What is patching?
Patching is a technique for treating amblyopia (lazy
eye). The good eye is patched to encourage the development
of good vision in the lazy eye. Amblyopia can be caused
by unequal refractive errors, crossed eyes, misaligned
eyes (strabismus), or other abnormalities.
When should treatment begin?
Patching should begin as early as possible. If the
child is old enough to understand, explain the reason
the patch is being used. It may be helpful to demonstrate
the patching on a doll.
If the child attends school or preschool, explain the
patching treatment and schedule to the child's teacher.
Enlist the teacher's help in encouraging the child to
perform his usual tasks, while making allowances for
added difficulty. The teacher can also help explain
the child's situation to classmates.
How long will the child need to wear a patch?
The time will vary for different children. As a general
rule, the younger the age of the child and the shorter
the time the eye has been lazy, the less time it will
take for treatment. In young children, vision may change
rapidly.
Occasionally, vision in the good (patched) eye may
be decreased when the patch is removed, but will usually
return to normal as soon as that eye is used again.
To ensure that a child is given the best possible chance
to develop normal vision, patching may be continued
for a few weeks or months after vision stabilizes. Once
vision has improved in the lazy eye, there is a chance
that it can worsen again, and close monitoring is necessary
throughout childhood.
If the vision does not improve after a reasonable period
of effective patching, your ophthalmologist may recommend
that this treatment be discontinued.
Will patching correct misaligned eyes?
No. Usually patching improves vision in an amblyopic
(lazy) eye but does not change misalignment of the eyes.
Once vision is good in each eye, your ophthalmologist
can recommend treatment for realigning the eyes.
What kind of patch should be used?
The patch should be comfortable, should remain firmly
in place, and should not allow the child to peek around
the edges. Commercial patches come in regular and junior
sizes, and are available at most drug stores. A gauze
pad held firmly in place with hypoallergenic tape can
also serve as an adequate homemade patch.
Black eye patches with elastic or ties are not recommended,
as they are too easy to remove or peek around. The patch
should be attached directly to the skin around the eye
for best results. Sometimes, a cloth or plastic patch
attached to the child's glasses can be effective, but
peeking is occasionally a problem.
What should be done if the skin becomes sore or irritated?
Leave the patch off at night and try a different type
of patch. Change the shape of the patch by reversing
its position on the eye. Switch to a gauze pad and hypoallergenic
tape. Special skin preparations can also be useful.
What if the child removes the patch?
For infants and toddlers, applying extra tape over
the patch is often enough to secure it. If your child
still succeeds in dislodging the patch, you may need
to cover his or her hands with mittens. Tube socks that
extend over the elbow under a long-sleeved T-shirt work
well. Distraction is often helpful for younger children
and positive reinforcement may be effective for older
ones. As a last resort, your ophthalmologist may recommend
specially designed plastic elbow restraints.
Older children may feel self-conscious about wearing
a patch to school. Wearing the patch only when not in
school or on weekends may achieve good results, but
the improvement may take longer.
Will exercises help?
The best exercise is wearing the patch! Fine, detailed
work which holds the child's interest will also encourage
use of the lazy eye and speed visual recovery.
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