Eye Diseases

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Lazy Eye

Overview:

It is condition that develops in childhood causing a defect in visual development in one or both eyes.
It is one of the most common vision problems and the leading cause for vision loss among children.
A child can develop a lazy eye as a result of other eye problems.
A delay or lack of treatment can cause a child lifetime vision problems.
It is essential to keep an eye on children’s vision habits and get them checked up regularly.

What is a lazy eye?

Lazy eye is a condition that results from abnormal visual development early in life, leading to a lack of stimulation of the nerve pathways between the eye and the brain. This causes one eye's vision to be weaker, and it receives fewer visual signals. Eventually, the eyes' ability to work together decreases and the brain suppresses or ignores input from the weaker eye. It is one of the common vision problems and the leading cause for vision loss among children.

Other names:

Amblyopia

Causes:

A child can develop a lazy eye as a result of other eye and vision problems. Below are some of the cases that could cause a lazy eye in children:

Strabismus: The brain starts to ignore the double-vision image, resulting in a "lazy eye". As a result, the brain becomes increasingly reliant on the stronger eye, which prevents the other eye from developing correctly.
Refractive errors: They are disorders where the eye becomes unable to focus light on the retina. They include:

Nearsightedness;
Farsightedness;
Astigmatism (distorted or blurry vision).

A refractive error may be worse in one eye. When this occurs, the brain begins to rely on the better eye, causing the vision to develop improperly.

Cataracts: Some children are born with cataracts. A cloudy lens inside your eye can make things look blurry. The vision in that eye might not develop the way it should.
Droopy eyelid (ptosis): A sagging eyelid can block the vision, causing a lazy eye.

Risk factors:

Some children are born with a lazy eye, and others develop it throughout their lives. A child might be more likely to have a lazy eye if they:

Were born early (premature);
Were smaller than average at birth;
Have a family history of amblyopia or other eye conditions;
Have developmental disabilities.

Symptoms:

The symptoms of a lazy eye may be difficult to distinguish unless accompanied with other clear symptoms (e.g. a squint). Younger children (under the age of 3 years) often do not realize they have a problem with their vision, and even if they do, they probably can't explain it. Older children (over the age of 3 years) may complain about their inability to see with one eye. They will notice that they have problems with reading, writing and drawing; however, in some cases, parents may be able to notice the difference between both eyes. Signs and symptoms include:
Crossed eyes
Staring, closing one eye, or tilting the head while looking at things
Asymmetric movements of the eyes
One eye turns inward or outward (horizontal motion)
Trouble with depth perception
Trouble telling how near or far away something is
Ptosis of the upper eyelid

When to see a doctor?

Lazy eye treatment requires early diagnosis and detection as treatment is most effective before the age of 6. However, because the symptoms of a lazy eye are difficult to detect in children, it often goes undiagnosed until the first routine eye check-up. This is why parents must have their children undergo the routine eye examinations recommended by the Saudi Ministry of Health. If any of the aforementioned symptoms were noticed, the child must be immediately taken to an ophthalmologist. If the child suffers from any of the vision problems mentioned above (leading to a lazy eye) regular check-ups are necessary.

Complications:

A delay or lack of treatment can cause a child lifetime vision problems. Moreover, lazy eye treatment in adults is usually less effective, which may cause permanent vision loss.

Diagnosis:

In a regular check-up, an ophthalmologist looks for signs of strabismus, or refractive errors, as well as a difference in vision between both eyes, or a double vision. He uses eye drops to open up the eyes. This could cause the vision to become blurry for several hours or a day. The method used to test a child’s vision depends on their age:

Children under the age of 3 years (before speaking): A luminous device is used to discover cataracts, along with other tests to assess the child’s ability to fix their gaze and follow a moving object.
Children above the age of 3: They can be examined using pictures or letters to assess their vision. Usually one eye is covered to test the other.

Treatment:

Most cases of vision loss caused by a lazy eye can be prevented or reversed with quick intervention and the right type of treatment. Treatment of a lazy eye includes:

Correcting any underlying vision problems:

Glasses: They're used to treat conditions like nearsightedness, farsightedness, or strabismus.
Contact lenses are used for older children.
Surgery: it can treat cataracts, droopy eyelid (ptosis), or some cases of eyes strabismus to help the eyes better work together.

Stimulating the lazy eye using:

An eye patch: It is worn 2-6 hours a day on the “good” eye to force the lazy eye to work better.
Eye drops: Eye drops blur the strong eye. This forces the brain to use the weak eye.
Medical glasses can be used in cases where both eyes are affected.

Prevention:

ou cannot prevent a lazy eye; however, the resulting vision loss can be avoided, therefore it is important to monitor the child's vision habits and get them regularly checked according to the dates specified by MOH. When discovered, diagnosed, and treated early, a lazy eye won't cause a child’s vision to completely deteriorate.

FAQs:

Can eyeglasses help a child with a lazy eye see better?

Glasses improve visual acuity to some extent, but it is not the only treatment. In the case of a lazy eye, the brain becomes accustomed to blurry vision, so it needs to learn how to see better with that eye. Over time, with the correct treatment, the brain will eventually learn how to do that.

How long should an eye patch be used for treatment? How can I make the most out of it?

How long the patch should be worn depends on your child’s age, how severe the problem is, and how flexible he is with wearing patch. Once treatment begins, vision improves within a few weeks; however, it will probably take months to get the best results. Your child may still need to use the patch from time to time to prevent lazy eyes from returning. While your child is wearing the patch they should do activities that require closely focusing on objects (e.g using a tablet, coloring, reading, or doing homework).

What would happen if the condition was not diagnosed and treated early?

If left untreated until the age of 10, a child with a lazy eye will likely have vision problems for the rest of his life. Early diagnosis is the key to preventing vision loss.

Myths & Truths:

Using an eye patch is better than using eye drops.

Truth: Both methods are equally effective. It is a matter of preference. Some children do not like eye drops, and others do not like wearing eye patches.

Eye patches are the ideal choice for children of all ages and should be worn all the time.

Truth: Eye patches are most effective before the age of 6. Children with a lazy eye will need to wear an eye patch several hours a day for a few months.

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