wandering eye in infants

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Pediatric Amblyopia (lazy eye)

What you need to know, key symptoms.

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.

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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
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• Main Hospital
• Northern Virginia
• Prince George's County

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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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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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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.

Lazy eye (amblyopia)

Lazy eye (amblyopia) is reduced vision in one eye caused by abnormal visual development early in life. The weaker — or lazy — eye often wanders inward or outward.

Amblyopia generally develops from birth up to age 7 years. It is the leading cause of decreased vision among children. Rarely, lazy eye affects both eyes.

Early diagnosis and treatment can help prevent long-term problems with your child's vision. The eye with poorer vision can usually be corrected with glasses or contact lenses, or patching therapy.

Signs and symptoms of lazy eye include:

• An eye that wanders inward or outward
• Eyes that appear to not work together
• Poor depth perception
• Squinting or shutting an eye
• Head tilting
• Abnormal results of vision screening tests

Sometimes lazy eye is not evident without an eye exam.

When to see a doctor

See your child's doctor if you notice his or her eye wandering after the first few weeks of life. A vision check is especially important if there's a family history of crossed eyes, childhood cataracts or other eye conditions.

For all children, a complete eye exam is recommended between ages 3 and 5.

Lazy eye develops because of abnormal visual experience early in life that changes the nerve pathways between a thin layer of tissue (retina) at the back of the eye and the brain. The weaker eye receives fewer visual signals. Eventually, the eyes' ability to work together decreases, and the brain suppresses or ignores input from the weaker eye.

Anything that blurs a child's vision or causes the eyes to cross or turn out can result in lazy eye. Common causes of the condition include:

• Muscle imbalance (strabismus amblyopia). The most common cause of lazy eye is an imbalance in the muscles that position the eyes. This imbalance can cause the eyes to cross in or turn out, and prevents them from working together.

Difference in sharpness of vision between the eyes (refractive amblyopia). A significant difference between the prescriptions in each eye — often due to farsightedness but sometimes to nearsightedness or an uneven surface curve of the eye (astigmatism) — can result in lazy eye.

Glasses or contact lenses are typically used to correct these refractive problems. In some children lazy eye is caused by a combination of strabismus and refractive problems.

• Deprivation. A problem with one eye — such as a cloudy area in the lens (cataract) — can prohibit clear vision in that eye. Deprivation amblyopia in infancy requires urgent treatment to prevent permanent vision loss. It's often the most severe type of amblyopia.

Risk factors

Factors associated with an increased risk of lazy eye include:

• Premature birth
• Small size at birth
• Family history of lazy eye
• Developmental disabilities

Complications

Untreated, lazy eye can cause permanent vision loss.

CON-20166981

Amblyopia (Lazy Eye)

At a glance: Amblyopia

Poor vision in 1 eye

Eye drops or wearing an eye patch

What is amblyopia?

Amblyopia (also called lazy eye) i s a type of poor vision  that usually happens in just 1 eye but less commonly in both eyes. It develops when there’s a breakdown in how the brain and the eye work together, and the brain can’t recognize the sight from 1 eye. Over time, the brain relies more and more on the other, stronger eye — while vision in the weaker eye gets worse.

It’s called “lazy eye” because the stronger eye works better. But people with amblyopia are not lazy, and they can’t control the way their eyes work.

Amblyopia starts in childhood, and it’s the most common cause of vision loss in kids. Up to 3 out of 100 children have it. The good news is that early treatment works well and usually prevents long-term vision problems.

What are the symptoms of amblyopia?

Symptoms of amblyopia can be hard to notice. Kids with amblyopia may have poor depth perception — they have trouble telling how near or far something is. Parents may also notice signs that their child is struggling to see clearly, like:

• Shutting 1 eye
• Tilting their head

In many cases, parents don’t know their child has amblyopia until a doctor diagnoses it during an eye exam. That’s why it’s important for all kids to get a vision screening at least once between ages 3 and 5.

Is my child at risk for amblyopia?

Some kids are born with amblyopia and others develop it later in childhood. The chances of having amblyopia are higher in kids who:

• Were born early (premature)
• Were smaller than average at birth
• Have a family history of amblyopia, childhood cataracts, or other eye conditions
• Have developmental disabilities

What causes amblyopia?

In many cases, doctors don’t know the cause of amblyopia. But sometimes, a different vision problem can lead to amblyopia.

