Strabismus is common enough. In young children, such a defect can sometimes look touching and funny, but violations cannot be underestimated. At any age, this is an unpleasant pathology that needs to be fixed - both from the point of view of medicine, and from the point of view of aesthetics. Although in the vast majority of cases children are affected, adults are also not protected from it.
In children, strabismus is, of course, easier to correct, especially if it is found at the very beginning of development, and treatment is started in a timely manner. Strabismus gives a lot of inconvenience to the patient, the squinting eye over time can completely “fail”, not to mention the psychological and aesthetic discomfort. Fortunately, diagnosing strabismus is very simple, and modern medicine provides a whole arsenal of tools for treating it, including surgery, if necessary.
What is strabismus
Strabismus (other names - strabismus, heterotropy) is a very common ophthalmic disorder. According to statistics, one out of fifty children 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 are focused on a certain point, transmitting a picture from each eye to the brain, then with strabismus as a result of muscle weakness, one eye deviates from this point, the image obtained from one eye does not correspond to the image received from the other. Because of this, the nervous system excludes the image obtained from the squinting eye, a volumetric image in the brain is not created. As a result, a person sees a flat image, and the eye that mows almost does not participate in the visual process stops working. Because of this, over time, amblyopia develops, or lazy myopia, “lazy eyes,” as the squint in children is sometimes called.
The causes of the disease can be different, but in any case, if you do not treat a sick eye, his visual acuity decreases, he is generally excluded from participation in the visual process.
Types of Strabismus
The causes of visual impairment may be different. As for strabismus, ophthalmologists consider a congenital and acquired disease.
The types of strabismus are distinguished into friendly and unfriendly.
Causes of Congenital Strabismus
In fact, pure congenital squint occurs in isolated cases. If strabismus develops in the first six months of life, it is called infantile. In such cases, genetic disorders, such as Cruson syndrome and Down syndrome, become the causes of the disease; heredity - in this case, strabismus is also diagnosed in relatives of the first and second lines; congenital defects of the eyes, cerebral palsy. Often the disease appears as a result of prematurity, exposure to the fetus of various medications and drugs, and if the mother suffered an infectious disease during pregnancy (measles, cytomegalovirus, acute respiratory viral infections, and some others), this can also provoke strabismus in the baby.
Reasons for 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.
The reasons for acquired strabismus are many. 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 disorders of eye refraction : glaucoma, cataracts, astigmatism, and others. In addition , these are various eye diseases, including retinoblastoma, strabismus after trauma, swelling and other injuries.
Strabismus is a consequence of muscle paralysis that accompanies certain diseases, such as encephalitis, multiple sclerosis, neurosyphilis, as well as somatic and mental illnesses. In addition, it is acquired if the eyeball is not adequately supplied with blood flow, intracranial pressure rises sharply, pathologies of the brain or spinal cord develop. Strabismus can manifest itself as complications after flu, measles, scarlet fever, diphtheria.
Strong fright can also cause strabismus in children. The reasons of a psychological nature, stressful situations, psychological trauma, nervous strain often lead to the fact that in preschool children (and sometimes in older children and even adults) it starts to squint.
Friendly strabismus
Friendly is a disease in which the angles of strabismus are the same. That is, one single eye mows, but the deviation angle of the squinting eye (primary) and the deviation angle of the healthy (secondary) are equal. Despite the fact that the muscular system of the eyes is developed in different ways, there is no double vision, both eyeballs are fully mobile.
Friendly strabismus is divided into three groups of visual impairment:
Accommodation.
Non-accommodative.
Partially accommodative.
With accommodative strabismus, the disease is accompanied by any pathology of vision - hyperopia or nearsightedness. This type of strabismus develops at the age of 2-4 years. Adjusted 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 that have been postpartum. This type of strabismus is difficult to determine at the initial stage. Often he accompanies cerebral palsy.
It happens:
- horizontal (when the eyes are directed in different directions - exotropia, or divergent strabismus; when the eyes are directed to the bridge of the nose - isotropy, or converging strabismus);
- vertical (when the eye mows up - hypertropy, when the eye mows down - hypotropy);
- mixed (when several forms of strabismus are combined).
With glasses, this type of strabismus is not corrected.
Varieties of non-accommodative strabismus:
- sensory (with a decrease in the vision of one eye);
- acute (strabismus, suddenly arising after stress, psychological trauma or nervous tension);
- cyclic (strabismus arises and disappears after a certain period of time, the reason is violations of the central nervous system);
- secondary (strabismus, which reversed direction after surgical or spectacle correction).
