Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- assintomático
- acuidade visual subnormal para a idade em um ou em ambos os olhos
- falha no teste de "fixar e seguir" em bebês
- reflexo vermelho anormal
Other diagnostic factors
- 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
- erros de refração altos (não corrigidos)
- opacidade dos meios
- ptose grave ou oclusão prolongada de um ou de ambos os olhos
- prematuridade
- história familiar de ambliopia ou estrabismo
- atraso do desenvolvimento
- anormalidade estrutural da retina ou do vítreo
Diagnostic tests
1st tests to order
- teste do reflexo vermelho binocular (teste de Brückner)
- testes de acuidade visual (monocular)
- teste de estereopsia/visão binocular
- avaliação de fixação, alinhamento ocular e motilidade ocular
- exame do segmento anterior usando uma lâmpada de fenda
- fundoscopia dilatada
- retinoscopia cicloplégica
Emerging tests
- potenciais evocados visuais (PEVs)
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
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
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.
Differentials
- Erros de refração sem ambliopia
- Comprometimento funcional visual
- Patologia do sistema nervoso central afetando as vias visuais
More DifferentialsGuidelines
- Amblyopia preferred practice pattern
- Pediatric ophthalmology/strabismus summary benchmarks
More Guidelines
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer