Last reviewed: November 2017
Last updated: December  2016

Summary

Definition

History and exam

Key diagnostic factors

  • infant not tracking parent's face
  • abnormal red reflex

Other diagnostic factors

  • asymptomatic
  • subnormal visual acuity for age in 1 or both eyes
  • asymmetric corneal light reflex
  • unequal behavioral response to alternate eye occlusion
  • abnormal cover/uncover testing
  • blurred vision
  • eye strain
  • congenital nystagmus
  • abnormal pupil exam
  • abnormal external eye exam

Risk factors

  • age <9 years
  • prematurity
  • FHx of amblyopia or strabismus
  • strabismus (misalignment of the eyes)
  • hyperopic anisometropia (farsightedness with unequal refractive error between the 2 eyes) of >+1.50 diopter
  • myopic anisometropia
  • astigmatism (cylindrical, rather than spherical, defocus of the eye) >2.00 diopter
  • hyperopia >+4.50 diopter
  • myopia >-3.00 diopter
  • opacity in the cornea, anterior chamber, lens, vitreous, or retinal surface
  • severe ptosis or prolonged occlusion of 1 or both eyes
  • developmental delay

Diagnostic investigations

1st investigations to order

  • visual acuity tests (by specialist)
  • stereopsis (perception of depth or 3-dimensionality) and binocular vision testing
  • assessment of fixation, ocular alignment and ocular motility
  • anterior segment exam using a slit lamp
  • dilated fundoscopy
  • cycloplegic retinoscopy
  • binocular red reflex test (Br├╝ckner test)
Full details

Emerging tests

  • visual evoked potentials
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor of Ophthalmology

Department of Neuroscience, Psychology and Behaviour

University of Leicester

Ulverscroft Eye Unit

Leicester Royal Infirmary

UK

Disclosures

IG has undertaken amblyopia research supported by the National Eye Research Centre, the Ulverscroft Foundation, the National Institute of Health Research, and Action Medical Research. An employer of IG, The University of Leicester, holds a European patent for glass dose monitors. IG is an author of references cited in this monograph.

Research Orthoptist

Department of Neuroscience, Psychology and Behaviour

University of Leicester

UK

Disclosures

GM declares that she has no competing interests. GM is an author of a reference cited in this monograph.

Dr Irene Gottlob and Dr Gail Maconachie would like to gratefully acknowledge Dr Tina Rutar, the previous contributor to this monograph. TR declares that she has no competing interests.

Peer reviewers VIEW ALL

Associate Clinical Professor of Ophthalmology

Alpert Medical School of Brown University

Director of Ophthalmology

Hasbro Children's Hospital

Providence

RI

Disclosures

DRT declares that he has no competing interests.

Associate Professor of Ophthalmology and Pediatrics

Duke Eye Center

Durham

NC

Disclosures

DKW has received NEI grants of more than 6 figures USD. DKW is an author of a number of references cited in this monograph.

Reader in Ophthalmology

Newcastle University

Newcastle

UK

Disclosures

MC has received NHS research grants of more than 6 figures USD. MC is an author of a number of references cited in this monograph.

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