Squint is quite common. In young children, such a defect can sometimes look touching and funny, but the violation should not be underestimated. At any age, this is an unpleasant pathology that needs to be corrected - both from the point of view of medicine and from the point of view of aesthetics. Although the vast majority of cases affect children, adults are not immune from it either.
In children, strabismus is, of course, easier to fix, especially if it is detected at the very beginning of development, and treatment is started in a timely manner. Strabismus delivers a lot of inconvenience to the patient, the squinting eye can completely “fail” over time, not to mention the psychological and aesthetic discomfort. Fortunately, diagnosing strabismus is very simple, and modern medicine provides a whole arsenal of tools for its treatment, up to surgery if necessary.
What is strabismus
Strabismus (other names - strabismus, heterotropia) - verycommon ophthalmic disorder. According to statistics, one child out of fifty suffers from it. This is a defect associated with the inconsistent activity of one or more eye muscles responsible for the movement of the eyeball.
If normally the eyes focus on a certain point, transmitting an image from each eye to the brain, then with strabismus, as a result of muscle weakness, one eye deviates from this point, the image received from one eye does not match the image received from the other. Because of this, the nervous system excludes the picture received from the squinting eye, and no three-dimensional image is created in the brain. As a result, a person sees a flat image, and the eye that squints almost does not participate in the visual process, stops working. Because of this, over time, amblyopia develops, or lazy myopia, “lazy eyes,” as strabismus in children is sometimes called.
The causes of the disease may be different, but in any case, if the diseased eye is not treated, its visual acuity decreases, it is generally excluded from participation in the visual process.
Types of strabismus
Causes of visual impairment can be different. With regard to strabismus, ophthalmologists consider a congenital and acquired disease.
By type, strabismus is distinguished into friendly and unfriendly.
Causes of congenital strabismus
In fact, pure congenital strabismus occurs in isolated cases. If strabismus develops in the first six months of life, it is calledinfantile. In such cases, the causes of the disease are genetic disorders, such as Cruson's syndrome and Down's syndrome; heredity - in this case, strabismus is diagnosed in relatives of the first and second lines; congenital eye defects, cerebral palsy. Often the disease appears as a result of the consequences of prematurity, the effects of various drugs and drugs on the fetus, and if the mother had infectious diseases during pregnancy (measles, cytomegalovirus, SARS and some others), this can also provoke strabismus in the child.
Causes of acquired strabismus
The disease can develop after the first six months of life and even in an adult. In this case, it is called acquired.
There are many causes of acquired strabismus. First of all, the disease is provoked by medium and high degrees of myopia, hyperopia, astigmatism and sudden changes in vision without noticeable reasons. Also, strabismus can develop due to various refractive disorders of the eye: glaucoma, cataracts, astigmatism and others. In addition, these are various eye diseases, including retinoblastoma, strabismus after trauma, tumors and other injuries.
Strabismus is the result of paralysis of the muscles that accompanies certain diseases, such as encephalitis, multiple sclerosis, neurosyphilis, as well as somatic and mental illness. In addition, it is acquired if the eyeball is not sufficiently supplied with blood flow, intracranial pressure rises sharply, and pathologies develop.brain or spinal cord. Strabismus can appear as a complication of influenza, measles, scarlet fever, diphtheria.
Severe fright can also cause strabismus in children. Reasons of a psychological nature, stressful situations, psychotrauma, nervous overstrain quite often lead to the fact that preschoolers (and sometimes older children and even adults) begin to squint.
Concomitant strabismus
Friendly is a disease in which the angles of strabismus are the same. That is, one eye is mowed, but the value of the angle of deviation of the squinting eye (primary) and the angle of deviation of the he althy (secondary) are equal. Despite the fact that the muscular system of the eyes is developed differently, there is no double vision, both eyeballs are fully mobile.
Concomitant strabismus is divided into three groups of visual disorders:
- Accommodative.
- Non-accommodative.
- Partly accommodative.
In accommodative strabismus, the disease is accompanied by any pathology of vision - farsightedness or myopia. This type of strabismus develops between 2 and 4 years of age. Corrected by wearing glasses.
Paralysis of the muscles responsible for eye movement causes non-accommodative strabismus. The causes of paralysis may lie in problems during fetal development or diseases suffered after birth. This type of strabismus is difficult to identify at the initial stage. Often heaccompanies cerebral palsy.
Sometimes:
- horizontal (when the eyes are directed in different directions - exotropia, or divergent strabismus; when the eyes are directed to the bridge of the nose - isotropia, or convergent strabismus);
- vertical (when the eye squints up - hypertropia, when the eye squints down - hypotropia);
- mixed (when several forms of strabismus are combined).
Glasses do not correct this type of strabismus.
Varieties of non-accommodative strabismus:
- sensory (with vision loss in one eye);
- acute (strabismus that suddenly occurred after stress, trauma or nervous tension);
- cyclical (strabismus occurs and disappears after a certain period of time, the reason lies in disorders of the central nervous system);
- secondary (strabismus that has changed direction to the opposite after surgical or spectacle correction).
There is also a special kind of non-accommodative strabismus - kurtosis of divergence. In this case, strabismus appears only when a person peers into the distance.
