eMedicine Specialties > Ophthalmology > Neurologic Disorders

Amblyopia: Differential Diagnoses & Workup

Author: Kimberly G Yen, MD, Assistant Professor of Ophthalmology, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine
Contributor Information and Disclosures

Updated: Dec 31, 2008

Differential Diagnoses

Esotropia and Exotropia, A-patterns
Exotropia, Acquired
Esotropia and Exotropia, V-patterns
Exotropia, Congenital
Esotropia, Accommodative
Monofixation Syndrome
Esotropia, Acquired
Ptosis, Congenital
Esotropia, Infantile
Esotropia, with High AC/A Ratio

Other Problems to Be Considered

Consider organic problems that may be subtle or difficult to diagnose, such as optic nerve hypoplasia.

Workup

Imaging Studies

  • If suspicion exists of an organic cause for decreased vision and the ocular examination is normal, then further investigations into retinal or optic nerve causes should be initiated. Studies to perform include imaging of the visual system through CT scan, MRI, and fluorescein angiography to assess the retina.

Other Tests

  • Although differences in the electrophysiologic responses of normal eyes versus amblyopic eyes have been reported, these techniques remain investigational and the differences are controversial.

Procedures

Histologic Findings

Histologic studies of the lateral geniculate nucleus in kittens with deprivation amblyopia have shown that cells receiving input from the deprived eye were shrunken and atrophied, while cells receiving input from the nondeprived eye were expanded.

More on Amblyopia

Overview: Amblyopia
Differential Diagnoses & Workup: Amblyopia
Treatment & Medication: Amblyopia
Follow-up: Amblyopia
References
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References

  1. American Academy of Ophthalmology. Amblyopia. In: Basic and Clinical Science Course: Pediatric Ophthalmology and Strabismus. 1997: 259-65.

  2. Kushner, BJ. Amblyopia. In: Nelson LB, ed. Harley's Pediatric Ophthalmology. 1998:125-39.

  3. von Noorden GK. Binocular Vision and Ocular Motility: Theory and Management. 1996;216-54.

  4. Lempert P. Retinal area and optic disc rim area in amblyopic, fellow, and normal hyperopic eyes: a hypothesis for decreased acuity in amblyopia. Ophthalmology. Dec 2008;115(12):2259-61. [Medline].

  5. Daw NW. Critical periods and amblyopia. Arch Ophthalmol. Apr 1998;116(4):502-5. [Medline].

  6. Kirschen DG. Understanding Sensory Evaluation. In: Rosenbaum AL, Santiago AP, eds. Clinical Strabismus Management: Principles and Practice. 1999: 22-35.

  7. Lin LK, Uzcategui N, Chang EL. Effect of surgical correction of congenital ptosis on amblyopia. Ophthal Plast Reconstr Surg. Nov-Dec 2008;24(6):434-6. [Medline].

  8. Flynn JT. Amblyopia: its treatment today and its portent for the future. Binocul Vis Strabismus Q. Summer 2000;15(2):109. [Medline].

  9. Flynn JT, Woodruff G, Thompson JR, et al. The therapy of amblyopia: an analysis comparing the results of amblyopia therapy utilizing two pooled data sets. Trans Am Ophthalmol Soc. 1999;97:373-90; discussion 390-5. [Medline].

  10. Flynn JT. 17th annual Frank Costenbader Lecture. Amblyopia revisited. J Pediatr Ophthalmol Strabismus. Jul-Aug 1991;28(4):183-201. [Medline].

  11. Brown SM. Verisyse IOL implantation in a child with anisometropic amblyopia. J Cataract Refract Surg. Jul 2008;34(7):1057-8. [Medline].

  12. Cotter SA, Edwards AR, Wallace DK, et al. Treatment of anisometropic amblyopia in children with refractive correction. Ophthalmology. Jun 2006;113(6):895-903. [Medline].

  13. Wallace DK, Chandler DL, Beck RW, et al. Treatment of bilateral refractive amblyopia in children three to less than 10 years of age. Am J Ophthalmol. Oct 2007;144(4):487-96. [Medline].

  14. Holmes JM, Kraker RT, Beck RW, et al. A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children. Ophthalmology. Nov 2003;110(11):2075-87. [Medline].

  15. Repka MX, Beck RW, Holmes JM, et al. A randomized trial of patching regimens for treatment of moderate amblyopia in children. Arch Ophthalmol. 2003;121:603-11. [Medline].

  16. Scheiman MM, Hertle RW, Beck RW, et al. Randomized trial of treatment of amblyopia in children aged 7 to 17 years. Arch Ophthalmol. Apr 2005;123(4):437-47. [Medline].

  17. Holmes JM, Beck RW, Kraker RT, et al. Risk of amblyopia recurrence after cessation of treatment. J AAPOS. 2004;8:420-8. [Medline].

  18. Pediatric Eye Disease Investigator Group. A randomized trial of atropine vs. patching for treatment of moderate amblyopia in children. Arch Ophthalmol. 2002;120:268-278. [Medline].

  19. Repka MX, Wallace DK, Beck RW, et al. Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate amblyopia in children. Arch Ophthalmol. 2005;123:149-157. [Medline]. [Full Text].

  20. Repka MX, Cotter SA, Beck RW, et al. A randomized trial of atropine regimens for treatment of moderate amblyopia in children. Ophthalmology. 2004;111:2076-85. [Medline].

  21. Scheiman MM, Hertle RW, Kraker RT, et al. Patching vs atropine to treat amblyopia in children aged 7 to 12 years: a randomized trial. Arch Ophthalmol. Dec 2008;126(12):1634-42. [Medline].

  22. Collins RS, McChesney ME, McCluer CA, et al. Occlusion properties of prosthetic contact lenses for the treatment of amblyopia. J AAPOS. Dec 2008;12(6):565-8. [Medline].

  23. Repka MX. How much amblyopia treatment is enough?. Arch Ophthalmol. Jul 2008;126(7):990-1. [Medline].

  24. Levartovsky S, Oliver M, Gottesman N, Shimshoni M. Factors affecting long term results of successfully treated amblyopia: initial visual acuity and type of amblyopia. Br J Ophthalmol. Mar 1995;79(3):225-8. [Medline].

  25. Wallace DK, Edwards AR, Cotter SA, Beck RW, Arnold RW, Astle WF, et al. A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic amblyopia in children. Ophthalmology. Jun 2006;113(6):904-12. [Medline].

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Further Reading

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Keywords

amblyopia, lazy eye, functional amblyopia, organic amblyopia, decreased vision, poor visual acuity, vision loss, monocular vision loss, blindness in one eye, strabismus, strabismic anisometropia, anisometropia, amblyopia treatment studies, ATS, refractive error, occlusion therapy, patching

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Contributor Information and Disclosures

Author

Kimberly G Yen, MD, Assistant Professor of Ophthalmology, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine
Kimberly G Yen, MD is a member of the following medical societies: Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Gerhard W Cibis, MD, Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas, Kansas City
Gerhard W Cibis, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Ophthalmological Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida
J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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