A 4-year-old child is found to have amblyopia in the right eye (vision 6/60) secondary to dense right esotropia (accommodative). After refractive correction with glasses, the most appropriate treatment for amblyopia is:

• A Surgical correction of esotropia as the first step before any patching
• B Atropine penalization drops in the RIGHT (amblyopic) eye
• C Occlusion (patching) of the LEFT (non-amblyopic) eye for a prescribed number of hours per day — penalizing the preferred eye ✓
• D Optical penalization of the amblyopic eye with a Bangerter foil

Explanation

Amblyopia treatment involves patching (occlusion therapy) of the sound, non-amblyopic eye to force use of the amblyopic eye during the critical period. Full-time or part-time patching of the LEFT eye is prescribed based on amblyopia severity and age. Atropine penalization of the preferred (sound) eye — not the amblyopic eye — is an alternative to patching (cycloplegia blurs near vision in the sound eye, forcing use of the amblyopic eye). Surgery for strabismus is performed after optimal amblyopia treatment to achieve best alignment; operating before treating amblyopia does not correct the lazy eye and may even worsen outcomes.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.