Strabismus is a very common cause of amblyopia. Strabismus is a misalignment of the eyes where one eye turns inward (esotropia), outward (exotropia), up (hypertropia), or down (hypotropia). It is sometimes known as a “wandering eye. ” Eventually, the “straight” comes to dominate the visual signals to the brain, causing “strabismic amblyopia. However, not all lazy eyes are associated with strabismus. [5] X Research source Amblyopia may also be the result of a structural problem, such as a droopy eyelid. [6] X Research source Other problems in the eye, such as a cataract (a “cloudy” spot in the eye) or glaucoma, can also cause a lazy eye. This type of amblyopia is called “deprivation amblyopia” and usually must be surgically treated. Severe differences in the refraction between each eye can also cause amblyopia. For example, some people are nearsighted in one eye and farsighted in the other (a condition known as anisometropia). The brain will choose one eye to use and will ignore the other. This type of amblyopia is known as “refractive amblyopia. ”[7] X Research source Occasionally, bilateral amblyopia can affect both eyes. For example, an infant may be born with cataracts in both eyes. An eye care professional can diagnose and provide treatment options for this type of amblyopia.
Becoming fussy or upset if you cover one eye. Some children may become fussy or upset if you cover one of their eyes. This could be a sign that the eyes are not sending equal visual signals to the brain. [9] X Research source Poor depth perception. Your child may have trouble with depth perception (stereopsis) and may also have trouble seeing movies in 3-D. Your child may have trouble seeing distant objects, such as a chalkboard at school. Wandering eye. If your child’s eyes appear misaligned, she may have strabismus, a common cause of amblyopia. Frequent squinting, eye rubbing, and head tilting. These may all be signs of blurry vision, which is a common side effect of amblyopia. Difficulty at school. Sometimes, a child may have difficulty at school due to amblyopia. Speak with your child’s teacher and ask whether your child is making excuses when asked to read from a distance (e. g. , “I feel dizzy,” or, “My eyes are itchy”). [10] X Research source You should ask your eye care professional to check for misalignment or vision problems in children younger than six months. At this age, your child’s vision is still developing so much that at-home tests may be ineffective. [11] X Trustworthy Source American Optometric Association Professional medical organization dedicated to supporting optometrists and improving public eye and vision health Go to source .
Ask the child to focus on the same part of the object as he follows the colored object with his eyes. Move the object slowly to the right and then to the left. Then, move it up and down. Observe the child’s eyes carefully as you move the object. You should note if one eye is slower than the other while following the object. Cover one of your child’s eyes and move the object again: left, right, up and down. Cover the other eye and repeat the test. Make note of how each eye responds. This will help you determine if one eye is moving more slowly than the other.
You can use existing photos if they show the eyes in clear detail. If you don’t have any photos that are suitable, ask someone to help you make some new photographs. Use the reflection from a small penlight to help rule out a lazy eye. Ask your assistant to hold a small penlight about three feet from your child’s eyes. Ask the child to look at the light. As the light is shining on your child’s eyes, take a picture of the eyes. Look for symmetrical reflection of the light in their iris or pupil area. If the light reflexes are in the same spot on each eye, then your child’s eyes are likely straight. If the light reflexes are not symmetrical, then one eye might be turned inward or outward. If you’re unsure, take multiple photos at different times to recheck the eyes.
Have your child sit facing you or have her sit on a partner’s lap. Gently cover one eye with your hand or a wooden spoon. Ask the child to look at a toy with the uncovered eye for several seconds. Uncover the covered eye and watch how it responds. Check to see if the eye snaps back into alignment because it drifted away. This can indicate an issue that should be checked by a pediatric ophthalmologist. Repeat the test on the other eye.
