12.5  Paediatrics and Strabismus Procedures

12.5.1 Patching for Amblyopia

Y (Why Have the Procedure)

“Your (child) has a “lazy eye” (the vision is poorer due to poor development: turn, short / long sighted, cataract etc.)

Aim: Strengthen vision in the poor eye.

NB: Patching is not used to correct the turn.

M (Mechanism, What is the Procedure)

“A patch is placed on the better eye.”

  • “The duration (full time or part time) depends on the severity of the amblyopia. When wearing the patch your child should have at least 2 hours of close work each day.”
  • “Your child is unlikely to like the patch. However it is very important for their vision that they continue to use it. If you are having difficulty, please contact me.”

Follow-up depends on the age.

C (Complications)

Most Common

  1. Intolerance / Allergy to patch
  2. Failure

Less Common

  1. Amblyopia develops in good eye (occlusion amblyopia)

Stress compliance, follow-up.

A (Alternatives)

  1. Do nothing- Amblyopia is largely irreversible after 9 years (earlier we start treatment the better)
  2. Atropine
  3. Optical penalization
  4. Newer amblyopia therapies are being trialed (including 3D games or movies) but have not yet been proven to be superior to patching

Confirm that the patient understands. Any questions?

12.5.2 Strabismus Surgery

Y (Why Have the Procedure)

“Your (child) has a “squint” (turn in the eye)”


  1. Cosmesis (“straighten the eyes”)
  2. Improve head posture
  3. Attempt to restore binocular single vision

Surgery in isolation will not improve vision. Ideally this is treated prior to undertaking squint surgery. It will not relieve the need for spectacles. This should be emphasised, particularly for children with partially accommodative esotropia.

M (Mechanism, What is the Procedure)

“A squint operation involves moving the muscles of the eye so that the eye is straightened (draw a diagram).”

  • “The procedure can be performed with fixed or adjustable sutures. If performed with adjustable sutures, the adjustment is performed a few hours after the procedure or the following day. Adjustable sutures are generally offered to older children or adults. We may choose to operate on either one or both eyes at the same time. The operation takes about 30-60 minutes. The operation is usually performed under a GA- your anaesthetist will explain this further.”
  • Pre-operation: Fasting, stop anticoagulants
  • Post-operation: Usually no admission, drops qid


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