Partial accommodative strabismus combines symptoms of accommodative and motor disturbances, such as fluctuations of the eyeballs, which occur involuntarily and regularly. It can be converging (when the eyes are focused on the bridge of the nose) and diverging (the eyes “look” at the temples).
Squint can have different degrees of severity:
- stronglyrendered has an angle of more than 37 degrees,
- clearly visible has an angle of 22-36 degrees,
- average - 11-21 degrees,
- minor - 6-10 degrees,
- practically not expressed - the angle is less than 5 degrees.
Unfriendly strabismus
In unfriendly strabismus, the primary and secondary angles of deviation are not the same. The mobility of the eye is limited or absent in one or more directions. Most often, this strabismus also has a paralytic nature of origin, as a non-accommodative species. The causes of this disease are lesions of the oculomotor nerves.
There is also pseudo-paralytic strabismus. The causes of visual impairment in this case are developmental anomalies or after surgery, but not nerve damage.
Imaginary strabismus
All types of strabismus that have been described are true. They should not be confused with the imaginary strabismus that occurs in young children. Due to their age, they are often unable to focus on an object, which gives the appearance that the child is squinting.
However, imaginary temporary strabismus sometimes happens to adults. This is usually due to alcohol intoxication.
Diagnosis
Even if it seems that strabismus is almost imperceptible or harmless, you should not delay treatment. This is not a cosmetic defect at all, so it requires immediate attention as soon as it is discovered. If strabismus is not corrected,the eye may lose the ability to see.
First symptoms of strabismus:
- Deviation of one or both eyes towards the nose (convergent strabismus) or to the side (divergent strabismus),
- the inability to focus on the subject (the so-called floating gaze).
In this case, you need to take into account many details so as not to confuse the disease with an imaginary one. For strabismus, you can take a special section of the eyes or their specific location, characteristic of a particular child. Here it is important to distinguish the actual symptoms of strabismus from imaginary signs. These physiological signs most often disappear on their own with age. A floating gaze can also be found in infants up to six months old, who cannot yet focus on an object. This also goes away with age. There are many parents who began to panic when they suspected strabismus in children under one year old, their worries were dispelled either by specialists or by the disappearance of symptoms at a later age.
Often strabismus is noticed by the parents themselves and they turn to an ophthalmologist. This is the disease that you can actually diagnose on your own, without the help of a specialist.
Also, the disease can be detected during a routine examination of a child. The eye doctor performs diagnostics of the entire visual apparatus, including using a computer, conducts tests confirming the absence of volumetric vision and the fact that the child has strabismus. The causes of the disease must be found out in order to prescribe a treatment suitable for this type of problem.
The doctor selects glasses or lenses, prescribes hardware treatment and, if necessary, medications. In difficult cases, he can refer you to an ophthalmological clinic for surgery.
If you start treatment at an early stage of development, in most cases it is possible to completely get rid of the disease.
Non-drug treatment
Strabismus in some cases is corrected with glasses or lenses. This method is indicated for accommodative and partially accommodative strabismus.
For partially accommodative strabismus, Fresnel prisms are glued onto the lenses of the glasses - complex compound lenses.
The pleoptics method, that is, occlusion treatment, is also successfully used. In this case, a bandage is put on a he althy eye or an eye patch is glued. Treatment should last at least 4 months and is indicated mainly in the treatment of childhood strabismus. With this method, it is necessary to constantly monitor the visual acuity of a he althy eye that is subjected to permanent gluing. To make the treatment more effective, pleoptics is combined with hardware correction, which includes laser therapy, amblyocor, electrical stimulation and other methods.
Drug and hardware treatment
Drugs are prescribed in conjunction with hardware treatment and exercises for the eyes and either relax the muscles and dull vision, like atropine, or, like pilocarpine, prevent pupillary constriction. The essence of the treatment is to increase the load on the eye and stimulate its activework.
Hardware is also effective in treating the disease. Devices such as monobinoscope and synoptophore are used. The first irritates the retina with light rays and thereby fights amblyopia (low vision) and double vision. The second is used for sensory strabismus if the angle of strabismus is large enough.
Patients are also shown orthopto-diplopticheskoe treatment, which consists in training exercises on the apparatus. This treatment is aimed at developing binocular vision.
Surgical treatment
Surgical intervention is recommended in some cases of strabismus. Thanks to him, the muscle that is responsible for the movement of the eyeball is strengthened or weakened. Strabismus surgery is used if complex treatment has not helped. It is also indicated for paralytic and non-accommodative forms.
In case of strongly visualized strabismus, several operations can be performed on each eye with a break of at least six months.
In the case of strabismus, two types of operations are performed: resection, which shortens the length of the eye muscle, and recession, which moves the eye muscle. The choice of the nature of the operation depends on the type of strabismus and its angle. A combination intervention can also be performed. Operations are performed both under general and local anesthesia.
It is worth replacing that up to 3-4 years of age, strabismus is not surgically corrected. It is necessary to wait until binocular vision is formed, that is, the ability to see an image of an object with both eyes. In moreat an early age, surgical intervention is possible only if there is a congenital strabismus with a significant deviation angle. Only an eye doctor - a surgeon can perform such operations.
After the operation, treatment should be continued by some other of the above methods in order to restore and strengthen binocular vision.
