Psychological Issues for Children.

When an eye is lost at an early age because of congenital abnormality, cancer (e.g. retinoblastoma) or accident, parents often feel the loss more than the child. This is because self-awareness in children does not occur until about 2 years of age. This is when they begin to recognise that their movements are somehow connected to their reflections in the mirror. This novel experience is different from other things they see around them, and further exploration ultimately leads them to become aware of themselves as seperate entities capable of being projected in the minds of others. they recognise themselves in photographs as 'me', and at baout 3 years of age, they become self–concious and aware of how special they are to only have one eye.

Sometimes, young children stubbornly refuse to accept their prosthesis and prefer not to wear ot or to have anybody touch their socket. A German Eye Cancer trust has recognised this problem and has created a therapeutic tool in the form of a toy elephant with a removable eye (see image below).

This toy is called 'Elli', and the trust makes and donates Elli to children with retinoblastoma around the world – free of charge. The Ellis can be ordered via email from

At about the age of 5 years, a child's self–awareness differentiates into three categories: their social self, their school work persona and their physical self.
Parents of anophthalmic children may strengthen a child's self–image through reassurance, communication, support of hobbies and finding good role models. Parents should acknowledge their child's different appearance but not twell on it to the point where the child feals quilty for being the source of their parent's anxiety.
Probably the most enduring harm to the self–esteem of anophthalmic children is the impact of negative comments and hurtful teasing about the way they look from classmates and peers. Although these hurtful comments often stem from ignorance, they amount to bullying, and parents and teachers should be alert for any suggestion of this happening and be ready to stop it immediately.

Low self–esteem and a negative body image affect many adolescents when they begin puberty because of the numerous changes the bosy goes through. these changescome at a time when adolescents want to feel accepted by friends, and they are often tempted to compare themselves with others. This can be a difficult time for anophthalmic teenagers, and the support of family and friends is most important during this period.