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If the brain favors one eye over the other, lazy eye can result. Usually, this happens when one eye is weaker or has worse vision than the other. Over time, the brain starts to favor the stronger eye and stops receiving visual signals from the weaker eye. For optimum vision, the brain and both eyes must work together.
In some cases, lazy eye may result from untreated strabismus. Strabismus is a condition earmarked by having a crossed or turned eye.
Lazy eye can worsen over time if it left untreated. In addition to other treatments, eye exercises can help you manage and avoid this.
Eye exercises are beneficial for strengthening eye muscles. They can also train the brain and the weaker eye to work together more effectively.
Eye exercises alone aren’t enough to eliminate lazy eye. But they can be very effective when used in combination with other techniques.
In this article, we’ll go over some of the most effective exercises for lazy eye and also explain other therapies your ophthalmologist may use to treat this condition.
At-home eye exercises may be prescribed as homework by an ophthalmologist, optometrist, or orthoptist as part of a vision therapy treatment plan. Most exercises are beneficial for strabismus, amblyopia, and other eye conditions, such as convergence insufficiency.
You may be instructed to do the following exercises at home:
1. Pencil pushups treatment (PPT)
For this exercise, you can use a pencil or any object that’s pencil shaped. It’s most effective if the pencil or object contains a visual element, such as alphabet letters. If your child doesn’t know their alphabet yet, look for a pencil that has a recognizable shape or symbol on it, such as a cartoon character they like. This may help them stay focused.
You can do PPT yourself or with your child. When doing this exercise, don’t place an eye patch over the stronger eye. To try PPT:
- Hold the pencil in front of you (or your child) at arm’s length.
- Slowly move the pencil as close to the nose as possible, without it becoming blurry or doubled.
- Once the pencil becomes blurry, move it away from the nose.
- If the pencil contains a visual element, focus on it.
- Repeat 5 times. Do a PPT session at least 3 times daily.
2. Coloring within the lines
Many children love to color. Encouraging your child to color in a coloring book is an excellent way to sneak in an eye exercise. The goal here is to have your child color within the lines, not just on the page.
Before starting this exercise, make your child has sharpened coloring pencils or crayons without dull points. To do this exercise:
- Choose a coloring book with simple pictures that have strongly delineated lines.
- Place an eye patch over your child’s stronger eye.
- Instruct them to carefully color the objects on the page and stay within the lines.
- Make sure to supervise your child so that they don’t remove the eye patch.
3. Brock string exercise
This exercise helps the eyes learn how to work together to focus on an object. It was developed by Frederick Brock, a Swiss optometrist and strabismus specialist who died in 1972.
This exercise requires a Brock string or a homemade version. A Brock string is a white string that’s approximately 15 feet long. It has colorful wooden beads on it, which can be moved around. Don’t use an eye patch when doing this exercise.
To do the Brock string exercise:
- Tie a loop on both ends of the Brock string.
- Use one loop to attach the string to a doorknob or other fixed object.
- Position the beads along the string so that one is close to the doorknob (far fixation), one is around 3 feet away from you (middle fixation), and one is 6 inches from your nose (near fixation).
- Stand directly in front of the doorknob.
- Use the other string loop to place the Brock string around your finger.
- Hold the string flush along your upper lip, right under your nose.
- The cord should be stretched tight. If it isn’t tight, take a moment to adjust and shorten it by making the loops larger.
- Look at the bead closest to you, and make sure you see one bead, not two. If you see two beads, move the bead until you see one. You should see two strings, as if one string is coming from each eye. The strings should form an X shape.
- As you move the bead closer to your nose, the strings should meet exactly at the bead, and take on a V shape.
- Repeat by shifting your focus to the middle fixation bead and then the far fixation bead.
- As your weak eye becomes stronger, the bead should be able to be moved closer to your eyes, until it’s only 1 inch away.
4. Video games
Specially designed video games that are played while wearing goggles have shown promise for lazy eye. These games are played dichoptically, meaning each eye views something different through the goggles, such as high or low contrast images.
For adults, a dichoptic version of Tetris has been shown by scientists at the Research Institute of the McGill University Health Centre to be effective for strengthening the weaker eye.
Playing video games with an eye patch may also have a beneficial effect. A small 2011 study indicated that both action and non-action video games had benefits for adults with lazy eye.
5. Dot card
For this exercise, you’ll work to maintain a single image of a dot on a card with both eyes. To use a dot card:
- Draw dots on a rectangular card made out of cardboard or another type of stiff paper.
- Hold the card lengthwise and touching your nose so that the line of dots is directly in front of your face.
- Tilt the card down slightly.
- Focus on the dot farthest away from you. If your eyes are converging correctly, the pattern of dots should look like they’re in an A shape. The dot you’re focusing on should be singular and not blurry.
- Focus on the next dot in line, and then the next, holding each dot in focus for a count of five. If your eyes are continuing to converge correctly, an X shape will form.
- When you reach the dot that’s closest to you, the dots in the back will double and form a V shape.
6. Barrel convergence cards
This exercise is used primarily to treat exotropia, a form of strabismus. You can buy these cards or make them yourself.
To make barrel convergence cards, draw three red barrels on one side of the card in a lengthwise pattern. The barrels should increase in size toward the bottom of the card. Draw corresponding barrels on the other side of the card in green.
To use barrel convergence cards:
- Hold the card lengthwise touching your nose so that the three barrels appear in a vertical line, pointing away from your face. The largest barrel should be farthest from your nose.
- Stare at the largest barrel until you see one image with both colors. The other two barrels should appear doubled.
- Hold your gaze for the count of five, then move onto each smaller barrel, repeating the exercise.
Putting together jigsaw puzzles with an eye patch can help strengthen the weaker eye. There’s a very large range of jigsaw puzzle types. Make sure to opt for age-appropriate puzzles that won’t frustrate your child with their complexity.
If your child can read, have them read an age-appropriate book they enjoy for at least 30 minutes daily with a patch over their stronger eye.
Treatment for lazy eye can be highly effective, especially when started early. Full correction of lazy eye is possible, especially in children who receive treatment before the age of 7.
Older children, teenagers, and adults may also see significant improvement in this condition with treatment that includes eye exercise.
Other treatments your ophthalmologist may recommend include:
- In-office vision therapy. Vision therapy is a type of physical therapy for eyes. It’s overseen by an orthoptist. Techniques may include using prism lenses, therapeutic lenses, optical filters, and computer software.
- Eye patching. This requires covering the stronger eye with an eye patch for 2 to 6 hours or longer every day.
- Corrective eyeglasses or contact lenses. Corrective eyewear will address the different prescriptions in each eye and work to strengthen vision in the weaker eye.
- Eye drops. Your doctor may recommend blurring the vision in the stronger eye with a medication called atropine (Isopto Atropine).
- Surgery. Surgical solutions may sometimes be recommended when lazy eye is caused by a droopy eyelid, cataract, or squint. Surgery is done to lengthen or reposition the eye muscles.
If you suspect that your child has lazy eye, don’t wait to see a doctor. Prompt treatment is pivotal for correcting this condition. Some signs of lazy eye include:
- shutting one eye in an attempt to focus
- tilting the head in order to see better
Exercises for lazy eye can be an effective addition to your treatment plan. Many eye exercises can easily be done at home. They may be prescribed as homework by your ophthalmologist.
Some require that the stronger eye remain patched during the exercise, but others require that both eyes work together.
The best type of eye exercise is one that your child will focus on and enjoy, such as putting together jigsaw puzzles or playing specialized video games.