Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- lactente não segue a face dos pais
- reflexo vermelho anormal
Other diagnostic factors
- assintomático
- acuidade visual subnormal para a idade em um ou em ambos os olhos
- reflexo da luz na córnea assimétrico
- resposta desigual à oclusão alternada dos olhos
- teste de cobrir/descobrir anormal
- visão turva
- fadiga ocular
- nistagmo congênito
- exame da pupila anormal
- exame ocular externo anormal
Risk factors
- idade <9 anos
- estrabismo (desalinhamento dos olhos)
- opacidade na córnea, câmara anterior, cristalino, câmara vítrea ou superfície retiniana
- ptose grave ou oclusão prolongada de um ou de ambos os olhos
- prematuridade
- história familiar de ambliopia ou estrabismo
- anisometropia hipermétrope (vista longa com erro de refração desigual entre os 2 olhos) >+1.50 dioptria
- anisometropia miópica
- astigmatismo (desfocamento cilíndrico, e não esférico, do olho) >2.00 dioptrias
- hipermetropia >+4.50 dioptrias
- miopia >-3.00 dioptrias
- atraso do desenvolvimento
Diagnostic tests
1st tests to order
- testes de acuidade visual (por especialista)
- estereopsia (percepção de profundidade ou 3 dimensões) e teste da visão binocular
- avaliação de fixação, alinhamento ocular e motilidade ocular
- exame do segmento anterior usando uma lâmpada de fenda
- fundoscopia dilatada
- retinoscopia cicloplégica
- teste do reflexo vermelho binocular (teste de Brückner)
Emerging tests
- potenciais evocados visuais
Treatment algorithm
ambliopia sem privação de forma
ambliopia por privação de forma
ambliopia refratária (paciente não observante)
Contributors
Authors
Irene Gottlob, MD
Professor of Ophthalmology
Department of Neuroscience, Psychology and Behaviour
University of Leicester
Ulverscroft Eye Unit
Leicester Royal Infirmary
UK
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
David Robbins Tien, MD
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.
David K. Wallace, MD, MPH
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 topic.
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
Key articles
Cruz OA, Repka MX, Hercinovic A, et al. Amblyopia preferred practice pattern. Ophthalmology. 2023 Mar;130(3):P136-78.Full text Abstract
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 - 2022. December 2022 [internet publication].Full text
Wallace DK, Lazar EL, Holmes JM, et al; Pediatric Eye Disease Investigator Group. A randomized trial of increasing patching for amblyopia. Ophthalmology. 2013 Nov;120(11):2270-7.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Erros de refração sem ambliopia
- Comprometimento funcional visual
- Patologia do sistema nervoso central afetando as vias visuais
More DifferentialsGuidelines
- Vision rehabilitation preferred practice pattern
- Vision screening for infants and children
More Guidelines
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