Lazy Eye

Overview

Lazy eye (amblyopia) is reduced vision in one eye caused by abnormal visual development early in life. The weaker — or lazy — eye often wanders inward or outward.

Amblyopia generally develops from birth up to age 7 years. It is the leading cause of decreased vision among children. Rarely, lazy eye affects both eyes.

Early diagnosis and treatment can help prevent long-term problems with your child's vision. The eye with poorer vision can usually be corrected with glasses or contact lenses, or patching therapy.

symptoms

Symptoms of amblyopia can be hard to notice. Kids with amblyopia may have poor depth perception — they have trouble telling how near or far something is. Parents may also notice signs that their child is struggling to see clearly, like:

• Squinting
• Shutting 1 eye
• Tilting their head

In many cases, parents don’t know their child has amblyopia until a doctor diagnoses it during an eye exam. That’s why it’s important for all kids to get a vision screening at least once between ages 3 and 5.

child at risk

Some kids are born with amblyopia and others develop it later in childhood. The chances of having amblyopia are higher in kids who:

• Were born early (premature)
• Were smaller than average at birth
• Have a family history of amblyopia, childhood cataracts, or other eye conditions
• Have developmental disabilities

Causes

Doctors don’t always know what’s behind some cases of amblyopia. Causes may include:

Refractive errors. One eye might have much better focus than the other. The other eye could be nearsighted or farsighted. Or it could have astigmatism (distorted or blurry vision). When your brain gets both a blurry image and a clear one, it starts to ignore the blurry one. If this goes on for months or years, vision in the blurry eye will get worse.

Strabismus. This is when your eyes don’t line up the way they should. One could turn in or out. People who have strabismus can’t focus their eyes together on an image, so they often see double. Your brain will ignore the image from the eye that isn’t aligned.

Cataracts. A cloudy lens inside your eye can make things look blurry. The vision in that eye might not develop the way it should.

Droopy eyelid (ptosis). A sagging eyelid can block your vision

Treatment

Treatment tends to be more effective the younger the child is.

After a child is 8 years old, the likelihood of vision improvement drops significantly, but treatment can still be effective.

There are two approaches to lazy eye treatment. A doctor can treat the underlying eye problem or attempt to get the affected eye to work so that vision can develop.

Treatment for underlying eye problems

Many children with unequal vision or anisometropia do not know they have an eye problem because the stronger eye and the brain compensate for the shortfall. The weak eye gets progressively weaker, and amblyopia develops. Treatment includes:

Glasses

Doctors will prescribe glasses to a child with nearsightedness, farsightedness, or astigmatism. The child will have to wear the glasses all the time so that the specialist can monitor how effective they are at improving the vision problems in the lazy eye. Glasses may also correct an eye turn. Sometimes, glasses can solve amblyopia, and no more treatment is required.

It is not uncommon for children to complain that their vision is better when they don’t wear glasses. Caregivers may need to encourage them to wear them for the treatment to be effective.

Cataract surgery, or phacoemulsification

If a cataract is the cause of amblyopia, doctors can surgically remove it under either local or general anesthesia.

Correcting droopy eyelids

For some people, amblyopia results from an eyelid that blocks the vision of the weaker eye. In this case, the usual treatment is surgery to lift the eyelid.

Getting the lazy eye to work

Once the vision is corrected and any underlying medical issues addressed, several other actions can help improve vision.

Occlusion, or using a patch

A doctor will place a patch over the stronger eye so that the lazy eye has to work. As the brain is only getting information from that eye, it will not ignore it. A patch won’t get rid of an eye turn, but it will improve vision in the lazy eye.

The length of treatment depends on many factors, including the child’s age, the severity of their condition, and how much they adhere to the specialist’s instructions. They usually wear the patch for a few hours each day. Caregivers should encourage a child to do close-up activities while wearing the patch, such as reading, coloring, or schoolwork.

Atropine eye drops

Doctors may use these to blur vision in the unaffected eye. Atropine dilates the pupil, resulting in blurring when looking at things close up. This makes the lazy eye work more. Atropine is usually less conspicuous and awkward for the child than a patch and can be as effective. Doctors may prescribe drops to children who cannot tolerate wearing a patch.

Vision exercises

Different exercises and games aim to improve vision development in the child’s affected eye. Experts say this is helpful for older children. They may do vision exercises in combination with other treatments.

Surgery

Sometimes, doctors perform eye surgery to improve the appearance of an eye turn, resulting in better alignment of the eyes. This may or may not improve vision.

Exercises

Exercises to help correct vision are known as orthoptics. However, there are no specific exercises that can help to improve amblyopia.

During exercises, with a patch covering the stronger eye, the weaker eye is stimulated with a range of vision-intensive activities, such as coloring, dot-to-dot drawing, word games, or building Lego, depending on the child’s age.

Once strength has returned to the weaker eye, the child may do other exercises like home-based pencil pushups. These exercises involve slowly moving a pencil towards the tip of the nose and focusing on the end of the pencil during this movement until it becomes blurry.

However, doctors are unlikely to use home-based exercises as a first-line treatment for people with amblyopia. Many orthoptic exercises require vision in both eyes and can help people with different vision problems

Diagnosis

Early diagnosis is essential, preferably before the age of 6. Because the child often does not realize there is a problem, this is not always possible.

Routine eye examination

Between the ages of 3–5, a child should have a thorough eye examination to ensure their vision is developing properly and there is no evidence of eye disease. This means that doctors diagnose and subsequently treat most cases of amblyopia.

If the ophthalmologist or optometrist suspects the child has a lazy eye, they will conduct further tests before diagnosing.

They test each eye separately to determine whether there is any near- or farsightedness and how serious it is. They will also test the child carefully to determine whether there is an eye turn.

Complications

Certain complications can occur with amblyopia, including:

Blindness: If untreated, the person may eventually lose vision in the affected eye. This vision loss is usually permanent. According to the National Eye Institute, lazy eye is the most common causeTrusted Source of single-eye vision impairment in young and middle-aged adults in the U.S.

Eye turn: Strabismus, where the eyes are not aligned, can become permanent.

Central vision: If children do not receive treatment for amblyopia, their central vision may not develop correctly. This may affect their ability to do certain tasks.

Outlook

Although amblyopia affects a small proportion of children in the U.S., it is important that a child has routine eye checks. That way, a doctor can treat amblyopia or any other eye condition early.

Several treatments are in place to help with a lazy eye, including glasses, an eye patch, vision exercises, or surgery in some cases.