What are the treatment options for lazy eye (amblyopia)?

Photo of children with their teacher (PantherMedia / Cathy Yeulet)

  • Lazy eye (amblyopia) in children can be treated with glasses, an eye patch or eye drops. The treatment will depend on factors like the type and severity of the problem.

In some children, only one eye focuses properly. This is a vision problem called lazy eye (medical term: amblyopia). It is caused when the two eyes send different images to the brain. This may happen if the child has a squint, or if one of their eyes is more nearsighted or farsighted than the other. The brain then mainly processes the information coming from the better eye, ignoring the other.

What are the treatment options?

The treatment for lazy eye will depend on things like how severe it is. The main treatment options are:

  • Glasses that can correct existing refractive errors (nearsightedness, farsightedness, blurred vision).
  • Occlusion therapy using an eye patch: Here the eye that sees better is covered up with a special patch for several hours a day. For children who wear glasses, the lens on that side can be covered. The aim of this treatment is to encourage the weaker eye to work harder. The word "occlusion" comes from the Latin word that means “to shut or close.”
  • Eye drops: Eye drops can be used to temporarily make it harder for the “good” eye to see properly, so the weaker eye has to take over and work harder. The drops contain medication such as atropine. This drug numbs the muscles in the stronger eye, making the lens of the eye unable to focus for a few hours.

In rare cases, lazy eye may be caused by a cloudy eye lens at birth (congenital cataract) or a droopy eyelid. That condition is then treated before the lazy eye is treated.

What does the treatment involve?

In children with a lazy eye, one eye is usually more nearsighted or farsighted than the other, or is affected by an astigmatism. That other vision problem is then corrected first using glasses. In some children, that’s enough to fix the lazy eye problem. But many children also need an eye patch or eye drops to effectively treat the lazy eye.

If the child's vision doesn't clearly improve in the lazy eye within twelve weeks despite wearing glasses, an eye patch or eye drops are used. This treatment typically takes a few months, during which regular eye tests aredone.

Eye patches should be worn for at least six hours each day. The eye drops are used once a day, just after getting up in the morning. Their effect also lasts for a few hours.

Research has shown that treating amblyopia with an eye patch or eye drops can improve vision in children. There was no difference between the two treatments in the studies.

How is lazy eye treated if it is caused by a squint?

If the lazy eye is caused by a squint, it is usually treated with an eye patch – together with glasses, if necessary. A lot of children who have a squint also have a refractive error. Research has found that treatment with glasses and eye patches improves the vision of children who have a squint.

Surgery is sometimes used if the squint is severe. This involves tightening or loosening eye muscles in order to change the position of the eyeball. The aim is to improve spatial vision (ability to judge how close or far away things are) and make the squint less noticeable to other people. The surgery doesn't improve the lazy eye problem itself, though, so it is typically only done after the lazy eye has been treated.

Are there side effects too?

Some people worry that covering the healthy eye could make it weaker because it's then used less during the treatment. But research in this area hasn’t found that to be true.

Eye patches may irritate some children’s skin. Eye drops can cause temporary sensitivity to light or a burning sensation. Sometimes a child might not be able to see properly with the healthy eye for a short while after treatment with eye drops. Eye drops may be particularly suitable for children who have problems wearing an eye patch.

 

Can amblyopia be treated later on?

Specialists recommend treating lazy eye as early as possible. For a long time, it was assumed that treatment would only be successful if it was started before the age of 7. But studies involving children and teenagers aged 7 to 17 suggest that later treatment can probably improve eyesight, too.

Can special exercises improve vision even more?

Sometimes children are encouraged to train their weaker eye by doing activities like drawing or making things while wearing the eye patch. Two studies have shown that this doesn't lead to a greater improvement in vision in most children. But it’s still not clear whether these activities help in certain children, such as those with severe vision problems.

How can I help my child?

Most children don't have any problems wearing their eye patch in everyday life. But some find it hard to wear it as much as they are supposed to. There are several reasons for this: While the "good" eye is covered by the patch, they can only see with their weaker eye. So they have worse vision during the treatment. This can lead to trouble playing or learning, and can be tiring too. They might also be teased about their eye patch in day care or at school.

Having to wear an eye patch for such a long time every day can be a real problem for some children. Parents use different strategies to try to help their child accept the patch. Some explain why it's important to wear the patch. Or they might explain the results of past eye tests to show their child that their vision really is improving. It might also be possible to talk with the doctor to see if or when you can shorten the time that the eye patch needs to be on.

Some parents have reported that doing things like putting eye patches on dolls or soft toys, or even wearing eye patches themselves, makes eye patches seem more normal to their children. Some parents praise their children or reward them with small gifts as an incentive. Other families manage better by not making a big deal out of wearing the eye patch.

Eye patches might look ugly or too plain. Some children prefer to cover up their glasses with something more interesting that they have chosen themselves. As with so many things, having the patch be part of a regular daily routine may also be important for the child. The good news is that in a few months’ time it will most likely be a thing of the past.