Amblyopia (Lazy Eye)

Amblyopia is a condition in which the brain has not learned to properly understand the signals that come from one of the eyes. You may hear people refer to amblyopia as "lazy eye," but this term is not very specific and is not preferred.

Causes of amblyopia

There are 2 common causes for amblyopia.

• A focusing issue where the eyes don’t send the same signal to the brain. This can happen when the glasses requirement of the two eyes is very different. This can cause the brain to ignore the blurred image from one of the eyes.
• Strabismus (misaligned eyes). This leads to the brain ignoring the image from one eye because the eyes are not pointing to the same place.

There is one less common cause:

Deprivation (complete blockage of vision). Anything that completely blocks the vision in a young child, such as a cataract, can lead to amblyopia. 

Symptoms of amblyopia

Most of the time, there are no symptoms from amblyopia. Amblyopia is often first discovered when child fails a vision test at school or at a pediatrician’s office. 

Sometimes parents can see signs of the problems that lead to amblyopia, such as misaligned eyes or cataracts. A child should be seen by an eye specialist whenever such a problem is detected or suspected. 

Goals of amblyopia treatment

• Fix the problem causing the amblyopia
• Make the image on the retina as sharp as possible
• Teach the brain to use the signals from each eye
• Make the eyes work together

Treatments for amblyopia

The treatment for each child will depend on the cause of the amblyopia

• Eyeglasses – Glasses are used to correct any refractive error or focusing problem in the eyes.
• Eye patches – An eye patch may be placed over the eye with better vision for 2 or more hours each day to help encourage the brain to use the signal from the eye with weaker vision.
• Atropine eye drops – These eye drops dilate the pupil and blur the vision of the eye with better vision. This can help the brain to use the signal from the eye with weaker vision.
• Special glasses –There are several options for glasses available that adjust the focus of each eye while wearing the glasses that may be helpful to treat amblyopia.
• Surgery – Refractive surgery (PRK or LASIK) is reserved for a very few selected children with amblyopia that has not been successfully treated with other more standard methods. 

Prognosis

The majority (up to 80%) of children with the 2 common causes of amblyopia will achieve improved vision with treatment. It takes several months to a year or more to complete treatment.

Age Considerations

It is better to treat amblyopia when a child is young. 

Treatment will still work in children older than 8 years of age if the child has not had previous treatment for amblyopia. Vision may not improve as much in older children.

Troubleshooting Issues with Atropine Eye Drops

Situation

My child seems to be having a reaction to the eye drops. Her skin is red, and she is running a fever.

Possible Solution

Stop using the drops immediately and call the Ophthalmology Clinic. Most reactions to atropine are not serious.

Situation

My child cannot do school work since starting the eye drops.

Possible Solution

There are several alternatives to using atropine drops. Other treatment options, such as an eye patch, can be discussed with your doctor.

Situation

Sunlight bothers my child since she started using the eye drops.

Possible Solution

Most children’s vision will adapt after being in sunlight for a few minutes. Wearing a wide-brimmed hat can also be helpful. If the child continues to be bothered other treatment options are available.

Situation

My child’s pupil is still dilated 3 days after stopping the eye drops.

Possible Solution

Pupil dilation can last for up to 2 weeks after stopping the atropine eye drops.

Situation

My vision is blurry. I think I may have gotten atropine eye drops in my eyes.

Possible Solution

If this has happened, your pupil will be dilated, and your vision will be blurry for up to 2 weeks. The effect cannot be reversed any earlier.

Troubleshooting Issues with Patching Problems

Situation

My child says he can’t see when wearing the patch.

Possible Solution

A child with amblyopia who is wearing a patch does not see as well while wearing a patch. This is normal, and should get better as the child’s vision improves. If you feel that your child is not safe when wearing the patch, it is important to monitor the child carefully while wearing the patch.

Situation

My child will not wear the patch. I’ve tried everything!

Possible Solution

Another treatment option, such as atropine drops, should be considered, when appropriate. Contact your doctor for more information.

Situation

My child gets a rash around her eye from the patch.

Possible Solution

Try putting a thin layer of Milk of Magnesia on the skin around the eye and after it has dried, put the patch on the eye.

Situation

My child does not like the way the patch touches his eyelashes.

Possible Solution

Try the pinch patch technique. Pinch the middle of the long sides of the patch together so that the middle of the patch raises in the middle and is higher over the eyelashes.

Situation

I would like an alternative to an adhesive eye patch that goes over glasses.

Possible Solution

There are several patches available that slip over a pair of glasses. Any of these glasses patches are fine, as long as they have a front and 4 sides that block out all light.

Situation

My child keeps lifting up the edge of the patch to look around it.

Possible Solution

Another treatment option, such as atropine drops, should be considered, when appropriate. Contact your doctor for more information.