How to get rid of congenital glaucoma in children? Types of treatment, prognosis and timely prevention. Effective ways to treat glaucoma in infants and newborns Glaucoma in children treatment

Glaucoma in children is a disease characterized by an increase in eye pressure, leading to a violation of the outflow of aqueous humor from the eyes. Delayed treatment of the disease can provoke, loss of sharpness, and sometimes complete loss of vision.

Doctors have not identified the main causes provoking the development of glaucoma in children. Experts tend to the disease can manifest itself due to hereditary predisposition or due to the influence of other factors during the period of the child's stay in the womb.

The following prerequisites for the disease are distinguished:

• pathology nervous, cardiovascular, or endocrine systems;
• infectious diseases mothers during pregnancy (typhus, rubella, beriberi);
• anomalous eye structure child;
• bad habits mothers;
• carried by the fetus in the womb.

Symptoms

Glaucoma identified by visual symptoms and behavioral signs. Infants suffering from the disease are in constant nervous tension crying, refusing to eat.

Symptoms by which oculists determine the disease:

• lacrimation,;
• frequent blinking, occasional redness of the eyes;
• clouding of the cornea, pupil dilation is observed;
• The sclera acquires a bluish tint, then stretches, due to which the choroid becomes visible.

The disease can occur without obvious symptoms, so newborns are regularly recommended to be shown to an ophthalmologist.

Kinds

In childhood, there are several types of the disease: congenital (primary, secondary), infantile, juvenile.

congenital primary

Congenital glaucoma in children of the primary type is most often manifested in a hereditary line. Symptoms of the disease can be found among relatives of the newborn. In addition to heredity, the onset of the disease can be affected by injuries to the abdomen, in which the fetus is located, or an unhealthy lifestyle of the expectant mother.

In the eyes of an unborn baby, there are tissues that must be absorbed inside the womb. Under the influence of negative factors, tissues remain in the corner of the anterior chamber of the baby's eyes, forming the basis for the development of glaucoma.

Secondary

The development of secondary congenital glaucoma suggests that the baby in the womb suffered an injury or inflammatory disease eye(ulcerative, inflammation of the cornea or iris). Damage to the ocular structure of the anterior angle during childbirth leads to a deterioration in the outflow of fluid inside the eye, but fluid production remains at the same level, which leads to glaucoma.

Infantile

Infantile glaucoma occurs in the first months after birth and up to 3 years. The causes are the same as in the early development of the disease. But the symptoms are different: there is no photophobia, the size and shade of the eyeball does not differ from a healthy one.

Only an ophthalmologist with the help of special equipment can diagnose the disease. After the gonioscopy procedure, the doctor will examine in detail the detected symptoms of the disease, prescribe the necessary treatment.

Juvenile (youthful)

Juvenile glaucoma occurs in children from 3 years of age (up to 35 years). The disease, according to the causes of occurrence, is divided into three types:

• With signs of aging. It is characterized by a change in the structure of the iris (the development of radicular atrophy). But the limbus, sclera and shell of the eye remain unchanged (do not thicken, do not expand). Children feel symptoms in the same way as older people (pressure in the eye increases, vision deteriorates);
• Congenital pathologies of the anterior region of the eyes. This type of glaucoma is caused by pigment dispersion syndrome (the trabecular meshwork is affected by small particles of pigment) or by highly proliferating retinal vessels caused by diabetes. Diagnosing the disease during the initial examination is difficult, since the symptoms appear sluggishly, and sometimes they do not exist at all. Requires hardware diagnosis;
• Glaucoma due to (myopia).

The organs of vision are extremely important for normal development child. Delay is unacceptable, which can lead to a partial or complete patient. Therefore, the child needs urgent treatment under the supervision of a specialist.

Treatment

Treatment of glaucoma in children only in a medical way will be ineffective. The drugs will not be able to provide a sufficient outflow of fluid from the eye. Ophthalmologists recommend surgery.

Operations

Depending on the severity of the disease, the doctor can choose the appropriate type of operation.

Goniotomy

The operative method of goniotomy is used in the early stages of the disease, with small growths on inside front camera of the eye. The methodology involves operation with air(a bubble is blown into the anterior chamber of the eyeball).

The air space allows you to better see the area where the operation is performed, normalize intraocular pressure, and stop the development of complications that reduce vision.

Sinustrabeculectomy

The sinustrabeculectomy method is used in serious cases of the disease, when the angle of the anterior chamber is severely deformed, or because of the unsuccessful outcome of the goniotomy. During surgical intervention with the help of the drainage system, formations that interfere with the outflow of eye fluid are removed.

The technique may be accompanied by complications: accumulation of blood in the anterior chamber, which can cause infection, a decrease in intraocular pressure. If the operation is performed by a good specialist, exacerbations quickly pass.

Laser cyclophotocoagulation

The technique is the treatment of affected areas with temperature (low or high). Interfering formations cauterized by cold or hot air within a few seconds. With a decrease in growths, further surgery will not be required. Otherwise, repeat the procedure after three months.

• Recommended reading:

Rehabilitation

Postoperative treatment lasts from 2 to 2.5 weeks. Restoration of visual functions is accompanied by photophobia, lacrimation, discomfort in the operated area. At this time, parents should carefully monitor the cleanliness of the hands and eyes of the baby. Give vitamins and medicines prescribed by the attending physician.

It is worth refusing to visit crowded places where a lot of dust accumulates, forbid the child to lift weights.

Prevention

Hereditary glaucoma cannot be prevented. The disease will either show up or it won't. Prevention of the occurrence of defects due to negative factors is carried out as follows: the expectant mother must give up bad habits, provide her diet with balanced food, be careful when walking so as not to injure her stomach.

After the birth of the baby, it is necessary to protect the eyes from injury, observe hygiene, and for timely diagnosis, it is necessary to be regularly observed by an ophthalmologist. At the first signs of the disease, the doctor will determine the complexity of the situation and prescribe adequate treatment.

Good day, dear readers and guests of the site! Today I would like to talk about a serious disease that can threaten children with complete loss of vision. In today's article, we will talk about the causes, the main symptoms, and most importantly, we will analyze the treatment of glaucoma in children.

Glaucoma is one of the most dangerous diseases in ophthalmic practice. It is characterized by an increase in pressure in the chambers of the eye, due to a violation during the outflow of intraocular moisture.

The disease more often, of course, manifests itself in patients older than 45-50 years, but, nevertheless, it can often be diagnosed in children.

Even newborns are not immune from the manifestations of glaucoma, as statistics show, glaucoma is found in 1 case per 10-20 thousand newborns. In childhood, pathology can be divided into the following types:

• Congenital. The disease is diagnosed in children under one year old. It is believed that the main reason is hereditary predisposition. However, traumatic damage to the organ of vision is also distinguished during the passage of the child through the birth canal of the mother or damage to the embryo in the prenatal period. The cause of intrauterine damage can be both an infectious disease of the mother, and exposure to trigger factors: smoking, alcohol, drug addiction, poisoning, taking drugs, especially in the first trimester, when the vision of the unborn child is laid.
• Infantile. It occurs in children from two to ten years. The cause may be birth defects that manifest themselves delayed.
• Juvenile or youthful glaucoma. Most often secondary and is the result of acquired diseases, it is diagnosed in children after 10 years. Most often, diseases leading to the development of glaucoma: myopia, traumatic eye damage, pathology of the endocrine, nervous, cardiovascular systems, and so on. It can also be inherited, is a dominant trait, more often manifested in boys.

Accordingly, children can have both acquired and acquired glaucoma. Also, the disease can be primary, that is, develop directly as a result of eye pathology, anatomical defects.

And also glaucoma can be: against the background of eye myopia, trauma, against the background of pathologies of other systems and organs, infectious lesions, and so on.

Symptoms of the disease

Glaucoma can be found in the literature as "green cataract" or "dropsy of the eye", which most accurately characterizes the main manifestation of the pathology.

Visible changes are characterized by clouding of the cornea, while it acquires an azure hue, reminiscent of green water. In children, the eyes acquire a special luster, and due to the protrusion of the cornea, the symptom of "cow's eyes" appears.

Due to the protrusion of the cornea, the iris also suffers: sometimes there is atrophy along the inner edge, a change in color.

Babies with congenital pathology very restless, they cry all the time. Decreased response to light. In parallel, other developmental anomalies are often found: microcephaly, heart defects, deafness. It may also be seen:

• - clouding of the cornea of ​​​​the eye;
• Aridia - the absence of the iris;
• Microkernea - unformed, small cornea.

In this case, the child has photophobia, accompanied by lacrimation. Often there is reddening of the sclera, their injection. Most often, the process is two-way.

The child may complain of clouding of the picture or dimming of vision on a clear sunny day.

In children, the field of vision narrows much more slowly than in adults and glaucoma rarely occurs.

More often the process is chronic with periodic exacerbations. During exacerbations, rainbow circles appear when looking at the source of light rays, as well as pulling pain in the eye, sometimes simulating a migraine attack, and sometimes even toothache.

Diagnostics

Diagnostic measures in children are designed to differentiate not only the disease itself, but also its form. This is fundamental, since different forms require completely different therapy.

Early diagnosis juvenile form is the key to preserving your child's vision!

From general surveys to without fail an external examination of the eyeball, measurement of visual fields, acuity. An important diagnostic method is the measurement of pressure inside the eye, the most accurate is using the Mikulich tonometer, but it is extremely difficult for children to make such a measurement, so they use modern technique- pneumotonometry.

In children, it is mandatory to look at the fundus of the eye: an expansion of the venous pattern, congestive optic nerves, and blanching of the retina is found.

It is also mandatory to carry out a topographic and gonioscopic study, which allows to determine the level of damage and the patency of the Schlemm canal. Often used methods of ultrasound diagnostics.

Unfortunately, the whole range of ophthalmological examinations is currently unavailable in Russia. It is believed that the most informative and progressive non-invasive and most accurate techniques are used in Germany.

In particular, they can inspect damage to the optic nerve, thereby preventing the development of certain types of hereditary glaucoma in children.

Treatment

With anatomical congenital anomalies, the most effective method therapy - surgical correction of the defect. If the disease is hereditary and develops gradually, most often it is a youthful and infantile form, then therapy should begin with the use of conservative treatment, to stabilize the process and complete the growth of the eyeball.

This tactic is motivated by the fact that with early and unprepared surgical intervention, a relapse with progressive deterioration is possible.

In Russia, as a standard, any therapy begins with the use of medications. The main preference is given to drugs of the prostaglandin group.

Folk remedies for the treatment of glaucoma in children are not recognized by official medicine, due to the low evidence base and the difficulty of applying compresses or the impossibility of using alcohol-based infusions.

