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Amblyopia (Lazy Eye)

Division of ophthalmology, what is amblyopia.

Amblyopia, also known as lazy eye or wandering eye, is a common vision problem in children. In most cases of amblyopia, your child’s brain ignores the signals coming from one eye, meaning the other eye is the only one being used.

Over time, the brain gets used to working with only one eye. The eye that’s being ignored by the brain doesn’t develop normal vision.

If treated while your child is young and the eyes are still developing, he has a good chance of overcoming amblyopia. The goal of treatment is to make your child’s brain use both eyes. Getting the eyes to work as a team becomes harder as your child grows. Early treatment is best; and treatment may not work at all if started after 7-10 years of age.

If left untreated, amblyopia may keep your child from developing normal vision.

Amblyopia affects 2-5 percent of children.

Amblyopia has three main causes:

• Strabismus , which occurs when a child’s eyes aren’t aligned (straight). The eyes don’t work together. This leads the brain to ignore one eye.
• Refractive error , or need for glasses. Children are especially at risk if one eye has larger need for glasses compared to other eye.
• Conditions that cause poor vision in one eye, like cataract or droopy eyelid (ptosis), which prompts the brain to ignore the blurry pictures seen by that eye.

Additional factors can place a child at a higher risk for amblyopia, including:

• A family history of amblyopia
• Prematurity
• Developmental delay
• Craniofacial disorders
• Certain genetic conditions, such as Down syndrome (trisomy 21) , 22q deletion syndrome , Williams syndrome and Noonan syndrome

Symptoms of amblyopia can vary from child to child, but may include:

• Squinting in one or both eyes
• Rubbing one eye (not just when tired)
• Holding items close to the eyes to see them
• A wandering or crossed eye (strabismus)

It’s important to note that some children display no symptoms of amblyopia. The child’s strong eye — and her brain — can compensate for the weaker eye, making it appear that the child has good vision.

Testing and diagnosis

Vision screening is the best way to detect presence of amblyopia or risk factors for developing amblyopia. Photoscreening, a type of vision screening that uses a special camera to determine how well a child can see, is often performed in conjunction with vision testing at pediatricians or schools.

The goal of treatment for amblyopia is to:

• Correct the problem that is causing amblyopia
• Make each eye see as well as it can, which often involves forcing the brain to use the “weak” eye
• Force the brain to use the signals from both eyes
• Make both eyes work together

Amblyopia is most often treated by blocking one eye to keep it from doing all the work. The brain can learn to accept signals from the eye that’s being ignored. Gradually, vision in this eye may improve.

Commonly used treatments include:

• An eye patch  is placed over the eye that’s being used. With this eye blocked, the brain is forced to start working with the eye it’s ignoring. The patch must be worn while your child is awake. Your child may not like wearing a patch. But remember that treatment will work only if your child wears the patch as often as instructed.
• Medicated (atropine) eye drops  can be used instead of a patch. Drops are put in the “good” eye, blurring near vision in that eye. This allows the eye that’s being ignored to start working with the brain. Eye drops may be an option for certain children who don’t like wearing a patch. But putting in eye drops can take practice.
• Eyeglasses can help correct focusing problems . They can also be prescribed to blur sight in the eye that’s being used. This forces the brain to work with the eye it’s ignoring. In some cases, sight in one eye is blocked by sticking a patch or a filter to the inside of an eyeglass lens. As vision improves, your child’s eyeglass prescription may change.

Follow-up care

Once amblyopia improves, maintenance treatment may be needed to prevent vision from slipping. Maintenance treatment includes continued wearing of eyeglasses and/or wearing an eye patch for decreasing amounts of time during the day than was required during the treatment period.

Amblyopia can cause blindness, but fortunately it is the most reversible cause of blindness. Treatment is highly successful as long as children and families stick to the treatment plan.

Reviewed by Stefanie L. Davidson, MD

Providers Who Treat Amblyopia (Lazy Eye)

William Anninger, MD

Gil Binenbaum, MD, MSCE

Stefanie L. Davidson, MD

Emily A. DeCarlo, MD

Brian j. forbes, md, phd.

Anne Jensen, MD

Priyanka Kumar, MD

Ayesha Malik, OD

Monte D. Mills, MD

Julia E. Reid, MD

Your Child's Ophthalmology Appointment

Find information to help you prepare for your child’s visit to the Division of Ophthalmology.

Preparing for Eye Surgery

Is your child having eye surgery at CHOP? Here's what you should know, from scheduling and referrals to how to prepare your child for the procedure.

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Strabismus and amblyopia

What should I do if my child looks cross-eyed or his eyes seem to wander?

What is strabismus, how will i know if my child has strabismus, what's the treatment for strabismus, what causes strabismus, what is amblyopia, how will i know if my child has amblyopia, how can i test for amblyopia at home, what's the treatment for amblyopia.

If your child's eyes look crossed or misaligned, the problem could be strabismus (misaligned eyes) or amblyopia (lazy eye). Talk to his doctor, who will probably refer you to an ophthalmologist. Fortunately, these conditions can be successfully treated if detected early.

Note that it's normal for a newborn baby's eyes to wander or cross now and then, up to about 4 months of age. He's just getting the hang of making his eyes work together. If your baby's eyes seem crossed most of the time, though, or if it doesn't get better, talk with the doctor.

Strabismus is a lack of coordination between the eyes. If your child's eyes seem to point in different directions or not focus on the same object, strabismus could be the culprit.

Strabismus is a problem with the way the brain is controls the eyes, not with the eye muscles. (That's why experts don't usually recommend eye exercises for strabismus.)

If your child has strabismus and it isn't treated, his brain could start ignoring the input from one of his eyes, eventually causing the vision in the ignored eye to deteriorate. This condition is known as amblyopia or "lazy eye" (see below). Depth perception could also be damaged.

If your child has strabismus, his eyes may appear to be "crossed" or one may seem to drift inward, outward, or upward. When the eyes turn inward it's called esotropia, and when they turn out it's called exotropia. Strabismus can be constant (meaning the eyes are always crossed or misaligned) or intermittent (meaning it happens now and then).

