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Traitement de l’amblyopie [lundi 5 février 2007]


L'occlusion, un des traitements de l'amblyopie fonctionnelle chez l'enfant

L’amblyopie consiste en une acuité visuelle basse, qui se manifeste soit sur un seul oeil (amblyopie unilatérale) soit sur les deux yeux (amblyopie bilatérale). Souvent l’amblyopie unilatérale est accompagnée par un strabisme.

Plus l’amblyopie fonctionnelle est diagnostiquée précocement, plus son traitement pourra être efficace. Le traitement le plus souvent préconisé chez le jeune enfant consiste dans la mise en place d’une occlusion. Celle-ci consiste à gêner la vision de l’oeil sain pour obliger l’oeil atteint de troubles visuels à travailler. Un pansement va donc être placé soit directement sur l’oeil sain, soit sur la paire de lunettes. Cette deuxième possibilité est souvent moins efficace : L’enfant a tendance à regarder par-dessus ses lunettes pour contourner le traitement qui gêne sa vision. Mais appliquer le pansement directement sur l’oeil est loin de régler complètement le problème. Très souvent, l’enfant tente aussi de tricher en décollant le pansement très légèrement. Il faut donc une vigilance importante pour s’en rendre compte. Un indice est une tendance de l’enfant à tourner la tête, souvent sur le côté, afin de voir par l’interstice qu’il s’est ménagé. Si vous notez que votre enfant ne regarde plus droit devant lui, mais légèrement en décalé, vous pouvez toujours prendre une photo de celui-ci en vous plaçant bien en face de lui. N’hésitez pas à l’amener à l’orthoptiste ou à l’ophtalmologiste qui suit votre enfant. Les pansements appliqués sur l’oeil ont aussi tendance à se décoller spontanément. Pensez donc à coller celui-ci en le faisant dépasser largement sur l’arête nasale. Une autre méthode encore plus efficace consiste à rajouter du sparadrap de chaque côté du pansement occlusif afin de bien le maintenir en place.

Par ailleurs, ce traitement n’est pas toujours bien accepté par l’enfant. Au delà de l’explication qu’on peut lui donner s’il est en âge de la comprendre : "Ton oeil est malade, il ne veut plus travailler. C’est pour ça qu’on bouche l’autre, ça l’oblige à retravailler", il paraît indispensable de ne jamais négocier. Le risque d’une aggravation de la chute de son acuité visuelle est trop important. L’enfant DOIT porter ce pansement, parce qu’il n’a pas le choix, et non pas en échange d’une éventuelle récompense. En revanche, pour alléger la contrainte de ce traitement pour l’enfant, et quand l’indication le permet, jouer avec lui à son jeu préféré pendant un moment durant la période de l’occlusion peut transformer ce laps de temps désagréable en un instant de complicité entre parents et enfants. Pour les petits garçons, les déguiser en pirates ou corsaires, lorsqu’ils portent le pansement à la maison, peut également favoriser l’acceptation de celui-ci. Cela présente évidement moins d’attrait pour les petites filles. Mais dans certains cas, on peut leur proposer de coller sur leur pansement un autocollant de leur choix, ceci , bien sûr, avec l’autorisation de l’orthoptiste ou de l’ophtalmologiste.

Enfin, il est à noter que dans certains strabismes avec amblyopie bilatérale, l’occlusion peut se placer tantôt sur un oeil , tantôt sur l’autre , afin d’obliger alternativement les deux yeux à travailler.

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  • Traitement de l’amblyopie 19 février 2009 19:39, par mili87

    Bonjour, j’ai une amie qui a une trentaine d’années et qui souffre d’amblyopie qui a atteint le nerf optique et je voulais savoir quelles étaient les solutions possibles a ce problème en vous remerciant.

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Strict Standards: date(): It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Europe/Berlin' for 'CEST/2.0/DST' instead in /homepages/12/d515576852/htdocs/cecite.org/www/ecrire/inc/log.php on line 47

Strict Standards: date(): It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Europe/Berlin' for 'CEST/2.0/DST' instead in /homepages/12/d515576852/htdocs/cecite.org/www/ecrire/inc/log.php on line 47

Strict Standards: date(): It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Europe/Berlin' for 'CEST/2.0/DST' instead in /homepages/12/d515576852/htdocs/cecite.org/www/ecrire/inc/log.php on line 47

Strict Standards: date(): It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Europe/Berlin' for 'CEST/2.0/DST' instead in /homepages/12/d515576852/htdocs/cecite.org/www/ecrire/inc/log.php on line 47

Strict Standards: date(): It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Europe/Berlin' for 'CEST/2.0/DST' instead in /homepages/12/d515576852/htdocs/cecite.org/www/ecrire/inc/log.php on line 47

Strict Standards: date(): It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected 'Europe/Berlin' for 'CEST/2.0/DST' instead in /homepages/12/d515576852/htdocs/cecite.org/www/ecrire/inc/log.php on line 47