With the progression of the disease or with the appearance of complications in the form of retinal detachment or the development of an acute attack, it is necessary surgical intervention.

In Russia, it is possible to carry out standard surgical interventions:

• Trabeculectomy - this removes part of the trabecular network, as well as parts of adjacent structures of the eye.
• Endoscopic cyclophotocoagulation - due to laser exposure, a part of the ciliated body is coagulated, thereby reducing the production of aqueous humor and opening the Schlemm duct.

However, at the present level of medical development, there are more progressive methods of therapy. In Germany, dropsy of the eye in children is given special attention and new progressive and minimally invasive techniques are being developed that are suitable for children and reduce the risk of complications and relapse.

The most progressive method of treatment at the moment with the help of the thinnest artificial thread, with which the ciliary body is sutured to the inside of the eye. This allows you to open the Schlemm duct and resume the outflow of aqueous humor. This does not form scars, as in conventional operations.

At the end of the article, I suggest you watch a video about glaucoma in children and during pregnancy:

Conclusion

So, dear friends, glaucoma in a child is very serious illness requiring the initiation of therapeutic measures immediately. Early diagnosis and progressive treatment methods can preserve a child's perfect vision.

With the wrong approach, a complete loss of vision in a child is possible. We hope that the information has clarified the concept of pediatric glaucoma. Subscribe for updates and see you soon!

Glaucoma is very serious disease eye caused by increased intraocular pressure, which can lead to corneal and retinal detachment, and, as a result, complete or partial blindness. It is expressed in the changed color of the pupil. Because of the greenish tint, the disease is also called "green cataract". Glaucoma can be congenital (intrauterine or hereditary), juvenile (juvenile) and secondary. Diagnosed as hydrophthalmos (dropsy of the eye). The symptoms and causes of glaucoma in children are closely related. The signs of the disease, which are listed below, will help parents self-diagnose the disease in a child.

Causes of congenital disease

Congenital glaucoma in children in 80% of cases is caused by a gene mutation, and in 20% by the pathology of pregnancy in the first 3 months, it is mainly:

• STIs (sexually transmitted infections);
• various poisonings, including intestinal;
• abuse of alcoholic beverages, smoking mixtures;
• altered radioactive background in places of residence;
• lack of vitamins, mainly retinol. Possibly due to poor nutrition;
• fetal hypoxia (lack of oxygen).

Causes of an acquired disease

Causes of glaucoma in children of the acquired form:

• increased arterial and intraocular pressure;
• dysfunction of the main body systems (endocrine, cardiovascular and nervous);
• hereditary disease eye;
• eye injury.

Symptoms

Glaucoma is a progressive eye disease characterized by an increase in intraocular pressure and a decrease in visual acuity. In children, this pathology may have a congenital etiology. Also, the disease can occur due to the anatomical features of the structure of the eye. Ophthalmologists distinguish the following symptoms of glaucoma in children:

1. An increase in the size of the eyeball.
2. The presence of signs of fear of light and brightly lit rooms by the child, tarnishing of the cornea and its swelling.
3. At the initial stages of the development of the disease, this phenomenon is not observed, however, with the progression of glaucoma, severe destructive changes may appear.
4. Manifestation clinical symptoms and their severity depends on the stage and form of the disease.

The danger of this disease lies in the rapid progression of the manifestations of the disease and the risk of developing blindness in a child. Therefore, parents need to undergo an annual examination by a specialist for the treatment and control of the visual functions of the child.

In children, ophthalmologists usually distinguish congenital, secondary infantile and juvenile forms of glaucoma. More details about them will be discussed below.

congenital glaucoma

The disease is usually detected in newborn babies. According to ophthalmologists, the main cause of this form of glaucoma is precisely hereditary predisposition. But no less important are possible eye injuries during childbirth, as well as intrauterine damage to the embryo.

With congenital glaucoma in children, the photo of which is given in the article, the embryo can be affected as a result of an infectious disease of a pregnant woman, as well as due to the action of trigger factors on it: taking certain dangerous drugs, poisoning, drug addiction, alcohol, smoking, especially at the beginning of pregnancy, when the child's organs of vision are laid.

Secondary glaucoma

The development of this form occurs against the background of an infectious lesion, trauma, eye myopia, as well as pathologies in other organs and systems. The fetus may experience injury or inflammatory process In eyes. Damage to the anterior angle of the eye structure during childbirth often causes a decrease in the outflow of fluid, but still it continues to stand out, provoking the appearance of glaucoma.

Inflammatory

Inflammatory glaucoma develops as a result of the presence of inflammation in the choroid of the anterior part of the eye. Adhesions that form between the lens capsule and the posterior part of the shell of the eye can cause a circular infection of the pupil around the edge. This causes an increase in pressure in the eyes.

Infantile glaucoma

Glaucoma of this type occurs in children from birth to 3 years. The reasons for its appearance do not differ from the factors of the early development of the disease. Symptoms are enlargement of the affected eyes, as the collagen in the cornea and sclera of the eyes can be stretched due to increased pressure in the eyes. The cornea may become cloudy and thinned, the child begins photophobia and lacrimation.

Juvenile glaucoma

This type of glaucoma usually develops in children older than 3 years. It occurs mainly due to the pathological development of the angle of the cornea and the iris, which can also be due to a hereditary factor. In most cases, such glaucoma occurs without obvious symptoms, so it is detected quite late. If juvenile glaucoma is left untreated, clouding of the cornea will progress over time, the optic nerve will become damaged, it may swell, and even blindness may develop.

Treatment

Diagnosis of pediatric glaucoma is performed by an ophthalmologist, who prescribes an examination to determine the stage of the disease, as well as possible cause that prompted her appearance. Also, a specialist may ask for a pregnancy card - this will also help determine the prerequisites for this disease.

It is noteworthy that the symptoms are often confused with conjunctivitis in a child. It is necessary to check the eye pressure and the size of the cornea. Eye pressure is measured to the child after the introduction of anesthesia to the child. The diameter of the cornea between the limbs is also measured. Carry out a survey optic nerve, the integrity of the cornea membrane, its transparency, refraction.

Medical and conservative therapy

With some forms this disease eye conservative treatment of glaucoma in children alone may not be enough. Usually combine the use of "Acetazolamide" intravenously and oral use of drugs. Also, a pediatric ophthalmologist may prescribe Pilocarpine and Betaxolol. The dose of the drug is prescribed taking into account the age and weight of the baby.

Conservative therapy is an exclusively additional concomitant method used to prepare for the operation, as well as for some time after it. To normalize disturbed intraocular pressure, Halothane or similar medications are used. However, they are not effective enough to completely eliminate the symptoms of the disease. Therefore, doctors recommend the fastest possible surgical intervention, which has no age-related contraindications.

Miotics are designed to reduce ophthalmotonus, but they do little to reduce the symptoms of the disease in children. With hydrophthalmos, for at least a slight decrease in ophthalmotonus, the use of 1% pilocarpine is indicated. The production of fluid inside the eye is reduced by "Diakarb", and "Glycerol" is an effective osmotic antihypertensive agent.

Surgery

As noted above, the examination of the baby is carried out after the introduction of anesthesia (ketalar or ferrous-fluorothane). But it is not recommended to use intubation, suxamethonium and ketamine, since these substances can increase the pressure inside the eyes. Children with glaucoma are operated on using high-precision microsurgical instruments and an operating microscope. Basically, a goniotomy is performed if a transparent cornea is noted. But if there is a corneal rupture, trabeculotomy is indicated.

1. Yttrium-aluminum-garnet goniotomy restores eye pressure for a longer time when compared with surgical goniotomy. But there are other facts that refute this information. Primarily this operation carried out at the initial stage of the disease. In this case, air is used - an air bubble is blown into the eye chamber, which allows you to view the area for surgical intervention. The result of goniotomy should be the normalization of intraocular development, the suspension of the progression of complications that provoke problems with normal vision.
2. Trabeculotomy is performed in the treatment of congenital glaucoma, especially if a normal view of the anterior chamber of the corner of the eyes is not provided.
3. Endolaser, cyclocryotherapy and implantation of drains are effective. Basically, tubular drainages are installed if the surgical intervention did not bring the desired result. Through the use of a drainage system, the ophthalmologist removes formations that prevent the outflow of excess fluid. This technique can cause blood to pool in the eye, sometimes leading to infection and reduced eye pressure. But if the operation is carried out qualitatively, the child's complications will disappear quite quickly.
4. Sinustrabeculectomy is used in more complex cases of glaucoma, if the goniotomy did not bring a positive result and excessive changes in the camera angle of the eyes.
5. Laser cyclophotocoagulation consists in the treatment of damaged areas of the eye by exposure to high or low temperatures. Bad formations are cauterized for several seconds, and if the growths decrease, the operation can be omitted.

Otherwise, cyclophotocoagulation is repeated after 3 months. The effectiveness of the operation is influenced by the timeliness of the parents' appeal to the ophthalmologist, the duration of clinical symptoms, the correct choice of treatment methods, the age of the child and the severity of the disease.

After operation

The duration of rehabilitation after performing surgery in a child is usually 2-3 weeks. During the restoration of visual functions, the child may experience slight discomfort at the site of the operation, lacrimation and photophobia. After the operation, parents must make sure that the children have clean hands and eyes, if possible, do not visit dusty places with a lot of people, do not allow them to lift heavy things, and also give him vitamins and medicines prescribed by the attending physician.

Prevention

First of all, for prevention it is necessary to know why and under what conditions a child can develop glaucoma. If the disease is detected at the initial stage, then the risk of acquiring disability disappears. Therefore, it is recommended to visit an ophthalmologist with your child at least once a year. The undoubted benefit in maintaining eye health will bring a balanced diet and maintaining a healthy active lifestyle. In this case, it is necessary to eliminate factors that can negatively affect the disease detected in the child. It will help to improve the state of affairs and the rejection of any bad habits, reducing stressful situations.

The doctor may prescribe eye drops for a child or teenager for preventive purposes. The action of the drops in such cases is aimed at reducing the pressure in the eyes and reducing the volume of fluid produced. Also, many experts strongly recommend 8-hour sleep per day, and it is strictly forbidden to lift any weights in case of problems with the eyes. Work with small details, such as embroidery or plasticine modeling, reading and watching TV should be done only with good lighting so that eye strain is minimal.

Glaucoma in children is a disease characterized by an increase in intraocular pressure, leading to a violation of the outflow of aqueous humor from the eyes. Delayed treatment of the disease can provoke optic nerve atrophy, loss of acuity, and sometimes complete loss of vision.

Causes

Doctors have not identified the main causes provoking the development of glaucoma in children. Experts tend to the disease can manifest itself due to hereditary predisposition or due to the influence of other factors during the period of the child's stay in the womb.