Normally, the brain uses nerve signals from both eyes to see. But if an eye condition makes vision in 1 eye worse, the brain may try to work around it. It starts to “turn off” signals from the weaker eye and rely only on the stronger eye.

Some eye conditions that can lead to amblyopia are:

• Refractive errors. These include common vision problems like nearsightedness (having trouble seeing far away), farsightedness (having trouble seeing things up close), and astigmatism (which can cause blurry vision). Normally, these problems are easy to fix with glasses or contacts. But if they’re not treated, the brain may start to rely more on the eye with stronger vision.
• Strabismus . Usually, the eyes move together as a pair. But in kids with strabismus, the eyes don’t line up. One eye might drift in, out, up, or down.
• Cataract. This causes cloudiness in the lens of the eye, making things look blurry. While most cataracts happen in older people, babies and children can also develop cataracts.

How will my child’s doctor check for amblyopia?

As part of a normal vision screening , your child’s doctor will look for signs of amblyopia. All kids ages 3 to 5 need to have their vision checked at least once.

What’s the treatment for amblyopia?

If there’s a vision problem causing amblyopia, the doctor may treat that first. For example, doctors may recommend glasses or contacts (for kids who are nearsighted or farsighted) or surgery (for kids with cataract).

The next step is to re-train the brain and force it to use the weaker eye. The more the brain uses it, the stronger it gets. Treatments include:

Wearing an eye patch on the stronger eye. By covering up this eye with a stick-on eye patch (similar to a Band-Aid), the brain has to use the weaker eye to see. Some kids only need to wear the patch for 2 hours a day, while others may need to wear it whenever they're awake.

Putting special eye drops in the stronger eye. A once-a-day drop of the drug atropine can temporarily blur near vision, which forces the brain to use the other eye. For some kids, this treatment works as well as an eye patch, and some parents find it easier to use (for example, because young children may try to pull off eye patches).

After your child starts treatment, their vision may start to get better within a few weeks. But it will probably take months to get the best results. After that, your child may still need to use these treatments from time to time to stop amblyopia from coming back.

It’s important to start treating children with amblyopia early — the sooner the better. Kids who grow up without treatment may have lifelong vision problems. Amblyopia treatment is usually less effective in adults than in children.

Last updated: September 22, 2022

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Amblyopia (Lazy Eye)

Amblyopia is a loss of vision, or poor vision, in an eye that did not develop correctly in early childhood. Amblyopia is also called lazy eye because one eye (the amblyopic eye) has weaker vision than the other. While amblyopia most often affects one eye, it can occur in both. This eye condition affects approximately two to three out of every 100 children and is the most common cause of pediatric vision loss.

Pediatric ophthalmologists at Riley at IU Health provide young children with medical and surgical treatment of eye conditions like amblyopia. Our ophthalmologists are board certified in ophthalmology and are committed to providing high-quality care in a child-friendly environment.

How Amblyopia Develops and the Importance of Early Diagnosis

To develop good eyesight, infants need both eyes to provide the same clear image to the brain. If the images differ, the brain tries to block the image from the weaker eye. This eye continues to be ignored and amblyopia develops if the problem is not corrected.

Amblyopia can result from any condition that prevents the eye from focusing clearly, such as misalignment of the eyes ( strabismus ), or a droopy eyelid or clouding of the front part of the eye (a  cataract ). Refractive error—a problem with the eye’s ability to focus caused by the shape of the eye—may also cause amblyopia. Refractive errors can include nearsightedness, farsightedness and astigmatism.

Early diagnosis of amblyopia is critical because the brain’s vision system is typically completed between the ages of 8 and 10. If amblyopia is not addressed in early childhood, problems such as poor vision, permanent visual defects and problems with depth perception can continue throughout life.

Early treatment can improve vision and deliver the best long-term outcome. Studies show that children age 7 and up are less responsive to treatment than those 3 to 6 years old. One recent study, however, suggests that children up to age 17 may benefit from treatment.

Three Types of Amblyopia:

• Strabismic amblyopia. The eyes are not straight and one eye may turn in, out, up or down with strabismic amblyopia. When the brain begins to ignore this weaker eye, vision loss occurs in the eye that is not straight.
• Deprivation amblyopia. When cataracts or similar conditions impair one or both eyes, deprivation amblyopia may develop. If not treated early, children with deprivation amblyopia may have very poor vision for life.
• Refractive amblyopia. This condition occurs when there is a big difference in the vision capabilities of each eye. The brain learns to rely on the vision of the stronger eye. Refractive amblyopia can be difficult to detect because there may be no noticeable difference between the two eyes. Children may not complain about blurry vision because the brain relies on images from the stronger eye. As a result, refractive amblyopia may only be detected after a vision screening that tests the capability of each eye. Refractive amblyopia can affect one or both eyes, and early diagnosis and treatment are important for optimal vision.

