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Amblyopia

Última revisión: 19 Aug 2025
Última actualización: 17 Sep 2025

Resumen

Definición

History and exam

Key diagnostic factors

  • asymptomatic
  • subnormal visual acuity for age in one or both eyes
  • failure to ''fix and follow'' in infants
  • abnormal red reflex
Full details

Other diagnostic factors

  • 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
Full details

Risk factors

  • age <9 years
  • strabismus
  • high (uncorrected) refractive errors
  • media opacity
  • severe ptosis or prolonged occlusion of one or both eyes
  • prematurity
  • family history of amblyopia or strabismus
  • developmental delay
  • structural abnormality of the retina or vitreous
Full details

Diagnostic investigations

1st investigations to order

  • binocular red reflex test (Brückner test)
  • visual acuity tests (monocular)
  • stereopsis/binocular vision testing
  • assessment of fixation, ocular alignment and ocular motility
  • anterior segment exam using a slit lamp
  • dilated fundoscopy
  • cycloplegic retinoscopy
Full details

Emerging tests

  • visual evoked potentials (VEPs)

Treatment algorithm

ONGOING

without form-deprivation amblyopia

form-deprivation amblyopia

refractory amblyopia

Contributors

Authors

Irene Gottlob, MD

Professor of Ophthalmology

Cooper University Health Care

Cooper Medical School

Rowan University

Glassboro

NJ

Disclosures

IG declares that she has no competing interests. IG is an author of references cited in this topic.

Gail Maconachie, PhD, BMedSci

Lecturer

School of Allied Health Professions, Nursing and Midwifery,

Faculty of Health

University of Sheffield

UK

Disclosures

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

Eleni Papageorgiou, MD, PhD

Consultant in Pediatric Ophthalmology, Strabismus and Neuro-Ophthalmology

Department of Ophthalmology

University Hospital of Larissa

Larissa

Greece

Disclosures

EP declares that she has no competing interests.

Acknowledgements

Dr Irene Gottlob, Dr Gail Maconachie, and Dr Eleni Papageorgiou would like to gratefully acknowledge Dr Tina Rutar, the previous contributor to this topic.

Disclosures

TR declared that she had no competing interests.

Peer reviewers

Mary C. Whitman, MD, PhD

Assistant Professor of Ophthalmology

Boston Children’s Hospital

Harvard Medical School

Boston

MA

Disclosures

MCW declares that she has no competing interests.

Nathan Cheung, OD, FAAO

Assistant Professor of Ophthalmology

Duke University

Durham

NC

Disclosures

NC declares that he has no competing interests.

Michael Clarke, FRCS, FCOphth

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 topic.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American Academy of Ophthalmology. Amblyopia PPP 2022 - updated 2024. Dec 2022 [internet publication].Full text

Hutchinson AK, Morse CL, Hercinovic A, et al. Pediatric eye evaluations preferred practice pattern. Ophthalmology. 2023 Mar;130(3):P222-70.Full text  Abstract

US Preventive Services Task Force; Grossman DC, Curry SJ, Owens DK, et al. Vision screening in children ages 6 months to 5 years: US Preventive Services Task Force Recommendation Statement. JAMA. 2017 Sep 5;318(9):836-44.Full text  Abstract

American Academy of Ophthalmology. Pediatric ophthalmology/strabismus summary benchmarks - 2024. Dec 2024 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Amblyopia images
  • Differentials

    • Refractive error with no amblyopia
    • Functional visual impairment
    • Central nervous system pathology affecting visual pathways
    More Differentials
  • Guidelines

    • Amblyopia preferred practice pattern​​
    • Pediatric ophthalmology/strabismus summary benchmarks
    More Guidelines
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