The following prerequisites for the disease are distinguished:

• pathology nervous, cardiovascular, or endocrine systems;
• infectious diseases mothers during pregnancy (typhoid, rubella, poliomyelitis, syphilis, mumps, toxoplasmosis, beriberi);
• anomalous eye structure child;
• bad habits mothers;
• hypoxia carried by the fetus in the womb.

Symptoms

Glaucoma identified by visual symptoms and behavioral signs. Infants suffering from the disease are in constant nervous tension, cry, refuse to eat.

Symptoms by which oculists determine the disease:

• lacrimation, photophobia;
• frequent blinking, occasional redness of the eyes;
• clouding of the cornea, pupil dilation is observed;
• The sclera acquires a bluish tint, then stretches, due to which the choroid becomes visible.

The disease can occur without obvious symptoms, so newborns are regularly recommended to be shown to an ophthalmologist.

Kinds

In childhood, there are several types of the disease: congenital (primary, secondary), infantile, juvenile.

congenital primary

Congenital glaucoma in children of the primary type is most often manifested in a hereditary line. Symptoms of the disease can be found among relatives of the newborn. In addition to heredity, the onset of the disease can be affected by injuries to the abdomen, in which the fetus is located, or an unhealthy lifestyle of the expectant mother.

In the eyes of an unborn baby, there are tissues that must be absorbed inside the womb. Under the influence of negative factors, tissues remain in the corner of the anterior chamber of the baby's eyes, forming the basis for the development of glaucoma.

Secondary

The development of secondary congenital glaucoma suggests that the baby in the womb suffered an injury or inflammatory eye disease(ulcerative keratitis, inflammation of the cornea or iris). Damage to the ocular structure of the anterior angle during childbirth leads to a deterioration in the outflow of fluid inside the eye, but fluid production remains at the same level, which leads to glaucoma.

Infantile

Infantile glaucoma occurs in the first months after birth and up to 3 years. The causes are the same as in the early development of the disease. But the symptoms are different: there is no photophobia, the size and shade of the eyeball does not differ from a healthy one.

Only an ophthalmologist with the help of special equipment can diagnose the disease. After the gonioscopy procedure, the doctor will examine in detail the detected symptoms of the disease, prescribe the necessary treatment.

Juvenile (youthful)

Juvenile glaucoma occurs in children from 3 years of age (up to 35 years). The disease, according to the causes of occurrence, is divided into three types:

• With signs of aging. It is characterized by a change in the structure of the iris (the development of radicular atrophy). But the limbus, sclera and shell of the eye remain unchanged (do not thicken, do not expand). Children feel symptoms in the same way as older people (pressure in the eye increases, vision deteriorates);
• Congenital pathologies of the anterior region of the eyes. This type of glaucoma is caused by pigment dispersion syndrome (the trabecular meshwork is affected by small particles of pigment) or by highly proliferating retinal vessels caused by diabetes. Diagnosing the disease during the initial examination is difficult, since the symptoms appear sluggishly, and sometimes they do not exist at all. Requires hardware diagnosis;
• Glaucoma due to nearsightedness (myopia).

The organs of vision are extremely important for the normal development of the child. Delay, which can lead to partial or complete blindness of the patient, is unacceptable. Therefore, the child needs urgent treatment under the supervision of a specialist.

Treatment

Treatment of glaucoma in children only with medication will be ineffective. The drugs will not be able to provide a sufficient outflow of fluid from the eye. Ophthalmologists recommend surgery.

Operations

Depending on the severity of the disease, the doctor can choose the appropriate type of operation.

Goniotomy

The operative method of goniotomy is used in the early stages of the disease, with small growths on the inside of the frontal chamber of the eye. The methodology involves operation with air(a bubble is blown into the anterior chamber of the eyeball).

The air space allows you to better see the area where the operation is performed, normalize intraocular pressure, and stop the development of complications that reduce vision.

Sinustrabeculectomy

The sinustrabeculectomy method is used in serious cases of the disease, when the angle of the anterior chamber is severely deformed, or because of the unsuccessful outcome of the goniotomy. During surgery with the help of the drainage system, formations that interfere with the outflow of eye fluid are removed.

The technique may be accompanied by complications: accumulation of blood in the anterior chamber, which can cause infection, a decrease in intraocular pressure. If the operation is performed by a good specialist, exacerbations quickly pass.

Laser cyclophotocoagulation

The technique is the treatment of affected areas with temperature (low or high). Interfering formations cauterized by cold or hot air within a few seconds. With a decrease in growths, further surgery will not be required. Otherwise, repeat the procedure after three months.

• Recommended reading: glaucoma treatment in Israel

Rehabilitation

Postoperative treatment lasts from 2 to 2.5 weeks. Restoration of visual functions is accompanied by photophobia, lacrimation, discomfort in the operated area. At this time, parents should carefully monitor the cleanliness of the hands and eyes of the baby. Give vitamins and medicines prescribed by the attending physician.

It is worth refusing to visit crowded places where a lot of dust accumulates, forbid the child to lift weights.

Prevention

Hereditary glaucoma cannot be prevented. The disease will either show up or it won't. Prevention of the occurrence of defects due to negative factors is carried out as follows: the expectant mother must give up bad habits, provide her diet with balanced food, be careful when walking so as not to injure her stomach.

After the birth of the baby, it is necessary to protect the eyes from injury, observe hygiene, and for timely diagnosis, it is necessary to be regularly observed by an ophthalmologist. At the first signs of the disease, the doctor will determine the complexity of the situation and prescribe adequate treatment.

Glaucoma is a serious disease of the organ of vision, which is characterized by increased intraocular pressure. This pathology leads to a gradual deterioration of vision or blindness.

In children, this disease does not occur often. Pediatric glaucoma includes many diseases. A large number of forms of childhood glaucoma are the result of malformations of the anterior segment of the eye and structures of the anterior chamber angle.

Despite the pathophysiological mechanism, many forms of the disease have similar clinical symptoms, which differ significantly from glaucoma in adults.

Causes of glaucoma in a child

This disease is hereditary or occurs due to the influence of certain factors during the stay of the baby in the womb. Doctors have long agreed that there is no specific reason manifestations of glaucoma. Basically, this is a set of any disorders in the body and certain risk factors. Often, the prerequisites for the onset of the disease are:

• abnormal structure of the eyes in babies;
• diseases of the endocrine, as well as nervous and cardiovascular systems;
• infectious diseases of the mother during pregnancy: toxoplasmosis, mumps, rubella, vitamin deficiency and others;
• hypoxia, which the fetus suffered in the womb;
• maternal bad habits.

Since such risks do not occur often, glaucoma in children is quite rare. Also, in infancy, it is easier to prevent its development and to carry out an operation in time, which provides good chances for good vision.

Symptoms of glaucoma in children

In addition to symptoms, behavioral factors help diagnose glaucoma, although their manifestation is possible in the later stages, when vision is already seriously impaired. Main symptoms:

• an increase in the size of the cornea,
• pupil dilation is noted;
• the sclera becomes bluish in color, then it stretches, as a result of which the choroid is visible;
• photophobia, temporary redness of the eyes;
• tearing of the eyes.

With the development of the disease, the behavior of children is restless, there is no appetite. Infants are usually naughty, they have poor sleep. Older children have pain in the eyes. But often glaucoma in the early stages is asymptomatic. Accordingly, visits to the optometrist are of no small importance for babies in order to understand that the child has no vision problems.

Related material: What restrictions in life await a person with glaucoma

Varieties of glaucoma

There are several types of glaucoma among children:

• congenital;
• secondary;
• infantile;
• juvenile.

congenital glaucoma

This type of glaucoma in a child often occurs due to heredity. Symptoms of the disease can be observed in relatives of the baby. Also, the appearance of the disease is influenced by abdominal trauma, where the fetus developed or the bad habits of the expectant mother.

Secondary glaucoma

The development of secondary glaucoma indicates that the crumbs in the womb had an injury or an inflammatory process of the organs of vision took place. Damage to the structure of the anterior angle of the eye during childbirth causes a decrease in intraocular fluid outflow, but the fluid itself is released as before, which causes glaucoma.

Infantile glaucoma

This species can appear in the first months of a baby's life and up to three years. The factors of its occurrence are the same as in early development illness. However, the symptoms are different: there is no photophobia, the size and color of the eyeball is difficult to distinguish from a healthy one.

Juvenile glaucoma

Juvenile can be observed in children over the age of 3 years. The disease is characterized by a genetic predisposition, often asymptomatic, and therefore, diagnosed late. This problem is now quite relevant, because there is a high increase in the incidence.

Treatment of pediatric glaucoma

Diagnosis of pediatric glaucoma is carried out by an ophthalmologist who prescribes an examination in a medical genetic clinic to determine the stage of the disease and the cause of its occurrence. In addition, a specialist may need a pregnancy map to determine the prerequisites for the onset of the disease. Keep in mind that the symptoms of glaucoma are similar to conjunctivitis. In this regard, it is mandatory to check the size of the cornea and the pressure in the eye.

At drug treatment are used eye drops to normalize intraocular pressure. But they are not effective enough to eliminate diseases. That is why surgery is recommended, for which there are no contraindications by age. Therefore, if there is no reason to refuse a surgical solution, it should be carried out as early as possible.

The operation is laser and traditional (knife): it depends on the type of disease, its stage, as well as on the magnitude of intraocular pressure.

Treatment of glaucoma with a laser pulse

Laser surgery for pediatric glaucoma has effective result. Its task is to restore the outflow of fluid through its natural channels. With help laser beam fluid drainage is restored and the operation is done mainly in the iris. The use of a laser has a large number of advantages, the most important of which are: the highest accuracy, non-invasiveness, short duration of exposure to a laser pulse.

traditional method

Surgery for a child with glaucoma is performed under general anesthesia. Its essence is to create a new outflow path, bypassing the broken one.

Operation price

It is impossible to say unequivocally how much glaucoma surgery costs. The price will be determined by the method of the operation, which can cost both 19-20 thousand rubles and 37-40 thousand rubles. And also it will differ depending on the chosen medical center.

rehabilitation period

After the operation, drug therapy is prescribed, which is aimed at a speedy recovery. In addition, children must be under the supervision of an ophthalmologist. It is necessary to visit it approximately every three months, because such children arrive all their lives at risk for increased intraocular pressure.
It is important to know what is acceptable and what not to do in postoperative period, since it is in the first decade that the operated child needs special care, consisting of the following parts:

1. Proper care. In no case should you wash the eye on which the operation was performed. Do not scratch or rub the eyeball. And also you can not self-medicate.
2. Dream. You can only sleep on your side and in such a position that the operated eye is at the top. On the stomach and on the side where the sore eye is not worth sleeping, as there may be a violation of the circulation in the eye.
3. Nutrition. After the operation, you will have to give up hard, hot, salty and pickled foods. All other food can be consumed.
4. Daily activity. The operated child must refuse physical activities. In addition, it is forbidden to visit baths or saunas.

