Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

Amblyopia 105

Screening

■Form deprivation: evaluate red light reflex form in both pupils <6 mo

of age

■Strabismic: examine eye alignment by light reflex or cover test in first

few years of life

■Anisometropic: visual acuity testing in preschool years

differential diagnosis

■Monocular:

➣Form deprivation: eg, congenital monocular cataract

➣Strabismic: eg, esotrope w/ fixation; preference for 1 eye

➣Anisometropic: eg, high myopia in 1 eye

■Binocular:

➣Form deprivation: eg, congenital binocular cataracts

➣Ametropic: eg, high hyperopia in both eyes

■Sensitive period for each type (when vision can be recovered toward

normal):

➣Monocular:

Form deprivation: <6 mo

Strabismic: <6 y

Anisometropic: <8–9 y

➣Binocular:

Form deprivation: <6 mo

Ametropic: <8–9 y

management

■Reverse unequal inputs:

➣Form deprivation: remove cataract

➣Strabismic: realign eyes w/ glasses, contacts, eye drops, surgery

➣Anisometropic: correct refractive error w/ glasses or contacts

■Decrease visual input to nonamblyopic eye:

➣Patching: part- or full-time

➣Penalization for cycloplegic eyes: drop in fixing eye (pt must be

hyperopic in fixing eye)

➣Black contact lens: must be removed daily

specific therapy

n/a

follow-up

■Monitor visual acuity in amblyopic eye until it returns to normal

complications and prognosis

n/a