Lazy Eye (Amblyopia) and Patching

“Lazy eye” is a non-precise term that can mean different things to different people. Sometimes the term is used to describe an eye that doesn’t see as well, but other people describe a turned eye (strabismus or squint) as a lazy eye. Some people even call an eye with a droopy eyelid, but no other problems, a lazy eye.

baby eye testsAmblyopia, or “lazy eye”, is a condition where one eye does not see as well as the other, even with glasses. Really ambylopia is a neural (brain) condition, but it’s usually caused by a vision problem in one eye: if one eye has weaker vision from birth or in young childhood, then the part of the brain that processes vision from that eye never has a chance to develop to its full potential. Then later, even if the correct spectacles are worn, the brain is still unable to process and interpret the image properly. The result is amblyopia – blurry vision in one eye, even with glasses. Amblyopia can also be the result of a turned eye (also known as strabismus, squint, or “cross-eyes”), but that’s not to say amblyopia is same as a turned eye.

IMG_8618irfanviewedIf your child has been diagnosed with amblyopia, the good news is that with early treatment, visual outcomes can be very good. Sometimes, parents feel a little guilty for not noticing that their child had amblyopia, but there’s no need to, because usually there is no way to tell that a child has amblyopia without having a proper assessment.

Amblyopia is treated initially by prescribing the appropriate glasses. Usually, these glasses will have a stronger lens in one eye than the other. Sometimes after a couple of months of full-time spectacle wear, the ambylopia has resolved, but more commonly a program of patching therapy will need to be commenced. This involves wearing a patch on the “good” eye for a total of two hours per day in order to stimulate the visual processing of the image from the “weak” eye (now made clearer with the glasses). Patching therapy usually goes on for at least several months, and sometimes longer, with fairly frequent review visits to monitor progress and improvement in vision (visual acuity).

Patching can sometimes be difficult for the child to accept initially, since the “good” eye is being covered. However as the days go on, the vision in the “weak” eye gradually improves and the child becomes more accepting. Different types of patch are available, such as stick-on patches for younger children who are prone to removing the patch; pirate patches for quick & easy application & removal; and cute novelty animal patches which sit on the glasses rather than directly on the face. Active hand-eye activities such as Lego, colouring-in, craft, and iPad games are ideal activities when wearing the patch. Sometimes, encouragement in the form of a simple reward system, such as sticky stars on a calendar or reward chart, helps to motivate young children. It’s important not to let your child dictate terms though, as patching does need to be done consistently, while the child is still young, for it to be effective.

A turned eye, also known as strabismus, squint, esotropia or exotropia is a different thing. Many people call a turned eye a “lazy eye’, and it’s true that a turned eye can lead to a lazy eye. Depending on which way the eye is turning (in or out), glasses are often required either to straighten the eyes (for inward-turning eyes or esotropia) and/or sometimes to assist with concentration and focussing (for school-aged children with outward turning eyes or exotropia).

An eye that starts to turn inwards around age 2-5 is often accommodative esotropia, and this is remedied with spectacles. An eye turn that suddenly develops at older ages may be an indicator of other problems, and if so in this case we would recommend seeing your doctor. Babies from newborn up until around six months of age may have eyes that aren’t perfectly straight 100% of the time, but we are certainly happy to check your baby’s eyes if you are concerned.

Occasionally eye muscle surgery is required to straighten turned eyes, but we like to consider this as a last resort, because glasses are often an effective and safe solution, and because surgery is not 100% guaranteed to straighten the eyes perfectly anyway. If our assessment shows that your child needs eye muscle surgery (squint surgery) we will be happy to provide a referral letter of introduction to an experienced Newcastle eye surgeon (also known as an eye doctor or an ophthalmologist).

Amblyopia and strabismus runs in families, so it’s worth getting sisters and brothers checked, as well as your children if you had a lazy eye as a kid yourself. Amblyopia does not get better by itself. At Custom Eyecare we regularly see children of all ages from throughout Newcastle and the Hunter Valley for assessment and customised treatment of amblyopia (lazy eye) and strabismus, with patching therapy when needed, as well as long-sightedness and all other vision problems.

Contact us to arrange an assessment and comprehensive eye & vision check.

Further Reading:

Amblyopia (Lazy Eye)


What is Ambylopia or Lazy Eye?