A baby's eye color can change, mostly in the first months. Eye color comes from melanin in the front layers of the iris, the colored ring of the eye: a lot makes eyes brown, and much less makes them blue. A newborn's iris doesn't have its adult color yet, and it usually gets there by 3 to 5 months of age. Some children's eyes keep changing longer: in one twin study, 10% to 20% of children had a change in eye color between 3 months and 6 years. A white pupil in a flash photo, a cloudy or enlarged eye, or strong sensitivity to light needs a doctor right away: call your pediatrician or an eye doctor, or go to an emergency room if you can't reach one. Eyes that don't match deserve an exam soon.
Key takeaways
- Most babies reach their adult eye color by 3 to 5 months of age, though some children's eyes keep changing for years.
- Not every baby is born with blue eyes: in one study of 192 newborns, 63.0% had brown eyes at birth and 20.8% blue.
- A white pupil in a flash photo needs a call to your pediatrician or an eye doctor right away, or an emergency room if you can't reach one.
- One pupil newly larger or smaller than the other, together with a droopy eyelid, means calling 911.
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When do babies' eyes change color?
In the first few months, for most babies. A review in the journal Eye notes that the final adult iris color isn't present at birth, and that the iris normally takes on its adult color by 3 to 5 months of age.
Some children's eyes keep changing for years. The researchers behind a 2016 newborn study point to the Louisville Twin Study, in which 10% to 20% of children had a change in iris color between 3 months and 6 years of age.
The change comes from melanin. Shifts in how much melanin the iris makes can change its color from infancy on. Eye color runs on a continuum from very light blue to dark brown, and the more melanin in the front layers of the iris, the darker the eye looks.
In a newborn with blue eyes, the front of the iris has few pigment cells, which may not have arrived or matured yet. The final color depends on how much melanin ends up in the front layers of the iris.
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Are all babies born with blue eyes?
No. In the Newborn Eye Screening Test study of 192 newborns at Lucile Packard Children's Hospital, 63.0% had brown eyes at birth, 20.8% blue and 5.7% green or hazel; another 9.9% couldn't be classified. The researchers call the belief that all babies are born with blue eyes a popular myth.
Blue eyes at birth were much more common in babies whose parents identified them as white, and most Asian and Hispanic newborns had brown eyes:
| Newborns, by parents' description | Brown eyes at birth | Blue eyes at birth |
|---|---|---|
| All 192 newborns | 63.0% | 20.8% |
| White | 34.4% | 54.7% |
| Hispanic or Latino (any race) | 74.4% | 7.3% |
| Asian | 80.0% | 2.2% |
Brown is the most frequent eye color worldwide.
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Can you predict what color your baby's eyes will be?
Only roughly. Eye color is determined by variations in many genes. A region on chromosome 15 that holds two genes, OCA2 and HERC2, plays a major role, and several other genes play smaller ones.
Parents' eye colors often predict a child's. Still, two blue-eyed parents can have a brown-eyed child: it's uncommon, and scientists once believed it couldn't happen.
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What if your baby's eyes are two different colors?
Different-colored eyes in the same person are called heterochromia. It can come from genetic changes or a problem during eye development, or it can be acquired from a disease or injury to the eye. Doctors watch iris color as a child grows, because a change in color may be a sign of disease. Conditions behind mismatched or unusually light eyes include:
- Horner syndrome, which affects the eye and nearby tissue on one side of the face, with a drooping upper eyelid and a smaller pupil on that side. When it starts before age 2, the iris on that side may be lighter than the other. About 1 in 6,250 babies is born with it.
- Waardenburg syndrome, a group of genetic conditions that can cause hearing loss and changes in coloring. People with it often have very pale blue eyes or eyes of different colors, and sometimes one eye has segments of two colors.
- Ocular albinism, which reduces the pigment of the iris and retina and causes severely reduced sharpness of vision; it's also associated with rapid, involuntary eye movements (nystagmus), eyes that don't look in the same direction and increased sensitivity to light.
Horner syndrome can follow a nerve injury during a difficult birth, but it can also come from a tumor or a problem with the artery that supplies blood to the head and neck, so eyes that don't match, or a color change in only one eye, should be examined soon.
When the iris lets in too much light, as with albinism or aniridia (an iris that's missing or partial from birth), we fit children with custom soft lenses with a printed iris that cut glare and can be matched to the other eye.
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Can eye color change after the baby years?
For some people it does. In the Louisville Twin Study, 10% to 15% of white participants had eye color changes up until adulthood.
A change in only one eye is different. Horner syndrome that starts in childhood can occasionally leave the two irises different colors, and an injury to the eye can change its color too. If one of your child's eyes starts to look a different color from the other, book an exam soon.
After a blow to the eye that leaves pain or changed vision, call us at 310-828-2010 for a same-day exam, or go to an emergency room when we're closed. An eye that is cut or pierced needs an emergency room right away: don't rinse it or remove anything, and protect the eye without pressing on it.
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Which changes in a baby's eyes need a doctor?