Prevention of glaucoma in children

Of course, the best way to prevent glaucoma is to identify the disease at the beginning of its development. Once a year, the baby needs to be examined by an ophthalmologist.

If the crumbs have been diagnosed with vision problems, you should immediately visit a doctor and follow his recommendations.

It is necessary to exclude from the life of the baby factors that can aggravate the course of the disease. It is necessary to give up bad habits, if any. You also need to try to reduce the amount of stress and normalize the proper rest of the baby. By following these recommendations, it is possible to avoid blindness, which often becomes a complication of glaucoma among children.

Ophthalmologists do not recommend lifting weights over 10 kg. You need to sleep at least eight hours a day. You can not read, sit at the computer and watch TV shows if the room has poor lighting. In addition, shirts with tight collars should not be worn, as they have a negative effect on blood circulation.

To prevent glaucoma, the doctor may prescribe eye drops that reduce the amount of fluid produced and reduce intraocular pressure.

When a doctor prescribes glasses or lenses, you should not refuse them.

Read also:

• Astigmatism
• Myopia
• farsightedness
• color blindness
• Conjunctivitis
• inflammation
• optic nerve
• Neoplasms of the eyelids and eyeball
• Barley
• Eye diseases in children
• Accommodation
• Diseases of the eyelids
• Retinal diseases
• Glaucoma
• Cataract
• Keratitis
• Strabismus

• Full boobs of doctors in your city

• Preparations

  Medical treatment

Get the latest news on gastrointestinal treatment

• With honey. education for writing articles
• Journalist for medical news

Congenital glaucoma (ICD-10 code - Q15.0) is a congenital most complex disease that occupies one of the first places in the list of ophthalmic diseases, in which, subsequently, congenital or hereditary disorders increase eye pressure, as a result, the intraocular fluid flows out.

If not resolved this problem in a timely manner, constantly increasing eye pressure will provoke a violation of the nutrition of the optic nerve, as a result of which complete irreversible blindness may occur. Congenital glaucoma is a disabling and serious pathology. Timely diagnosis of open-angle or closed-angle glaucoma gives a great chance for the child to recover and return to a normal life.

To date, distinguish the following reasons congenital glaucoma in children:

• 80% of cases of anomalies in children are the result of a mutation in the CYP1B1 gene (located on the 2nd chromosome). It is responsible for encoding the cytochrome P4501B1 protein, the full functionality of which has not yet been fully studied today. Defects in this protein lead to abnormal work of the synthesis and destruction of signaling molecules, therefore, the intrauterine process of eye formation is disrupted and congenital glaucoma develops. There are about fifty varieties of CYP1B1 mutation, but it has not yet been possible to determine the exact relationship of the gene defect with the manifestation of certain clinical manifestations;
• Another reason is considered to be a defect in another gene - MYOC (location - 1st chromosome). This gene is responsible for the production of myocillin (participates in the stimulation of work and the formation of the trabecular eye network). Experts have found that a defect in this gene provokes the development of open-angle glaucoma, but with a violation of MYOC and CYP1B1, congenital glaucoma develops in a child;
• 20% of cases of manifestation of pathology are the reaction of the fetus to diseases carried by the mother during pregnancy (chickenpox, influenza, toxoplasmosis, rubella, etc.), exposure to taratogenic factors, retinoblastoma and intrauterine trauma. This type of disease, since its manifestation does not depend on genetic mutations, is called secondary congenital glaucoma.

Regardless of the causes of this pathology, eye disorders are almost the same. Due to the underdeveloped angle of the anterior eye camera and the trabecular meshwork, aqueous humor does not naturally escape from the eye cavity, as a result, an increase in its amount is observed, and an increase in intraocular pressure is provoked. A feature of congenital glaucoma is the presence of an elastic cornea and sclera in children, therefore, during the period of moisture accumulation, a change in the size of the eyeball is provoked (basically, this pathology affects both eyes).

Due to the possibility of changing the volume of the eyeball, intraocular pressure in glaucoma decreases somewhat. With age, an enlarged cornea and a flattened lens are observed, small tears form on the cornea, which cause it to become cloudy; the retina becomes thinner, and the optic disc is damaged. As a result, detachment of the cornea, retina is observed, leading to complete or partial blindness.

Classification of congenital glaucoma

There are three clinical manifestations of congenital glaucoma: primary, secondary and combined:

1. Primary - a consequence of a genetic disorder.
2. Secondary - a consequence of intrauterine diseases and injuries.
3. Combined - the presence of both a genetic failure and intrauterine lesions.

Primary is divided into three types:

• Early - all signs of an anomaly are visualized immediately after the birth of a child or during its development up to the age of three;
• Infantile - visualized in children from three to ten years old, a more difficult flowing form;
• Juvenile - often manifested in adolescence, during active puberty, all symptoms are similar to the infantile appearance.

The age of manifestation of the disease depends on the degree of intrauterine underdevelopment of the trabecular ophthalmic network. The deeper the violation, the sooner the pathology will be dried. If the degree of underdevelopment of the angle of the eye anterior chamber is minimal, then all manifestations of the pathology will be visualized at a later age.

Symptoms

Pathology can be diagnosed by the following signs:

1. enlarged eyeball.
2. fear of bright light.
3. increased lacrimation.
4. high intraocular pressure.
5. corneal diameter is greater than normal.
6. swelling and clouding of the cornea.
7. the anterior chamber of the eye is deepened.
8. swelling or change in the optic disc.
9. dilated pupil, delayed reaction to light.
10. deterioration in the quality of vision.

Symptoms in children directly depend on the depth, type and complexity of the anomaly. With the initial development of congenital glaucoma in newborns, the vitreous body is completely transparent, later single opacities begin to appear, in the later stages there is complete opacification with partial hemorrhages. Since the blood circulation in the eye is disturbed, dystrophy of the optic nerve head occurs, further its complete atrophy, as a result of which irreversible blindness develops.

Diagnosis of the disease

Diagnosis in infants is complex. The list of mandatory examinations includes:

• clinical general examination;
• keratometry;
• biomicroscopy;
• gonioscopy;
• gonioscopy with corneocompression;
• ophthalmoscopy;
• tonometry;
• tonography;
• study of the state of visual functions.

In children under 3 years of age, all studies are performed under general anesthesia (medicated sleep).

Most often, congenital glaucoma becomes known immediately after examination by a micropediatrician in the maternity hospital. From early signs can be distinguished: an increase in the diameter of the cornea and its clouding, a large iris in a child, expressive and large eyes in an infant. With a high probability, both eyes are affected at once, and the child needs a lightning-fast surgical examination and treatment.

If the disease is not identified at birth, in most cases the diagnosis is made within the first year of the child. It is in order not to miss important days for the diagnosis and treatment of such a dangerous and insidious disease that you need to regularly visit a pediatrician and a pediatric ophthalmologist. The first time you need to come to the ophthalmologist in the first trimester after the birth of the baby.

To date, to treat an ailment, regardless of its form, is possible with only one method - surgery. Before and after the operation, an appropriate conservative therapy. There are no age restrictions for operable intervention. The success of treatment directly depends on the timely diagnosis of the pathology, on the complexity and age of the baby.

Today, you can choose a variety of methods of surgical treatment of the disease: laser technologies - cyclopriopexy and cyclophotocoagulation, installation of drainage systems, sinustrabeculectomy and trabeculotomy, homeopuncture and goniotomy.

If, after the first operation, the eye pressure has not returned to normal and the ophthalmotonus is increased, it is necessary to perform a second operation and prescribe a course of medication. In early childhood, the disease progresses as quickly as possible, therefore, if necessary, reoperation cannot be tightened.

Features of operations in the presence of congenital glaucoma of various forms:

1. The operation is minimally traumatic.
2. There are no postoperative complications.
3. The hospital stay is short.

• Touching the eye after surgery should be minimized;
• Within two weeks, you need to regularly drip into the eyes the medicine prescribed by the doctor for disinfection;
• In a thirty-day period, abandon saunas / baths and protect your eyes from sudden temperature changes;
• Do not visit dusty rooms to avoid eye irritation;
• Month to protect yourself from physical exertion;
• Follow all instructions of the ophthalmologist.

Children diagnosed with congenital glaucoma and after surgery should regularly (monthly) visit an ophthalmologist for prevention. During a preventive examination, the doctor prescribes medication, pleoptic treatment, intraocular pressure and the condition of the nerve disk of the eye are checked. The main goal of observation is the timely detection of progressive glaucoma and the appointment of repeated surgical intervention. It is important to remember that the treatment of glaucoma with folk remedies is contraindicated, since without surgery you can only aggravate the problem.

Warts on the hands of a child treatment at home quickly

Anomalies and diseases of the eyelids, lacrimal organs, conjunctiva. Features of the course in children. Treatment. Anomalies and diseases of the refractive optical media of the eye. Features of the course and treatment. Recommendations for the process of teaching and educating children with anomalies and diseases of the cornea. Recommendations for the process of teaching and educating children with lens pathology. Limitation of physical activity (lifting weights, prolonged tilting of the head and torso down, shaking the body, jumping, somersaults). Constraint continuous visual work near, which should correspond to the age and functional data of the child. To prevent the development of amblyopia, work is shown with the distinguishability of small details (small mosaic, designers, etc.), a combination of pedagogical classes with therapeutic measures. Anomalies and diseases of the vascular tract.

Recommendations for the process of education and upbringing of children with pathology of the vascular tract: with this pathology, all the main visual functions suffer, therefore, children have low visual, general performance and fatigue. It is necessary to limit the time of continuous visual work near, physical activity, it is necessary to plant the child in the study room so that direct rays of light do not fall into the eyes.

Developmental anomalies and diseases of the retina and optic nerve. Recommendations for the process of education and upbringing of children with pathology of the retina and optic nerve: with visual and physical stress - a strictly differentiated, individual approach depending on the form, course, depth of the process.

Glaucoma congenital and acquired. Recommendations for the process of education and upbringing of children with glaucoma: conditions of the body and environmental conditions that increase intraocular pressure are contraindicated. Restriction of visual and physical activity is shown; it is contraindicated to stay in a hot room, in the sun, in a dark room. Pathology of the oculomotor apparatus of the organ of vision. Strabismus concomitant and paralytic. Prevention and treatment of strabismus and amblyopia in clinics, vision protection rooms, specialized kindergartens, sanatoriums for children with strabismus. The role of the teacher, educator in the process of prevention and treatment of strabismus and amblyopia. Close relationship with the child's family. The role of parents in the treatment and rehabilitation of strabismus and amblyopia. Recommendations for the process of education and upbringing of children with strabismus and amblyopia; all pedagogical measures must be coordinated with medical and rehabilitation work.

