A 4-year-old child is found to have a dense right amblyopia (BCVA 6/60) due to a large right esotropia. The left eye BCVA is 6/6. After prescribing full cycloplegic refraction and allowing 8 weeks of glasses wear, the next step in management is:

• A Immediate surgery for esotropia
• B Patching (occlusion therapy) of the better eye for at least 2 hours per day
• C Atropine penalisation of the better eye
• D Both B and C are equally recommended first-line options ✓

Explanation

After optical correction with glasses, patching and atropine penalisation of the sound eye are both first-line amblyopia treatments with equivalent efficacy as demonstrated in multiple PEDIG (Pediatric Eye Disease Investigator Group) randomised controlled trials. Patching is typically 2–6 hours per day (depending on severity) for moderate-to-severe amblyopia; atropine (1% weekly to the sound eye) blurs distance vision in the preferred eye. Surgery for strabismus is performed only after maximising amblyopia treatment.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.