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Normally, the brain processes the information coming in from both eyes equally. This is needed for the best possible vision. In some children, however, one eye is favored by the brain because it provides a better image. If this happens, the other eye is neglected from childhood on, and it does not get the chance to develop well. This is known as amblyopia or “lazy eye”.

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A.D.A.M. Medical Encyclopedia.

Amblyopia

Lazy eye

Last reviewed: September 18, 2012.

Amblyopia, or "lazy eye," is the loss of one eye's ability to see details. It is the most common cause of vision problems in children.

Causes, incidence, and risk factors

Amblyopia occurs when the nerve pathway from one eye to the brain does not develop during childhood. This occurs because the abnormal eye sends a blurred image or the wrong image to the brain.

This confuses the brain, and the brain may learn to ignore the image from the weaker eye.

Strabismus is the most common cause of amblyopia. There is often a family history of this condition.

The term "lazy eye" refers to amblyopia, which often occurs along with strabismus. However, amblyopia can occur without strabismus and people can have strabismus without amblyopia.

Other causes include:

Symptoms

  • Eyes that turn in or out
  • Eyes that do not appear to work together
  • Inability to judge depth correctly
  • Poor vision in one eye

Signs and tests

Amblyopia is usually easily diagnosed with a complete examination of the eyes. Special tests are usually not needed.

Treatment

First, any eye condition that is causing poor vision in the amblyopic eye (such as cataracts) needs to be corrected.

Children with a refractive error (nearsightedness, farsightedness, or astigmatism) will need glasses.

Next, a patch is placed on the normal eye. This forces the brain to recognize the image from the eye with amblyopia. Sometimes, drops are used to blur the vision of the normal eye instead of putting a patch on it.

For treatment of crossed eyes, see: Strabismus

Children whose vision will not fully recover, and those with only good eye due to any disorder should wear glasses with protective polycarbonate lenses. Polycarbonate glasses are shatter- and scratch-resistant.

Expectations (prognosis)

Children who get treated before age 5 will usually recover almost completely normal vision, although they may continue to have problems with depth perception.

Delaying treatment can result in permanent vision problems. After age 10, only a partial recovery of vision can be expected.

Complications

  • Eye muscle problems that may require several surgeries, which can have complications
  • Permanent vision loss in the affected eye

Calling your health care provider

Call for an appointment with your health care provider or ophthalmologist if you suspect a vision problem in a young child.

Prevention

Early recognition and treatment of the problem in children can help to prevent permanent visual loss. All children should have a complete eye examination at least once between ages 3 and 5.

Special techniques are needed to measure visual acuity in a child who is too young to speak. Most eye care professionals can perform these techniques.

References

  1. Olitsky SE, Hug D, Plummer LS, Stass-Isern M. Disorders of eye movement and alignment. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF,eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 615.
  2. Olitsky SE, Coats DK. Amblyopia and its management. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins. 2009:chap 10.

Review Date: 9/18/2012.

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Treatment of amblyopia (lazy eye) caused by strabismus (squint) with patching and/or optical treatment (glasses or penalisation)
    Amblyopia is a common childhood condition which causes a reduction in vision of one or both eyes which is not caused by any eye disease. Amblyopia can be caused by the presence of a squint (misalignment of the eyes where one eye may turn inwards, outwards, upwards or downwards). This review aims to look at the treatment of reduced vision caused by the presence of a squint, not the treatment of the squint itself. Three randomised controlled trials (RCTs) conducted in the United States were included in this review. The results of one of these trials indicate that patching therapy combined with any necessary glasses is more effective than glasses alone in the treatment of this condition. Two of the trials analysed the role of adding near activities to supplement patching therapy. These trials suggest there may be benefit to adding near activities to prescribed occlusion regime. No trial examining the role of optical penalisation (altering glasses strength) or using partial occlusion (frosted lens opposed to a patch) was found. The effectiveness of optical penalisation and partial occlusion for the treatment of strabismic amblyopia is unknown.
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Figures

  • Visual acuity test.
    Walleyes.

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