Symptoms That Suggest Amblyopia

Symptoms of amblyopia can vary. In many cases, neither the child nor the parent is aware of any symptoms. Amblyopia may be present if:

• Your child has poor overall vision or complains about blurriness in one eye
• There are obvious physical differences in the eyes, such as strabismus or misalignment of the eyes
• Your child squints with one eye, brings objects closer to see, has abnormal head posture or involuntary eye movements
• Your child has problems with depth perception
• There is a family history of amblyopia

Sometimes amblyopia is not detected until a vision screening is done. The U.S. Preventative Services Task Force recommends vision screening for all children by a pediatrician or primary care doctor at least once between the ages of 3 and 5.

Diagnosis of Amblyopia

Riley at IU Health pediatric ophthalmologists use a variety of diagnostic tests to detect amblyopia at various ages. Infants are checked for their ability to fix and follow objects with their eyes. An ophthalmologist can screen for strabismus and see how a baby reacts when one eye is covered.

Physicians may test toddlers’ pupillary red reflexes or conduct other tests to identify significant refractive errors like nearsightedness, farsightedness and astigmatism. Once children can read or match objects, they can complete a vision screening to test the acuity of each eye.

An ophthalmologist examines the inside of your child’s eye to look for diseases or conditions like cataract inflammation (swelling) or tumors.

Improved vision is the goal of ophthalmologic treatment. Some children do not achieve 20/20 vision, but they can significantly improve their eyesight if diagnosed and treated early. The best time to treat amblyopia is infancy and early childhood.

The most common types of treatment for amblyopia are:

• Patches. During this treatment, your child wears an adhesive eye patch over the stronger eye for weeks or months. This forces him or her to use the weaker eye, which strengthens this eye and helps develop the part of the brain that works with vision. The patch may be worn daily for two to six hours. Older children who want a less noticeable option may use a Bangerter filter over an eyeglass lens of the non-amblyopic eye.
• Atropine eye drops. This treatment option places eye drops in the stronger eye to blur vision, causing your child to rely on the eye with amblyopia. Some families find using eye drops easier than using the eye patch because there is no need to worry about the child refusing or removing the patch. Eye drops do not work as well when the stronger eye is nearsighted.
• Surgery. The ophthalmologist may first need to treat the issue(s) causing the amblyopia. For example, a cataract can be removed from the eye or surgery can be performed to fix droopy eyelids. These options can help the eyes begin to work together. Surgery for these underlying conditions will not improve vision for those with amblyopia.

Treatment usually lasts until vision is normal or stops getting better. In most children, this may last several weeks, but in a few cases, patching can be necessary for years.

Children with amblyopia may wear glasses and contacts before and after treatment. These corrective measures will not fix amblyopia, but consistent use can improve overall vision and can be worn by children as young as one week old. Children can choose glasses and be fitted for contacts at our full-service optical shop.

Treatment for amblyopia may not significantly improve vision for some children. For those with good vision in one eye, safety glasses or sports goggles can protect the normal eye. If the normal eye stays healthy, children can function and enjoy all normal activities.

Points to Remember

• Amblyopia, often called lazy eye, is the most common cause of vision loss in children. 
• Amblyopia can occur in one or both eyes and can be caused by any condition that prevents the eye from focusing clearly.
• Parents, and even children themselves, may not detect amblyopia.
• Ophthalmologists test for amblyopia in infants and children using a variety of diagnostic tools.
• Early detection and vision screening are important because the parts of the brain that control vision are developed early in life.
• The best time to treat amblyopia is infancy and early childhood. Patching and eye drops are the most commonly prescribed treatments.

Support Services & Resources

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

This National Institutes of Health website offers information and links related to health conditions, including amblyopia.

This website is supported through the American Academy of Family Physicians and has public information for conditions such as amblyopia.

The NEI, which is part of the National Institutes of Health (NIH), conducts and supports research, provides training, and shares health information about eyesight, eye diseases and conditions like amblyopia (lazy eye).

The American Academy of Ophthalmology is the largest national membership association of physicians who provide eye care in the United States. Their website contains information for parents about diagnosis and treatment of amblyopia.

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Lazy eye (amblyopia) in children: overview.

