PANCE Blueprint EENT (7%)

Amblyopia (lazy eye)

Patient will present as → a 5-year-old male is brought by his parents and referred by his teacher for suspected decreased vision in his left eye. His mother had not noticed any vision problems. He has had normal growth and development. On exam, the patient has an abnormal vision screen of the left eye and red reflex asymmetry. 

Amblyopia (lazy eye) is reduced visual acuity is not correctable by refractive means

  • Amblyopia occurs in early childhood. When nerve pathways between the brain and an eye aren't properly stimulated, the brain favors the other eye
  • It may be caused by strabismus (crossed eye); uremia; or toxins, such as alcohol, tobacco, lead, and other toxic substances
  • Symptoms include a wandering eye, eyes that may not appear to work together, or poor depth perception, blurred vision or double vision. Both eyes may be affected

Screening to detect amblyopia in all children younger than five years of age

  • Screening includes vision risk assessment at all health maintenance visits and vision screening at three, four, and five years of age

Treatment includes correction of refraction error as well as forced use of the amblyopic eye by patching the better eye

  • Some children cannot tolerate the patch, in which case the sound eye is blurred with glasses or drops (penalization therapy) to stimulate proper visual development of the more severely affected eye
  • It is more resistant to treatment at an older age; thus children should be treated early
Question 1
The definition of amblyopia is
A
Congenital cataracts noted at birth
B
Retinal detachment seen in premature children
C
Irregular pupillary size
D
Increased distance between the medial and lateral canthus
E
Subnormal visual acuity in one or both eyes despite correction of refractive error
Question 1 Explanation: 
E. Amblyopia is subnormal visual acuity in one or both eyes despite correction of a refractive error. It results when the child suppresses the vision in one eye to avoid diplopia. Organic disease may be present but is insufficient to explain the level of vision. Amblyopia is frequently asymptomatic and detected only by screening programs. It is more resistant to treatment at an older age; thus children should be treated early. Other causes (neurologic, psychologic) must be considered if the history and ophthalmologic examination are not suggestive of amblyopia. Treatment includes correction of refraction error or removal of cataract, as well as forced use of the amblyopic eye by patching the better eye. Some children cannot tolerate the patch, in which case the sound eye is blurred with glasses or drops (penalization therapy) to stimulate proper visual development of the more severely affected eye.
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