There is also a special kind of non-accommodative strabismus - the excess of divergence. In this case, strabismus appears only when a person peers into the distance.
Partially accommodative strabismus combines the symptoms of accommodation and motor impairment, such as fluctuations in the eyeballs, which appear involuntarily and regularly. It converges (when the eyes are focused on the nose) and diverging (the eyes "look" at the temples).
Strabismus can have a different degree of severity:
- highly visualized has an angle of more than 37 degrees,
- well visible has an angle of 22-36 degrees,
- average - 11-21 degrees,
- insignificant - 6-10 degrees,
- practically not pronounced - the angle is less than 5 degrees.
Unfriendly squint
In case of 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 several directions. Most often, the paralytic nature of origin, as a non-accommodative species, has this squint. The causes of this disease are damage to the oculomotor nerves.
Pseudoparalytic strabismus also occurs. The causes of visual impairment in this case are developmental abnormalities or after surgery, but not nerve damage.
Imaginary strabismus
All types of strabismus that have been described are true. They can not be confused with the imaginary strabismus that happens in young children. Because of their age, they are often unable to focus on the subject, which creates the appearance of what the child mows.
However, imaginary temporary strabismus sometimes happens with adults. This is usually due to intoxication.
Diagnostics
Even if it seems that the squint is almost imperceptible or harmless, do not postpone treatment. This is not a cosmetic defect at all, and therefore requires immediate attention as soon as it is discovered. If strabismus is not corrected, the eye may lose its ability to see.
The first symptoms of strabismus:
- deviation of one or both eyes to 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 consider many details in order not to confuse the disease with the imaginary. For strabismus, you can take a special section of the eyes or their specific location, characteristic of a particular child. It is important to distinguish the actual symptoms of strabismus from the imaginary signs. These physiological symptoms most often disappear on their own with age. A floating gaze can also be found in infants up to six months who cannot yet focus on the subject. It also goes away with age. There are many parents who began to panic, suspecting strabismus in children under one year of age, their worries were dispelled either by specialists or by the disappearance of symptoms at a later age.
Often the squint is noticed by the parents themselves and turns to the ophthalmologist. This is a disease that can be diagnosed virtually independently, without the help of a specialist.
Also, the disease can be detected during a routine examination of the child. The eye doctor diagnoses the entire visual apparatus, including using a computer, conducts tests confirming the lack of volumetric vision and that the child has strabismus. The causes of the disease must be clarified 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 direct for surgery to an ophthalmologic clinic.
If you start treatment at an early stage of development, in most cases you can completely get rid of the disease.
Non-drug treatment
Strabismus in some cases is corrected with the help of glasses or lenses. This method is indicated for accommodative and partially accommodative strabismus.
With partially accommodative strabismus, Fresnel prisms are glued onto the lenses of the glasses - complex composite lenses.
Also successfully used is the method of pleoptics, that is, treatment with occlusion. In this case, a blindfold is put on a healthy eye or an eye patch is glued. Treatment should last at least 4 months and is indicated mainly in the treatment of strabismus. With this method, it is necessary to constantly control the visual acuity of a healthy eye, subjected to constant bonding. 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
The drugs are prescribed together with hardware treatment and gymnastics for the eyes and either relax the muscles and dull the eyesight, like atropine, or, like pilocarpine, prevent the pupil from narrowing. The essence of treatment is to increase the load on the eye and stimulate its active work.
Hardware is also effective in treating a disease. Used devices such as monobinoscope and synoptophore. The first irritates the retina with light rays and thereby fights with amblyopia (low vision) and double vision. The second is used for sensory strabismus if the strabismus angle is large enough.
Patients are also shown orthopedic-diploptic treatment, consisting in training exercises on the apparatus. Such treatment is aimed at the development of binocular vision.
Surgery
In some cases with strabismus, surgical intervention is recommended. Thanks to it, the muscle that is responsible for the movement of the eyeball is strengthened or weakened. A strabismus operation is used if complex treatment has not helped. It is also indicated in paralytic and non-accommodative forms.
With a highly 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, shortening the length of the eye muscle, and recession - the movement of the eye muscle. The choice of the nature of the operation depends on the type of strabismus and its angle. Combined intervention may also be performed. They perform operations under both general and local anesthesia.
It is worth replacing that up to 3-4 years, strabismus is not corrected surgically. It is necessary to wait until binocular vision is formed, that is, the ability to see the image of an object with both eyes. At an earlier age, surgery is possible only if there is a congenital strabismus with a significant angle of deviation. Such operations can only be performed by an eye doctor - a surgeon.
After surgery, treatment should be continued by any of the other methods above to restore and strengthen binocular vision.