Amblyopia

A 6-year-old boy is brought to the paediatric ophthalmology clinic by his mother with a complaint of poor vision in the right eye noticed over the past 2 years. On examination, visual acuity is 6/60 in the right eye and 6/6 in the left eye. Anterior segment examination is normal bilaterally. Fundoscopy reveals no abnormality in either eye. Ocular motility is full and pupils are reactive. The child has a history of left esotropia since age 2, which was never treated. Cover test confirms 15 prism diopters of esotropia. What is the most likely diagnosis?

A 6-year-old boy is brought to the eye clinic by his mother who noticed that he tends to tilt his head to the left and squints with his right eye. On examination, visual acuity is 6/60 in the right eye and 6/6 in the left eye. Ocular motility is full and there is no apparent strabismus. Fundus examination is normal bilaterally. Cycloplegic refraction shows: OD +3.50 DS and OS +1.00 DS. What is the most likely diagnosis and the primary mechanism underlying the reduced vision in the right eye?

An 8-year-old girl is brought to the pediatric eye clinic with a complaint of poor vision in the left eye, which was first noticed 2 years ago. Her mother reports that the child has never worn glasses. On examination, visual acuity is 6/9 in the right eye and 6/36 in the left eye. Cover test reveals a 15° esotropia of the left eye. Cycloplegic refraction: OD +0.50 DS and OS +0.75 DS (nearly equal). Fundus examination is normal. The child's right eye shows normal fixation preference. What is the most appropriate first-line management?

A 6-year-old boy is brought to the ophthalmology clinic by his mother with a complaint of poor vision in the right eye. She reports that the child has been squinting with the right eye for the past 2 years and tends to cover it with his hand while playing. On examination, visual acuity in the right eye is 6/60 and in the left eye is 6/6. Cycloplegic refraction shows: right eye +3.50 D sphere, left eye +1.00 D sphere. Fundoscopy is normal in both eyes. Ocular motility is full and pupillary responses are normal. What is the most likely diagnosis?

An 8-year-old girl is referred to the eye clinic after her school teacher noticed she was having difficulty reading the blackboard with her left eye. On examination, visual acuity is 6/9 in the right eye and 6/36 in the left eye. Cycloplegic refraction shows: right eye −2.00 D sphere, left eye −0.50 D sphere. Fundoscopy and anterior segment examination are unremarkable. Ocular motility is full with no deviation on cover test. The child's mother reports that the left eye has been "lazy" since early childhood, and she was advised to patch the right eye 2 years ago but compliance was poor. What is the most likely reason for the poor visual prognosis in this case?