Damage to the organ of vision as a whole. Microphthalmos, anophthalmos, albinism: causes, features of the course and outcomes. Prevention and treatment.

Recommendations for the process of teaching and educating children with this pathology: visual and exercise stress must correspond to the visual capabilities (i.e. the state of visual functions), the physical development of the child, his age.

Basic concepts: eyelid coloboma; inversion, eversion of the eyelid; epicanthus, ptosis, stye, chalazion, blepharitis, conjunctivitis, keratoconus, macro- and microcornea, macro- and microphakia, spherophakia, dislocation, lens subluxation, cataract, amblyopia, aniridia, iris coloboma, choroidal coloboma, uveitis, retinal detachment, degenerative dystrophic changes in the retina, retinoblastoma, glaucoma, concomitant strabismus, paralytic strabismus, microphthalmos, anophthalmos, albinism,

It is necessary to have a clear idea of ​​the causes of the development of a particular disease and the nature of the resulting changes in the body in order to prevent the onset of the disease or determine its nature and help the patient. You also need to know what consequences the disease can cause. However, one clinical experience accumulated by observations at the patient's bedside is not enough for this. Medical workers must understand the essence of the disease deeper than the limits that are possible when studying the disease at the patient's bedside. Pathology helps them in this.

Pathology (from the Greek. Pathos - disease, logos - science) - a science that studies the disease, its essence and patterns of development.

Pathology studies the whole variety of deviations in the state of health from the norm, the causes and patterns of the occurrence of diseases and gives scientific rationale for a directed effect on a diseased organism, i.e. for treatment. To this end, she deepens the observations obtained in the clinic with the help of physiological, morphological and experimental laboratory studies.

Modern medicine is based on strictly verified scientific data. Pathology is one of the leading sciences in medicine. This science has become so voluminous that it has broken up into a number of sections. These sections are closely related to each other, but they differ so much in their methods that each of them is independent, has its own specialists and its own medical institutions.

Pathology of the visual sensory system studies various anomalies and diseases of the organs of vision, the causes and patterns of eye diseases, prevention and methods of their treatment.

Pathology of the cornea.

The cornea is one of the most important optical structures of the eye. She is very vulnerable due to almost continuous contact with environment while awake. Since the cornea is located in the area of ​​​​the open eye gap, it is most exposed to light, heat, microorganisms, foreign bodies therefore, various morphophysiological and functional disorders can occur in it. The post-traumatic and inflammatory pathology of the cornea is especially unfavorable, since it is often not strictly isolated due to the common blood supply and innervation of the cornea and other parts of the eye.

Corneal pathology occurs in the form of congenital anomalies, tumors, dystrophies, inflammations and injuries.

Corneal anomalies.

Anomalies of the cornea are more often characterized by changes in its size, radius of curvature, and transparency.

Microcornea. Microcornea, or small cornea, is a condition of the cornea in which its diameter is reduced. When measuring the cornea, it is revealed that it is reduced by more than 1-2 mm compared to the age norm, i.e. the diameter of the cornea of ​​a newborn may not be 9, but 6-7 mm, and a child of 7 years old - not 10.5, but 8-9 mm, etc.

Macrocornea. Macrocornea (macrocornea), or megalocornea, large cornea, i.e. its dimensions are increased in comparison with the age norm by more than 1 mm.

Depending on the magnitude of deviations from the age norm, they can affect clinical refraction and visual functions to varying degrees, since this changes the radius of curvature of the cornea, and sometimes its transparency. In addition, it should be borne in mind that conditions such as micro- or macrocornea may be accompanied by an increase in intraocular pressure. Therefore, in every child with both small and large corneas, it is necessary to examine the intraocular pressure.

Treatment of such conditions, as a rule, is not carried out. There may only be a need for spectacle or contact correction of ametropias of various types and sizes.

Keratoconus. Keratoconus is a condition of the cornea in which its shape and curvature are significantly changed (Fig. 1).

Keratoconus.

At the same time, its central part predominantly protrudes conically. The presence of such an anomaly should be assumed in cases where a decrease in visual acuity is found in children with transparent refractive optical media and normal fundus. In such cases, it is necessary to determine the shape, curvature and refraction of the cornea (keratometry, ophthalmometry, refractometry). In this case, pronounced astigmatism is always detected, more often incorrect. Keratoconus often has a malignant course, i.e. its degree increases, and most importantly, clouding of the cornea occurs and progresses, and at the same time vision drops sharply.

In biomicroscopic examination, ruptures of the basement membrane of the epithelium, thickening, fibrillar degeneration and cracks of the anterior border plate (Bowman's membrane), folds and bends of the posterior border plate (Descemet's membrane) are distinguished.

The process occurs more often at the age of 8-9 years and older, develops slowly, usually without inflammation. As a rule, both eyes are affected, but not always at the same time and to varying degrees. In the initial stage of the disease, a protrusion (cone) appears, the degree of which and the direction of the axes periodically change. Gradually, the top of the cone becomes cloudy. Sometimes there is hyperesthesia of the cornea, accompanied by pain and photophobia. The tip of the cone may re-ulcerate and even perforate. Sometimes there is a condition called acute keratoconus: the posterior border plate is torn, chamber moisture penetrates the cornea and causes edematous clouding of the stroma.

Keratoglobus. Keratoglobus is characterized by the fact that the surface of the cornea has a convex shape not only in the center, as in keratoconus, but throughout. Ophthalmometry reveals an altered radius of curvature of the cornea in different meridians, which is accompanied by astigmatism. Vision with keratoglobus is often reduced according to the degree of change in the curvature of the cornea, i.e. size and ametropia.

The treatment of these anomalies of the cornea consists primarily in the optical correction of ametropia (glasses, contact lenses), as well as in the implementation of surgical interventions. In acute keratoconus, anesthetics, corticosteroids (dexazone), neurotrophic agents (dibazole, B vitamins, amidopyrine, etc.) are primarily prescribed. Favorable results in acute keratoconus and keratoglobus can give the so-called hemo-filling procedures. Autoblood (autoplasma) is used, which is administered through a puncture of the limbus from under a small conjunctival flap.

Inflammation of the cornea (keratitis).

Keratitis (keratitis) is approximately 0.5% in the structure of children's eye morbidity, however, due to the pronounced residual opacities often lead to reduced vision (up to 20% of cases of blindness and low vision).

The leading symptom of keratitis is the presence of an inflammatory infiltrate (infiltrates) in different departments cornea, characterized by a diverse shape, size, different depth, color, sensitivity, vascularization. Very early, keratitis can be suspected by photophobia, blepharospasm, watery eyes, foreign body sensation in the eye (blockage), pain, and pericorneal injection. The injection may also be conjunctival, ie. mixed. Due to the fact that inflammation of the cornea is characterized by a loss of its transparency, there is varying degrees decreased vision.

The color of infiltrates depends on their cellular composition. So, with a small number of leukocytes, the infiltrates are gray, with an increase in purulent infiltration, the clouded cornea becomes yellowish, and after it disappears, a whitish hue. Fresh infiltrates have vague boundaries, and in the stage of reverse development they are more clear.

When an infiltrate appears in the cornea, its transparency, sphericity, specularity and luster are lost, which, as a rule, is primarily due to violations of the integrity of the epithelium. With many types of keratitis, especially superficial ones, the epithelium in the area of ​​infiltration is destroyed, exfoliated and eroded. This can be easily verified by dropping a 1-2% solution of alkaline fluorescein onto the cornea, which stains the eroded surface greenish. Deep infiltrates may ulcerate.

The most common outcome of keratitis is corneal clouding. It is caused not so much by the germination of blood vessels as by the connective tissue degeneration (scarring) of its deep non-regenerating structures and, as a rule, does not undergo complete reverse development. In this regard, with keratitis, there is a persistent decrease in visual acuity of varying degrees.

Depending on the properties of the pathogen, keratitis may be accompanied by a change in the sensitivity of the cornea. In this case, both a decrease, even loss, and an increase (toxic-allergic processes) of sensitivity are possible. A decrease in the sensitivity of the cornea can be observed not only in the sick, but also in a healthy eye, which indicates a general violation of the nervous trophism (herpes, etc.).

Clinical manifestations of certain types and forms of keratitis may vary in children of different ages, depending on the general initial state of their body, the properties of the pathogen, the ways it spreads and the location of the lesion, as well as the condition of the eye membranes.

In order to facilitate the diagnosis, as well as the choice and implementation of treatment in pediatric practice, it is advisable to distinguish keratitis only on the etiological principle:

I. Bacterial:

• 1. staphylo-, pneumo-, diplo-, streptococcal;
• 2. tuberculosis;
• 3. syphilitic;
• 4. malaria, brucellosis, etc.

II. Viral:

• 1. adenovirus;
• 2. herpetic;
• 3. measles, smallpox, etc.

III. Infectious (toxic) - allergic:

• 1. phlyctenular (scrofulous);
• 2. allergic

IV. Exchange:

• 1. amino acid (protein);
• 2. beriberi.

V. Others:

• 1. fungal;
• 2. neuroparalytic;
• 3. post-traumatic, etc.

Congenital opacities. Congenital opacities of the cornea, as a rule, are the result of a violation of embryogenesis due to illness of the mother (syphilis, gonorrhea, tuberculosis, toxoplasmosis, etc.). The opacities are usually diffuse in nature, located deep and predominantly in the center, the epithelium above these opacities is shiny and smooth.

A change in the transparency of the cornea can also occur along the periphery of the limbus, in which case it is called a congenital embryotoxon, which resembles a senile arch.

As a casuistry, there is also such a type of clouding of the cornea as its congenital pigmentation in the form of brownish polymorphic mottling in the middle layers.

It should be borne in mind that, as the cornea grows as the child grows due to its thinning, clouding can significantly decrease or almost completely disappear.

Treatment of congenital corneal opacities should begin with the appointment of medications that enhance trophism (vitamins, glucose, defibrinated blood, diabazol, etc.) and resorption of opacities (dionin, lidase, trypsin, microdoses of dexazone, biostimulants), which are used in the form of forced instillations. They also carry out electro- and phonophoresis, oxygen therapy.

With stable and pronounced opacities, accompanied by a decrease in visual acuity in children, more often occurring from the age of 3, when the growth of the cornea is basically completed, surgical treatment is indicated using various types of keratoplasty.

pathology of the lens.

Among the pathological conditions of the lens, there are anomalies in its shape and size, violations of the position and transparency.

