Intended for healthcare professionals

Clinical Review


BMJ 2015; 351 doi: (Published 12 November 2015) Cite this as: BMJ 2015;351:h5811
  1. Joanna M Jefferis, ophthalmology trainee1,
  2. Alan J Connor, paediatric ophthalmology fellow23,
  3. Michael P Clarke, consultant paediatric ophthalmologist3
  1. 1Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
  2. 2Department of Ophthalmology, Hospital for Sick Children, Toronto, Canada
  3. 3Newcastle Eye Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle Upon Tyne NE1 4LP, UK
  1. Correspondence to: J M Jefferis jojefferis{at}

What you need to know

  • Amblyopia is a form of cortical visual impairment which can result from any condition that prevents normal visual stimulation in the first few years of life

  • Most amblyopia arises as a result of a difference in refractive errors between the two eyes (anisometropia), ocular misalignment (strabismus or squint), or a combination of these two factors

  • Most amblyopia is unilateral and, as such, may go unnoticed by children and parents until detected at screening

  • In the UK, orthoptic-led vision screening is recommended for all children at school entry age (4-5 years)

  • There are two phases in amblyopia treatment: (1) optical correction of any refractive error for a period of 12-16 weeks, which will be the only treatment required in 25% of children, and (2) occlusion or atropine therapy

  • Occlusion therapy with patches in a 4 year old child would typically be prescribed for 3-6 hours a day for a period of 3 months in the first instance

  • Atropine eye drops can be used in children older than 3 years as an alternative to patching, with 1% atropine once daily at the weekends an effective dose

What is amblyopia?

Amblyopia is a form of cortical visual impairment. It results from abnormal visual development in childhood, secondary to another pathological process, and can lead to permanent, usually monocular, reduced vision.1 It affects a variety of visual functions (see table 1). The term “lazy eye” is often used, but amblyopia should be differentiated from strabismus (squint). These conditions may coexist, but the treatments should be considered separately.

View this table:
Table 1

Visual functions adversely affected in amblyopia and their definitions. Note that visual fields, colour vision, and pupillary responses are usually unaffected

Sources and selection criteria

We searched Medline from 1950 to 2015 using a broad search strategy with appropriate descriptors and key words: amblyopia, vision screening, occlusion, atropine, or a combination of …

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