Lazy Eye
by Robert J. Engelhardt, MD

What is Amblyopia?
Amblyopia, also known as "lazy eye", is often the result of poor vision in one or both eyes. This poor vision can result from numerous causes including near sightedness, misalignment of the eyes (strabismus), a cataract, or a physical barrier to sight (drooping eyelid). The newborn brain requires visual stimulation to grow and fully mature. If this stimulation is not present, then centers of the brain which account for vision do not fully develop and amblyopia occurs. Prematurity, developmental delay, cerebral palsy and a family history are conditions that place children at higher risk for amblyopia.

What is Strabismus?
Strabismus is the misalignment of the eyes and is the most common cause of vision loss and amblyopia. Nearly all newborns will have intermittent eye crossing for the first 3-4 months of life. If this eye crossing is persistent or if it occurs after 4 months of age, then it should be discussed with a pediatrician. Persistent misalignment will force the brain to use a single eye for most of the vision. As a result, the eye that is not used does not give the brain stimulation it needs for proper development. If this process is not corrected in the first decade of life, then deficits may be permanent.

What are the symptoms?
There are many ways that vision problems may present in an infant. Persistent eye crossing, even if intermittent after 4 months of age, is concerning. Other signs include abnormal head posture, abnormal eye movements, or avoidance of light.

What is the treatment?
The first objective in treatment is to remove any obstruction to vision. After that, the options range from simple patching to surgical correction. The surgery essentially strengthens or weakens the individual muscles that move the eye. Treatment should be overseen by an ophthalmologist with pediatric experience.