Poor Eye Contact in Infants Associated With Neurologic, Ocular Disease

Mother taking care of her newborn baby at home.
Newborn baby
Researchers advocate comanaging these patients with a pediatric neurologist.

Poor eye contact in infants may be a sign of severe underlying disease, such as neurological or ocular disease, according to findings published in BMC Ophthalmology.

Researchers conducted a cross-sectional study to evaluate the causes of poor or lacking eye contact in infants. The study reviewed all referrals of infants younger than 1 year of age from January 2016 to December 2018, and data was retrieved from patient files covering pregnancy, birth, diagnostic workup, and ocular parameters such as refraction, visual acuity, and structural findings. The study included 99 infants who fit these parameters.

The study found the relative frequency of causes or poor or lacking eye contact to be 36.4% neurologic disease (n=36), 24.2% delayed visual maturation (n=24), 21.2% ocular disease (n=21), and 4% idiopathic infantile nystagmus (n=4). Despite poor eye contact at the time of referral, 14 infants had a visual function within age-related norms at first examination. At latest follow up (0-41 months), the available data showed that 33.3% (18/27) with neurologic cause, 65.2% (15/23) with delayed visual maturation, and 42.9% (9/21) with ocular cause had visual acuity within the age-related norms. A genetic cause was found in 23 infants.

The study explains that, while autism spectrum disorder (ASD) is often associated with poor eye contact, the current literature on this feature in infants reports varying results. For example, while some studies have found that “attention to eyes is reduced in infants who are later diagnosed with [ASD],” others have normal face-orientation even if they are later diagnosed with the disorder.

“Although this study could not provide long term follow-up, it is important to emphasize that none of the infants in this study had an autism-spectrum disorder diagnosis, although some had severe neurological disease that may be associated with autistic features,” the researchers explained.

Study limitations include the fact that, due to its cross-sectional nature, some findings may have been missed since not all of the infants received the same diagnostic workup. Strengths include the fact that it covered a large proportion of the nation of Denmark, and that all data were accessible to the researchers.


Levinsen M, Børresen ML, Roos L, et al. Causes of poor eye contact in infants: a population-based study. BMC Ophthalmol. Published online November 7, 2021. doi:10.1186/s12886-021-02151-7