"Patching" usually means the use of a stick-on (band-aid type patch or tape) patch, and this is the only way to ensure the child is not looking at objects of interest through small gaps at the edges of other patches. However, purpose-made patches that fit so well over the face, or especially your child's glasses, that there is no gap to peek through, can be just as good. Watch your child to make sure they are using the eye that you are trying to help:

• Glasses on correctly, not looking over the top, but through.
• Head straight, not turned to the side (usually means they are looking around the edge of the patch).
• Patch on the correct eye (I've met at least 1 child who switches his stick-on patch to the other eye to look like he is still patching :)

Tips on patching

1. It gets easier. Getting started is the hardest part of patching. Most children will learn to tolerate patching over time, often because the vision starts to improve in the bad eye. 

2. King/Queen for the Day. It may be helpful to start patching on a weekend when there may be more adult support available. Focus your attention on that child. Filling the day with special privileges and attention may distract the child from some of the initial difficulties.

3. Positive reinforcement. Rewards, or linking patching with activities the child enjoys (eg, spending time reading to them, playing games, watching videos) is usually more successful than negative reinforcement or punishment. Try to avoid a battle of wills between child and parent. If this occurs, try a lower level of patching to regain co-operation (however these must be for reasonable blocks, ie 30 min, repeated during the day) and use positive reinforcement to build it up again.

4. Be creative. Putting pictures or bows on the patch or even creating games (eg, pirates) can be helpful. 

5. For young children there are strategies you can use to keep a patch on:

• Hand socks to make it more difficult for a child to peel the patch off.
  
• Inflatable water wings, when placed around the elbows can prevent a child from bending his arms enough to reach the patch on his face, whilst still allowing him to use his arms normally for play.
• At times I also use a proper arm splint bandaged onto each elbow (doen at hospital), which is left on for 1-2 weeks, during which time the child has patching all day. This is sometimes the only way to fix the problem, but it works!

6. Patching can be done at home or at kindergarten or school. Some parents find the supervision and distraction is greater at Day Care or kindergarten and it may be better to patch during these hours.

Year 0 and 1 children often do well with the patching at school, but most children are better patching before and after school, especially from age 6.

7. Treat skin irritation early. Some children will experience skin irritation where the patch is attached to the face. This may be due to a minor allergy to the adhesive and switching tape/patch brands may help eliminate the problem.

Making your own patch with hypo-allergenic tape would be the cheapest option, with pre-made patches like 'Krafty patches' or Ortopad elite being the best (I supply these at low cost, and they can be subsidised if you have a community services card).

8. Tincture of Benzoin (see your chemist, applied carefully on the skin where the patch will adhere)- makes it harder (and a bit painful) for the child to remove the patch, which should only be done when absolutely necessary. However if it takes this more definite solution to achieve the goal of 2 eyes with normal vision, then it could be tried if your child is very resistant. To remove the patch, use a wet, warm washcloth to help massage the patch off.

9. Don't give up. There are lots of ways to tackle the problem, an important one being switching to the use of drops that blur the good eye and force the brain to use the weaker one. If the patching is proving impossible then it is reasonable to have some time out before trying again. Your aim is to use reliable patching of at least 2 hours/day and/or drops twice per week for a total of between 3 to 9 months.

Atropine drops: for most cases of amblyopia this treatment has been proven to be as effective as good patching.

Put them in the 'good' eye 2 evenings a week, it is easy to remember if these are on the same nights every week, such as Saturday and Sunday, or Sunday and Monday.

Drops can be put in while a child is sleeping, but they need to be lying on their back, and hold a tissue over the other eye to stop the drop running into it when they shift their head!

Drops get in with a closed eye as long as you drip them in the inner corner and wait long enough before you let them sit up, but a child squeezing hard will keep the drop out, they should be asked to blink, and you can pull down on the bottom lid to open a gap.

If the drop is seen to disappear into the slit of their lids then it's done, otherwise you can repeat the drop once more. 

10. Tape versus commercial patches: 5cm wide micropore tape is recommended for patching. A smaller strip is placed lengthways on the back surface of the longer piece of tape. This provides a smooth surface over the eyelid itself, so that the tape does not stick to the eyelid itself, with at least 1cm at the side to be stuck down around the eye to prevent any peeking.

Commercial patches can be obtained from some chemists and from the clinic but are relatively expensive, unless you have a Community Services Card, which makes them 'free' (we supply them free to our patients who have CSC) from the optometrist or eye surgeon who is treating you.