The American Optometric Association lists five signs in a baby's eyes that need an optometrist's immediate attention: excessive tearing, red or crusted eyelids, an eye that turns constantly, extreme sensitivity to light and a white pupil. What each can mean, and how fast to act:
| What you notice | What it can mean | What to do |
|---|---|---|
| A white pupil, in person or in a flash photo | Retinoblastoma, a rare eye cancer that's most common before age 5 | Call your pediatrician or an eye doctor right away, or go to an emergency room if you can't reach one |
| A cloudy eye, eyes that look larger than normal, extra tears or strong sensitivity to light | Congenital glaucoma, a drainage problem that raises pressure in the eye | Call your pediatrician or an eye doctor right away, or go to an emergency room if you can't reach one |
| One pupil newly larger or smaller than the other, or a smaller pupil with a droopy upper eyelid on the same side | Horner syndrome is one cause | A new size difference with a droopy eyelid: call 911. A new size difference on its own: call your pediatrician or an eye doctor right away, or go to an emergency room if you can't reach one. Signs there since birth: tell your pediatrician soon, because some causes can be life-threatening |
| Eye drainage, or red, puffy or crusted eyelids | An eye infection; in the first weeks after birth, pink eye can be serious | See a doctor right away: call your pediatrician, or go to an emergency room if you can't reach one. A red, swollen eyelid with a fever: call us at 310-828-2010 and come straight in, or call your child's pediatrician right away; when we're closed, go to an emergency room |
| An eye that turns in or out all the time, or crossing that continues after about 2 months | Strabismus (an eye turn), which can lead to amblyopia, or lazy eye; crossed or drifting eyes can also be a sign of retinoblastoma | A constant turn: call your pediatrician or an eye doctor right away. Crossing that comes and goes after about 2 months: book an eye alignment exam soon |
| Tearing all the time | A blocked tear duct; extra tears can also be a sign of congenital glaucoma or retinoblastoma | Call your pediatrician or an eye doctor right away; if the eye also looks cloudy or large, or light bothers your baby, follow the congenital glaucoma row |
Parents often first notice the white pupil of retinoblastoma in a photo taken with a flash. It's curable when doctors catch it before it spreads outside the eye and start treatment quickly.
Congenital glaucoma is rare, affecting about 1 in 10,000 babies born in the United States. Surgery works very well to treat it, and babies who have surgery early enough usually won't have any permanent vision loss.
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When should a baby have a first eye exam?
The American Optometric Association recommends a baby's first thorough eye exam at about 6 months of age. By around 3 months, babies should begin to follow moving objects with their eyes and reach for things.
Our pediatric eye exams page lists the exams that follow in the preschool and school years, and our optometrists in Los Angeles can help you pick the timing: call 310-828-2010. Children don't need to know their letters for an eye exam. Toddlers are tested with pictures and lights, and the exam checks how each eye sees, focusing and eye alignment, and the health of the eye inside and out.
Early care matters because amblyopia, poor vision in one eye that starts in childhood, responds well to early treatment; our page on amblyopia explains how it's treated.
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Questions patients ask
How do you remove red eye in photos?
Most phone and photo apps have a red-eye tool that darkens the pupils. Before you use it on your baby's pictures, look at the originals: a child's pupil should never appear white, and a white eye in a flash photo is often the first sign of retinoblastoma, a rare eye cancer. If one pupil looks white, call your pediatrician or an eye doctor right away, or go to an emergency room if you can't reach one.
How well can a newborn see?
Not as well as older children or adults. At birth, a baby's eyes and visual system aren't fully developed, but vision improves a lot during the first few months. By eight weeks, babies begin to focus more easily on the face of a parent or another person near them.
When can babies see color?
By about 5 months. The American Optometric Association says an infant's color vision isn't as sensitive as an adult's, but it's generally believed that babies have good color vision by 5 months of age. Around the fifth month, the eyes also become able to work together to see the world in three dimensions.
Are crossed eyes in babies normal?
For the first two months, usually yes: a baby's eyes aren't well coordinated yet and may wander or look crossed. A constant eye turn is different: the AOA lists it among the signs that need immediate attention, and crossed eyes can also be a sign of retinoblastoma, so call your pediatrician or an eye doctor right away. An eye turn can lead to amblyopia, poor vision in one eye; our page on eye turns explains when to book an alignment exam.
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Sources
- MedlinePlus Genetics: Eye color
- Acta Ophthalmologica, 2016
- Eye, 2012
- MedlinePlus Genetics: Horner syndrome
- MedlinePlus Genetics: Waardenburg syndrome
- MedlinePlus Genetics: Ocular albinism
- American Optometric Association: Infant vision
- National Eye Institute: Retinoblastoma
- American Optometric Association: Retinoblastoma
- National Eye Institute: Types of glaucoma
- National Eye Institute: Amblyopia
- CDC: Pink eye in newborns
- StatPearls: Orbital cellulitis
Written by
Dr. Kevin Cohenmehr, OD
Medical eye care: glaucoma, diabetic eye exams, macular degeneration and eye infections, plus vision therapy for children. A graduate of UCLA and SUNY College of Optometry.
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