Does your child wear glasses over the patch?
Glasses worn over a patch still need low shots and a snug fit, and the glasses guide covers both.
See the glasses guidePlaying Football With a Child Wearing an Eye Patch for a Lazy Eye
Kit, Rules & Safety
A patch makes the ball harder to judge, so the game has to get easier. Roll it, keep it close and aim at something big, then check anything about the patch itself with your child's orthoptist, because they set the hours and know the eyes.
Playing football with a child wearing an eye patch for a lazy eye is often possible, but it needs a slower, closer and softer game, and a yes from your child's orthoptist before bounces, catches or faster balls. With one eye covered, depth perception is reduced and so is the field of view on that side (CUH, Manchester Royal Eye Hospital), so a moving ball is harder to judge. NHS hospital leaflets ask for extra supervision when a patched child plays outside (Manchester, Sussex). Start with rolling to a big target, leave catching until last, and never shorten or skip patch time without asking the orthoptist first.
For a long time I assumed a patch meant no ball until it came off, and I only noticed how much of the day that covered when the patch hours turned out to be most of the after-school stretch. I am a dad, not an orthoptist, so everything below is a starting point to check with the person who looks after your child's eyes.
Start here
Lazy Eye Treatment and Playing Football: The Short Answer
The NHS page on lazy eye describes treatment as wearing an eye patch over the stronger eye for a few hours a day for several months, often with glasses. Cambridge University Hospitals' parent information on amblyopia says the time is usually between 2 and 6 hours, depending on how reduced the vision is.
Football does not change the prescription, so the first job is to find out how your child's orthoptist feels about ball play with the patch on. Hospital leaflets point in slightly different directions, so the person who knows your child's eyes decides.
Manchester Royal Eye Hospital's patching leaflet says "You may prefer your child not to wear the patch for activities such as running around or riding a bike". A 2008 trial counted supervised outdoor play and ball play as acceptable distance activities during 2 hours of patching (the trial of near versus distance activities while patching).
Until you hear back, keep the patch on as prescribed and play the gentle end of the ladder below, with a grown-up close by. Moorfields Eye Hospital's leaflet on patching notes that poor success of treatment is most often down to the patch not being worn enough, so the aim is to make patch hours more enjoyable, not shorter.
Why the ball feels harder
Depth Perception With an Eye Patch: What Changes in a Game
With one eye patched, CUH says a child "will have reduced depth perception", may "struggle to judge distances accurately" and has "a reduced field of vision". Manchester says a little side vision is lost on the patched side.
Moorfields says a child may seem clumsier than usual in the first few weeks, which should settle as they get used to the patch. The British and Irish Orthoptic Society's patching page lists catching a ball among the tasks that may feel more challenging.
What that changes in a garden is my own reasoning, not something from a source. A ball rolling along the ground is easier to place than one arriving through the air, and a fast ball leaves less time to judge. Steps, flowerbed edges and a patio lip on the covered side are easier to miss. So stand on the side of the eye that is not covered, so your child can see you and the ball.
The NHS lists difficulty catching or throwing as one sign of a lazy eye in the first place, so a miss is not a sign of poor effort. A study of fine motor skills in children with amblyopia found some children with a lazy eye find hand tasks harder even without a patch, though that was one study of hand skills.
Earlier work, quoted in a research note, found that adults with weak depth vision had a much smaller catching gap for a slow ball than a fast one (a research note on stereo vision and catching). That is a reason to start slow.
Start low, move up one rung
Eye Patch Football Coordination for Kids: A Patch-Time Play Ladder
This ladder runs from the games that ask least of depth judgement to the ones that ask most, whether you roll, bounce or catch. It is parent-level reasoning drawn from the sources, not clinical advice, and none of it replaces your orthoptist.
| Rung and game | Set-up | Why it comes in this order |
|---|---|---|
| Rung 1. Roll and stop. | Sit or stand three or four steps apart and roll a big soft ball along the grass. Your child stops it with a foot or a hand. | The ball stays on the ground and moves slowly, so there is no flight to judge. A child who flinches as well can start with the roll-before-you-kick approach. |
| Rung 2. Still ball, big target. | Kick a ball that is not moving at a gap as wide as a door, two big strides away. A pair of bags or cones is enough. | Your child judges the distance to something that is not moving. The target is generous, so a miss is a near miss. |
| Rung 3. Slow ground passes. | Pass back and forth along the ground, softly, three steps apart, counting passes together. Stand on the open-eye side. | Now the ball moves, but slowly and along the floor, which keeps timing easy. Count together so the game stays about the rally. |
| Rung 4. Bounces, catches and fast balls. | Last, and only once your orthoptist has said yes to bounces, catches and faster balls. Underarm tosses and bounces, as in the goalkeeper catching basics. | A ball arriving through the air asks the most of depth judgement, and catching is the task BIOS says may feel harder with a patch. If in doubt, save it for another day. |
Move up one rung at a time and only when the current one feels boring. Change the distance or how the ball arrives before anything else, as in the four dials guide.
"Shall we roll it to each other for a bit? The patch makes the ball trickier to judge, so we'll stay close and slow."
A missed catch gets "the patch makes that one tricky", never "keep your eye on it".
Who decides
Amblyopia Eye Patch and Ball Games: Ask Your Orthoptist First
The sources lean two ways. Manchester says you may prefer your child not to wear the patch for running around and bike riding. Sussex and CUH ask for extra supervision outdoors and care where a child is not closely supervised. The 2008 trial counted supervised outdoor play, active games and ball play as distance activities that did no worse than near tasks for vision (the trial of near versus distance activities while patching).