In some cases a child's eyes appear crossed (especially when he looks to the right or the left) when in fact they're aligned. This is called pseudostrabismus.

The most common example of pseudostrabismus is pseudoesotropia, in which a child's eyes appear to cross inward when in fact it's an optical illusion caused by large eyelid folds or a wide nasal bridge. Your child's doctor can perform a simple examination to distinguish pseudostrabismus from true strabismus.

Strabismus that's a result of farsightedness can usually be corrected with glasses, especially if caught early. Strabismus that persists even when a child wears glasses may require surgical correction.

While the lack of coordination between the eyes centers in the brain, it's not possible to operate on the brain to change the alignment of the eyes. Instead, doctors operate on the eye muscles, which are accessible.

The surgery compensates for – rather than corrects – the problem. "If your car was steered by a computer and the computer kept telling the car to pull to the right, you could at least realign the wheels to the left to compensate," explains pediatric ophthalmologist James Ruben, a member of the AAP section on ophthalmology.

Sometimes strabismus is present at birth. The condition seems to run in families.

Strabismus can also show up in children with no family history – and when that's the case, it sometimes indicates a more significant vision problem. (Disorders such as cerebral palsy and Down syndrome make strabismus more likely.)

Babies born prematurely or at low birth weight are at higher risk. Children who are farsighted also seem to be at higher risk.

Amblyopia (also called lazy eye) develops when the brain shuts off or suppresses vision in one eye. This can happen if your child's eyes are misaligned or if she can't see as well with one eye because of nearsightedness, farsightedness, astigmatism, or something that's blocking clear vision in that eye, like a cataract or a drooping eyelid.

About 3 to 6 percent of children under the age of 6 develop amblyopia. Treatment is most successful before age 5 or 6, although recent research shows that even older children may recover their vision. (Recovery is less assured in an older child, though.) If ignored, amblyopia can result in permanent vision loss.

Identifying the problem isn't easy because children can get along fine using only one eye. The less-used eye may look perfectly normal, even though your child isn't using it to see.

Your child's doctor should routinely test for amblyopia (as well as strabismus) by checking the eyes independently and together. But, as pediatric ophthalmologist Ruben says, "Moms are often the best screeners around because they're so connected with their children and often notice something that's not quite right sooner than any doctor."

It's also a good idea to occasionally test the vision in your child's eyes at home.

Here's a simple way to get an idea of whether your child's eyes are both pulling their weight:

Cover one of your child's eyes (it helps to have a partner for this). Hold an object (such as a teddy bear for a little one or a picture or a letter for an older child) in front of her.

See if she follows the object with her uncovered eye as you move it from side to side and up and down. (You can ask an older child to tell you what the letter is, or ask her something about the picture or object.) Then cover the other eye and see if she follows the object just as well – and as far.

It's a little tricky to test a baby, who may lose interest or become distracted before your informal test is over. But if one eye seems weaker, try testing it again another time – maybe starting with the other eye.

If your child consistently seems to be able to see better with one eye than the other, schedule an appointment with either your child's doctor for a vision screening test or an ophthalmologist, who can diagnose and treat the problem.

The first step is to address any underlying problem – by correcting the astigmatism or nearsightedness with glasses or removing a cataract with surgery, for example. Once that's taken care of, the goal is to encourage your child's brain to connect with the weaker eye, eventually improving its ability to see.

If your child has amblyopia due to a need for glasses, the glasses will act like a camera lens and help bring objects into focus on the back of the eye. Wearing them provides the brain will a clearer image, which may improve the eye-brain connection. But if your child's eyes naturally focus light properly, glasses won't help with the amblyopia.

Instead, your doctor will probably recommend covering your child's stronger eye with a patch or using eyedrops once a day to blur the vision in that eye. Either of those will force the brain to use the weaker eye. The process could take weeks, months, or even years.

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BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

AAPOS. Undated. Strabismus. American Association for Pediatric Ophthalmology and Strabismus. http://www.aapos.org/terms/conditions/100 Opens a new window

Medscape. Undated. Pseudoexotropia.

MedlinePlus. 2012. Strabismus. http://www.nlm.nih.gov/medlineplus/ency/article/001004.htm Opens a new window [Accessed April 2016]

MedlinePlus. Undated. Retinopathy of prematurity. http://www.nlm.nih.gov/medlineplus/ency/article/001618.htm Opens a new window

Nemours Foundation. Undated. Strabismus. http://kidshealth.org/parent/general/eyes/strabismus.html Opens a new window

UpToDate. 2014. Patient information: Crossed eyes and lazy eye (the basics). http://www.uptodate.com/contents/crossed-eyes-and-lazy-eye-the-basics?source=see_link Opens a new window

UpToDate. 2013. Evaluation and management of strabismus in children. http://www.uptodate.com/contents/evaluation-and-management-of-strabismus-in-children Opens a new window [Accessed April 2016]

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Amblyopia: What Is Lazy Eye?

Amblyopia is when vision in one or both eyes does not develop properly during childhood. It is sometimes called lazy eye. Amblyopia is a common problem in babies and young children.

A child’s vision develops in the first few years of life . It is important to diagnose and treat amblyopia as early as possible. Otherwise, a child with amblyopia will not develop normal, healthy vision.

What Is the Cause of Lazy Eye?

Amblyopia can develop from other eye and vision problems. Here are some conditions that may cause amblyopia in a child.

Strabismus  is when the eyes point in two different directions. One eye may be focused straight ahead while the other turns in, out, up, or down. To avoid seeing double , the child's brain may ignore the image from the eye that is not focused straight ahead. But this can keep that eye from developing properly.

Refractive errors

Having a refractive error means being nearsighted , farsighted , or having astigmatism (distorted or blurry vision ). A child may have a refractive error that is worse in one eye. That eye can "turn off," and vision will not develop properly. This can be difficult to tell since the child's vision seems fine when using both eyes.

Cloudiness in the normally clear parts of the eye

Some children are born with a cataract , where the eye's normally clear  lens is cloudy. This can keep vision from developing properly in that eye.

Droopy eyelid

Ptosis, or a droopy eyelid , can block vision in a child’s developing eye and lead to amblyopia.