Last Update: June 4, 2020 ; Next update: 2023.

• Introduction

Normally, our brain processes the images sent by both eyes equally. This is needed for the best possible vision.

In some children, though, one eye is favored by the brain because it provides a sharper image. The brain then ignores the images from the other eye. As a result, the child's vision doesn’t develop properly because the information from the weaker eye is no longer used. This is known as amblyopia, or “lazy eye.”

If your child has a squint or trouble recognizing things, it could be a sign of lazy eye. They may, for instance, have to hold toys or other objects very close to their eye to see them properly, or always turn their head to one side when looking at things.

Amblyopia develops when the two eyes keep sending such different images to the brain that the brain can’t merge them into one. The most common cause of this is a squint (strabismus). If a child has a squint, one eye will look straight ahead while the other looks up, down or to the side, so it is taking in a completely different image. In an effort to avoid seeing double, the brain often blocks out the images from the eye that doesn’t see as well, and relies on just one eye.

About 60 to 70% of children who have a squint have a lazy eye because of this, compared to only 2% of children who don’t have a squint.

Refractive errors are another common cause of amblyopia. They make the image that appears on the retina of the eye blurry. There are three different kinds of refractive error:

• Nearsightedness (shortsightedness or myopia): The eye can only focus clearly on objects that are close by. When looking into the distance, though, the lens can’t bend the incoming light in a way that results in a clear image on the retina. This might happen if, for instance, the eyeball is a little too long.
• Farsightedness (hyperopia): The eye can only focus clearly on objects that are far away. When looking at things close-up (e.g. when reading) the lens can’t bend the incoming light enough, for instance because the eyeball is too short.
• Astigmatism ( not shown in the illustration ): Everything appears blurry because the lens or the cornea is deformed.

Refractive errors are more likely to lead to a lazy eye if each eye is affected in different ways:

• one eye is farsighted or nearsighted and the other one is normal.
• one eye is farsighted and the other is nearsighted.

Lazy eye is only rarely caused by another eye disorder. Eye disorders that can cause lazy eye include a cloudy lens at birth (congenital cataracts), a droopy eyelid (called ptosis) or a missing eye lens (aphakia) at birth.

Lazy eye is a common vision problem in children and young adults. It is estimated that about 3% of children and young people in Europe are affected overall, and up to 6% of preschool children.

Lazy eye is equally common in boys and girls. It usually develops before the age of 7.

There are several tests that eye doctors can do to find out whether a child has amblyopia:

A physical examination can help to see whether the poor eyesight is caused by something else, like a cataract . The following eye tests are suitable for diagnosing lazy eye:

Eye charts: Doctors can use eye charts to find out how well a child can see. The child is asked to read things like numbers or letters from an eye chart or screen.

Eye charts for younger children may have simple symbols on them – like a circle, a house or an apple – and the child is asked to say what they can see. Or there might be symbols that look like the letter C (a broken ring) or E.

The symbols are arranged in rows on the charts and face in different directions. Then the child is asked to say where the “gap” in the C-shaped ring is, for example. Or they are given a kind of E-shaped plastic fork and are asked to hold it in the same direction as the symbol they are looking at.

Retinoscopy: Toddlers and babies can have an examination using an instrument known as a retinoscope. Here the child doesn’t have to recognize anything or say what they can see. Instead, the doctor shines a light into the child’s eye and observes how the light reflects off the retina at the back of the eye. By holding various corrective lenses in front of the light beam, the doctor can find out exactly how farsighted or nearsighted the child is in that eye.

Covering one eye: A slight squint isn’t always visible to the naked eye. To tell whether a child has a squint, the position of their eyes can be measured – for instance, with a test in which the eyes are covered one at a time. The doctor then checks whether the other eye moves.

These tests are generally safe. Depending on the equipment used, eye drops are typically given to dilate (open) the pupils before examining the eyes with a retinoscope. The eye drops occasionally cause skin irritations or burning in the eyes.

Specialists believe that eyesight mainly develops in the first five years of life. They think that lazy eye should be detected and treated as early as possible in order to avoid lifelong vision problems, as well as problems at school and in the child's social development.

For this reason, an extra screening test was introduced in Germany for all preschool children who have statutory health insurance. This test is called “U7a” in the German health care system, and its main aim is to detect vision problems. It is offered in addition to the existing screening examinations for children in Germany (the so-called “ U-Untersuchungen ”), and is aimed at toddlers who are nearly three years old (between 33 and 35 months old).