That trial measured eyesight after 8 weeks, not injuries, so it does not say football is safe with a patch on. Reading and colouring are the usual suggestions, but the trial found they gave no extra gain over distance activities with 2 hours of daily patching. Patch time does not have to be spent at a table, and that is a point for the orthoptist, not a licence.
Three things to ask:
- "Is ball play fine with the patch on for my child, and is anything off limits?"
- "If the patch ever comes off for sport, does that time need making up, and can the hours be split through the day?" (An Australian children's hospital's patching fact sheet says splitting patching across the day does not affect gains.)
- "Would you change the patch type or the way it sticks if we are running about?"
Ask by phone or at the next appointment, and do not wait for a problem. If your child ever reports double vision, Manchester says to stop patching and ring the orthoptic department.
When it moves
Patch, Glasses and Sweat: The Practical Bits of a Running Game
- Glasses go over the patch. Moorfields, Manchester, Sussex and CUH all describe an adhesive patch stuck to the skin with glasses worn on top, and a fabric patch over glasses invites peeking (Moorfields, Adelaide). If glasses are worn, the glasses guide has the low-shot rule.
- A clean, dry edge sticks best. Wash the skin first, because patches stick better to grease-free skin. Milk of magnesia on the skin before the patch is the sensitive-skin tip from BIOS and the American Association for Pediatric Ophthalmology and Strabismus patching tips.
- Check it halfway. A hot, sweaty run lifts the edge of any sticky patch, so a quick press-down at half time beats a patch slipping into the game. If it keeps peeling, Moorfields suggests extra sticky tape or a distraction. Ask the orthoptist what they prefer.
- Red or sore skin means a call. CUH and Sussex both say to tell the orthoptist, who can recommend hypoallergenic patches.
Decorated elastic patches need a word with the orthoptist too. Elastic round the head could catch on something in a running game. That is my own reasoning, and I found no NHS or orthoptic source on it, so ask the orthoptist before using one for play.
I once spent most of a kickabout holding one corner of a sticky patch down with a thumb while the ball rolled gently into the flowerbed. That is how I learned to press it down before the first pass, not during it.
What is known and what is not
What the Trials Say, and What They Do Not
The Pediatric Eye Disease Investigator Group trial (2003) randomised 189 children under 7 with moderate amblyopia to 2 or 6 hours of daily patching. Both groups improved by the same 2.40 lines over 4 months (the National Eye Institute's summary of the patching hours trial). It covered moderate amblyopia only, over 4 months, in the US, and it tested hours, not sport, so it cannot tell any parent how long their own child should patch.
The same group's 2008 trial of 425 children aged 3 to under 7 found 2 hours of patching with distance activities did as well as 2 hours with near activities. Both groups improved by about two and a half lines at 8 weeks, a difference of 0.1 line. The distance list included supervised outdoor play and ball play (the trial of near versus distance activities while patching). It measured acuity at 8 weeks, not safety. The authors say it cannot be extended to shorter or longer patching, and parents reported the activities.
A research note on catching (Mazyn et al., 2007) tested 23 adult women in groups of 8, 6 and 9. Catching training helped people with good depth vision far more than people with weak depth vision. The note quotes earlier work where the gap was small for a slow ball and large for a fast one (a research note on stereo vision and catching). Those studies were of adults catching fast machine-fired tennis balls, not children in a temporary patch.
The authors warn that one eye covered is not the same as lacking stereo vision.
Webber and colleagues (2008) compared 82 children with amblyopia and 37 controls, and the amblyopia group scored worse on 9 of 16 fine motor subtests (a study of fine motor skills in children with amblyopia). The children wore no patch, the tests were of hand skills not ball skills, and it shows association only.
No study was found that tested football with a patch on, and trials of apps or video-game treatments are left out. That is why the orthoptist decides.
Cambridge University Hospitals' parent information on amblyopia is the fullest plain account of the depth and field-of-view effect.
Quick answers
Common Questions About Eye Patches and Football
Can a child play sports while wearing an eye patch for a lazy eye?
Often, with care, but ask the orthoptist. Hospital leaflets ask for extra supervision when a patched child plays outside (Manchester, Sussex), and one trial counted supervised outdoor and ball play as an acceptable activity during patching (the 2008 trial).
Does an eye patch affect depth perception?
Yes. One NHS trust says a patched child "will have reduced depth perception", may struggle to judge distances and has a reduced field of vision (CUH).
Should my child take the eye patch off to play football?
Ask the orthoptist first. One hospital says you may prefer your child not to wear the patch for running around or riding a bike (Manchester), but poor success is most often down to the patch not being worn enough (Moorfields).
Why does my child seem clumsier with the eye patch on?
Moorfields says a child may seem clumsier than usual in the first few weeks and that it should settle. Catching a ball is one of the tasks that may feel harder (BIOS).
Do glasses go over or under the eye patch?
Over. A sticky patch goes on the skin with the glasses worn on top (CUH, Moorfields). Fabric patches over glasses make peeking easy (Adelaide).
What if the eye patch comes off or the skin gets sore?
Press it back down, and for red or sore skin tell the orthoptist, who can recommend hypoallergenic patches (CUH). KidsHealth's guide to amblyopia also suggests playing outside as a distraction while patched.
Keep going
Where to Go From Here
Three places to go next, depending on what you need.
Misses piling up?
Move the distance and how the ball arrives one notch at a time, without stopping the game.
See the four dials guideWant the full kit and safety list?
Everything on kit, rules and safety in one place.
See Kit, Rules & SafetyTonight's five minutes
Roll it close and slow, then ask the orthoptist.
Sit three steps apart, roll a big soft ball along the grass and stay on the open-eye side. Write down the three questions for your next appointment.