Your child might not be aware of having better vision in one eye than the other. And you may not realize it either unless your child has  strabismus or another eye problem you can see.

Amblyopia Diagnosis

Ophthalmologists diagnose amblyopia by checking to see if vision differs between the two eyes. To check a baby's or young child's vision, the ophthalmologist may cover one of the child's eyes and watch how well they can follow a moving object. The doctor may also watch how the child reacts when one eye is covered. If one eye has amblyopia and the other is covered, the child may try to look above or below the patch, pull it off or cry.

The ophthalmologist will do a complete medical eye exam , looking for other eye problems that could be affecting vision.

Poor vision in one eye does not always mean a child has amblyopia. In some cases, wearing  glasses to correct a refractive error in one eye can improve vision.

When Should a Child's Vision Be Tested?

All children should have their vision checked by their pediatrician, family physician, or ophthalmologist at or before entering pre-K or kindergarten. If there is a family history of misaligned eyes, childhood cataracts or serious eye disease, an ophthalmologist should check their eyes when they are an infant.

Most doctors test vision as part of a child's medical exam. If they see any sign of eye problems, they may send a child to an ophthalmologist for further tests.

Amblyopia Treatment

Amblyopia is usually corrected by making the child use their weaker eye . This is often done by putting a patch over the child’s stronger eye. In some cases,  eye drops can be used to blur vision in the stronger eye. Or the child may wear eyeglasses with a lens that blurs vision in that eye.

It generally takes several weeks to several months for vision to get stronger in the weaker eye. Once the child has better vision in that eye, they may need to wear an eye patch part-time for a few years. This helps keep their vision strong. Remember to keep all appointments with the child’s ophthalmologist who will carefully monitor your child’s vision.

How to Choose and Use an Eye Patch

An eye patch should be comfortable, yet remain firmly in place. It should also not allow the child to peek around its edges. Most drug stores have a variety of sizes and types of eye patches. Decorated fun patches are available online. Do not use the black eye patches with elastic bands or ties (such as a pirate-type patches). These are too easy for a child to remove or peek around. To wear the patch, simply attach it to the skin around your child’s eye.

If your child wears glasses, there are patches designed to attach to the lens. These may be good for children who are used to wearing a patch, but they are not as good for a child new to treatment. This is because the patch can slip or the child may learn to peek around it. If your child wears glasses and is not used to patching, it is best to attach the patch directly around the stronger eye underneath the glasses.

Keep Your Child from Taking Off the Eye Patch

Children do not like to have their stronger eye patched or blurred. However, you need to help your child do what is best for them. Otherwise, treatment will not work.

Try distracting the child or having them do something that keeps their attention. Or reward the child with a treat for wearing the patch.

It can take a while for your child to get used to wearing a patch. Over time, this should get easier for them and you. Remember that strengthening the weaker eye is the only way to develop healthy, normal vision.

If your child still takes off the patch, as a last resort, you might cover his or her hands with gloves, mittens, or socks.

Teach Your Child About the Eye Patch

Pre-school or school-age children might not want to wear an eye patch or use blurring eye drops. To help, parents should explain how important these treatments are to be able to see well. And reassure them that lots of children wear eye patches for the same reason.

Consider having a very young child practice putting an eye patch on a doll. Or let the child decorate his or her patch with crayons or markers.

Explain the amblyopia treatment to the child’s teacher. Ask the teacher to compliment the child on being so good about wearing the patch. Children thrive on positive feedback from their teachers.

Things to consider with patching treatment:

• In very rare instances it is possible to overuse the patch or blurring eye drops. This can affect vision in the stronger eye. Be sure to keep the child’s appointments with the ophthalmologist so that vision in both eyes can be closely monitored.
• The skin near your child’s eye patch can get irritated. To help, try a different size or type of patch, and angle the patch differently each day.
• Your child may initially be clumsy when wearing a patch. Try to keep an eye on your child when they are climbing stairs or being active.

Surgery to Correct Causes of Amblyopia

In some cases, the ophthalmologist will recommend surgery to correct certain eye problems causing amblyopia. After surgery, the child may need to keep wearing a patch or otherwise cover the stronger eye until their vision improves.

It is possible to prevent vision loss from amblyopia. For best results, amblyopia should be treated before a child reaches 7 or 8 years old. Many children do not like to have their stronger eye patched or blurred. However, you need to help your child do what is best for them.

Treating Amblyopia Using New Technology

A new treatment for amblyopia uses a virtual reality (VR) headset to help improve vision in children aged 4 to 7. A child watches videos wearing the headset, which helps them use their weaker eye. To learn more, ask your child’s ophthalmologist.

Treating Amblyopia for Better Lifelong Vision

When a child has amblyopia, it is important to make vision stronger in the weak eye. Even if eye problems causing amblyopia are corrected with glasses or surgery, the amblyopia itself must be treated. If not, the child may have lifelong vision problems.

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Lazy eye (amblyopia)

On this page, preparing for your appointment.

Your doctor will conduct an eye exam, checking for eye health, a wandering eye, a difference in vision between the eyes or poor vision in both eyes. Eyedrops are generally used to dilate the eyes. The eyedrops cause blurred vision that lasts for several hours or a day.

The method used to test vision depends on your child's age and stage of development:

• Preverbal children. A lighted magnifying device can be used to detect cataracts. Other tests can assess an infant's or toddler's ability to fix his or her gaze and to follow a moving object.
• Children age 3 and older. Tests using pictures or letters can assess the child's vision. Each eye is covered in turn to test the other.

It's important to start treatment for lazy eye as soon as possible in childhood, when the complicated connections between the eye and the brain are forming. The best results occur when treatment starts before age 7, although half of children between the ages of 7 and 17 respond to treatment.

