Amblyopia (lazy eye)

A "lazy eye" (amblyopia) is a childhood condition where the vision doesn't develop properly.

It happens because one or both eyes are unable to build a strong link to the brain. It usually only affects one eye, and means that the child can see less clearly out of the affected eye and relies more on the "good" eye.

It's estimated that 1 in 50 children will develop a lazy eye.

This page covers:

How to tell if your child has a lazy eye

When to get medical advice

Causes

Treatment

How to tell if your child has a lazy eye

A lazy eye doesn't usually cause symptoms. Younger children are often unaware that there's anything wrong with their vision and, if they are, they're usually unable to explain what's wrong.

Older children may complain that they can't see as well through one eye and have problems with reading, writing and drawing.

In some cases, you may notice that one eye looks different from the other.

However, this is usually a sign of another condition that could lead to a lazy eye, such as:

a squint (strabismus) – where the weaker eye looks inwards, outwards, upwards or downwards, while the other eye looks forwards
refractive errors – where there's a problem with how the eye focuses light; refractive errors include short-sightedness (myopia), long-sightedness (hyperopia) and astigmatism
childhood cataracts – cloudy patches that develop in the lens, which sits behind the iris (the coloured part of the eye) and pupil

If your child is too young to tell you how good their vision is, you can check their eyes by covering each eye with your hand, one at a time. They might object to covering the good eye, but they might not mind if you cover the lazy eye.

If they try to push your hand away from one eye but not the other, it may be a sign they can see better out of one eye.

When to get medical advice

Lazy eye is often diagnosed during routine eye tests before parents realise there's a problem.

If you want to be reassured about your child's vision, they can have their eyes tested when they're old enough to attend a sight test at a high street opticians, which is usually after they're three years old.

All newborn babies in the UK have an eye test in the first days of life, and then again at 2-3 months old, to look for conditions such as cataracts. Problems like squint and refractive errors may not develop until the child is a few years old.

It's difficult to treat lazy eye after the age of six, so it's recommended that all children have their vision tested after their fourth birthday. This is the responsibility of your local authority, which should organise vision testing for all children between 4-5 years of age (when children start school).

Causes of lazy eye

The eyes work like a camera. Light passes through the lens of each eye and reaches a light-sensitive layer of tissue at the back of the eye called the retina.

The retina translates the image into nerve signals that are sent to the brain. The brain combines the signals from each eye into a three-dimensional image.

A lazy eye occurs when the brain connections responsible for vision aren't made properly. To build these connections, during the first eight years of a child's life, the eye has to "show" the brain a clear image. This allows the brain to build strong pathways for information about vision.

A lazy eye can be caused by:

a reduced amount of light entering the eye
a lack of focus in the eye (a refractive error)
confusion between the eyes – where the two images aren't the same (such as a squint)

Left untreated, this can lead to the eye's central vision never reaching normal levels.

Read more about the causes of a lazy eye.

Treatment for lazy eye

In most cases it is possible to treat a lazy eye, usually in two stages.

If there's a problem with the amount of light entering the eye, such as a cataract blocking the pathway of light, treatment will be needed to remove the blockage.

If there's a refractive error, it will first be corrected using glasses to correct the focus of the eye, which often helps correct a squint as well.

The child is then encouraged to use the affected eye again. This can be done using an eye patch to cover the stronger eye, or eye drops to temporarily blur the vision in the stronger eye.

Treatment is often effective, but it's a gradual process that takes many months to work. If treatment is stopped too soon, any improvement may be lost.

Treatment for lazy eye is most effective for younger children. It's uncertain how helpful it is for children over eight years of age.