Case history
Case history #1
A 5-year-old girl presents with a 1-year history of intermittent crossing of the right eye. Her parents have not noticed deficits in her vision, and the child does not complain of any problems. She was born full-term and is otherwise healthy. Examination reveals visual acuity of 20/100 in the right eye and 20/25 in the left eye. Cover testing shows a constant right esotropia (inward deviation). She does not maintain fixation with the right eye. Ocular motility is full. A referral to an ophthalmologist is made to confirm a diagnosis.
Case history #2
A 6-week-old boy is referred to ophthalmology because of an abnormal red reflex in both eyes. His mother does not think her baby tracks her face. He was born full-term and is otherwise healthy. There was no history of intrauterine infections or drug exposure. On examination, the baby does not fix and follow with either eye, but he does respond to light by blinking. The pupils are equally reactive without afferent pupillary defect. Nystagmus is absent. The eyes are exotropic (deviated outward), detected on corneal light reflex testing. There is no red reflex on retinoscopy and no view of the fundus.
Other presentations
Warning signs that amblyopia may be present include strabismus, subnormal result on vision testing (inability to fix and follow with each eye in a preverbal child, decreased monocular or binocular visual acuity in a verbal child), a visible structural abnormality of the eye (such as an opaque cornea or absent red reflex), and nystagmus. Eye strain is not a common presentation of amblyopia.[4] Amblyopia does not occur in patients with subnormal vision due to low to moderate myopia (nearsightedness). Children with mild hyperopia (farsightedness) that is equal in the two eyes also do not typically develop amblyopia, nor do they have subnormal vision. Amblyopia prevalence does not vary with age.[5] However, detection of amblyopia is more challenging in young preverbal children than in older children. Anisometropic amblyopia tends to be diagnosed later than strabismic amblyopia because anisometropic children exhibit signs of a vision problem only when monocular visual acuity is tested.[6][7]
Use of this content is subject to our disclaimer