Treatment options depend on the cause of lazy eye and on how much the condition is affecting your child's vision. Your doctor might recommend:

• Corrective eyewear. Glasses or contact lenses can correct problems such as nearsightedness, farsightedness or astigmatism that result in lazy eye.
• Eye patches. To stimulate the weaker eye, your child wears an eye patch over the eye with better vision for two to six or more hours a day. In rare cases, wearing an eye patch too long can cause amblyopia to develop in the patched eye. However it's usually reversible.
• Bangerter filter. This special filter is placed on the eyeglass lens of the stronger eye. The filter blurs the stronger eye and, like an eye patch, works to stimulate the weaker eye.
• Eyedrops. An eyedrop of a medication called atropine (Isopto Atropine) can temporarily blur vision in the stronger eye. Usually prescribed for use on weekends or daily, use of the drops encourages your child to use the weaker eye, and offers an alternative to a patch. Side effects include sensitivity to light and eye irritation.
• Surgery. Your child might need surgery if he or she has droopy eyelids or cataracts that cause deprivation amblyopia. If your child's eyes continue to cross or wander apart with the appropriate glasses, your doctor might recommend surgical repair to straighten the eyes, in addition to other lazy eye treatments.

Activity-based treatments — such as drawing, doing puzzles or playing computer games — are available. The effectiveness of adding these activities to other therapies hasn't been proved. Research into new treatments is ongoing.

For most children with lazy eye, proper treatment improves vision within weeks to months. Treatment might last from six months to two years.

It's important for your child to be monitored for recurrence of lazy eye — which can happen in up to 25 percent of children with the condition. If lazy eye recurs, treatment will need to start again.

Clinical trials

Explore Mayo Clinic studies  testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Your child's doctor might refer you to a doctor who specializes in treating eye disorders in children (pediatric ophthalmologist).

Here's some information to help you get ready.

What you can do

Make a list of the following:

• Symptoms, including any that may seem unrelated to the reason why you scheduled the appointment, and when you noticed them
• All medications, vitamins and supplements your child takes, including doses
• Key medical information, including other conditions or allergies your child has
• Your family history of eye problems, such as lazy eye, cataracts or glaucoma
• Questions to ask your doctor

For lazy eye, questions to ask your doctor include:

• What is the likely cause of my child's lazy eye?
• Is there another possible diagnosis?
• What treatment options are most likely to help my child?
• How much improvement can we expect with treatment?
• Is my child at risk of other complications from this condition?
• Is this condition likely to recur after treatment?
• How often should my child be seen for follow-up visits?

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

• Does your child appear to have problems seeing?
• Do your child's eyes appear to cross or wander?
• Does your child hold things close to see them?
• Does your child squint?
• Have you noticed anything else unusual about your child's vision?
• Have your child's eyes been injured?

Aug 14, 2021

• Coats DK, et al. Amblyopia in children: Classification, screening, and evaluation. https://www.uptodate.com/contents/search. Accessed June 8, 2021.
• AskMayoExpert. Amblyopia. Mayo Clinic; 2021.
• Amblyopia. National Eye Institute. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/amblyopia-lazy-eye. Accessed June 8, 2021.
• Amblyopia preferred practice pattern. American Academy of Ophthalmology. https://www.aao.org/preferred-practice-pattern/amblyopia-ppp-2017. Accessed June 8, 2021.
• Coats DK, et al. Amblyopia in children: Management and outcome. https://www.uptodate.com/contents/search. Accessed June 8, 2021.
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Pediatric Amblyopia (lazy eye)

What you need to know.

Every year hundreds of children are evaluated and treated at Children’s National Hospital for amblyopia ("lazy eye") and its underlying causes. Children's National pediatric ophthalmologists  have extensive experience in identifying and treating the condition, which affects 4-5% of the population.

Amblyopia is almost always treatable if detected early. With increased awareness, early vision screening and referral, and timely diagnosis and management of amblyopia, proper visual acuity can be restored. Drawing on their wide experience, Children's National pediatric ophthalmologists will design an individualized treatment plan for each child.

Appointments

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Frequently Asked Questions

What is amblyopia (lazy eye).

Amblyopia, often called "lazy eye" is poor sight in a normal eye. During early childhood, a child's brain actively develops its visual pathways from the eyes to the visual processing center. This process occurs from the first month of life until around 8 to 10 years of age, after which the pathways are permanently set. If development of the visual pathways is impeded, the affected eye may never develop good vision.

Some of the most common causes of amblyopia include various forms of  strabismus  (misalignment of the eyes), uncorrected refractive errors, newborn cataracts or ptosis ("droopy eyelid").

What are the symptoms of lazy eye in children?

There may be no symptoms. Because vision problems from amblyopia affect only one eye, the child may function with one good eye and be unaware of the problem. Early detection is important.

How is lazy eye in children diagnosed?

A visual acuity test is an important screening tool. These tests are performed at schools, health fairs and primary care clinics , usually beginning around 3 or 4 years of age. If there are concerns regarding visual acuity, a full eye exam is needed.

What is included in the treatment of lazy eye in children?

Treatment of lazy eye at Children's National is designed to both address the underlying cause and help the brain use the eye that has been effectively ignored. Based on their extensive experience, Children's National pediatric ophthalmologists will carefully individualize each child's treatment timeline and regimen, taking into account what is most suitable for the condition, the child's age and temperament, and the family's dynamics.

Treating the underlying cause of lazy eye may involve:

Treatment of lazy eye may involve the use of patching or atropine drops in the good eye to encourage the brain to use the affected eye more, making its visual development stronger.

Patching can be a challenge for any parent and child. Most children with lazy eye are too young to appreciate the benefits of patching and it can be an annoyance. Adhesive patches, available at most pharmacies, are the gold standard for treatment.

Some patients may be able to use atropine eye drops instead, depending on the type and severity of their lazy eye. There are rare occasions when felt patches also can be used. A Children’s National specialist will be able to tell you which options are appropriate for your child, based on a thorough evaluation.

What is the long-term outlook for a child with lazy eye?

The good news about lazy eye is that it can be a very treatable disease, leading to improved vision, if effectively addressed in a timely manner. Treatment may be needed throughout childhood to best treat the child and timely follow-up is of crucial importance. Follow-up appointment intervals may range from a few weeks to a few months, depending on the age of the child, type of lazy eye, and severity of the disease.

All members of the  Pediatric Ophthalmology Team  are trained to detect, properly diagnose, and manage strabismus in children and adults. Learn more about the Division of Ophthalmology  and our locations or call us at  202-476-3015.