Lazy eye can’t be fixed instantly by putting on glasses that correct the problem. But there are a number of different ways to improve vision in the weaker eye – for instance with glasses, an eye patch on the stronger eye, or with eye drops. Treatment might only be needed for a few weeks.

Although it can sometimes take quite a long time to get good results, lazy eye can be treated successfully in most children.

If another eye problem (e.g. a droopy eyelid) is causing the lazy eye, that problem is treated first.

• Further information

When people are ill or need medical advice, they usually go to see their family doctor or pediatrician first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

• Fu Z, Hong H, Su Z, Lou B, Pan CW, Liu H. Global prevalence of amblyopia and disease burden projections through 2040: a systematic review and meta-analysis . Br J Ophthalmol 2019; 08: 08.
• Gesellschaft für Neuropädiatrie (GNP). Visuelle Wahrnehmungsstörungen (Sk2 Leitlinie) . AWMF-Registernr.: 022-020. April 2017.
• Hashemi H, Pakzad R, Yekta A, Bostamzad P, Aghamirsalim M, Sardari S et al. Global and regional estimates of prevalence of amblyopia: A systematic review and meta-analysis . Strabismus 2018 [Epub ahead of print]: 1-16.
• Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Screening for visual impairment in children : Final report; Commission S05-02. April 1, 2008. (IQWiG reports; Volume 32).
• Jefferis JM, Connor AJ, Clarke MP. Amblyopia . BMJ 2015; 351: h5811. [ PubMed : 26563241 ]
• Pschyrembel. Klinisches Wörterbuch. Berlin: De Gruyter; 2017.
• West S, Williams C. Amblyopia in children (aged 7 years or less) . BMJ Clin Evid 2016: pii: 0709.
• Zhang X, Wang J, Li Y, Jiang B. Diagnostic test accuracy of Spot and Plusoptix photoscreeners in detecting amblyogenic risk factors in children: a systemic review and meta-analysis . Ophthalmic Physiol Opt 2019; 39(4): 260-271. [ PubMed : 31236980 ]

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

• Cite this Page InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Lazy eye (amblyopia) in children: Overview. [Updated 2020 Jun 4].
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Lazy eye in children: Know what leads to reduced vision in one eye

• What is a lazy eye
• Vitamin deficiency
• How to prevent

A child’s health develops slowly through growing up years. Vision or sight is one of the aspects of overall health that needs attention. At times, there is a disruption in the normal development of vision during early childhood. It is a common condition called lazy eye or amblyopia. If left untreated, the weaker eye of the child may fail to develop normal vision. This may result in permanent vision impairment or lead to more health problems later in life. Read on to know the symptoms and causes of lazy eye in children.

What is a lazy eye?

Lazy eye, medically known as amblyopia, is a condition that typically develops during childhood and affects vision in one eye, says eye expert Dr Madhavi Majety . In a lazy eye, the brain tends to favour one eye over the other, leading to reduced visual clarity in the affected eye. It is the most common cause of vision loss in children, according to a 2022 research published in the Frontiers in Pediatrics .

What causes lazy eye in children?

Amblyopia is relatively common in children mostly because it often develops during early childhood when the visual system is still developing and maturing, says the expert. There are several factors that can contribute to the development of lazy eye in children:

1. Misaligned eyes

When a child’s eyes are misaligned, which means they do not point in the same direction, the brain may receive conflicting visual information from each eye. In response, the child’s brain may suppress or ignore the input from one eye, leading to amblyopia in the weaker eye.

2. Refractive errors

Significant differences in refractive errors such as nearsightedness or farsightedness between the eyes can cause blurry or distorted vision in one eye. If left uncorrected, the brain may favour the eye with clearer vision, leading to amblyopia in the less focused eye.

3. Eye conditions or diseases

Certain eye conditions such as cataracts , drooping eyelid or other structural abnormalities of the eye can interfere with normal visual development and contribute to lazy eye.

4. Genetic factors

Lazy eyes can sometimes run in families, suggesting a genetic predisposition to the condition, says Dr Majety. Children with a family history of amblyopia or related eye conditions may be at increased risk of developing the condition themselves.

Which vitamin deficiency causes a lazy eye?

There is no direct link between a specific vitamin deficiency and lazy eye, as it is typically caused by factors such as misaligned eyes or eye conditions that obstruct clear vision. However, a well-balanced diet rich in nutrients is essential for overall eye health and development.

What are the symptoms of a lazy eye?

