A lazy eye is when the eye and the brain aren’t working together properly so that the vision in one of the eyes is poor. The affected eye usually looks fine physically, but it isn’t being used as much because the brain is favouring the other eye. The eye that isn’t being used properly may be called a ‘lazy eye’. It's thought that up to three in 100 children have a lazy eye.
A lazy eye usually begins in childhood, during a key phase when your child's vision is still developing and his or her brain is learning to understand the information coming from the eyes. This process is usually complete by age eight. A lazy eye is a problem with the development of vision by your child's brain rather than a disease or condition affecting the eye itself.
When your child looks at an object, each eye picks up an image. This information is sent to the brain and turned into one image. The images from each eye provide slightly different information about the object, which enables your child to judge depth (the ability to determine the distance between objects).
If your child has a problem with the images from one eye, for example if the visual image from one eye is somehow too different to that from the other, because the eyes aren't both facing the same direction or the image is blurred, then a lazy eye could develop. When this happens, the brain starts to ignore the poor image and uses just the image from the other eye.
If your child’s brain only takes in the visual information from one eye, he or she will have a reduced ability to judge depth. This may not be an immediate concern but it could mean your child has problems reading, doing some sports and, in later life, may make certain careers impossible, for example becoming a pilot. Also, relying on vision in one eye alone could lead to serious sight problems if vision in the other eye is affected later in life.
Often, your child will have no obvious symptoms of having a lazy eye and won’t know that one eye is working better than the other. Even if your child does notice a difference, he or she may not be able to explain that his or her vision differs in each eye. If your child is young, it may be easier to notice that he or she has a lazy eye by covering one eye at a time. It’s likely that when the eye that is working well is covered your child will try to push the cover away. If your child is older, he or she may mention having problems seeing with one eye.
For some children who have a lazy eye, you may be able to notice that their eyes look different to each other. One eye may look in a different direction to the other (a squint), one eye may be cloudy (from a cataract for example) or one eyelid may be drooping and covering part of that eye (a ptosis). These physical eye problems could cause a lazy eye to develop and will need to be treated before your child can be treated for a lazy eye.
These symptoms aren’t always caused by a lazy eye, but if your child has them, see your GP.
If a problem with the vision in one eye is left untreated, it can lead to a permanent loss of vision in that eye. A squint can also develop and your child’s ability to judge depth may be affected (this may lead to your child being unable to do certain occupations later in life). However, lazy eye does not cause complete blindness and your child will still be able to get around obstacles when using his or her affected eye. Occasionally the development of vision in both eyes will be affected.
Vision development continues until about age eight – after this it is much more difficult to treat a lazy eye and correct your child’s vision.
Underlying causes of a lazy eye may occasionally lead to more serious health problems. Therefore, if you think your child may have a lazy eye, it’s important to see your GP.
The visual information from one of your child's eyes may be ignored by the brain as a result of the following eye conditions.
If your GP thinks your child may have problems with his or her vision, he or she will refer your child to an orthoptist or an ophthalmologist. An orthoptist is a health professional who specialises in eye movement problems such as squints, lazy eyes and double vision. An ophthalmologist is a doctor who specialises in eye health, including eye surgery.
An orthoptist will carry out routine assessments using specialised techniques to determine whether your child is at the right stage of visual development. Often orthoptists do screening before children start school to identify those who might otherwise go untreated.
An ophthalmologist will carry out a detailed examination of your child's eyes to exclude any other causes of poor vision. If the ophthalmologist thinks that your child has a lazy eye or is at high risk of developing one, it may be necessary to monitor your child for several years.
Even if your child has previously had an eyesight check, it's still worth seeking advice if you have any concerns about his or her vision.
It's important to get treatment for your child's visual problems as early as possible. After about the age of eight, treatment may not be effective.
The success of treatment for your child's lazy eye will depend on what is causing it, his or her age, level of vision at diagnosis and how carefully your child sticks to the treatment plan.
