Pediatric amblyopia (lazy eye)

What is pediatric amblyopia (lazy eye)?

Amblyopia (am·​bly·​opia), or lazy eye, is a common vision disorder in children. It occurs when one or both eyes send a blurry image to the brain (even if there is no structural problem with the eye itself).

Left untreated, amblyopia can lead to permanent loss of vision. In fact, lazy eye is responsible for more vision loss in children than all other causes combined.

What are the different types of pediatric amblyopia (lazy eye)?

• Strabismic amblyopia is an imbalance in the muscles that position the eyes, which causes the eyes to cross or turn outward. Because the eyes can no longer coordinate, the brain favors one eye, leading to lazy eye in the other one. It is the most common form of amblyopia.

• Deprivation amblyopia occurs when there is an issue with one eye such as a cataract (a cloudy area on the lens).

• Refractive amblyopia is the result of significant differences in vision between the eyes. It is most often due to nearsightedness, farsightedness or astigmatism (an imperfection on the eye). Glasses or contacts can correct refractive amblyopia.

What are the signs and symptoms of pediatric amblyopia (lazy eye)?

Children with lazy eye may complain of vision problems or headaches or have droopy eyelids. They also may have poor depth perception. A child with strabismic amblyopia may have eyes that cross or turn out.

Amblyopia usually runs in families and most often occurs in kids who were born prematurely or with low birth weight. If you have a family childhood cataracts or another serious eye disease, take your child to a doctor for an eye exam.

If your infant's eyes wander during the first few weeks after birth, consult her pediatrician.

Other symptoms of amblyopia include:

• One eye that wanders, either inward or outward

• Eyes that don't seem to work together

• Poor depth perception

How is pediatric amblyopia (lazy eye) diagnosed?

Your child's doctor will perform a thorough eye examination to diagnose amblyopia. He is looking for a wandering eye or poor vision in one or both eyes. Tests are different depending on the age of the child.

• Newborns - Your child's doctor will look for cataracts using a device called an ophthalmoscope (red reflex test).

• Infants - The doctor will test your child for her ability to fix her gaze and to follow a moving object. He will also look for strabismus.

• Toddlers - The doctor will perform a red reflex test on a machine called an autorefractor to examine your child's eyes.

• Older children - Kids preschool-age and older will receive the same eye test adults do. The doctor will patch or cover one eye while your child identifies letters or pictures on a chart.

Lazy eye usually occurs in only one eye, but sometimes it affects both eyes, making it difficult to diagnose. Your doctor may refer your child to an ophthalmologist or optometrist for a complete eye exam.

What are the causes of pediatric amblyopia (lazy eye)?

The eye works by sending signals to the brain along the optic nerves. When the eye and the brain don't work together as they should, vision can become blurry or impaired. Amblyopia is usually the result of one eye not focusing as well as the other. This can be due to nearsightedness, farsightedness or astigmatism.

How is pediatric amblyopia (lazy eye) treated?

Most treatments for amblyopia in children involve forcing the weaker eye to work harder. Although standard treatments for amblyopia may be effective through the teen years, it is important to treat lazy eye earlier. Crucial visual system development occurs during early childhood, allowing for better treatment outcomes. 

There are two main treatments for lazy eye in children.

1. 

   Patching - Your child wears an adhesive patch over the stronger eye for several weeks, to a few months. By forcing your child to use his weaker eye, it stimulates vision development in the brain.

2. Eye drops - Like patching, eye drops are used in the stronger eye to stimulate vision in the weaker one. Drops of a drug called atropine blur vision in a child's strong eye, forcing the child to use her weak one. Eye drops may be easier to use than patches for some parents and children.

Other treatments for amblyopia include:

• Corrective eyewear - If your child's lazy eye is the result of nearsightedness, farsightedness or astigmatism, a doctor will usually prescribe glasses or contact lenses.

• Surgery - Some children with strabismic amblyopia may need surgery to repair the weak eye muscles. Surgery is also used in the case of cataracts or droopy eyelids.

Prognosis

Most kids who get proper treatment early enough have significant improvements to their vision. Remember, when it comes to lazy eye, the earlier the treatment, the better.