A 5-year-old girl has right amblyopia (visual acuity 6/36) with right esotropia of 30 PD. Her right eye cycloplegic refraction is +5.00D and left +1.00D. The amblyopia treatment plan should be:

• A Immediate surgery for the esotropia, then treat amblyopia post-operatively
• B Penalisation with atropine to the right (amblyopic) eye to promote use of the left eye
• C Patching alone without optical correction since the hypermetropia is mild in the left eye
• D Full optical correction first (spectacles) for a minimum of 12–16 weeks, then reassess VA; if amblyopia persists, add patching/penalisation of the better eye ✓

Explanation

Treatment of amblyopia due to anisometropic esotropia follows a sequenced approach: first, full optical correction (spectacles) must be prescribed and worn consistently for ≥12–16 weeks. A significant portion of accommodative esotropia resolves or reduces with glasses, and amblyopia also improves with optical correction alone (refractive adaptation). Only after adequate optical correction has been established and VA remains reduced should occlusion therapy (patching 2–6 hours/day) or atropine penalisation of the fellow eye be added. Surgery is deferred until residual angle after full spectacle correction is assessed; it is not the first step.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.