Common symptoms of lazy eye in children may include –

• Reduced vision in one eye
• Difficulty focusing or maintaining visual attention
• Noticeable misalignment of the eyes.

However, some children with a lazy eye may not exhibit obvious signs.

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How to fix a lazy eye?

Treatment for a lazy eye in children should begin as soon as possible, irrespective of the age. It should be treated on time, as children may have health issues in adulthood. Adults who had a lazy eye in childhood are more likely to experience hypertension, obesity, and an increased risk of heart attack, according to a March 2024 study published in the eClinicalMedicine journal.

The treatment typically involves correcting the underlying issues that contribute to the condition. This may include:

• Prescribing glasses or contact lenses to correct refractive errors
• Patching the stronger eye to encourage the weaker eye to work harder and develop better vision
• Using eye drops to blur vision in the stronger eye temporarily
• Vision therapy to improve eye coordination and visual processing skills.

In some cases, surgery may be done to correct misaligned eyes or other structural abnormalities, says the expert.

How to prevent a lazy eye?

While some risk factors for lazy eye in children, such as genetic predisposition, cannot be prevented, there are steps you can take to promote healthy vision and reduce the risk of amblyopia. These include:

• Scheduling routine eye exams for your child, especially during early childhood, to detect and address vision problems early on
• Ensuring prompt treatment for eye conditions or refractive errors that may contribute to lazy eye
• Encouraging regular breaks from screens and outdoor activities to support healthy visual development.
• Promoting a balanced diet consisting of nutrients for better eye health.

Early intervention and proactive eye care are essential to prevent and manage a lazy eye in children.

Natalia Ningthoujam has written on various subjects - from music to films and fashion to lifestyle - as a journalist in her career that started in 2010. After getting stories from the crime scene, police headquarters, and conducting interviews with celebrities, she is now writing on health and wellness which has become her focus area. ... Read More

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What Is Strabismus?

Strabismus is when eyes don't line up or when one or both eyes wander. The eyes may turn:

• inward (called esotropia or "cross-eyed")
• outward (exotropia)
• up (hypertropia)
• down (hypotropia)

When eyes don't line up together, the straight or straighter eye becomes dominant. The vision strength (acuity) of this eye stays normal because the eye and its connection to the brain are working as they should. The misaligned or weaker eye, though, doesn't focus as it should and its connection to the brain doesn't form correctly.

Sometimes, strabismus (streh-BIZ-mis) is very noticeable. Other times, it might only be noticed when a child is tired or looking at something very closely.

Strabismus usually can be fixed when found and treated early. If it's not treated, the brain eventually will ignore the visual images of the weaker eye. This change — called amblyopia , or "lazy eye" — can make vision blurry, cause double vision, and harm a child's depth perception (seeing in 3D ). These problems can become permanent if they're not treated. 

What Causes Strabismus?

Kids can be born with strabismus or develop it in childhood. Often, it's caused by a problem with the muscles that move the eyes, and can run in families.

Most kids with strabismus are diagnosed when they're between 1 and 4 years old. Rarely, a child might develop strabismus after age 6. If this happens, it's important for the child to see a doctor right away to rule out other conditions.

What Are the Signs of Strabismus?

Most kids with strabismus don't complain of eye problems or notice changes in their vision. Usually, it's a family member, teacher, or health care provider who notices that the eyes are not straight.

Some kids may complain of double vision (seeing two objects when only one is in view) or have trouble seeing things in general. These problems also  can affect  reading skills and classroom learning.  Younger kids who aren't talking yet may squint a lot and turn or tilt their heads in an attempt to see more clearly.

If your child has any of these signs or symptoms, tell your health care provider. He or she can refer you to a pediatric ophthalmologist for care, if needed.

How Is Strabismus Diagnosed?

It's normal for a newborn's eyes to wander or cross occasionally during the first few months of life. But by the time a baby is 4–6 months old, the eyes usually straighten out. If one or both eyes continue to wander in, out, up, or down — even once in a while — it's probably due to strabismus.

How Is Strabismus Treated?

The earlier strabismus is treated, the better. That's because key connections between a child's eyes and brain  form by about 8 years old.

Treatment for strabismus may include:

• eye patching
• eye muscle surgery

Sometimes, wearing eyeglasses is enough to straighten out the eyes. If not, a child might be given an eye patch to wear over the straight eye for a few hours a day. This patch makes the weaker eye do the "seeing" work. Over time, the muscles and vision in the weaker eye become stronger.

