Children represent a real “challenge” for the Ophthalmologist. Visual impairment, even important, may remain silent and the little patients, who never experienced a binocular “normal” sight, are not able to report correctly their problem to parents. The presence of unrecognized visual impairment can affect the ocular apparatus development, causing permanent damage. Quite often the mandatory treatment is simple, but to be effective must be fulfilled in early childhood. Periodic screening is therefore strictly recommended between 2 and 4 years of age and must be joint to a good orthoptics evaluation.