Pathological changes in the lens can be congenital (cataracts, microphakia, spherophakia, lenticonus, letinoglobus, lens colobomas, remnants of the vascular bag, congenital aphakia, dislocations and subluxations) and acquired: traumatic and complicated (successive) cataracts, dislocations and subluxations of the lens.

Anomalies in the shape and position of the lens.

Microphakia is a congenital anomaly that manifests itself in a decrease in the size of the lens associated with a stop in its growth. Most authors believe that it is always combined with spherophakia, but cases of isolated true microphakia are known. Bilateral lesion is typical. Microphakia can be observed as an isolated eye anomaly or combined with general constitutional anomalies. Spheromicrophakia is one of the manifestations of Marchezani and Marfan syndromes.

The anomaly has a family - hereditary character. The occurrence of microphakia is associated with a primary defect in the development of the ciliary band, stretching and degeneration of zonular fibers.

Signs of microphakia are a decrease in the size of the lens, which has a spherical shape, excessively close attachment to the equator of the thinned fibers of the ciliary band, iridodonesis. With an enlarged pupil, the equatorial edge of the lens in the form of a golden ring is visible throughout. Often there is clouding of the lens. Myopic refraction of the eye is characteristic.

With microphakia, the lens is easily infringed in the pupillary opening or falls into the anterior chamber, which leads to a sharp increase in intraocular pressure, accompanied by pain. In such cases, urgent removal of the dislocated lens is indicated.

Spherophakia is a spherical lens, in most cases it is combined with microphakia, dislocations, as well as general constitutional anomalies. It is a congenital family - hereditary anomaly, the occurrence of which is associated with defects in the development of the ciliary girdle.

The clinical manifestations of spherophakia are the spherical shape of the lens, the deep anterior chamber of the eye, iridodonesis, myopia. Secondary glaucoma, subluxations and dislocations of the lens can be observed.

Spherophakia is not subject to treatment. When complications appear (glaucoma, dislocations), surgical intervention is required - antiglaucomatous surgery, removal of the displaced lens.

Complete and partial displacements of the lens can be congenital or acquired.

Congenital dislocations and subluxations of the lens. Congenital dislocations of the lens (ectopia) in most cases are hereditary. The cause of lens ectopia is anomalies in the development of the ciliary girdle (defects, partial or complete aplasia), underdevelopment of the ciliary body, ciliary processes due to improper closure of the choriodal fissure and pressure of the arteries of the vitreous body. Destruction and violation of the integrity of the ciliary band occurs with hereditary lesions connective tissue(Marfan syndrome, Marchezani, etc.), metabolic disorders of sulfur-containing amino acids (homocystin).

Lens ectopia can be an isolated lesion, but more often it is combined with other congenital eye defects: coloboma and clouding of the lens, coloboma of the iris and choroid, polycoria, aniridia, etc. often there are concomitant extraocular congenital anomalies and diseases - clubfoot, six-fingeredness, congenital heart disease, inguinal hernia, skeletal anomalies, etc.

Clinical manifestations of lens ectopia are diverse and are determined by the degree and direction of displacement, duration of existence, the presence or absence of concomitant eye changes and complications. The process is often bilateral.

Dislocation of the lens in the anterior chamber. With complete dislocation, the spherical lens is located in the anterior chamber (Fig. 2). Usually it is transparent, less often partially or completely clouded. The anterior surface of the lens is adjacent to the posterior surface of the cornea, the posterior - to the iris, pushing it from behind and pressing the pupillary edge against the anterior boundary membrane of the vitreous body. The pupil, as a rule, is deformed, especially in those cases when the fibers of the ciliary girdle are preserved in a separate area, which, when thrown over the pupil, change its shape. Vision is sharply reduced.

Dislocation of the lens in the anterior chamber.

When the lens is dislocated into the anterior chamber, the outflow of intraocular fluid is blocked, which leads to a sharp increase in ophthalmotonus, resulting in congestive injection, corneal edema, pain in the eye, and headaches. With a long stay of the lens in the anterior chamber, degenerative changes in the cornea develop.

Complete congenital dislocation of the lens into the vitreous is a rare anomaly.

Subluxation (subluxation) of the lens - partial displacement of the lens.

A dislocated lens, its equatorial edge, preserved individual thinned fibers of the ciliary girdle are visible in the pupil area (Fig. 3.).

Subluxation of the lens.

With a slight subluxation of the lens, its presence can only be judged by indirect evidence, and its equatorial edge can be seen only with a dilated pupil. The direction of displacement can be different. Symmetry of the directions of subluxation in both eyes is characteristic, while the degree of lens displacement, as a rule, is different. The displaced lens acquires a more regular spherical shape, it can be transparent or cloudy. The integrity of the anterior limiting membrane of the vitreous is often preserved; with its violations, the vitreous body can protrude into the anterior chamber. In cases where the lens occupies about or more than half of the pupil area, ophthalmoscopy produces a double image of the fundus.

Acquired dislocations and subluxations of the lens. Acquired displacements of the lens most often occur with contusion of the eye due to a violation of the integrity of its ligamentous apparatus. Predisposing factors for the occurrence of displacements in children may be congenital developmental defects, less often other etiological factors are detected. Cases have been noted when lens subluxation occurred with chalcosis of the eye as a result of the toxic effect of copper salts on the fibers of the ciliary girdle, after uveitis, and also with high myopia. In children, the displacement of the lens can occur in the advanced stage of congenital glaucoma as a result of stretching and tearing of the fibers of the ciliary girdle.

Surgical treatment of dislocations and subluxations of the lens. An individual approach is needed to determine the indications for the removal of a displaced lens, taking into account the nature and degree of lens displacement, visual acuity, intraocular pressure, and the condition of the eye.

With partial and complete dislocation of the lens into the anterior chamber, its urgent removal is indicated. In cases of a migratory nature of the lens displacement with frequent dislocation into the anterior chamber, surgical intervention is also required.

With subluxation of the lens, when it is not an obstacle to vision, and intraocular pressure is normal, it is not advisable to remove it. In these cases, correction, treatment of amblyopia, dynamic monitoring of the patient are necessary. If the displaced lens (transparent or cloudy) is an obstacle to vision and you can expect an increase in visual acuity after its removal, the operation is also indicated for normal intraocular pressure.

Cataract.

A cataract is a complete or partial clouding of the lens of the eye. The only treatment option is surgery.

Distinguish:

Congenital cataracts - can be hereditary or arise due to the influence of various teratogenic factors on the lens of the embryo or fetus in the prenatal period.

Complicated (successive) cataracts - clouding of the lens that develops with chronic diseases eyeball - iridocyclitis, uveitis, dystrophy and retinal detachment, glaucoma, etc.

It turned out that cataracts are accompanied by certain symptoms, knowing which, one can reliably make a self-diagnosis.

Often the pathological process begins with a thickening of the lens. As a result, it becomes more convex, and the light rays are refracted more sharply. Because of this, near vision is aggravated and a person develops myopia. Most often this phenomenon is observed in elderly people with senile farsightedness: they suddenly find that they can read without glasses. However, after a relatively short period of improvement, it worsens.

Another characteristic symptom is that a person sees better at dusk than in bright light. This occurs when only the central part of the lens, located directly behind the pupil, is clouded. In bright light, the pupil constricts and the rays passing through it fall on the central, clouded part of the lens, which becomes an obstacle on their way to the retina. In low light, the pupil dilates, and light rays pass freely through the transparent part of the lens to the retina. With a cataract, a person looking at a light bulb, car headlights, or any other light source may see a halo around them. This is due to the fact that the rays, having reached the clouded lens, are scattered, and do not fall directly on the retina, as happens with normal vision. Sometimes in similar cases people even have photophobia.

Whether or not a person notices a developing cataract depends on the size and location of the area of ​​clouding in the lens. If it is on the periphery, you can be unaware of the disease for a long time. Conversely, the closer to the center of the lens is the opacification, the faster vision problems occur. Objects begin to be seen indistinctly, their outline is blurred, sometimes they double. These negative phenomena are gradually increasing, forcing more and more often to change glasses to stronger ones. Usually black, the pupil may become yellowish or even white. If you find yourself with any of the symptoms listed above, you should definitely consult an ophthalmologist. Only a specialist can make a diagnosis, determine the type, shape and place of clouding of the lens.

Previously, ophthalmologists believed that cataracts should be removed only after they matured. This takes an average of 3 to 5 years or more. And now they have come to the conclusion that operations with incompletely mature cataracts give the best results. Therefore, if due to the appearance of a cataract, vision in the diseased eye has decreased by 20-30%, then, although this does not interfere much in everyday life, an operation must be performed. There are no drugs that can restore the transparency of the lens. Its turbidity is an irreversible change in the proteins contained in it, which cannot be eliminated either by diet, or by special massage, or by various folk remedies. The operation is done under local anesthesia so that the patient does not experience any discomfort. Moreover, the surgeon works with a special microscope, which simultaneously illuminates and enlarges the surgical field. The age of the patient does not play a role, it is easily tolerated even by people over 80 years old. If both eyes are damaged by a cataract, then one eye is operated on first, and after 1-2 months - the second.

The operation itself consists of several stages. The first stage is an incision, the size of which is only 2-3 mm. Moreover, it can be done not in the cornea, but in the sclera. Then a small tunnel is laid to the lens at an angle, through which the cloudy mass is removed. In this case, a suture can be dispensed with, since the incision closes itself under the pressure of the eyelids. This is quite enough for the complete healing of a tiny wound, since the edges of the sclera grow together quickly. In addition, the integrity of the cornea is preserved, and, consequently, the sphericity of its surface.

Through the incision, a hollow needle with a silicone coating is inserted into the lens, which protects the tissues from damage. Ultrasound of a strictly defined frequency is fed through it, which crushes the clouded nucleus of the lens. Then this mass is sucked off using the irrigation-aspiration tip of the phacoemulsifier, which cleans the inner surface of the capsule literally to a mirror shine. After that, an intraocular lens (IOL), that is, an artificial lens, is inserted with a special injector (resembling a syringe in terms of the mechanism of action). Big advantage new methodology is, among other things, the tightness of the surgical field during the entire operation. Yes, and this operation is done much faster than before.

A few tips for those who have undergone cataract surgery.

When you return home after the operation, you can read, watch TV, do your usual activities without adhering to a special sparing regimen, but there are still some restrictions.

During the first two to three weeks:

• ? do not sleep on the side of the operated eye;
• ? do not rub the eye or press it;
• ? do not bend down to pick up something from the floor - better sit down;
• ? do not lift weights;
• ? do not drive a car until the eye is completely healed;
• ? use sunglasses when outdoors;
• ? women at this time are not recommended to perm and dye their hair.

