Amblyopia and Eye Patching

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What is amblyopia (lazy eye)?

Amblyopia, sometimes called “lazy eye,” refers to vision problems in one or both eyes that can occur even though there might not be an obvious problem in the eye itself. The condition occurs when the nerve pathway from the affected eye to the brain does not develop properly in infancy or childhood because the eye sends a blurred or incorrect image to the brain. As a result, the brain can learn to disregard the image from the weaker eye.

Amblyopia usually occurs in early childhood, when the visual system is still developing. If left untreated, amblyopia can result in permanent loss of vision or depth perception.

Amblyopia is sometimes confused with strabismus, a separate condition in which one or both eyes turn in different directions, such as inward or outward (eye misalignment). However, amblyopia can occur without strabismus, and strabismus can occur without amblyopia.

Expert, Compassionate Care for Amblyopia (Lazy Eye)

Our team of pediatric ophthalmologists has specialized experience in care for children who have amblyopia, sometimes called “lazy eye.” We offer advanced diagnostic methods and treatments tailored to young patients’ unique needs, to restore eye alignment and improve vision.

Types and Causes of Amblyopia

Amblyopia has three types, each with different causes, and these include:

Refractive amblyopia: A refractive error in one or both eyes that was not corrected in early childhood is the most common cause of amblyopia. In this type, there is an unequal amount of refractive error between a child's eyes, and the brain learns to use the better-seeing eye and disregards signals from the other eye. Refractive amblyopia can occur in one or both eyes.
Strabismic amblyopia: Eye misalignment, or strabismus, is another common cause of amblyopia. One eye might turn in, out, up, or down, which causes the brain to ignore signals from that eye to avoid double vision. The result is poor vision in the misaligned eye.
Deprivation amblyopia: This type of amblyopia results from a structural problem that blocks the vision pathway, such as a droopy eyelid or a corneal condition (including corneal opacity or cataract), which prevents light from entering the eye. Deprivation amblyopia can occur in one or both eyes.

Risk factors for developing amblyopia include:

Family history of amblyopia, childhood cataracts, glaucoma, or any type of strabismus
Certain genetic disorders that affect the eyes
Childhood cataracts
Droopy eyelid (ptosis)
Eyelid tumor that blocks the pupil

What are the symptoms of amblyopia?

In some cases there are no symptoms. For example, refractive amblyopia might be undetectable because the child does not complain of blurry vision, and the amblyopic eye might not look any different from the normal-seeing eye.

When symptoms occur, they include:

Eyes that turn in or out (misalignment)
Eyes that do not look at or focus on the same object
Poor depth perception
Poor vision in one or both eyes

How is amblyopia diagnosed?

Our pediatric ophthalmology specialists can detect amblyopia with a comprehensive eye exam that includes a vision test, a sensory motor examination, and cycloplegic refraction tests with dilating eyedrops, to check refraction without the eye being able to autofocus.

A slit-lamp is used to examine the structures of the anterior portion inside the eye, and a funduscope is used to examine the posterior portion of the eye, including the retina and optic nerve.

Treatment Options for Amblyopia

At UT Southwestern, our specialists start by treating the underlying disease:

Glasses to correct refractive error (to focus image clearly)
Surgery to clear visual pathway obstruction, such as to remove a cataract or to correct ptosis (droopy eyelid)
Eye muscle surgery to straighten the eyes

If the vision is not improved, doctors will start patch treatment by covering the stronger eye with a patch, to help the brain use the weaker eye and make it stronger. In some cases, we might recommend eyedrops to blur vision in the stronger eye to force the use of the weaker eye.

The number of hours per day and overall length of time that a child must wear the patch depends on the age, severity, and cause of the amblyopia. Children with severe amblyopia might need patching for more hours of the day and for months or years.

Amblyopia is not always correctable. If the condition isn’t detected early, vision might not fully respond to patching. The earlier the detection and treatment of amblyopia, the better the vision outcome. Patching usually has more success in children younger than age 8, even though recent research has shown its benefits in children up to age 17.

Tips on Eye Patching

It is very common for children to resist wearing their patch, especially if the amblyopia is severe and their vision is poor in the weaker eye. Parents, other family members, teachers, and friends should be persistent in encouraging children to wear the patch. Patching usually becomes easier once the child has become accustomed to it.

If the skin around the eye becomes irritated from repeated patching, discontinue patching for two to three days until the irritation has improved.

If the child wears glasses, patches can be fit onto the lens of the glasses, as long as it completely blocks vision in that eye. Another option is to buy or make a pirate-style patch.