Patching Primer

This is a companion piece to the post about just starting out with glasses.  I’m hoping to pull together information for parents who have just learned that they need to patch their child’s eye.  Please leave comments with anything I’m missing!  – Ann Z

Why Patching?

boy and his toy monkey patching

George the monkey is wearing an adhesive patch. Owen is wearing a cloth patch (with adhesive tape keeping it on so he can’t peek).

Eye patching is done for a few different reasons.  Sometimes an eye is injured or recovering from surgery and needs to be protected by an eye patch.  More often, though, eye patching is done as part of the treatment for amblyopia (also known as “lazy eye”), or in an attempt to keep amblyopia from developing, and in some cases for helping with strabismus.  It’s these latter reasons that I’ll be focusing on (no pun intended) in this piece.

With amblyopia, even when the eye sight is corrected with glasses, the brain doesn’t see images clearly from one eye.  Basically, the brain favors one eye over the other.  Untreated, this disrupts stereovision (both eyes working together) and can lead to permanent vision loss in the weaker eye.  By patching or otherwise penalizing the stronger eye, you encourage the brain to start recognizing the weaker eye again.

Read on for more

Risks of Patching

There are very few risks associated with patching.  Children who are patching may be clumsier than normal, due to the fact that they will not be seeing as well as they’re used to.  Children may also have allergic reactions to the patches. In rare cases, patching can cause the stronger eye to weaken.  This can be treated if caught early, which is why close monitoring and follow ups are very important when patching.

How long to Patch

Most doctors start children off patching 2-4 hours per day, but the prescribed number of hours will differ based on your child’s situation.  As your child’s eye sight improves, the amount of patching time should be decreased.

Types of Patches

There are two main types of patches that work well for amblyopia treatment:

Adhesive
  • These look a little like bandaids and sit directly on your child’s skin, covering their eyes.
  • They are almost always disposable and one-use only.
  • Many come with posters where you can put the used patches on a poster like a sticker to help track progress.
  • They can be plain or decorated.
  • It can be easy for some kids to pull the patches off their faces.
  • The adhesive can sometimes irritate the skin.  Milk of magnesia, or other facial creams applied to the skin before putting the patch on, or putting the patch on your arm first to remove some of the adhesive, can help alleviate that.
Cloth (sometimes foam)
  • These go over the glasses.
  • They are almost always re-usable.
  • They can be plain or decorated.
  • It can be easy for some kids to peek around the patch, which renders them useless in amblyopia treatment.  Make sure that the patch fits well and offers no way to peek.
  • Some can get warm, especially in hot weather.
  • These are much easier on the skin as there’s no adhesive.
Read more:

Keeping the patch on

wearing a patch with your child can help with compliance

It can be extremely hard to have child patch.  When the good eye is patched, it makes it hard for your child to see, which is why many children fight patching.  It’s a frustrating conundrum, they need to patch to improve their eyesight in their weaker eye, but that weak eyesight is what makes the patching so difficult.

The best way to keep the patch on is going to depend a lot on your child, here’s some ideas:

  • For older children, explain the importance of patching, and talking about it as an exercise to strengthen the eye.
  • Reserve a favorite activity for patch time, and only let them do the activity while patching.
  • Use reward charts and stickers are another option.  If you’re using adhesive patches, those patches can be used as stickers – there are even posters sold by some patch companies.
  • Wear a patch along with your child, or have a favorite stuffed animal or doll wear a patch while your child patches.
  • For very young children, you can look at arm braces or flotation wings to keep them from reaching their eyes to remove the patch.
  • Have friends and family decorate patches for your child, and let your child choose the patch each day.
More reading:

Alternatives to patching

There are options beyond patching that that can provide similar benefits.  Patching is referred to as “occlusion therapy.”  The treatments below are “penalization therapy”.  They’re called that, because they don’t completely cover the stronger eye, but rather they reduce the vision in the strong eye.  One of the advantages to these is that they are not as visually obvious, w  As with all treatments, you should talk with your child’s eye doctor about the different treatment options.

Eye drops. National Eye Institute, National Institutes of Health.

Atropine drops
  • These are the drops you receive to dilate the eyes.  You put drops in the child’s good eye, and that reduces the vision in that eye
  • It is much less visibly noticeable to use atropine drops compared with patching
  • Once the drops are in, your child will not be able to escape being patched (they can’t remove the drops or peek around them)
  • The eye that receives the drops will be considerably more light sensitive
  • The drops can sting, and most children do not like them
  • The drops will not work well for cases where the corrected vision in the weak eye is very bad.  In those cases, the eye that received the drops will still be seeing better, and so there won’t be the encouragement for the brain to use the weaker eye.
  • Atropine is a drug, and like all drugs it has side effects.  Though most are mild, they can be severe, especially if the drops are used incorrectly.  Please talk with your doctor and make sure you understand the risks.
Filters / Fogging
  • The lens of the glasses for the stronger eye can be covered with opaque material.  In some cases, this is done by simply covering the lens with adhesive tape.
  • It may be easier for your child to peek around the lens.
More reading

Patching resources

  • Posts about patching on Little Four Eyes
  • AmblyopiaKids – a site dedicated to awareness and support for amblyopia.  Lots of patch reviews, tips, and links to many patch vendors.
  • Prevent Blindness America – Prevent Blindness has a forum for parents of children with vision issues, most of the discussion is around patching and amblyopia.  There is also the Eye Patch Club – a club for children who are patching.  Note – the club has a fee.
  • Bjort & Company – DVD and other items for kids who need to patch.
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4 responses to “Patching Primer

  1. As always, a wonderful post! We have to patch all the time and my daughter generally tolerates it well. Whenever you get time (hah!) I would love to hear how your daughter is faring with her regimen now and would also love to get an update from amomofelly.

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  2. Hi there,
    It’s been a while since we have posted but just wanted to share some good news to give those parents struggling with patching some positive words to keep going. We visited the opthalmologist on Monday for the first time in six months and Paris (4 years) has reached equal vision in both eyes! We are so so happy. She started out with very poor vision in her left eye due to being quite short sighted in it and having perfect vision in the other eye (she was shutting it off) She got glasses at one and has been patching a couple of hours every day for the past three years. Well her vision has just got better and better and the PO said it is due to sheer diligance and patching that has given us these fab results. In fact, her astigmatism has also reduced and her script. We are seeing her drift less and less and things are starting to get so much easier. We can now taper off the patching to just a few hours a week and don’t have to see him again for another six months. Also, just a little advice re the glasses. Paris has these lovely new plastic frames, they are great but we had soooo much trouble with them falling down her nose. No one has ever told me about to simple little plastic bits you stick on the nose bridge and viola! They do not move! at all! It lifts them up without flattening her eye lashes like magic. Anyone struggling with the glasses slipping you have to get them. Th PO said if she is looking over her glasses she might as well takea step backwards and not wear them at all. He recommended these. I cannot believe not one optomotrist has advised me about these. So simple. I was forever in trying to get them re fitted to make them stay up.! Anyway, just some positive vibes and had to share our happy news. KEEP GOING, patching works xxx

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  3. Pingback: More ways to help your child wear a patch « little four eyes·

  4. I’ve been wondering when Owen’s picture was going to be up! I’m a little late to the game! He’s been doing a lot better with his patching, he now wears Ortopad patches (he kept taking the other one off, even with it taped like the picture above), and is patching all waking hours…he’s been tolerating it really well! I know we’re in for a long haul, so thanks for the great advice and the fabulous freindships from Little Four Eyes!

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