Certain restrictions after cataract surgery will have to be observed for life:

• ? you can not lift weights weighing more than 10 kilograms and move heavy objects;
• ? you can not engage in power sports, wrestling, diving, etc.;
• ? the operated eye should be protected from impacts and mechanical influences.

Aphakia (absence of the lens in the eye) may be congenital or occurs after cataract removal. With biomicroscopy, the optical section of the lens is not determined. In the region of the pupil, remnants of the crystalline substance or capsule may be detected.

When examining Purkinje figurines, only one reflection of the candle flame from the anterior surface of the cornea is visible in the pupil area. A deeper anterior chamber than in an eye with a lens is characteristic. The unsupported iris trembles with eye movements (iridodonesis). There is a postoperative scar of the cornea or corneal-scleral area.

Refraction is on average 9.0-12.0 diopters weaker compared to the eye, which has a lens. After the removal of congenital cataracts, the majority of children are found to have farsightedness, the degree of which, varying from 1.0 to 18.5 diopters, most often equals 10.0-13.0 diopters. High degrees of farsightedness are more common with microphthalmos. In the first time after the removal of a congenital cataract, a significant number of patients experience reverse astigmatism, which decreases or disappears after 3-6 months. after operation. Visual acuity in aphakia without correction is reduced to several hundredths.

In order to create optimal conditions for vision in aphakia, one should strive for a complete correction of the refractive error. Use for aphakia spectacle correction, contact and intraocular lenses.

Glasses for children are prescribed based on the results of an objective study of refraction and a subjective test of the tolerability of correction, which is possible in children older than 4-5 years. In younger children, one has to be guided only by the results of an objective study. In addition to correcting the aphakia of the distance, it is necessary to prescribe glasses for working at close range. They are usually 2-3 diopters stronger spectacle lenses assigned to dali.

With unilateral aphakia, spectacle correction cannot be used due to a high degree aniseikonia (up to 25-30%), which makes it impossible to restore biocular vision and causes intolerance to glasses. If it is not possible to apply other types of correction of unilateral aphakia, glasses can be used for vision training (provided that the healthy eye is turned off).

To correct aphakia in children, contact lenses are widely used, which reduce the amount of aniseikonia. In this regard, they can be used to correct unilateral aphakia and in most patients to achieve restoration of binocular vision. Contact lenses are used for both unilateral and bilateral aphakia. They relieve the child of the need to use heavy glasses; the cosmetic side is also important. Patients tolerate soft contact lenses made of hydrocolloid (gel) more easily. Soft contact lenses can be prescribed as soon as possible after surgery, hard ones, as a rule, not earlier than six months after cataract removal. It should be borne in mind that in some cases there may be intolerance to contact lenses.

Intraocular correction of aphakia has been widely used in the treatment of adults in recent decades. Numerous models of intraocular lenses have been proposed: anterior chamber, posterior chamber. According to the method of attachment, anterior chamber fixation (in the region of the iris-corneal angle), fixation to the iris, to the iris and the lens capsule (iridocapsular), to the lens capsule (capsular) are distinguished. The most widespread was the iris - clip - lens Fedorov - Zakharov (1967).

Amblyopia. Retina human eye is designed to perceive a visual image, which, for its normal functioning, must be clear. The absence of a clear visual image on the retina for a long time leads to its so-called "blindness from inactivity", or amblyopia.

Amblyopia most often occurs in children. The cause of amblyopia can be, for example, the lack of light access to the retina, for example, with cataracts.

In addition, the cause of amblyopia can be a difference in the length of the eyes, the so-called anisometropia (oddsightedness), as a result of which the degree of myopia (farsightedness) of one eye can be more degree nearsightedness (farsightedness) of the other eye. There may be other combinations - one eye has normal vision, the other has myopia, hyperopia and astigmatism.

In any of these cases, the difference in visual acuity between the two eyes results in the brain not connecting the visual images from both eyes into a single whole. That is, vision is not binocular, spatial, or stereoscopic. One eye becomes the leading one, and the other eye may deviate to the side over time - strabismus develops, often accompanying amblyopia. Amblyopia can also be a consequence of, for example, astigmatism, when glasses were not prescribed to the patient for some reason (in particular, if they were intolerant).

Treatment of amblyopia should begin as early as possible, before the age of a teenager. After that, it is extremely problematic to make the retina of the "lazy" eye work.

First of all, it is necessary to restore the normal functioning of the amblyopic eye. Sometimes (depending on the age of the child) it is necessary to carry out laser correction. A course of various types of stimulation of the retina of the amblyopic eye is also being carried out in order to increase visual acuity, as well as a course of treatment that teaches both eyes to stereovision. There are also surgeries that correct strabismus.

The ophthalmologist of the clinic where you will apply will tell you more about the necessary methods of treatment.

Pathology of the vitreous body

Pathological processes in the vitreous body can be attributed to developmental anomalies, damage and dystrophies.

The main symptoms of diseases of the vitreous body are its opacities and decreased visual acuity.

Most pathological changes develop secondarily, as a result of the impact of diseases of adjacent structures. Inflammatory and degenerative processes in the vascular tract (especially in the ciliary body), retina, eye trauma and hemorrhage change the chemistry of the vitreous body, which leads to agglutination of colloidal micelles and the formation of fibers, films and opacities.

Opacities of the vitreous body (offuscati corporis vitrei) are clearly visible against the red background of the pupil when examined in transmitted light and look like fine dust, flakes, filaments, small films. They are easily displaced during eye movements, float, and sometimes are fixed with thin threads to the optic nerve head, retina.

Often people, mostly nearsighted, complain of flying flies before their eyes. It's visible shaped elements in the vitreous, casting shadows on the retina. Flying flies are especially noticeable during eye movements and when looking at an illuminated surface in the form of dark spots or threads that do not affect visual acuity. When viewed in transmitted light and ophthalmoscopy, they are not detected, which is how they differ from true vitreous opacities. Treatment is not subject.

have a certain meaning different kinds destruction of the vitreous body. Changes in its structure are detected by biomicroscopy. In particular, filamentous destruction is characterized by liquefaction of the vitreous body and the presence of flaky opacities in the form of woolen yarn or a strand of fine fibers. The threads are grayish-white, twisted, intersect with each other, in some places have a loop-like structure. This is often observed in the terminal stage of myopia, in the elderly with atherosclerosis. The pathogenesis of filamentous dystrophy probably lies in the adhesion of vitreous fibrils as a result of aging and protein coagulation or depolymerization of hyaluronic acid. Destruction is accompanied by detachment of the vitreous body.

Granular destruction of the vitreous body is characterized by the presence of tiny grains in the form of a grayish-brown suspension. The grains are deposited on the threads of the core. The granular destruction is based on the accumulation of pigment cells, lymphocytes migrating from the surrounding tissues. Granular destruction occurs due to inflammatory processes in the choroid, after trauma, retinal detachment, with intraocular tumors. The process of filamentous and granular destruction in some cases is reversible in the treatment of the underlying disease.

Destruction with crystalline inclusions (synchisis scintillans) is a peculiar pathology of the vitreous body - silver and golden rain.

When the eye moves, the shiny crystals move, flicker like gold and silver sparkles. The chemical composition of the crystals is not well understood. It is known that cholesterol plays an important role in their occurrence. This pathology occurs in most cases in the elderly and in people with diabetes. Vision may not be reduced.

Dystrophic changes include detachment and wrinkling of the vitreous body. Detachment can be anterior, posterior, lateral. Anterior vitreous detachment is detected by slit lamp examination. Partial or complete separation of the vitreous boundary layer from the posterior lens capsule can be seen. The space between the lens and the vitreous appears to be optically empty. Anterior vitreous detachment is observed in old age, less often with uveitis and trauma. Detachment of the posterior boundary layer of the vitreous body from the retina and optic disc is much more common. Posterior detachment is observed at high myopia, in elderly people. It is accompanied by a more or less pronounced retraction of the skeleton of the vitreous body. The posterior vitreous detachment can be of various shapes and lengths. More common is complete detachment of the vitreous body. Often it accompanies or precedes retinal detachment. The vitreous body with a posterior detachment comes off the optic disc, therefore, when examining both with an ophthalmoscope and especially with a slit lamp, an oval ring of various sizes can be seen. Details of the retina ophthalmoscopy through this hole appear clearer than when viewed through adjacent areas of the posterior layers of the vitreous body. Sometimes, in proliferating retinitis, the tension of the vitreoretinal ligaments causes a posterior vitreous detachment with the formation of a triangular hole.

Vitreous shrinkage is the most serious manifestation dystrophic changes in him. A decrease in the volume of the vitreous body and mooring are observed after penetrating wounds of the eye, intraocular operations, accompanied by prolapse of a significant amount of the vitreous body, and in chronic uveitis.

The most frequent and significant changes in the vitreous body are observed in inflammation of the uveal tract and retina. With iridocyclitis and chorioretinitis, there may be abundant serous exudation, creating diffuse opacification in the vitreous body. The fundus of the eye in such cases is seen as in a fog. The cellular elements of the exudate, sticking together with other products of inflammation, form flaky floating opacities of various shapes and sizes.

Hemorrhages of the vitreous body. From other types of pathological changes in the vitreous body special attention due to the severity of the process deserve hemorrhage. The presence of blood in the vitreous body is called hemophthalmos. There are partial and complete hemophthalmos. The first signs of hemorrhage into the vitreous body are a decrease in vision up to its complete loss and a weakening or absence of the fundus reflex. The causes of hemorrhages in the vitreous body can be traumas, intraocular operations, hypertonic disease, atherosclerotic changes in the vessels of the retina, diabetes, dystrophy and vasculitis of the retina, tumors and choroids.

Blood in the vitreous body can serve as a source of mooring formation. The formation of connective tissue strands contributes to the occurrence of traction retinal detachment.

The most informative way to detect hemophthalmia is vitreous biomicroscopy and ultrasound echography.

Treatment is aimed at resorption of hemophthalmia. In recent cases, hospitalization and bed rest with a binocular bandage are recommended. Anticoagulant therapy is indicated under the control of a coagulogram. Locally apply dionin, subconjunctival injections of oxygen and fibrinolysin. Autologous blood, lidase or chymotrypsin are administered intramuscularly. In some cases, if the hemorrhage does not resolve in the first 10 days, surgical intervention is recommended - vitreoectomy.

With preretinal hemorrhages, the skeleton of the vitreous body is free from blood. Such hemorrhages resolve faster than intravitreal ones.

Damage to the organ of vision in children.

Damage to the eyeball and its auxiliary apparatus in the structure of children's eye pathology is almost 10%. Most eye injuries in children are microtrauma (up to 60%) and blunt trauma (up to 30%), penetrating injuries account for no more than 2%, burns - about 8%. Up to 70% of injuries and burns and up to 85% of blunt injuries are observed in school-age children, and the rest is in preschool children.

