Complications

Complication
Timeframe
Likelihood
short term
low

Prolonged patching in a young child can lead to reverse amblyopia, which is vision loss due to deprivation of normal visual stimulation in the normal eye.

A similar phenomenon can occur with prolonged use of atropine to penalize the normal eye.

Full-time patching is not recommended for most types of amblyopia treatment. Vision in the atropinized eye should be periodically monitored.

If reverse amblyopia is recognized and addressed promptly, visual impairment is short term.

short term
low

Atropine toxicity is recognized by flushing of the face, rash, elevated temperature, thirst, agitation, inappropriate behavior, and tachycardia. Atropine should be discontinued if these occur.

In rare instances, the child may need evaluation in the ER and admission for monitoring of vital signs.

long term
high

Untreated amblyopia is unlikely to improve on its own.[90] If the amblyopia is not treated during early childhood, permanent vision loss will result.

People with unilateral vision loss due to amblyopia also have an increased risk of vision loss in the normal eye.[98][99]

variable
low

Prolonged patching in a young child can disturb binocular vision and precipitate strabismus.

Children with monofixation syndrome have small-angle strabismus with central suppression but preserved peripheral binocular vision. Aggressive patching of a child with monofixation syndrome can disrupt the peripheral binocular vision that maintains ocular alignment and lead to a constant large-angle strabismus (typically esotropia). These patients frequently require strabismus surgery.

Pediatric Eye Disease Investigator Group studies have found roughly equal rates of new or worsening strabismus and resolved or improved strabismus after amblyopia treatment.[71][101]

Strabismus

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