• Should I have my son’s good eye patched until he has surgery for a droopy eyelid?


    Question:

    My 3-month-old was diagnosed with congenital ptosis (droopy eyelid at birth) in his left eye at four weeks. Although both eyes are farsighted, the eye with the ptosis does not appear to be any worse off and there are no signs of amblyopia (when vision in one or both eyes does not develop normally during childhood). He tracks well and uses the eye despite the droop. He will need surgery, but we are waiting until he is 3. However, our pediatric ophthalmologist has us patching him for an hour per day simply as a “preventative” measure. She also is prescribing him glasses. Everything I read about patching is to treat children who already have amblyopia. We find the patching to be extremely difficult and frustrating to execute as he just gets angry and goes to sleep after only ten minutes or so. Is patching as a preventative measure really the standard of care? I am starting to think we should get a second opinion. I don’t understand why we are patching him if his vision is fine right now.


    Answer:

    It is very difficult to determine if a small child has a lazy eye. They are very clever at peaking around an occluder (patch). If your child has severe unilateral (in one eye) ptosis, the risk of amblyopia is significant. Patching ensures that your child will be using the eye with ptosis equally while awaiting ptosis repair. The degree to which a child struggles with a patch may be a measure of vision weakness. Check to see if your child fusses equally when the droopy lid is patched.

    We do recommend close cooperation with your pediatric ophthalmologist. Amblyopia avoidance is very important and the decisions regarding patching and timing and type of surgery are important and can vary as the child matures.


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