Providers Who Treat Amblyopia (lazy eye)

Mohamad S. Jaafar, MD

• Chief Emeritus, Ophthalmology
• Ophthalmologist
• Ophthalmology Chevy Chase
• Main Hospital
• Northern Virginia
• Prince George's County

Departments

Ophthalmology.

Marijean M. Miller, MD

• Vice-Chief, Ophthalmology
• Montgomery County

Departments that Treat Amblyopia (lazy eye)

Our specialized pediatric ophthalmologists are experts at recognizing and treating complex eye conditions in infants and children.

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Health Library Amblyopia (Lazy Eye)

What is amblyopia (lazy eye).

Amblyopia is poor vision in an eye that didn't develop normal sight during early childhood. It is sometimes called "lazy eye."

Cause of Amblyopia

One cause of amblyopia is strabismus (pronounced struh- biz- muhs). Strabismus is a condition where one eye turns inward or outward. The eyes cannot clearly focus on the same image, so the brain ignores the image from the turned eye. Over time, the vision in this eye becomes worse.

Another cause of amblyopia is when one eye has much better vision than the other eye. This can happen if there is a difference in glasses prescription between the two eyes or if something is blocking the vision of an eye, such as a cataract. The brain will get a blurry image from one eye and a clear image from the other eye. The images sent from the blurred eye are ignored by the brain and the vision in this eye becomes worse over time.

Some children have amblyopia in both eyes if they have a high glasses prescription or something blocking the vision in both eyes. Glasses can improve vision over time if caught early.

If not properly treated, amblyopia can cause:

• Permanent vision loss in the eye with amblyopia
• Loss of depth perception (seeing in three dimensions)
• May affect future jobs (for example, becoming a pilot)

Common treatments for amblyopia include wearing glasses, patching, and using eye drops. All of these therapies aim to strengthen vision in one or both eyes. Early treatment provides the best results, since children’s brains and eyes are still developing.

Patching or Eye Drops

A patch is placed over the strong eye, which forces the child to use the weaker eye. As a result, the weak eye gets stronger. Your child must wear the patch every day. Eye drops are used in the stronger eye to temporarily blur the vision and allow the weaker eye to strengthen. The number of hours per day of patching or frequency of using the eye drops depend on the cause of amblyopia and the visual acuity of the child – your doctor will specify your child’s treatment plan.

Ways to Help Your Child Pass the Time

• Using a close-up device such as an iPad or computer
• Coloring, cutting paper, making crafts, playing with Play-Doh
• Playing video games
• Reading books
• Having the child wear the patch when already distracted (for example, while playing, watching a movie, or eating)

Red Mark or Rash on Face from the Patch

Rub Aquaphor healing ointment or over-the-counter hydrocortisone cream on the irritation before bedtime to promote quick healing. To prevent further irritation, put a small layer of Milk of Magnesia (or similar brand) on the skin where the patch is to be applied. Then apply the patch on top of the dried Milk of Magnesia. This will protect the skin and help the patch come off more easily.

What if the Eye Starts To Turn In or Out?

Do not stop patching. Call your doctor.

Glasses and Treatment

If your child is wearing glasses, he/she should keep wearing the glasses during patching or before and after putting in eye drops.

Problems with the Patch

If your child has problems with patching, call your doctor; do not wait for your next appointment. There are alternative treatments, including eye drops. Talk with your child’s eye doctor for more information.

Additional Resources

• American Association for Pediatric Ophthalmology and Strabismus
• Division of Ophthalmology , Cincinnati Children's, 513-636-4751
• Ohio Amblyope Registry (Ohio residents only)
• Additional patches: available through local pharmacies

Last Updated 05/2021

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About lazy eye or amblyopia

Children with lazy eye can’t see properly or at all out of one eye.

Lazy eye develops when the part of the brain that controls how a child sees starts to favour one eye , and the other eye gets weaker as a result. This often happens because of a squint . It can also happen because of short-sightedness , long-sightedness and astigmatism , or when the eyes can’t focus equally.

Structural problems with the eye can also cause lazy eye. Examples of these problems are scars on the cornea, irregularly shaped pupils, droopy eyelids or cataracts .

Sometimes lazy eye has no clear underlying cause.

Lazy eye affects 2-4% of children. It often develops during infancy or early childhood.

Premature babies or babies with low birth weight have an increased chance of getting lazy eye. Lazy eye is also more likely if there’s a family history of eye problems.

Lazy eye is also known as amblyopia.

Signs and symptoms of lazy eye

Children with lazy eye often have no obvious symptoms . They might not look any different from other children or seem to have any problems with their vision.

But in some children, you might notice that:

• one eye turns in a different direction from the other
• one eye is fully or partially shut
• their head is always turned or tilted to one side
• they bump into things more often than other children the same age.

Occasionally, older children with lazy eye will say that they can’t see clearly.

Regular eye examinations: why they’re important

Because it can be hard to tell whether young children have lazy eye, regular eye examinations are the best way to detect this condition .

All children should have an eye test:

• before they start preschool, when they’re 3-3½ years old
• in their first year of school.

Most states and territories run free vision screening programs through local child and family health services or schools. Check with your child and family health nurse or school about what’s offered in your area.

Does your child need to see a health professional about lazy eye symptoms?

Yes. If you notice that your child has any of the signs above or you’re worried about your child’s vision, start by seeing your  GP or child and family health nurse . They can refer your child to an optometrist or ophthalmologist if your child needs more tests and checks.

Tests for lazy eye

If your child is referred to an optometrist or ophthalmologist to test for lazy eye, this professional will carefully examine your child’s eyes and vision to diagnose lazy eye and work out what’s causing it.

Lazy eye diagnosis involves various tests and tools. For example, the optometrist or ophthalmologist:

• will check your child’s vision using an eye chart that has letters or symbols on it
• might use medication like eye drops to measure the focus of your child’s eyes
• might use equipment like a retinoscope to work out whether glasses might help your child’s lazy eye.

Early diagnosis and treatment of lazy eye is essential. The earlier lazy eye is treated, the better the outcomes are for children. If lazy eye is left untreated, it can cause permanent vision loss.

