Pharmacological penalization with atropine has been shown to be equally effective as conventional occlusion therapy in the treatment of amblyopia in children. Reverse amblyopia of the sound eye with atropine penalization has been reported before, but is more common in cases where the effect is augmented with optical penalization and is mostly reversible. We report a case of reverse amblyopia with atropine penalization, in a 4-year-old girl, which was refractory to treatment. This report highlights the need for strict monitoring of the vision in the sound eye and regular follow-up in children undergoing amblyopia treatment.

Surgical success after one operation was achieved in the majority of all eyes that had combined surgery. In selected cases, combined strabismus and cataract surgery is a safe and effective procedure, optimizing the alignment of the visual axes, improving visual acuity, and minimizing the need for additional procedures.

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