Updated: 4/24/2021

Amblyopia

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Questions
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Evidence
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Topic
Snapshot
  • A 12-month-old girl presents to the pediatrician for a well-baby visit. The child is cooperative and playful. On physical examination, the boy has a head tilt. Deflection is noted on corneal light reflex testing, and cover test shows refixation of the left eye when the other eye is covered.

 

 

 

Introduction
  • Abnormal visual development → decreased visual acuity
    • visual stimulation is highly important for maturation of the visual cortex
  • Can divided into three etiologies:
    • strabismus (most common)
      • leads to the generation of images that cannot be fused properly
        • image generated by one eye is suppressed by the visual cortex
    • refractive error (second most common)
      • leads to differences in image clarity
    • visual deprivation 
      • e.g., cataracts
Presentation
  • Depends on the cause
    • strabismus
      • esotropia
        • inwardly deviated "crossed eyes"
      • exotropia
        • outwardly deviated "walled eyes"
      • pseudostrabismus
        • appears to be misaligned by eyes are in correct alignment
        • often due to certain facial features (e.g., wide nose bridge, epicanthal folds)
        • can differentiate from strabismus via the Hirschberg light reflex test (pupilary light reflex will be centered in both eyes) 
    • refractive error
      • abnormal vision screening
    • visual deprivation
      • e.g., cataracts
        • lenticular opacity noted on exam
Treatment
  • Correct underlying cause is the initial step
    • strabismus 
      • eye realignment via glasses or surgery in severe cases
    • refractive error
      • refractive correction with glasses
    • visual deprivation
      • remove insult
        • e.g., surgery to remove cataract
  • Patching or optic penalization 
    • patching  
      • occluding the "better" eye to encourage use of the amblyopic eye
    • optic penalization
      • atropine, a cycloplegic, is added to the "better" eye
    • both are equally effective

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Questions (3)

(M2.OP.17.4868) A 6-month-old male infant is brought to the clinic because the mother thinks that her child is "cross-eyed." The mother's prenatal history was unremarkable. The child was delivered vaginally without complications. His nutrition has been stellar, and his well-child visits documented appropriate reflexes and milestones. The mother reports that the infant's eyes are constantly crossed, and she is concerned that her child will need surgery. On physical exam, there is no white reflex seen with the ophthalmoscope in either eye. The infant's eyes are shown in Figure A. What is the best next step in management?

QID: 109572
FIGURES:
1

Right medial rectus muscle elongation

2%

(1/46)

2

Right lateral rectus muscle resection

2%

(1/46)

3

Occlusion of the right eye

11%

(5/46)

4

Occlusion of the left eye

76%

(35/46)

5

Reassurance

9%

(4/46)

M 7 D

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Evidence (2)
EXPERT COMMENTS (2)
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