A lazy eye (amblyopia) is often diagnosed and treated by an orthoptist under the supervision of an ophthalmologist, with support from an optometrist.
The younger the child is when a lazy eye is diagnosed, the more successful treatment is likely to be. Treatment is less successful if started after the age of six, and it's unlikely to be successful if started after the age of eight.
The two main treatment options for a lazy eye are:
- treating or correcting any underlying eye problems
- encouraging the use of the affected eye so vision can develop properly
Treating underlying eye problems
Refractive errors, such as short- or long-sightedness, can be corrected using glasses. These usually need to be worn constantly and checked regularly.
Glasses may also help to straighten a squint, and in some cases can fix the lazy eye without the need for further treatment.
Your child may say they can see better without their glasses. This is because their eyes have become used to working hard to focus and they now find it difficult to let the glasses focus for them.
They'll need plenty of encouragement to wear their glasses continuously.
Contact lenses are an alternative to glasses, but they may only be suitable for older children.
Read more about treating short-sightedness and treating long-sightedness with corrective lenses.
In children, most cataracts are removed to allow better development of vision in the affected eye.
Cataract surgery for children is carried out under general anaesthetic. The procedure usually takes about one to two hours.
Your child may be kept in hospital overnight to check their recovery process, and will have to use eye drops afterwards.
Read more about treating cataracts in children.
In some cases, surgery is used to improve the appearance of a squint. The operation will either strengthen or weaken the eye muscles of the lazy eye to change its position.
This means the lazy eye will appear to be better aligned with the good eye. The child's vision won't improve, but their eyes will appear straighter and it will help the eyes work better together.
Read more about treating squints.
A droopy eyelid (ptosis) can also be corrected using surgery.
Encouraging the use of the eye
A number of different treatment options can be used to encourage your child to use the affected eye. These are outlined below.
Using a patch
Using a patch is known as occlusion. It involves placing a patch with a sticky rim over the "good" eye so the lazy eye is forced to work. It can be very effective in improving the sight in the lazy eye. Patches often need to be worn with glasses.
The length of time the child will need to wear the patch will depend on how old they are, how serious the problem is, and how much they co-operate with wearing the patch.
The orthoptist and ophthalmologist will determine how often follow-up checks are needed.
Patches are most effective before a child reaches six years of age. Most children will need to wear the patch for a few hours a day for several months.
Using a patch to treat a lazy eye can be a time-consuming process and can often be an unpleasant experience for the child until they get used to it. This is understandable – from their point of view, you're making their vision worse by taking their good eye away from them.
This is why the most important thing for you to do is explain the reasons for using a patch, and the importance of sticking with the treatment, to your child so that they're motivated to do it.
If your child is too young to understand, try to think of incentives to encourage them to use the patch. While the patch is on, they should do close-up activities, such as playing with an electronic tablet, colouring, reading or schoolwork. Rewarding them with their favourite television programme is a useful option.
Atropine eye drops can be used to blur the vision in the good eye. They expand (dilate) the pupil of the good eye and blur vision, which encourages the use of the lazy eye.
Side effects that can occur after using eye drops include:
- eye irritation
- reddening (flushing) of the skin
However, these side effects are usually infrequent and rarely outweigh the benefits of using eye drops.
Eye drops can be as effective as using a patch, and often the choice of treatment is a matter of preference. Children who don't like having drops in their eyes can wear a patch, and vice versa.
Lack of improvement
In some cases, a lazy eye doesn't improve despite having proper treatment.
Sometimes poor results are due to the child or family finding it difficult to stick to using the patch or the drops.
If you're having trouble with one kind of treatment, you should discuss the alternatives with your eye specialist.
If surgery is recommended, more than one operation may be required to improve the appearance of a squint, and glasses may still need to be worn after surgery.
If the treatment is stopped too soon, any improvements in the lazy eye can be lost. A patch may also need to be worn or eye drops used, if the lazy eye returns.