Treatment and Avoidance of Strabismic Amblyopia

Strict occlusion therapy by eye patching or eyeglass occlusion is the most effective method of avoiding or treating strabismic amblyopia. Primarily the leading eye is patched.

478 17 Ocular Motility and Strabismus Occlusion therapy of amblyopia. -

478 17 Ocular Motility and Strabismus Occlusion therapy of amblyopia. -

Fig. 17.11 The leading eye is patched for several hours or days at a time to improve visual acuity in the deviating amblyopic eye.

Eye patching: Severe amblyopia with eccentric fixation requires an eye patch (Fig. 17.11). Eyeglass occlusion (see next section) entails the risk that the child might attempt to circumvent the occlusion of the good eye by looking over the rim of the eyeglasses with the leading eye. This would compromise the effectiveness of occlusion therapy, whose purpose is to train the amblyopic eye.

Eyeglass occlusion: Mild cases of amblyopia usually may be treated successfully by covering the eyeglass lens of the leading eye with an opaque material. In such cases, the child usually does not attempt to look over the rim of the eyeglasses because the deviating eye has sufficient visual acuity.

Procedure: The duration of occlusion therapy must be balanced so as to avoid a loss of visual acuity in the leading eye. The leading eye is occluded for several hours at a time in mild amblyopia, and for several days at a time in severe amblyopia depending to the patient's age. For example, the nondeviat-ing eye in a four-year-old patient is patched for four days while the deviating eye is left uncovered. Both eyes are then left uncovered for one day. This treatment cycle is repeated beginning on the following day.

H Amblyopia must be treated in early childhood. Theyoungerthe child is, the more favorable and rapid the response to treatment will be. The upper age limit for occlusion therapy is approximately the age of nine. The earlier therapy is initiated, the sooner amblyopia can be eliminated.

The goal of treatment in infantile strabismus is to achieve alternating strabismus with full visual acuity and central fixation in both eyes. Binocular vision is less important in this setting. It is not normally developed anyway in patients who develop strabismus at an early age and cannot be further improved.

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