Treatment for lazy eye

Lazy eye in children can usually be corrected with the right treatment.

Treatments for lazy eye aim to strengthen the lazy eye and get it working properly . The specific cause of lazy eye in each individual child guides their treatment.

Patching is a common treatment. Patching is when your child wears a sticky patch over their stronger eye for a period of time each day – usually 1-4 hours. The patch might go directly onto your child’s skin. If your child wears glasses, the patch goes over one lens.

To start with, your child might need patching for several hours a day, seven days a week. As your child’s vision improves, they’ll need fewer hours and/or fewer days of patching each week. If your child’s lazy eye is severe, patching might go on for several years.

Some children don’t cope well with patching. If patching is hard for your child, your child’s optometrist or ophthalmologist might give your child special eye drops instead. These blur the vision in the stronger eye.

Sometimes children need to do special exercises to make their lazy eye stronger.

Depending on the cause of the lazy eye, your child might also need to wear glasses .

If your child has a lazy eye, they‘ll need regular check-ups so your child’s optometrist or ophthalmologist can monitor the progress of treatment.

Your child’s optometrist or ophthalmologist might work closely with an orthoptist to treat your child’s lazy eye.

7 Signs Your Child Might Have a Lazy Eye

Do you know the signs to look for to identify lazy eye in your child?

Amblyopia , commonly known as “lazy eye” is a neuro-developmental vision condition that typically develops before a child turns eight years old.

Lazy eye occurs when one eye is unable to achieve normal visual acuity . The condition causes blurry vision in the affected eye (even with corrective lenses), poor depth perception, and reading difficulties.

• Lazy eye affects up to 3 percent of the population.
• Approximately 10 million children and adults in the U.S. have lazy eye.

A lazy eye is generally difficult to recognize because it usually develops in only one eye, without a noticeable eye turn.  

It is important to be aware of the signs that may indicate a lazy eye, since in most cases, the condition is not recognized easily— though it can significantly affect a child’s quality of life.

Contact an eye doctor near you that has experience in diagnosing and treating lazy eye.

The following 7 signs may indicate a “hidden” lazy eye 

1. frequently squints, rubs, or closes one eye.

Does your child squint his eyes, or close one eye when outdoors on a bright, sunny day? Does he rub his eye or cover it with his hand? 

These may be signs that one eye is weaker than the other, and your child may be trying to find ways to see more clearly.

2. Turns head to one side 

Does your child watch TV with his head turned to one side? 

Since lazy eye typically affects one eye, a child with a lazy eye may turn his head to utilize his dominant eye to see better. You may also notice that your child turns his head while playing sports or trying to catch a ball, or even while watching live sports games.

3. Reading difficulties

Does your child read below grade level or refuse to read altogether?

A lazy eye can make reading quite difficult— causing loss of place, skipping words, re-reading words, misreading or substituting words, and adding words into sentences.

A child with a lazy eye must exert extra focusing effort to keep the words clear. This additional effort can cause fatigue and reduced concentration while reading. A lazy eye can turn reading into a stressful task, instead of an engaging activity— especially as the words get smaller with higher grade level books.

Schedule an exam with an eye doctor near you to diagnose and treat your child’s lazy eye.

SEE RELATED: Does Amblyopia (Lazy Eye) Affect Eye-Hand Coordination?

Find a Vision Therapy Eye Doctor Near You

4. math difficulties.

Does your child struggle in math? Believe it or not, this may be a sign of a lazy eye. 

When a lazy eye develops, the eyes become slightly misaligned. Though it may not be noticeable when looking at your child’s eyes, blurry or double vision can occur, and affect the way math problems appear on a page.

When a child sees a math problem stacked in rows, they may not see the numbers accurately as a result of blurry or double vision— this will affect their ability to solve math problems accurately. Additionally, if the child exerts too much focusing effort, it may distract them from understanding the task at hand, or method of solving the problem.

5. Sports performance difficulties or accident prone

Does your child love to play sports, but for some reason cannot keep up with their peers? Does it seem like your child is frequently tripping, falling, or bumping into things?

A lazy eye can affect depth perception, or the ability to judge the distance or location of an object in space. Without clear depth perception, playing most sports can be quite challenging. Both eyes need to be working together in order to judge where objects are located in relation to yourself.

Without clear depth perception, a child with a lazy eye may also frequently trip over objects, fall down stairs, and maybe even get hit by a moving swing at the park.

6. Reduced fine motor skills

Does your child have messy handwriting?

Lazy eye symptoms such as poor binocular coordination and depth perception, can cause reduced fine motor skills. Binocular coordination enables clear depth perception, and is crucial for all fine motor skills, including legible handwriting. However, with a lazy eye, binocular coordination is reduced.

Without strong fine motor skills, the ability to stay on the line when writing can be a challenge. If your child continually writes above or below the line, their eyes may not be working in coordination.

7. Attention difficulties

Does your child’s attention seem to wander during times they should be focused on a task, such as reading or drawing?

While your child might appear to have an attention problem, in truth, a lazy eye can cause focusing difficulties during activities of prolonged visual focus. Therefore, your child’s inability to maintain concentration during visually-oriented tasks could be a sign of reduced focusing skills, and possibly a lazy eye.

How is lazy eye treated? 

If your child has a lazy eye, vision therapy , with or without eye patching or atropine eye drops, is the most effective way to strengthen the affected eye.

Vision therapy consists of a series of eye exercises performed under the supervision of your eye doctor. These exercises help to strengthen the eye-brain connections, to improve the visual skills necessary for binocular vision.

LEARN MORE: Guide to Vision Therapy for Lazy Eye

If your child is showing signs of a lazy eye, schedule an eye exam for a proper diagnosis, and to begin an effective treatment plan as soon as possible.

Vision therapy can help your child gain the confidence he deserves, academic and athletic success he desires, and the ability to view life in a more clear and comfortable way.

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A lazy eye (amblyopia) is when the vision in 1 eye does not develop properly. Rarely, both eyes can be affected.

Check if you have a lazy eye

A lazy eye does not always cause symptoms and is often first diagnosed during an eye test.

