Amblyopia (Lazy Eye)

Amblyopia, often called lazy eye, is when the vision in one eye (sometimes both) does not develop normally during early childhood [1][2].

A child's eyes and brain learn to see together in the first years of life. If one eye sends a blurred or different picture, the brain starts to ignore that eye. Over time, that eye does not learn to see clearly, even with glasses.

The eye itself is usually healthy. The problem is in how the brain and eye work together.

What causes it?

• Squint (strabismus): the eyes point in different directions, so the brain ignores the turned eye.
• Unequal glasses prescription: one eye is much more long-sighted, short-sighted or has more astigmatism than the other. The blurrier eye gets ignored.
• Something blocking vision: such as a cataract (cloudy lens) or a droopy eyelid (ptosis) covering the pupil. This type needs treatment quickly.

Your child's risk is higher if they [1][3]:

• have a squint
• need glasses, especially if one eye needs a much stronger lens
• were born early (premature) or with a low birth weight
• have a parent, brother or sister with a lazy eye, squint or strong glasses as a child
• have a droopy eyelid or cataract
• have developmental delay

Often there are no obvious signs. Children with one weak eye usually do not complain, because the good eye does the work. This is why eye checks in young children are so important [1][2].

You may notice your child:

• has an eye that turns in or out
• tilts the head or squints to see
• bumps into things on one side
• gets upset when you cover one eye, but not the other

A lazy eye is usually found with a vision test, one eye at a time. The eye team will also check whether your child needs glasses, using eye drops to get an accurate result, and check the eye is healthy.

The earlier treatment starts, the better. It works best before age 7–8, while the vision is still developing. Older children can still improve, but less so [1][2].

1. Treat the cause first. For example, removing a cataract or lifting a droopy eyelid that blocks vision.
2. Glasses: often the first step. Wearing the right glasses all the time for a few months can improve the lazy eye on its own.
3. Patching: a patch is worn over the good eye for a few hours a day, so the brain has to use the lazy eye. Even 2 to 6 hours a day can work well [5].
4. Atropine eye drops: a drop in the good eye blurs it for a while, so the lazy eye has to work. These drops work about as well as patching for many children, and some families find them easier [4].

Sticking with treatment matters most. Treatment only works if glasses are worn and patching or drops are used as advised, often for months. Make it part of the daily routine, use reward charts, and do close-up activities (drawing, puzzles, reading) during patching time.

Keep all follow-up visits. The lazy eye can slip back after treatment stops, so the eye team will keep checking.

Lazy eye is often linked with a squint. Read more:

Lazy eye cannot always be prevented, but finding it early gives the best chance of good vision [1][3]:

• Make sure your child has an eye check before starting school, and earlier if there is a family history or you have any worries.
• If your child is given glasses, help them wear them every day.
• Do not wait for your child to "grow out of" a turned eye.

Where to get help in Brunei

You can walk in to any Community Eye Clinic at your health centre. No referral is needed.