Search online to find a pediatric ophthalmologist in your area. The American Optometric Association has a search feature that can help you locate an eye doctor in your area. [14] X Trustworthy Source American Optometric Association Professional medical organization dedicated to supporting optometrists and improving public eye and vision health Go to source The American Association for Pediatric Ophthalmology and Strabismus also has a doctor locator. [15] X Research source If you live in a rural or small city, you may need to look in a nearby city to find a specialist. Ask friends and family with children for recommendations. If you know people who have children with vision trouble, ask them to recommend an eye doctor. This may give you a sense of whether that doctor will be right for you. [16] X Research source If you have health insurance, make sure that you choose a provider who is covered by your insurance plan. If you aren’t sure, you can contact your insurance company to verify whether they will cover the eye doctor you’re considering. [17] X Research source
Retinoscopy. The doctor may use a handheld tool called a retinoscope to examine the eye. The retinoscope shines a light into the eye. As the beam moves, the doctor can determine the refractive error (e. g. , nearsighted, farsighted, astigmatism) of the eye by watching the retina’s “red reflex. ” This method can be very helpful in diagnosing tumors or cataracts in infants, too. Your doctor will likely use eye-dilating drops to examine your child with this method. Prisms. Your eye doctor may use a prism to test the eye’s light reflex. If the reflexes are symmetric, the eyes are straight; if they are not symmetric, the child may have strabismus (a cause of amblyopia). The doctor will hold the prism over one eye and adjust it to determine the reflex. This technique is not as accurate as some other tests for strabismus, but it may be necessary to use when examining very young children. Visual acuity assessment testing (VAT). This type of testing includes several types of exams. The most basic uses the familiar “Snellen chart,” where your child will read the smallest letters he can on a standardized letter chart. [19] X Research source Other tests may include light response, pupil response, the ability to follow a target, color testing, and distance testing. [20] X Research source [21] X Trustworthy Source University of Rochester Medical Center Leading academic medical center in the U. S. focused on clinical care and research Go to source Photoscreening. Photoscreening is used in pediatric vision exams. It employs a camera to detect vision problems such as strabismus and refractive errors by examining light reflexes from the eye. Photoscreening is especially helpful with very young children (under age three), children who have difficulty sitting still, non-cooperative children, or children with disabilities such as Nonverbal Learning Disorder or autism. The test usually takes less than one minute. Cycloplegic refraction test. This test determines how the eye structure displays and receives images from the lens. Your eye doctor will use eye-dilating drops to perform this test. [22] X Trustworthy Source University of Rochester Medical Center Leading academic medical center in the U. S. focused on clinical care and research Go to source
The doctor will likely use eye-dilating drops to dilate your child’s eyes. This will help determine the level of refractive error in her eyesight during exams. The doctor may use a flashlight, penlight, or other light tool to help him observe light reflexes in the eyes. [24] X Trustworthy Source PubMed Central Journal archive from the U. S. National Institutes of Health Go to source The doctor may use objects and photographs to measure eye motility and misalignment. The doctor may use an ophthalmoscope or similar equipment in order to assess if there is any eye disease or abnormalities in the eye.
You should always feel as though your child’s doctors care about your child. If the eye doctor you have initially chosen is not willing to answer questions and communicate with you, find another. [27] X Research source You should not feel rushed or harassed by any doctor. If you had to wait an excessively long time, felt rushed through an appointment, or felt like the doctor considered you a nuisance, don’t be afraid to try out another doctor. You may find one who suits your needs better. [28] X Research source
It is possible that the doctor will suggest eye muscle surgery to realign the eye muscles to their proper position. This procedure is done under general anesthesia. The child will be given general anesthesia. A small incision will be made on the eye and an eye muscle will either be lengthened or shortened, depending on how the lazy eye needs to be corrected. Patching may still be required. [29] X Research source
Ask for sample patches from your eye doctor. For patching to work, the patch must cover the eye entirely. Your eye doctor can ensure a proper fit. You can usually choose an elastic-band patch or an adhesive patch. The Amblyopia Kids Network has reviews of various eye patches, as well as information on where to purchase them.
Your child may have to build up to wearing the patch for the prescribed amount of time. Start with 20–30 minutes, three times a day. [33] X Research source Gradually increase the time until your child wears the patch for the correct length of time every day. [34] X Research source Older children and children with severe amblyopia may need to wear the patch for a longer period of time each day. Your doctor can recommend when and for how long your child should wear the patch.