Getting a baby or toddler to accept wearing an eye patch can be a challenge. But most kids get used to the patch. Wearing it becomes part of their daily routine, like getting dressed in the morning.

Sometimes, though, kids refuse to wear an eye patch. Then, eye drops (called atropine drops ) might be used instead. Just as eye patching blocks the vision in the straight eye, the atropine drops temporarily blur out vision in that eye. This makes the weaker eye work harder so that eye muscles and vision get stronger.

If eyeglasses, eye patching, and/or atropine drops can't fix a child's strabismus, eye muscle surgery might be needed. Surgery involves loosening or tightening the muscles that cause the eye to wander. Most kids can go home the same day of surgery.

What Else Should I Know?

Regular eye exams are the best way to detect strabismus. Early diagnosis and treatment better a child's chances of having straight eyes and developing good vision and depth perception. But older kids and teens (and even many adults with strabismus) can still be helped by treatment.

Also keep in mind the social aspect to strabismus. Aligned eyes are important for a healthy self-image in adults and kids.

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Development

Postpartum recovery & tips, getting pregnant, am i pregnant, preconception health, stages of pregnancy, miscarriage, diet & fitness, labor & delivery, preparing for a baby, motherhood tools, due date calculator, zodiac center, baby name generator, what are the first signs of lazy eye in infants.

By: Peter Mitchell

28 November, 2018

The condition amblyopia, more commonly known as lazy eye, causes vision problems in around 2 percent of all infants. Lazy eye occurs when one eye struggles to see properly.

Over time, an infant will favor the other eye, further weakening the problem eye.

The first signs of lazy eyes in infants vary depending on the child. But, a few key symptoms mark the onset of this condition.

Outward Symptoms

Infants with a lazy eye often have one eye that wanders inward or at a different angle. Similarly, the eyes sometimes become crossed for prolonged periods. Because an infant won't tell you that her vision is fuzzy, you must keep a close watch on how her eyes move and behave.

A lazy eye may also make one eyelid droop, or cause an infant to close one eye more often than the other. As she gets a little older, she may use her hand to cover the lazy eye to help focus.

Eye Rolling in Infants

A baby that can't focus properly often squints with one or both eyes. The authors of "Children's Health for Dummies" suggest looking for early signs of squinting from 4 months of age.

Hold a colorful toy about 8 inches from your baby's face. Slowly move the toy left and right. Your baby's eyes should follow the toy. An eye that stays in place while the other moves, or eyes that go crossed or at strange angles might suggest a lazy eye.

Normal Symptoms

In the first 4 months after birth a baby's vision is still blurry and developing fast.

As your child adjusts to the new environment, her eyes might occasionally cross or flicker. This is a normal part of infant development. If the eyes stay crossed or looking in different directions for several hours at a time or longer, speak to your doctor. In some cases, this may suggest the conditions strabismus, a misalignment of the eyes in infants, rather than lazy eye.

Considerations

Causes of One Tearing Eye

Early signs of lazy eye in infants usually don't include inflammation, pus or itchy fluid. Any of these symptoms may suggest another eye condition, such as a blocked tear duct, conjunctivitis or even cataracts. The only way to know for sure if your infant has a lazy eye is to take him to a doctor or ophthalmologist. These medical professionals use light-emitting equipment or specialist eye drops to help look for any problems with the lens, pupil or eye in general.

Related Articles

Signs of Blindness in Newborns

Puffy Eyes in Babies

Signs of Head Trauma to a Baby

How to Use a Patch to Strengthen an Eye

How to Remove an Object From the Eye of a Newborn

Development of Depth Perception in Infants

Sundowning in Infants

Characteristics of a Visually Impaired Child

• NHS Choices; Lazy Eye; March 2009
• UIC Department of Opthalmology and Visual Sciences; Your Baby's Eyes; Lawrence M. Kaufman, M.D., Ph.D.
• "Children's Health for Dummies"; Katy Holland, et al.; 2006

Based near London, U.K., Peter Mitchell has been a journalist and copywriter for over eight years. Credits include stories for "The Guardian" and the BBC. Mitchell is an experienced player and coach for basketball and soccer teams, and has written articles on nutrition, health and fitness. He has a First Class Bachelor of Arts (Hons.) from Bristol University.

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Pediatric Eye Care

Wandering Eye / Exotropia

Intermittent exotropia (eye wandering).

