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(Lazy Eye)


Leila M. Khazaeni

, MD, Loma Linda University School of Medicine

Last full review/revision Jul 2020| Content last modified Jul 2020

Amblyopia, a common cause of vision loss in children, is a decrease in vision that occurs because the brain ignores the image received from an eye. Vision loss may be permanent if the disorder is not diagnosed and treated before age 8.

  • Amblyopia can be caused by focusing problems (refractive errors), misalignment of the eyes (strabismus), glaucoma, cataracts, or other eye problems.
  • Children can have no symptoms, or symptoms that include squinting, covering one eye, or having one eye that does not look in the same direction as the other.
  • The diagnosis is based on the results of vision testing.
  • If diagnosed and treated early, amblyopia can be corrected.
  • Treatment includes eyeglasses or contact lenses, an eye patch, eye drops, or a combination.

Amblyopia affects about 2 to 3% of children and usually develops before age 2. However, any child under about age 8 can develop amblyopia.

Causes of Amblyopia

A child's visual pathways are not fully developed at birth. The vision system and the brain need to be stimulated by clear, focused, properly aligned, overlapping images from both eyes in order to develop normally. This development takes place mainly in the first 3 years of life but is not complete until about 8 years of age. If the brain does not receive proper visual stimulation from an eye during the development period, it learns to ignore (suppress) the image from that eye, resulting in vision loss. If the suppression lasts long enough, vision loss can be permanent. This permanent loss of vision is called amblyopia. There are several reasons for lack of proper visual stimulation, each of which can cause a type of amblyopia:

  • Misalignment of the eyes (strabismus)
  • Focusing problems (refractive errors)
  • Blockage of vision

Amblyopia caused by strabismus

Misalignment of the eyes (strabismus) can also cause amblyopia. The eyes produce two images—one from each eye—that normally are fused or united into a single image in the brain and then integrated to produce three-dimensional images and high levels of depth perception. The ability to fuse images develops during early childhood. If the two images are so misaligned that they cannot be fused together, the brain suppresses an image, ignoring the input from that eye. The brain is unaware of the image from the affected eye even though the eye may be structurally normal. In adults, because the visual pathways are already developed, seeing two different images results in double vision (diplopia) rather than in loss of vision.

Amblyopia caused by refractive errors

Amblyopia may be caused by an unequal refractive error, usually farsightedness (inability to see close objects clearly), nearsightedness (inability to see distant objects clearly), or astigmatism (an irregular curvature of the focusing surfaces of the eye). A refractive error causes blurring of the image or images reaching the brain, which results in a large difference in focus between the two eyes. These errors can develop in one or both eyes.

Amblyopia caused by blockage or decrease of vision

A third type of amblyopia develops when a clouding or opacity of the lens of the eye (such as from a congenital cataract) or of the cornea reduces or distorts the light entering an eye or when another cause (such as glaucoma) leads to decreased vision in an eye. A very droopy eyelid also can block vision and cause amblyopia.

Did You Know...

  • Sometimes a teacher or school nurse is the first to notice a child has an eye disorder.

Symptoms of Amblyopia

Children with amblyopia may not notice their vision in one eye differs from the other or may be too young to describe symptoms. These children may squint, cover one eye, or have one eye that does not look in the same direction as the other, all of which may indicate a problem that requires examination. A cataract may go unnoticed. Some older children may report impaired vision in the affected eye or exhibit poor depth perception. Often, however, children do not appear to have a problem. If one eye sees well and the other does not, children compensate well and do not seem to function differently from their peers.

Diagnosis of Amblyopia

  • Vision screening

To detect problems in visual development, vision screening for all children should be started during early well-child examinations, preferably before age 3, and continued throughout childhood. In some areas, preschool children are screened by volunteers and local and regional agencies.

Once children reach school age, screening is also done in school by health care practitioners. If a problem is found during screening, the child should see an eye doctor, either an ophthalmologist (a medical doctor who specializes in the evaluation and treatment of all types of eye disorders) or an optometrist (a health care practitioner who specializes in the diagnosis and treatment of vision or refractive problems).

Prognosis of Amblyopia

The sooner amblyopia or risk factors for amblyopia are detected, the more likely amblyopia can be prevented or corrected. Amblyopia may become irreversible if not diagnosed and treated before age 8, at which time the visual system has often matured. Early diagnosis and treatment increase the likelihood that vision will be completely recovered. In certain circumstances, older children with amblyopia can still have vision improvement with treatment. Failure to effectively treat amblyopia may result in permanent visual impairment in the affected eye. For these reasons, vision screening programs for children should be supported by the community.

Treatment of Amblyopia

  • Eyeglasses or contact lenses
  • Patching or eye drops
  • Treatment of strabismus if present
  • Removal of cataracts

Treating amblyopia involves forcing the brain to use the visual images from the affected eye. Sometimes this is accomplished simply by correcting refractive errors with eyeglasses or contact lenses. Sometimes doctors force the child to use the weaker eye by putting a patch over the better eye (patching) or using eye drops to blur the vision in the better eye. Patching or using eye drops in the better eye allows the weaker eye to get stronger. Sometimes patching or eye drops are begun once refractive errors can no longer be corrected with eyeglasses or contact lenses.

If strabismus is the cause, it should be corrected with surgery after vision has been equalized between the eyes.

A cataract or other opacity in the eye may require surgical treatment.

More Information about Amblyopia

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

  • Children's Eye Foundation of AAPOS: Practical information about prevention, detection, research, and education to protect the vision of children

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