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Is lazy eye genetic

Updated: 4/28/2022
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12y ago

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First, let's be clear about the definition of "lazy eye". Many people who are untrained in the eyecare professions use this term loosely without really knowing what it is they are talking about. (They do this with "pink eye" also and this is my pet peeve, an issue for another day) They mistakenly think that a droopy eyelid (ptosis) is "lazy eye". Yet other people mistakenly think that an imbalance in the extraocular muscles resulting in the eye turning out (exotropia) or in (esotropia) is "lazy eye". The correct medical term for "lazy eye" is Amblyopia! This is defined as a decrease in vision - sometimes very mild and sometimes severe - resulting from one eye not being used. Why would one eye not be used? Good question! Two main reasons: 1. the eye is misaligned, esotropia, exotropia, vertical tropia, or 2. the two eyes have a large difference in their refractive error, one eye may be +4.00 diopters farsighted and the other eye may only be +1.00 diopters farsighted. If this child is not getting proper eyecare and forced to wear eyeglasses, the +4.00 eye will almost certainly become Amblyopic.

Remember, the brain has to accept the images from 2 different eyes and then fuse those together to allow us to see only one image. But what if the right eye is straight and the left eye is turned in 10 degrees? The brain receives 2 different images that are completely different and it cannot fuse them together. So it's natural response to double vision is to turn off or suppress the image coming from the eye which is turned in. Suppression is also occurring in the +4.00 diopter eye in the example above. The brain has a hard time fusing the images together from the +1.00 eye and +4.00 eye (which is blurry) so it just suppresses the +4.00 eye. Now you understand that suppression causes amblyopia or "lazy eye".

Back to the question: is lazy eye genetic? Amblyopia does tend to run in families so there is obviously some genetic component. However, it certainly is not the only determining factor. I see many patients with amblyopia who have no family history. So there are environmental factors also.

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