Intermittent exotropia, also called wandering eye, is a type of strabismus (eye misalignment) in which the eyes drift out (exotropia) from time to time. This is a relatively common type of strabismus in both children and adults. The amount of deviation varies widely from person-to-person.

Parents may begin to notice their child's eye turns out, especially when the child is tired, daydreaming, or sick. Parents may also notice their child closes or squints one eye when outside in bright sunshine.

The treatment for intermittent exotropia can range from observation, conservative management, to surgery. We typically choose to observe the child when:

• There is only a small to moderate deviation
• If they can control it well so the eye drifts less than half of their waking hours,
• So long as their ability to use their eyes together (stereoacuity) is good.

We may choose some conservative management like alternatively patching either eye when there is no amblyopia (lazy eye) in young children, or putting them in glasses that are purposely over-powered to encourage the eyes to come together in children until about age 10 or 11.

We can perform eye muscle surgery to make the eye easier to control at any age and may recommend surgery if:

• The deviation becomes large
• The child begins to lose the ability to use their eyes together (stereoacuity)
• The child experiences a psychosocial impact like being picked on at school

If you think your child or you have intermittent exotropia, we recommend they be seen by a pediatric ophthalmologist for an evaluation.

To schedule an appointment, call (509) 456-0107

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Children with lazy eyes at higher risk of developing serious health conditions

P eople who had “lazy eye” in childhood may be at higher risk of diabetes, heart disease and other serious health conditions later in life, a study suggests.

An analysis of data from more than 126,000 UK adults suggests those diagnosed with amblyopia as a child were also more likely to have high blood pressure and obesity when they are older.

The researchers said the findings, published in the journal eClinicalMedicine, do not show a “causal relationship” between amblyopia and ill health but added children with the condition may need even more incentive to follow a healthy lifestyle.

Professor Jugnoo Rahi, of UCL Institute of Ophthalmology and Great Ormond Street Hospital , said: “Amblyopia is an eye condition affecting up to four in 100 children.

“In the UK, all children are supposed to have vision screening before the age of five, to ensure a prompt diagnosis and relevant ophthalmic treatment.

“It is rare to have a ‘marker’ in childhood that is associated with increased risk of serious disease in adult life, and also one that is measured and known for every child – because of population screening.

“The large numbers of affected children and their families may want to think of our findings as an extra incentive for trying to achieve healthy lifestyles from childhood.”

Amblyopia is a neurodevelopmental condition where vision in one eye does not develop properly because the brain cannot properly process visual signals in the affected eye.

Up to 4% of children globally are thought to be affected by it.

In the UK, treatment usually starts before the age of seven, which can sometimes help improve vision in the weaker eye.

To carry out the study, the researchers looked at health data for 126,399 people, aged 40 to 69, in the UK Biobank – which holds medical and lifestyle records of more than half a million people.

It showed that among the 3,238 people who reported having a lazy eye as a child, more than four out of five had persistent reduced vision in one eye as an adult.

Those who had the condition as a child also had 29% higher odds of developing diabetes, 25% higher odds of having high blood pressure and 16% higher odds of being obese.

They were also at increased risk of heart attack – even when other risk factors for these conditions were taken into account, such as social class, ethnicity and other diseases, the team said.

Health problems were also seen in people who had amblyopia as a child but regained their vision, although the correlation was not as strong, the team added.

Dr Siegfried Wagner, of the UCL Institute of Ophthalmology and Moorfields Eye Hospital, said: “Vision and the eyes are sentinels for overall health – whether heart disease or metabolic disfunction, they are intimately linked with other organ systems.

“This is one of the reasons why we screen for good vision in both eyes.

“We emphasise that our research does not show a causal relationship between amblyopia and ill health in adulthood.

“Our research means that the ‘average’ adult who had amblyopia as a child is more likely to develop these disorders than the ‘average’ adult who did not have amblyopia.

“The findings don’t mean that every child with amblyopia will inevitably develop cardiometabolic disorders in adult life.”

Commenting on the research, Poonam Patel, eye health information services manager at the Royal National Institute of Blind People (RNIB), said: “This research provides a good opportunity to highlight the importance of eye tests and child vision screening for the early detection of refractive error and amblyopia in children.

“Early detection of amblyopia can help ensure timely treatment and limit the impact this has on sight.

“Child vision screening should be made available in all areas for all children when starting school at the age of four-five, though there are currently some areas where this isn’t yet available.

“Children should also have regular eye tests with an optometrist, especially if there is a family history of refractive error, squint or amblyopia.”

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