The main symptoms include:

• shutting 1 eye or squinting when looking at things
• eyes pointing in different directions (a squint )
• not being able to follow an object or person with your eyes
• tilting your head when looking at something
• having tired eyes and rubbing your eyes a lot
• difficulty catching or throwing
• tripping or falling over a lot
• blinking a lot

Many children do not notice anything wrong with their vision.

You can check a younger child's eyes by covering each eye with your hand, 1 at a time. They may complain if you cover their good eye.

Older children may say they're not able to see as well with 1 eye and may have problems with reading, writing and drawing.

Non-urgent advice: Go to an opticians if:

• you're worried about your or your child's vision
• you have not had an eye test for 2 years

What happens during an eye test

To check if you or your child have a lazy eye, an eye test specialist called an optometrist will usually do an eye test.

You'll be asked to look at lights or read letters while different lenses are placed in front of your eyes.

To check the health of your eyes, you or your child may be given eye drops so the optometrist can see the back of your eye more clearly.

If you or your child needs glasses, you'll be given a prescription. You can take this to any optician.

Find out more about eye tests for children

NHS eye tests

NHS eye tests are free for some people, including:

• children aged under 18, or under 19 and in full-time education
• people who have diabetes or glaucoma
• people on some benefits, including Universal Credit

Find out more about free NHS eye tests

Treatments for a lazy eye

How lazy eye is treated depends on what's causing it.

Treatment for a lazy eye aims to improve vision in the weaker eye.

This may include:

• wearing glasses to correct your vision
• wearing an eye patch over the stronger eye for a few hours a day for several months – these are usually worn with glasses
• using eye drops to temporarily blur vision in the stronger eye

Treatment should ideally start before the age of 7, when vision is still developing.

If lazy eye is caused by cataracts or a drooping eyelid, you may need surgery.

You may also need to have surgery if you have a squint. This will straighten the eyes and allow them to work together better, but does not improve your vision.

Some people are entitled to a voucher to help towards the cost of glasses or contact lenses, including:

• if you're on some benefits, including Universal Credit

If you do not have a voucher, you'll have to pay for glasses or contact lenses.

Find out more about NHS optical vouchers

Help us improve our information

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Page last reviewed: 04 January 2023 Next review due: 04 January 2026

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• Contrast sensitivity testing
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• Visual Acuity: 20/20 Vision
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• Digital Eye Strain
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Everything you need to know about your baby’s vision

By Gary Heiting, OD , and Adam Debrowski

A newborn’s vision takes time to develop

The first time a baby opens their eyes and makes eye contact is one of the greatest moments a new parent can experience. But don’t be concerned if that moment doesn’t happen right away.

A baby’s vision will take some time to develop. In the first week of life, babies don’t see much detail. Their first view of the world is indistinct and only in shades of gray.

It takes several months for your newborn’s eyesight to develop fully. Knowing the milestones of your baby’s vision development — and what you can do to help it along — ensures your child is seeing properly and enjoying their world to the fullest as soon as possible.

Baby vision development starts during pregnancy

Your baby’s vision starts to develop before they’re even born.

How you care for your own body during your pregnancy is extremely important for the development of your baby’s body and mind, including the eyes and the vision centers in the brain .

Be sure to follow the instructions your OB-GYN gives you regarding proper nutrition , including supplements, and get the proper amount of rest you need during your pregnancy.

Avoid smoking and consuming alcohol or drugs during pregnancy, as these toxins can cause multiple problems for your baby, including serious eyesight problems.

Smoking is particularly hazardous during pregnancy, as cigarette smoke contains an estimated 3,000 different chemicals that can potentially harm humans — including carbon monoxide, a known fetal toxin.

Even taking common medications like aspirin can be dangerous to your baby when you are pregnant, increasing the risk of low birth weight and problems during delivery. Low birth weight has been associated with an increased risk of vision problems in infants.

Always talk to your OB-GYN before taking any medications during your pregnancy, including over-the-counter medicines, herbal supplements and other non-prescription remedies.

SEE RELATED: How pregnancy can affect your vision

Newborn vision at birth

Soon after birth, your doctor will briefly examine your infant’s eyes to rule out signs of congenital cataracts or other serious neonatal eye problems. Though such eye problems are rare, they must be detected and treated early to minimize their impact on your child’s vision development.

An antibiotic ointment is usually applied to your newborn’s eyes to help prevent an eye infection from bacteria present in the birth canal.

At birth, your baby only sees in black, white and shades of gray, since the nerve cells that control vision in the retina and brain aren’t fully developed.

At this stage, a newborn’s eyes can’t focus on near objects. Don’t be concerned if your baby doesn’t seem to be “focusing” on objects, including your face. It just takes time.

Despite these visual limitations, studies show that, within a few days after birth, infants prefer looking at an image of their mother’s face to that of a stranger. [Read more about the importance of eye contact for child development .]

Researchers believe this preference depends on large, high-contrast stimuli, like the boundary of the mother’s hairline to her face. In studies, if these boundaries were masked with a scarf or bathing cap, the infants’ preference of looking at their mother’s face went away.

To encourage visual interaction with your newborn child, try to keep your hairstyle the same and avoid altering your appearance.

One thing you may notice about your newborn son or daughter is how large their eyes are. This is because normal infant development proceeds from the head down.

At birth, your baby’s eyes are already 65% of their adult size!

SEE RELATED: What nursery colors are best for a baby's vision?

Your baby’s eyes: The first month

Your baby’s eyes are not very sensitive to light in the first month after birth.

In fact, the amount of light required for a 1-month-old infant to be aware that light is present is 50 times higher than that of an adult.

That means that it’s okay to leave some lights on in the nursery. It won’t affect their ability to sleep, and it may keep you from stubbing your toe in the dark room.

Infants start to develop the ability to see in colors very quickly. One week after birth they can see red, orange, yellow and green, but it takes a little longer for your infant to be able to see blue and violet.

Why? Blue light has shorter wavelengths, and fewer color receptors exist in the human eye for blue light.

Don’t be too concerned if your baby’s eyes don’t always appear to be working together as a team early on.

