Amblyopia (Lazy Eye)

What is lazy eye?

Amblyopia is an eye condition that affects the ability to see clearly out of both eyes. It usually develops when a child is an infant or very young and can get worse over time if it’s not treated.

If a child has amblyopia, one of their eyes has blurry vision and the other has clear vision. Their brain starts ignoring their blurry eye and only uses the eye with clear vision to see. As their brain relies more on their stronger eye, their weaker eye’s vision becomes even worse over time. Amblyopia is a serious medical issue that needs treatment from an eye care specialist.

People sometimes refer to amblyopia as lazy eye or lazy vision. Even though these names are common, they’re not accurate. If a child has amblyopia, they’re not lazy, and neither are their eyes. They aren’t choosing to have blurry vision, and it’s not caused by anything they did.

How common is amblyopia?

Amblyopia is the most common reason kids lose their vision. It affects around 5% of children younger than 15.

What are lazy eye symptoms?

It’s not always easy to tell if your child has amblyopia. Most kids aren’t diagnosed until a healthcare provider or eye care specialist gives them an eye exam.

If you do notice amblyopia symptoms in your child, you’ll probably see changes in how they interact with objects and space around themselves. A child with amblyopia may:

• Bump into objects (especially on one side of their body).
• Favor one side of their body.
• Shut one eye or squint a lot.
• Frequently tilt their head to one side.
• Have crossed eyes.
• Have a droopy eyelid.

What does amblyopia look like?

You might not be able to see anything physically different in your child’s eyes if they have amblyopia. Their affected eye may not line up with the stronger eye — it might look off-center or like it’s drifting in a direction that doesn’t match where they’re looking.

What causes amblyopia (lazy eye)?

Amblyopia happens when something creates a difference between your child’s eyes and how they focus on the objects they look at. The most common causes of amblyopia are other vision problems, or structural issues with their eyes, including:

Refractive errors

A refractive error is something about the natural shape of your eyes or their ability to focus that makes your vision blurry. If your child has a refractive error that’s not treated right away, they can develop amblyopia. Refractive errors in kids that lead to amblyopia include:

• Nearsightedness (myopia) — trouble seeing far-away objects.
• Farsightedness (hyperopia) — trouble seeing objects that are up close.
• Astigmatism (having an oval-shaped cornea).

Strabismus

Strabismus (crossed eyes) happens when your eyes don’t line up with each other. Your eyes usually move together at the same time. If one of your child’s eyes moves without matching the other, their brain may start relying on one eye over the other.

Structural eye conditions

Any condition that affects how your child’s eyes function can cause blurry vision and lead to amblyopia, including:

• Droopy eyelids (ptosis) — especially if one eyelid droops enough to block some of your child’s eye.
• Cataracts — clouding in the lens of your eye.
• Issues with their cornea (the clear part at the front of your eye).

Amblyopia (lazy eye) risk factors

Any child can develop amblyopia. Some factors make kids more likely to experience amblyopia, including:

• Having biological family members with eye and vision problems.
• Developmental delays.
• Premature birth (being born before 37 weeks of pregnancy).
• Low birth weight (being born weighing less than 5 pounds, 8 ounces or 2,500 grams).

What are the complications of amblyopia?

If amblyopia isn’t treated, it can permanently affect your child’s vision. The good news is that amblyopia is reversible if treated early enough.

How is amblyopia diagnosed?

A healthcare provider or eye care specialist will diagnose amblyopia. Providers screen all kids for amblyopia during their regular checkup. They’ll perform an eye exam to check your child’s eyes (including inside them). Your provider will test how well your child can see. They’ll also look for anything that’s affecting your child’s eyes’ ability to work like they should.

It’s common for a provider to diagnose amblyopia before you notice any symptoms at home. Most kids diagnosed with amblyopia are too young to communicate that their vision is worse or changing before a provider notices it. Tell your provider or eye care specialist if you’ve noticed any changes in how your child holds their head or interacts with objects around them.

What are amblyopia treatments?

