoms. Children with anxiety disorders may experience dissociation or panic attacks when experiencing pain related to their sensitivity to light.

Physical Conditions That Lead to Light Sensitivity

Some instances of photophobia can be traced to underlying physical issues. These can lead to either short- or long-term photophobia. Short-term photophobia is very common, resulting from a wide array of potential causes. Long-term light sensitivity generally results from uncommon — and sometimes potentially fatal — conditions. Determining the root cause is essential. Here are some physical conditions that can cause photophobia:

Eye Irritation

One of the most common causes of light sensitivity is simple eye irritation, though there can be a number of conditions that lead to this. Causes of eye irritation include:

• Exposure to allergies and irritants;
• Foreign objects entering the eye area;
• Spending too much time looking at screens;
• Insufficient tears or blocked tear ducts;
• Recovery from surgery.

Beyond these common sources, eye irritation can also occur as a side effect to ocular rosacea, glaucoma, and multiple sclerosis, among other conditions. Usually, the clearest sign of eye irritation in children is excessive rubbing of the eyes, which can exacerbate the condition, as well as the child’s light sensitivity.

Contacts

According to a survey of optometrists, 41% of contact users are below the age of 18. These users, who are often not familiar with best practices for contact use, may experience eye irritation. Some examples of improper contact use include:

• Using lenses that are damaged or do not fit correctly;
• Wearing lenses for longer than recommended — particularly while sleeping;
• Failing to replace contact lenses as often advised by your optometrist;
• Improperly storing lenses;
• Failing to wash hands before applying contact lenses to the eyes.

These practices can lead to eye irritation and even infection, increasing a child’s chances of suffering from photophobia.

Medications

When starting certain medications, it’s not uncommon for children to experience light sensitivity — even if they don’t have a history of it. Some medications can cause light sensitivity as a side effect. These include:

• Antibiotics;
• Antihistamines;
• Furosemide;
• Non-steroidal anti-inflammatory drugs;
• Sulfonamides.

These are only a few examples; there are dozens of over-the-counter and prescription medications that can cause photophobia. If a child experiences light sensitivity after starting a medication, it’s important to discuss such symptoms with their pediatric doctor.

Concussion

When a child suffers a physical blow that causes the brain to move in its surrounding fluid, they may suffer from a concussion. A concussion can affect how a child thinks and feels, and it can sometimes result in a loss of consciousness. Signs of concussion in children and toddlers include:

• Sensitivity to bright lights or loud noises;
• Clumsy movement and slurred speech;
• Sleeping more or less than typical;
• Depression and irritability;
• Nausea;
• An inability to focus on tasks.

If a child experiences a blow to the head or body, take them out of any activity or sport they may be participating in and observe them. Even relatively minor blows can result in a concussion. It’s important to be watchful for these symptoms. If you notice irregularities, seek medical assistance for the child as soon as possible.

Meningitis

Meningitis is an inflammation of the membranes that protect the brain and spinal cord. This can lead to issues including brain damage, hearing loss, seizures, and death. Children should be given the meningococcal vaccine. Note that, while vaccines protect against high-risk forms of bacterial meningitis, viral meningitis is still relatively common. The viral form is typically a severe risk to only infants of less than three months. The bacterial form is a severe threat to children under the age of two, but it is very rare in developed countries.

A common sign of meningitis in children between the ages of two to five is light sensitivity. While other causes of photophobia may be more common, it’s important to determine if meningitis could be the underlying issue; prompt treatment can prevent serious complications in most cases.

Migraines

Migraines are severe and recurring headaches that can be caused by a number of potential triggers, including emotional turbulence, physical causes, diet and medication changes, and environmental factors. Migraines are fairly common, affecting about 10% of all school-age children.

Photophobia can be highly linked to migraines, as bright lights can be a trigger. Light sensitivity is also a common problem that affects children who are having a migraine attack. Because areas like schools and stores often use fluorescent lighting, children prone to migraines may be susceptible to such episodes at school and in public.

While there is no cure for individuals suffering from migraines, symptoms can be alleviated by addressing the cause. Over-the-counter medications like acetaminophen or ibuprofen can help, as can prescription medications like triptans. Children suffering from migraines should be placed in a relaxing environment with minimal light and noise until the episode subsides.

Other Causes of Light Sensitivity

It can seem like there are countless other causes of light sensitivity. Mercury poisoning, botulism, rabies, conjunctivitis — there are many, many conditions that can lead to photophobia. Certain rare genetic disorders can also make an individual susceptible to the condition. For this reason, the cause of photophobia can be unclear in some cases.

