Display Patient Information Leaflets

Date issued: October 2024 

For review: October 2026

Ref: C-598/SB/REI/Amblyopia Treatment

PDF: Amblyopia Treatment.pdf [pdf] 262KB

What is Amblyopia?

Amblyopia an underdevelopment of vision in infancy and early childhood. This occurs because the vision-sensing part of the brain (visual cortex) has not been stimulated sufficiently. Therefore, intervention is needed to allow for normal visual development.

Amblyopia can be caused by a squint (turn in the eye), a need for glasses or an obstacle blocking visual stimulation such as a cataract (cloudy lens) or a droopy eyelid. Although amblyopia usually affects only one eye, it can affect both eyes. 

What are the symptoms of amblyopia? 

Amblyopia often goes undetected due to children very commonly having no symptoms. Unless the child has a squint or other obvious abnormality, there is nothing to suggest the presence of amblyopia to even the most perceptive of parents.

Reason for treatment

In order for your child to have the best chance of growing up seeing well with each eye, it is important that we try to make the vision in the weaker eye develop whilst your child is still young.

The earlier amblyopia is diagnosed and treated; the more successful treatment will be. Doing nothing is an option, however, this would mean that it is very likely that your child would grow up with one eye that is permanently weak. 

Having a weak eye can be a restriction to certain careers, for example, it may harm your child’s chances of learning to drive an HGV, and it would be a major problem if your child lost the sight in their better eye due to accident or disease.

Your child will have regular monitoring of their progress throughout the treatment by the Orthoptist who will adjust the treatment as necessary. The length of treatment depends on the starting vision and how your child responds to treatment. Your child will be monitored regularly throughout their treatment, however, typically treatment is required for several months. 

Treatment options

If your child has been given glasses, it is important they are worn as much as possible to keep clear images falling on the retina (back) of each eye. However, your orthoptist has decided that glasses alone (if needed) are not sufficient to treat your child’s weaker eye and treatment to encourage use of the weaker eye is necessary.

Treatment involves preventing use of the better eye using either patches, and/or eye drops/ointment (atropine). Each treatment has its own advantages and disadvantages.

Which treatment is best for my child?

This will depend on the age of your child, the vision of the amblyopic eye and your preference. The Orthoptist will discuss the options with you in full to allow you to choose the treatment that is right for your child.

Patches

An adhesive patch is worn over the eye with better vision and the amount of time the patch must be worn is decided by the orthoptist. This is decided using researched guidelines to allow for evidence-based practice.

Patches are straightforward to use, and many children settle to wearing them after an initial period of difficulty, however, some children object to the patch stuck on their face and quickly learn to pull them off. Your orthoptist can show you non-sticky fabric patches that your child can use if they wear glasses. However, these patches are much easier for the child to peep around and can affect the effectiveness of the treatment. Patches can be worn part of the time/day so the child can have a break from the treatment. It is important that your child still wears his/her glasses (if worn) as well as the patch.

Tips

• Explaining the reasons for patching can prepare your child for possible questions they can be asked. 

• Playgroup, nursery and school are in good positions to support patching.

• It is important to make patching part of the daily routine.

• Encourage your child’s involvement when patching. You may need to distract them and encourage activities initially, for example using games.

• Patching-charts help motivate children and record success.

• Be aware that the vision may be quite limited with the patch on initially, but children often become more accepting of wearing the patch as their vision improves.   

Atropine

Atropine is a drug that works by blurring the near vision in the good eye so that the child then has to use the weaker eye in order to be able to see. It may not be successful if the vision in the weaker eye is very poor. The pupil of the eye you put the atropine in will be enlarged, which can cause the child to be more sensitive to light. Once the atropine is in the eye it will be effective continuously and the vision can remain blurred, and the pupil enlarged for up to two weeks. This form of treatment may be more successful for children who are unable to tolerate patching or have nystagmus (rhythmic involuntary movement of the eyes). It is important that your child still wears his/her glasses (if worn) as well as using the atropine. One drop is instilled twice a week to the better seeing eye.

Atropine like all medicines will have the potential to cause side effects, although these are relatively uncommon and generally mild. Local side effects around the eye include swelling of the eyelid, redness of the conjunctiva (the white part of the eye) and local irritation. Side effects in other parts of the body can occasionally occur and include dry mouth, flushing and dryness of the skin, increased body temperature, constipation or difficulty passing urine, fast heartbeat, nausea and vomiting and giddiness. If your child suffers from any side effects that cause you concern, stop the treatment and please speak to your child’s doctor, a pharmacist or A&E depending on the severity of symptoms.

Storing the drops:

• Store the drops safely out of the reach of children.

• Store the drops at a temperature less than 25^oC (room temperature), in a dry place away from strong light. 

Can my child continue normal activities whilst having treatment?

Yes. You should inform your child’s school or nursery and other carers that they are having treatment. Detailed visual activities (such as reading, writing, computer, or watching TV) help stimulate use of the lazy eye. You will need to take extra care to avoid accidents.

For children undergoing atropine treatment, your child may find it helpful to wear a hat or sunglasses outside in bright weather. 

Will amblyopia treatment help my child’s squint (turn in the eye)?

Treatment will only treat the reduced sight in the lazy eye. It will not stop the eye from squinting. We can treat some squints with glasses or an operation on the muscles that move the eye. If your child needs an operation for a squint, we will use patching to improve the vision as much as possible first.

Will the amblyopia return after we stop patching?

In many children, the improvement will last, but for some children the lazy eye will return. The orthoptist will monitor your child’s vision and advise you if you need to start patching again. Most children will need to continue wearing their glasses after they stop patching.