One eye may occasionally drift inward or outward from proper alignment. This is normal, but if you see a large and constant misalignment, notify your eye doctor.

To help stimulate your baby’s eyesight during this period:

Decorate their room with bright, cheerful colors.

Include artwork and furnishings with contrasting colors and shapes.

Try hanging a brightly colored mobile that features a variety of colors and shapes.

Months 2 and 3

Baby vision makes several important advances during months two and three. Infants develop sharper visual acuity during this period, and their eyes begin to move better as a team.

By this point, your baby should be following moving objects with their eyes and reaching for things they see.

Infants at this stage of development are learning how to shift their gaze from one object to another without having to move their head.

Their eyes are now becoming more sensitive to light. At 3 months, an infant’s light detection threshold is only 10 times that of an adult. You may now want to dim the lights a bit more while they’re sleeping.

To help stimulate your 2- to 3-month-old baby’s vision development, the American Optometric Association recommends:

Add new items to their room or frequently change the location of existing items, including their crib.

Talk to your baby as you walk around the room.

Keep a night light on to provide visual stimulation when your child is awake in their crib.

Let your baby crawl. While infants should be placed on their backs for sleep to decrease the risk of sudden infant death syndrome (SIDS), put them on their stomachs when they are awake and you can supervise them. This provides important visual and motor experiences.

Months 4 to 6

By age 6 months, significant advances have taken place in the vision centers of the brain, allowing your infant to see more distinctly and move their eyes more quickly and accurately while they follow moving objects.

Visual acuity improves from about 20/400 at birth to roughly 20/25 at 6 months of age. Color vision should be similar to that of an adult as well, enabling your child to see all the colors of the rainbow.

Babies also have better hand-eye coordination at 4 to 6 months of age, allowing them to quickly locate and pick up objects. That includes accurately directing a bottle — and many other things — toward their mouth.

Six months of age is also an important milestone because it’s when your child should have their first children’s eye exam (unless complications arise before this time).

Even though your baby can’t read the letters on an eye chart , your eye doctor can perform non-verbal testing to assess their visual acuity, detect nearsightedness , farsightedness and astigmatism , and evaluate eye teaming and alignment.

At this exam, your eye care practitioner will also check the health of your baby’s eyes and look for anything that might interfere with normal and continuing vision development.

For the most thorough eye exam for your 6-month-old, you may want to seek the services of an eye doctor who specializes in children’s eyesight and vision development.

SEE RELATED: What should my child expect at their first eye exam?

Months 7 to 12

Your child is now mobile, crawling about and covering more distance than you could ever have imagined. They are better at judging distances and more accurate at grasping and throwing objects.

This is an important developmental period for your child. At this stage, infants are developing a better overall awareness of their body and learning how to coordinate their vision with their movements.

It’s also a time that requires more diligence on your part to keep your baby from harm.

Bumps, bruises, eye injuries and other serious accidents can occur as they start to physically explore their environment. In particular, keep cabinets locked and put barriers in front of stairs.

Don’t be concerned if your infant’s eyes are starting to change color.

Most babies are born with blue eyes because darker pigments in the iris aren’t completely developed at birth. Over time, more dark pigment is produced, which can change your child’s eye color from blue to brown, green, gray or a mixture of colors — as is the case with hazel eyes or heterochromia .

READ NEXT: Vision problems of preschool children

To stimulate the development of your child’s hand-eye coordination:

Get down on the floor with your baby and encourage them to crawl toward objects.

Place a favorite toy on the floor just out of reach and encourage them to get it.

Provide plenty of safe objects and toys that they can take apart and put together.

Eye alignment problems

Be sure to pay close attention to how well your baby’s eyes work together as a team.

Strabismus is the term for a misalignment of the eyes. It’s important to detect and treat it early so your baby’s vision develops properly in both eyes.

Left untreated, strabismus can lead to amblyopia , commonly known as “lazy eye.”

It takes a few months for newborn eyes to develop coordination skills, but don’t hesitate to contact your pediatrician or eye doctor if you feel one of your baby’s eyes is misaligned or doesn’t move in sync with the other eye.

READ NEXT:  What Is Hypertelorism?

Premature babies and eyesight problems

The average length of a normal pregnancy is approximately 40 weeks. Babies born before 37 weeks of gestation are considered premature, according to the World Health Organization .

Smoking during pregnancy significantly increases the risk of giving birth prematurely.

Premature babies are at greater risk of eye problems than full-term babies, and the odds increase the earlier the child is born.

Two vision problems are more common in premature babies:

Retinopathy of prematurity (ROP)

ROP is the abnormal replacement of normal tissue in the retina with fibrous tissue and blood vessels. It can cause scarring of the retina, poor vision and retinal detachment . In severe cases, retinopathy of prematurity can lead to blindness.

All premature babies are at risk of ROP. Very low birth weight is an additional risk factor, especially if it is necessary to place the infant in a high-oxygen environment immediately after birth.

If your baby is born prematurely, ask your obstetrician to refer you to a pediatric ophthalmologist so they can perform an internal eye exam and rule out ROP.

Nystagmus is an involuntary, back-and-forth movement of both eyes.

In most cases, nystagmus causes the eyes to drift slowly in one direction and then “jump” back in the other direction. The eye movements are usually horizontal, but they can be diagonal or rotational as well.

Nystagmus can be present at birth, or it may develop weeks to months later. Risk factors include albinism , congenital cataracts and incomplete development of the optic nerve .

The magnitude of the eye movements will usually determine how much the baby’s vision and visual development will be affected.

If your baby shows signs of nystagmus, consult a pediatric ophthalmologist or other eye doctor as soon as possible.

No-cost eye exams for infants

If you can’t afford an eye exam for your baby , help is available.

Developed by the American Optometric Association in partnership with The Vision Care Institute, InfantSEE is a public health program designed to make sure vision care becomes a part of infant wellness routines in the United States.

Under this program, member optometrists offer a no-cost first eye assessment for infants within their first year of life.

To learn more about InfantSEE and to find a participating optometrist, visit the InfantSEE website .

READ MORE: Do your eyes grow?

Page published on Wednesday, February 27, 2019

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