AMBLYOPIA

Wasisdi Gunawan, Ophthalmologist

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 Amblyopia

Amblyopia is a unilateral or less

commonly, bilateral reduction of best-
best-
corrected visual acuity that cannot be
attributed directly to the effect of any
structural abnormality of the eye or the
posterior visual pathway

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Amblyopia occurs in approximately 2 %
of the general population

The most common cause of decreased

vision in childhood

Children are susceptible to amblyopia

between birth until 7 to 8 years of age

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 Symptoms

Poorer vision in one eye that is not improved with
refraction althought all the abnormality have already
treated well

No abnormality in fundus examination

Crowding phenomenon

A neutral-
neutral-density filter significantly reduces vision in
organic disease

Nystagmus

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 Pathophysiology

Amblyopia is primarily a defect of central

vision, the peripheral visual field nearly
always remains normal

In children < 6 years there is visual

stimulant disorder in it growing and visus

Prevalence : 2 - 4 % from population

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 Etiology

Strabismus

Anisometropia or high bilateral refractive

errors (isometropia)

Visual deprivation / occlusion (e.g,. ptosis,

eyelid hemangioma, cataract, corneal scar)

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 Classification base on etiology

A. Strabismic Amblyopia :
1. Congenital Esotropia
2. Congenital Exotropia
3. Accommodative Esotropia
4. Intermittent Exotropia

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Infantile left Esotropia

Good result following

recession of both redial
recti
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V pattern Exotropia in
primary position

V pattern Exotropia in Down-

Down-gaze
and Up-
Up-gaze
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 Strabismic amblyopia

Strabismus associated with strong

fixation preference results in constan
unilateral suppression of cortical
activity related to the nonpreferred
eye (deviated eye)

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Strabismic amblyopia is common, and
occurs in aproximately 50 % of patients
with congenital esotropia

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B. Monocular pattern distortion amblyopia :
1. Anisometropia

2. Unilateral cataract

3. Unilateral corneal opacity (Peter’s)

4. Unilateral vitreus hemorrhage or vitreus opacity

5. Unilateral ptosis

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Anisometropic amblyopia develops when
unequal refractive error in the two eyes
causes the image on one retina to be
chronically defocused

Hipermetropia 5 D, astigmat 2 D

Myop anisometropia > 3 D

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Strabismus

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Strabismus

Aphakic spectacle corrections

after congenital cataract surgery
for two romanian chidren

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C. Bilateral pattern distortion amblyopia :

1. Ametropic
a. Bilateral high hypermetropia
b. Meridional (astigmatism)

2. Media opacity
a. Bilateral congenital cataracts
b. Bilateral corneal opacities
c. Bilateral vitreous hemorrhages
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A bilateral reduction in acuity that is
usually relatively mild

Isometropic amblyopia result from large,

approximately equal,

Uncorrected refractive errors in both eyes

of a young child

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Hyperopia exceeding about 5 D and
myopia in excess of 10 D carry a risk of
inducing bilateral amblyopia

Uncorrected bilateral astigmatism in early

chilhood may result in loss of resolving
ability limited to the chronically blurred
meriadians (meridional amblyopia)

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 Cataract congenital

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 Cataract congenital

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 Cataract congenital

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 Diagnosis

Amblyopia is diagnosis when evidence of
reduced visual acuity that cannot be
explained entirely on the basis of physical
abnormalities

Crowding phenomen

Afferent pupillary defects

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 Occlusion therapy

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 Right amblyopia treated by occlusion of the
normal left eye

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 Management
1. It must be done before 6 years old

2. Eliminating (if possible) any obstacle to vision

such as a cataract, ptosis, corneal opacity

3. Correcting refractive error

4. In most unilateral or asymmetric cases, forcing

use of the poorer eye by limiting use of the
better eye (occlusion)

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Bilateral congenital cataract

Congenital convergent
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