Your eye care specialist will treat amblyopia by making your child’s brain use their weaker eye to see. This will repair and strengthen the connection between your child’s brain and both their eyes to correct the amblyopia.

The most common amblyopia treatments include:

• Wearing an eye patch: It’s a common misconception that kids wearing a patch to correct amblyopia cover their affected eye to help it heal. In fact, the opposite is true. Your child will wear a patch that covers their stronger eye for at least a few hours per day. Blocking vision from the stronger eye forces your child’s brain to use images from their weaker eye to see. It also strengthens the weaker eye.
• Eyeglasses: Wearing glasses can correct refraction errors that cause amblyopia. Once your child’s vision improves, their brain might return to using both eyes to see. Your child might need glasses and other treatments at the same time.
• Medicated eye drops: Your eye care specialist might put medicated eye drops (usually atropine) into your child’s strong eye. The medicine temporarily makes that eye blurry, which makes their brain use the weaker eye to see. The eye drops are safe and won’t permanently affect the vision in your child’s strong eye.
• Amblyopia (lazy eye) surgery: It’s rare to need surgery to correct amblyopia. Your child might need surgery if they have cataracts or another structural issue with their eyes that nonsurgical treatments can’t fix. Your eye care specialist will tell you which type of surgery your child will need and what to expect.

Most kids need amblyopia treatment for at least a few months. No matter which treatment your child needs, make sure to encourage them to stick with it as long as your eye care specialist suggests.

It can be tough for kids to get used to changes in their eyes and vision, and that’s especially true when they need amblyopia treatments. Remind your child why it’s important to wear their eye patch, glasses or to use their eye drops. Reward them for sticking with their treatment and encourage them to use their weaker eye as often as they should. It’s OK if your child (or you) feels discouraged sometimes. The important thing is that you’re working together to improve their vision.

Can you fix amblyopia with eye exercises?

There’s no evidence that eye exercises can treat or fix amblyopia. Your eye care specialist might suggest that your child do specific tasks (like playing games or solving puzzles) while they’re wearing an eye patch or using medicated eye drops. These activities will help strengthen the connection between their brain and weaker eye. There aren’t specific exercises or eye motions that can correct amblyopia.

Can I prevent my child from developing amblyopia?

You can’t prevent amblyopia or the other vision issues that cause it. The best thing you can do for your child’s eyes and vision is to have them checked regularly.

What can I expect if I my child has amblyopia?

Amblyopia is very treatable if it’s diagnosed early. Children with amblyopia who start treatment early in life are much more likely to have improved vision and fewer long-term effects.

Your eye care specialist will suggest treatments that improve your child’s sight as much as possible. They might need vision correction lenses like glasses or contact lenses their whole life.

Can my child grow out of amblyopia?

No, amblyopia doesn’t go away on its own and children can’t grow out of it. If it’s not treated, amblyopia can cause permanent vision issues, including blindness in the affected eye.

How often should I have my child’s eyes examined?

Having your child’s eyes and vision checked regularly can help an eye care specialist identify problems right away. A pediatrician should check your child’s eyes at every well-child visit until they’re old enough to start school, and then every one to two years.

When should I see my healthcare provider?

Visit a healthcare provider or eye care specialist as soon as you notice any changes in your child’s behavior, especially if it seems like they might not be able to see clearly or at all. Talk to your provider if your child starts favoring one side of their body more than the other, or if they seem less confident when they’re moving around.

What questions should I ask my healthcare provider?

• What’s causing the amblyopia?
• Which treatments will my child need?
• How long will my child need amblyopia treatment?
• Will they need surgery?
• Can you suggest ways to encourage my child to stick with their treatment?

Does amblyopia get worse with age?

Amblyopia is treatable, but it can cause permanent vision problems if it’s not treated when a child is young.

It’s possible to treat amblyopia in teens and adults, but it takes longer and is usually less effective.

Visit a healthcare provider or eye care specialist if you notice any physical changes in your child’s eyes or if they’re squinting, tilting their head or shutting one eye frequently.