In order to determine the underlying cause, parents and guardians of children with light sensitivity should be watchful and ask questions when the child feels discomfort. They should maintain a log of details about complaints related to light-related pain. Bringing this to wellness visits with the child’s physician can help them discover the root cause.

Types of Light Which Affect Photophobia

Children with photophobia can be impacted by certain types of lights more than others. There are several factors that determine how lighting affects your eyes.

• UV radiation can damage your eyes, and different lighting types emit different amounts of this.
• Flickering lights can be problematic. They can cause discomfort and pain for children with light sensitivity. This affects certain types of lighting more than others.
• Blue light can also damage your eyes. The concept of “digital strain” is related to this; blue light that is emitted from screens can damage your eyes through excessive exposure. Lighting can have a similar effect, causing eye strain.

With these factors in mind, let’s examine three of the most common lighting options and discuss how they impact children with photophobia.

• Incandescent bulbs, while inexpensive, emit UV radiation and can damage your eyes.
• Fluorescent lighting, which flickers faster than we can perceive, is commonly reported to cause headaches, migraine episodes, and eyestrain.
• LED lights do not flicker, which is why they are generally easier on the eyes, particularly for people with photophobia. While they emit more blue light than other lighting options, there are many dimmable LED bulbs that can mitigate this concern.

Mitigating the effects of photophobia requires avoiding the use of or exposure to problematic lighting. Business owners and municipalities can opt for photophobic-friendly lighting in industrial areas and public spaces such as parking lots. Parents and guardians must assess areas and react when children show signs of discomfort or pain. These efforts can improve symptoms in children with photophobia.

Light Wavelengths

As evidenced by the eyestrain blue lighting can inflict after sufficient exposure, it’s clear that light wavelengths also factor into how different types of lighting can affect children with photophobia. Indeed, the blue-green part of the color spectrum is known to cause considerable discomfort in people with light sensitivity.

Colored lenses can help address this concern. In fact, in a study involving people with light sensitivity post-concussion, researchers discovered that colored lenses provided relief in 85% of the patients. Addressing photophobia with blue, green, red, or purple lenses may help mitigate light sensitivity. Certain glasses providers specialize in lenses for people with photophobia, with FL-41 tinted glasses being particularly popular for preventing light-induced migraines.

Photophobia Prevention and Relief

When your child begins exhibiting signs of photophobia, you may feel overwhelmed. It can be difficult to help them avoid experiencing the discomfort associated with it, and treating the symptom requires preparation. However, the advice below can help you do both.

Photophobia Prevention

Short of preventing the physical conditions and diseases that may cause it, photophobia is not always preventable. Parents and guardians of children with light sensitivity should keep the following tips in mind in order to help their child avoid discomfort or pain:

• Be on the lookout for unusual behaviors. If your child is avoiding doing specific activities that they once enjoyed, could light sensitivity be to blame? Identifying this will help you find specific solutions to help them pursue their interests.
• Inform your child’s school of his or her condition in regard to their sensitivity to light. Ideally, they may be provided a learning environment without problematic lighting.
• Teach your child to avoid looking upward at the sun and to avoid spending excessive time in direct sunlight. If you’ve provided them with protective eyewear, instruct them on when to use it.

On a broader level, businesses and municipalities can help local populations by addressing this situation, as discussed above. Commercial lighting contractors can pre-empt potential photophobia symptoms by implementing lighting retrofit solutions and using LED lighting when possible.

Photophobia Treatment

While determining the root cause can sometimes prove challenging, most cases of photophobia are treatable. However, because of its common comorbidity with a wide range of conditions and causes, determining the course of treatment can take time and effort. In the interim, and in cases where the conditions are not treatable, there are steps you can take to alleviate a child’s symptoms and provide relief.

• Have your child use protective eyewear when outdoors or in areas with harsh lighting. FL-41 tinted glasses have been proven to be particularly helpful in many cases.
• When a child shows signs that they are experiencing pain or discomfort due to lighting, take them to a darker area until symptoms subside. Avoid excessive time in dark rooms, however, as they must be able to adapt to bright areas.
• If the child experiences migraines as a result of bright or flashing lights, consider providing them with acetaminophen or ibuprofen to help alleviate symptoms.
• If symptoms become more severe over time, consider consulting with a pediatrician, as the underlying condition may be worsening. Further medical evaluation and treatment may be necessary.

Following these tips will alleviate discomfort as a result of light sensitivity. While it can be distressing to discover that your child has begun experiencing photophobia, identifying and treating the root cause can help resolve the child’s sensitivity to light. Meanwhile, taking measures to prevent and treat pain related to photophobia is vital to helping your child live life to the fullest.

Credit: Faculty Solutions Group