Amblyopia and Patching

Amblyopia, or “lazy eye,” refers to reduced vision in an eye that cannot be corrected with glasses. Amblyopia is sometimes confused with the medical term strabismus, which describes an eye that wanders or crosses.

Amblyopia usually occurs in children before 7 or 8 years of age, when the visual system is still developing. If left uncorrected, these children may be left with permanent vision loss.

There are many causes of amblyopia, the most common being strabismus (drifting inward or outward of one eye). It also occurs when the vision in one eye is significantly different from the other such as when one eye is very nearsighted and the other is normal or farsighted. Anything that prevents light from getting into the eye, including cataracts, will cause amblyopia.

Treatment

Treatment usually requires covering the stronger eye with a patch, forcing the child to use the amblyopic or “lazy” eye. Drops rarely can be used to blur vision in the stronger eye to force the use of the “lazy” eye.

The number of hours per day and number of weeks or months that a child must wear the patch depends upon the severity and cause of his or her amblyopia. Patching may last for months or years in children with very severe amblyopia.

The more severe the visual loss the greater number of hours per day will be required to restore the vision to normal. Amblyopia is not always correctable. If the condition isn’t detected early on, the vision may not respond fully to patching. Though children will rarely respond to patching after 7 or 8 years of age, younger children will respond to patching therapy much more readily.

Glasses, eye muscle surgery, or other interventions may also be required to correct the cause of amblyopia. Frequent follow-up exams are required to assess the visual improvement and response to patching.

Tips on 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 “lazy” eye.

Some children can be convinced to wear the patch with positive reinforcement and a simple reward system. Other children may require more stringent measures such as elbow restraints that physically prevent the child from removing the patch. Patching usually becomes easier once the child has become accustomed to it.

Occasionally the skin around the eye becomes red and irritated from repeated patching. If this happens to your child, discontinue patching for two to three days until the redness has improved.

If your child wears glasses, patches may be adhered to the lens of the glasses, although you should be certain that the child does not peek around the lens and patch. Another option is to buy or make a pirate-style patch.