Continue to check for improvement monthly as the condition has been known to get better with treatments lasting six, nine, or 12 months. The response time will vary depending on the individual child (and how faithfully s/he wears the patch). [36] X Research source Have your child wear the patch for as long as you continue to notice improvement. [37] X Research source
Initiate art activities that involve coloring, painting, dot-to-dots, or cutting and pasting. Look at pictures in children’s books and/or read with your child. [39] X Research source Ask your child to focus on the details in the illustrations or to work through the words of the story. [40] X Research source Be aware that your child’s depth perception will be reduced because of the patch, so toss games may be extra challenging. For older children, video games are being developed to coordinate children’s eyes. For example, software developer Ubisoft has been collaborating with McGill University and Amblyotech to produce games like “Dig Rush” that treat amblyopia. Ask your eye doctor whether this is an option for your child. [41] X Research source
Some studies suggest that eye drops are as effective or more effective than patches for treating amblyopia. Part of this effect may be because using the drops is often less socially stigmatizing for children than wearing a patch. Thus, children are more likely to cooperate with their treatment. [43] X Trustworthy Source PubMed Central Journal archive from the U. S. National Institutes of Health Go to source These drops may not need to be used for as long as patching. [44] X Research source Atropine drops do have possible side effects, so do not use them without first consulting with your child’s eye doctor.
This treatment works best for children with mild to moderate anisometropic amblyopia (i. e. , amblyopia caused by eyes with different strengths). The Eyetronix Flicker Glass treatment is usually completed in 12 weeks. It is not likely to be effective if your child has previously tried patching to treat amblyopia. As with other alternative treatments, always consult with your child’s eye doctor before trying any treatment.
RevitalVision may be especially helpful for older amblyopia patients. You will need to consult with your eye doctor to purchase RevitalVision.
Nexcare produces a line of hypoallergenic adhesive patches. Ortopad produces hypoallergenic patches in adhesive and glasses-fitting styles. You can also consult your child’s doctor for recommendations.
You can also try trimming away some of the adhesive part of the patch so there will be less of it touching the skin. The trick is to make sure that the normal eye is still completely covered and that the patch is secure.
A patch that attaches to glasses can provide good coverage over the weak eye. However, you may need to attach a side panel to the glasses to prevent your child from trying to see around the patch.
Skin creams or ointments may reduce inflammation, but it’s important to follow instructions carefully and not to overuse these products. In some cases, the best treatment is to do nothing and simply allow the skin to “breathe. “[48] X Research source Check with your physician for advice on treating your child’s skin irritation.
Explain to your child how it can help her and what might happen if she doesn’t wear it. Let your child know that wearing the patch will make her eyes stronger. Without frightening your child, let her know that not wearing the patch could cause result in worsened vision. If possible, let your child have input in scheduling her “patch time” each day.
Ask the people around your child to empathize and encourage him to stick to his course of treatment. Let your child know that he has several people he can turn to with any problems. Be open to answering questions your child may have. Let your family and friends know about the reasons for patching so they can support your child too.
Discuss having the teacher explain to classmates why your child is wearing the patch and how they can be supportive. Make sure that the school officials and faculty are aware that teasing over the patch should not be tolerated. Discuss whether academic accommodations can be made for your child while she is wearing the patch. For example, ask whether teachers can give your child difficult assignments a little earlier, provide tutoring, offer a work plan, and/or check in with the student’s progress every week or so. These can all help your child feel more comfortable during patching and maintain good performance in school.
You could consider wearing an eyepatch in solidarity. Even if it’s just occasionally, your child may feel less self-conscious if he sees that adults can wear patches too. Offer eyepatches for dolls and stuffed animals too. [52] X Research source Encourage your child to see the patch as a game, rather than as a punishment. Even if your child understands that the patch is for a good reason, he may see it as a punishment. Point out that pirates and other cool figures wear eye patches. Suggest your child compete with himself to keep her patch on. There are several children’s books that deal with patching. For example, My New Eye Patch, A Book for Parents and Children uses photographs and stories to explain what it will be like to wear an eye patch. Reading about others’ experiences may help normalize patching for your child.
Post a calendar, chalk board or white board to keep track of your child’s progress. Give small prizes like stickers, pencils or small toys when she has reached a certain benchmark, such as wearing the patch every day for a week. Use rewards as a distraction for very young children. For example, if your child pulls off the patch, replace it and give the child a toy or other reward to distract from the patch.
Do something fun during this time to help make the transition easier. Creating a positive association between the patch and a pleasant experience may make it easier for your child to handle the patching process. [54] X Research source
Never decorate the inside of the patch (the side that faces the eye). Design websites such as Pinterest offer a variety of ideas for decorating. Prevent Blindness also has suggestions on how to decorate patches. [57] X Research source Consider hosting a decoration party. You can give your child’s friends novelty eyepatches to decorate. This may help your child feel less isolated during the patching experience.
