Patching for Amblyopia
Your child is being treated for a condition known as amblyopia, sometimes referred to a “lazy eye” in non-medical terms. Proper motivation and compliance with the patching schedule is of great importance to the success of the treatment. Several questions commonly asked by parents are:
Which type of Patch should I use?
For best effectiveness, I recommend “adhesive patches”. These fit securely on the face, preventing light from entering the eye and reduce your child’s ability to peep over or around the patch. Patches are available in junior size for infants and regular size for older children. A patch should not be used more than once.
If the child wears glasses and is old enough to understand not to “peep”, a cloth patch is available which fits on the glasses. It has side blinders to prevent looking around the side and is useful if the adhesive patch is irritating the skin.
I do not recommend the black eye patch that ties around the head as it may easily become displaced or the child may peep around the patch.
How is the Patch used
The patch is applied onto the skin, and spectacles, if worn, placed over the patch.
A child should never be patched without glasses (if glasses have been prescribed) as your child’s vision needs to be properly focused with glasses for the patching to work.
If the skin is irritated by the adhesive on the patch, the brand of patch should be changed.
Patching is prescribed for a particular number of hours per day depending on your child’s condition. Initially start patching for 15-20 minutes and increase the time patched daily until you have reached the prescribed number of hours. If your child objects to patching avoid confrontation, discontinue your efforts to patch that day and suggest re-patching the next day with some reward.
Apply E45 cream to skin and leave patch off for 24 hours
Change brand of patch
Child will not allow patch:
This is not an uncommon problem – again avoid confrontation and use a reward system occasionally an
alternative form of therapy (i.e. eye drops) can be used in children who will not allow patching.
Continue patching as prescribed until the next visit. Your child’s vision will be checked and a decision reached with regards future patching. It is common for children to patch up to age 8 or 9 depending on their particular condition.
Atropine drops for the treatment of Amblyopia
Atropine drops are another effective way to treat amblyopia. Atropine drops to the “better” eye causes vision in this eye to become blurred and forces the other eye to be used preferentially. This promotes visual recovery in the “weaker” eye. This treatment takes months to be effective and your child will be monitored on a four-monthly basis during therapy.
The drop causes the affected pupil to dilate, this is normal. If you attend your doctor or casualty please inform them that your child is taking atropine drops.
One drop is applied to the prescribed eye usually 2 nights per week. This is continued for 3.5 months and then stopped two weeks prior to your next visit. Occasionally daily atropine drops are prescribed. Once the drop is instilled put gentle pressure over the inside corner of the eye area for one minute to prevent absorption into the tear duct. One drop is all that is necessary and wash your own hands before and after placing the drops in your child’s eye. If you get this medicine in your eye the pupil will dilate.
Atropine is a safe medication if used correctly. It does have occasional side effects which are reversible when the medication is stopped. These include flushing, light sensitivity, dry mouth and eye redness.
If any of these effects occur, stop medication immediately and call 01-2103653 or 012440698. It is important to keep the medication out of reach of children as drinking it may have serious side effects.
Bangerter filters or foils are often used as secondary amblyopia therapy in situations where there is difficulty with patching or with atropine drops. A plastic filter of varying opacity is placed on the spectacle lens of the stronger eye. It remains in place and necessitates replacement every 3 -4 months as the material degrades. It has advantages in that it does not have the capacity to irritate the skin and is not very visible on the spectacle lens. It is not the preferred method for initial amblyopia therapy but is very helpful for maintenance therapy.
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