Your child may only need to wear a pair of glasses (or sometimes contact lenses). These will correct the blurring caused by long- or short-sightedness in the affected eye, or help to stop your child's eyes from squinting. It's important to try to ensure that your child wears his or her glasses as instructed by your orthoptist or ophthalmologist and to report back any problems.
More involved treatment aims to force the affected (lazy) eye to start working again. This is done by covering or blurring the vision in your child's other eye using either a patch (occlusion) or, less frequently, eye drops and ointments (penalisation). Occasionally, your child may be prescribed glasses or contact lenses to blur the vision in his or her other eye.
Your child may need to wear the eye patch for several hours a day over many weeks or months, or use eye drops or ointments for several days at a time.
There is a risk that the other eye may become lazy if it’s covered up too much or for too long. Your orthoptist or ophthalmologist will monitor your child's progress carefully and adjust treatment accordingly, but it's important to follow his or her advice and instructions, and to report back any concerns. Getting your child to wear a patch over his or her better eye can be hard work. If the treatment proves too difficult, talk to your orthoptist or ophthalmologist about other options.
Any conditions found to be causing your child's visual problems will also be treated or monitored by your ophthalmologist.
The length of time for which your child will need to wear an eye patch to prevent a lazy eye developing further will vary.
The time needed to treat a lazy eye using an eye patch depends on several factors.
First, the age at which your child's visual problems developed and how old he or she was when diagnosed can determine how long he or she will need to wear an eye patch. Generally, the younger your child is, the sooner he or she will respond to treatment and the better the outcome of this will be.
The severity of the lazy eye and how good your child's vision is will affect how long he or she will need an eye patch. The better your child's vision is, the quicker treatment will start to work.
The cause of a visual problem can also affect how well treatment works. If your child's lazy eye is caused by unequal vision in each eye because of problems such as long-sightedness, short-sightedness or astigmatism (where the cornea at the front of the eye isn’t perfectly curved), it will usually take longer for treatment to be effective than if it’s caused by a squint.
Finally, the biggest factor affecting the length and success of treatment is how strictly the treatment plan is followed. It’s very important that your child carefully follows the treatment plan from the orthoptist. Research has shown that the more closely the treatment plan is followed, the sooner the lazy eye starts to work again and the more vision is saved.
If you have any questions or concerns about your child's lazy eye, talk to your child's optometrist.
No, it isn't possible for a child to grow out of a lazy eye. If left untreated, your child may never be able to see properly out of the affected eye.
Up to the age of six, your child's eyesight is very sensitive. Any changes to the balance of vision through their eyes can interrupt the healthy development process. If a physical visual problem is left untreated, vision in the affected eye can be permanently damaged or lost. This is usually irreversible by the age of eight.
If you suspect that your child has a lazy eye, it's very important to get treatment as soon as possible. Regular eye checks with an optometrist will ensure that any problems are picked up and treated early.
If you have any questions or concerns about your child's lazy eye, talk to your GP or optometrist.
Yes, it’s possible for lazy eye to recur in children who have already been treated for the problem. This usually only happens before a child is eight, after which time there will be little change in vision.
The earlier your child is treated the more chance there is of his or her sight being completely corrected. However, it’s possible that your child’s lazy eye may come back until after his or her visual system has fully developed (about age eight). Your child may find he or she has less clear vision even after his or her vision is completely developed.
Your child’s optometrist will recommend the best treatment. It’s important that any underlying causes of the lazy eye are treated before any use of a patch or drops begins. This may mean your child needs to wear glasses or contact lenses to correct long- or short-sightedness. If your child has any cataracts, these will need to be removed and if his or her eyelid droops and covers part of the eye (ptosis), this will need to be corrected.
Your child will then be encouraged to use the lazy eye by putting a patch over the good eye or by using drops in the good eye. These blur the vision in that eye and make the lazy eye work harder. Your child’s optometrist may recommend that your child continues with maintenance treatment until he or she is about 10 to try to prevent the lazy eye coming back again. This may involve part-time patching, or full- or part-time use of drops to blur vision in the good eye.
If you have any questions or concerns about a lazy eye, talk to your child's optometrist or GP. He or she will refer you to either an orthoptist or ophthalmologist for further investigation.