The greatest number of injuries of the organ of vision occur in March - April and September - October due to changes in weather conditions (spring and early autumn). In addition, children are very active in games before the start of learning, and at this time the frequency of damage to the eyes, as well as other parts of the body, increases significantly. Injurious objects according to the seasons are snowballs, hockey sticks, pucks, sticks, stones and metal or other objects. Boys make up 85%, girls - 15% among patients with injuries. Thus, damage to the organ of vision in children is of a domestic nature and is mainly associated with adult oversight and poor organization of games.

In order to determine the type and severity of damage to the eye, it is necessary to establish what object caused the injury (size, composition, temperature, concentration, etc.), as well as the time and circumstances in which the damage occurred. The degree or severity of the process is determined by the depth and area of ​​damage, the presence or absence of foreign bodies and a number of other signs in relation to wounds, injuries or burns.

Only after a thorough ophthalmological and radiological examination, and, if necessary, also otorhinolaryngological and neurological (frequent concussions) studies, can a correct diagnosis be established and effective treatment carried out.

Blunt eye injuries.

Blunt trauma to the eye in children can be varying degrees gravity and be caused by a variety of objects. Blunt injuries are usually called contusions, but this is not entirely correct, since, in principle, with any injuries, including wounds and burns, contusion phenomena can be observed. In essence, contusion is a symptom of trauma.

For blunt injuries of the eyeball and its auxiliary apparatus, a variety of symptoms can be characteristic:

Erosion of the tissues surrounding the eyes and the cornea (approximately 60%). In this case, mainly the epidermis or epithelium is damaged, and therefore infection and the development of inflammation are always possible. With the formation of erosion, some haze, roughness, lack of specularity and sphericity of the cornea are observed.

Hemorrhages in the membranes and transparent structures of the eye (anterior and posterior chambers, vitreous body, retina) are one of the most common (about 80% of cases) changes that occur due to blunt trauma. The hyphema is more often observed (60%). In the first hours after the injury, the blood in the anterior chamber is in suspension, and if the hemorrhage is insignificant, then it can only be detected using biomicroscopy. With severe hemorrhage, it can be seen during a routine examination. A few hours after the injury, the blood settles to the bottom of the anterior chamber and a homogeneous red formation with an even horizontal level appears - hyphema. characteristic feature in children is its rapid resorption. Hyphema 2-3 mm high disappears within 3 days after injury, which does not occur in adults, especially the elderly.

Hemophthalmos is a hemorrhage into the vitreous body. It occurs when there are ruptures in the area of ​​​​the ciliary body and the choroid. At the same time, a homogeneous brown (red) diffuse or limited polymorphic mobile formation is visible behind the lens. Dark spots are visible in transmitted light. Complete hemophthalmus leads to an almost complete loss of vision, and partial hemophthalmus leads to a significant decrease in it and the appearance of dark moving spots in front of the eyes.

Hemophthalmos is a very severe manifestation of ocular injury and requires immediate and aggressive remedial action.

Retinal hemorrhages occur relatively often (up to 30% of cases) with blunt trauma. Their central, macular, paramacular and disk, as well as peripheral localization can be observed. Treatment of hemorrhages in the structures of the eye should be started immediately upon diagnosis, it should be comprehensive, systematic and directed primarily at homestasis.

The outcomes of hemorrhages in children are more favorable than in adults, since during their relatively short existence, irreversible dystrophic and atrophic intraocular processes do not have time to develop.

Iridodialysis, or detachment of the iris at its root, is a fairly common manifestation of blunt trauma to the eye. It is characterized by the presence in the region of the iris of a dark area of ​​various shapes and sizes, while, according to iridodialysis, the shape of the pupil can change (flatten). Treatment of iridodialysis and ruptures of the pupillary edge is only surgical: suturing the defects without opening or opening the eyeball. The results of operations are usually good.

Cataract - clouding of the lens. It can be detected both under side illumination and biomicroscopy, and in transmitted light. Turbidity may be different kind, localization and magnitude. In most patients, mainly in older children and adults, there is a progression of lens opacities to diffuse polymorphic. In most patients preschool age opacities have a local stationary character.

Depending on the massiveness of opacities, the degree and speed of their progression, visual functions are impaired.

The treatment of lens opacities consists in the use of absorbable agents, as a result of which an increase in vision appears or is determined by biomicroscopy. In cases where resorption of the cloudy substance of the lens does not occur and visual acuity with a correction below 0.3, cataract extraction can be performed, otherwise amblyopia and secondary strabismus will develop.

Subluxation of the lens can be detected by the deepening and unevenness of the anterior chamber, pronounced iridodonesis, changes in clinical refraction, decreased visual acuity, single double vision, as well as increased intraocular pressure and diffuse iridocyclitis.

Treatment of lens subluxation is indicated in cases where it is accompanied by a significant decrease in visual acuity, or a persistent increase in intraocular pressure. Treatment is surgical only. There are no indications for implantation of intraocular lenses in young children (under 10 years of age), but in older children they are possible.

Dislocation of the lens is diagnosed by deepening of the anterior chamber, iridodenesis, movement of the lens in the vitreous body or in the anterior chamber, vitreous hernia, cyclitis, lack of accommodation, possible increase in ophthalmotonus. Dislocation of the lens is sooner or later complicated by secondary glaucoma, as well as iridocyclitis, so it is necessary to constantly monitor the amount of ophthalmotonus.

The treatment of dislocation of the lens is to remove it, since otherwise various complications may develop that will lead to loss of vision. As a rule, intracapsular removal of the lens is performed, and subsequently (after 3-6 months) contact correction aphakia.

Rupture of the sclera (subconjunctival or open) is manifested by the presence of a wound and presentation to it or protrusion of dark (choroid) or light (vitreous body, retina) tissue, as well as hypotension of the eye. Treatment of scleral ruptures consists in urgent suturing of the wound and diathermocoagulation of this zone to prevent retinal detachment. In the future, anti-inflammatory treatment is carried out.

Choroidal ruptures are of various shapes, sizes and localizations, and depending on this, visual acuity can more or less decrease and defects appear in the field of vision. Ruptures of the choroid during the first week after injury may not be visible, as they are almost always accompanied by extensive, subretinal hemorrhages.

Treatment of ruptures of the choroid consists in the appointment of drugs that promote the resorption of hemorrhages and swelling of the surrounding tissues.

Retinal contusions occur in almost all cases of blunt trauma to the eye, as well as penetrating wounds. They are characterized by turbidity, swelling, the appearance of grayish - and milky - white areas. There is a pronounced redistribution of the pigment. One of the most severe types of retinal commotion is a lesion. In some cases, dystrophy can manifest itself in the formation of cysts, which leads to a decrease in visual acuity and, possibly, retinal detachment.

Treatment of retinal contusions consists mainly of dehydration therapy, the use of neurotrophic agents, as well as cysteine, dibazol, ATP, microdoses, dexazone, papain, etc.

Rupture and detachment of the retina occur on average in 2% of children, in 10% with blunt injuries and contusions of the organ of vision. These pathological processes can manifest immediately after injury and in the long term.

The boundaries of the detachment and the place of retinal break can be determined using special ophthalmochromoscopic, perimetric and echobiometric techniques. Dangerous gaps in the area of ​​the spot and the central fossa, as visual acuity is sharply reduced and almost never restored.

Treatment of ruptures and retinal detachment is only surgical. Various operations are performed depending on the type, size and location of the retinal defect.

Detachment (rupture) of the optic nerve in blunt eye trauma occurs on average in 0.2% of victims. In this case, almost complete or complete blindness instantly occurs.

In children, it is advisable to distinguish 4 degrees of severity of injuries: I - mild, II - moderate, III - severe, IV - very severe. Morphological and functional changes in the eye and their reversibility are taken as the basis for determining the degree of severity. Blunt injuries of the eyeball of the 1st degree usually end successfully. In 95% of children, almost full recovery visual functions. After a blunt injury of the II degree in 85% of children, visual acuity is restored to at least 0.8. In case of damage III degree 65% of children have visual acuity of 0.8-1.0, 25% - 0.7-0.3 in the presence of gross organic changes along the periphery of the fundus, 10% of children - 0.2-0.09. blunt grade IV injuries result in near or total blindness. The average bed-day stay of children in the hospital for blunt eye trauma is 15 days.

Eye wounds.

Eye wounds can be non-penetrating, penetrating and penetrating.

Non-penetrating eye wounds. Non-penetrating wounds can have any localization in the capsule of the eye and its auxiliary apparatus and a variety of sizes. These wounds are more often infected, often with metal (magnetic and amagnetic) and non-metallic foreign bodies. The most severe are non-penetrating wounds in the optical zone of the cornea and its stroma. Even with a favorable course, they lead to a significant decrease in visual acuity. AT acute stage process, it is due to edema and clouding in the wound area, and subsequently persistent clouding of the corneal scar in combination with irregular astigmatism. In the case of infection of the wound, the presence of a foreign body in it and late seeking help, the eyes can become inflamed, post-traumatic keratitis develops and the choroid is involved in the process - often keratoiritis or keratouveitis occurs.

Penetrating eye injury. The most severe, both in terms of course and outcomes, are penetrating, especially penetrating wounds of the eye. Wounds with penetrating wounds are almost always (conditionally always) infected, so a severe inflammatory process can occur in them. Finally, one of the main factors is the massiveness and localization of the wound. To unify a clear diagnosis of penetrating eye injuries, it is advisable to grade them according to the depth and massiveness of the lesion, the presence or absence of a foreign body (its nature), as well as infection. The choice of treatment method and the expected outcome to a large extent depend on the localization of the process. In this regard, it is useful to distinguish between:

Simple penetrating wounds - the integrity of only the outer shell is violated. They occur in about 20% of cases. Wounds can be adapted and open, with even or uneven edges. An important diagnostic sign of injury is the condition of the anterior chamber. When the cornea is injured, in fresh cases, even in adapted ones (in the first hours), it is shallow, and when the sclera is injured, it is excessively deep.

Complicated penetrating wounds - when the internal structures of the eye are also affected. They occur in about 80% of cases. Most often (in 20% of patients) with penetrating wounds of the cornea, the lens is damaged and a cataract occurs, and with wounds of the sclera, almost all the internal membranes and structures of the eyeball can be damaged.

In turn, both with simple and complex wounds, foreign bodies (metallic, magnetic and amagnetic, non-metallic) can be introduced into the eye. It is often possible to establish their presence with the help of biomicroscopy and ophthalmoscopy. If foreign bodies are found, it is necessary to establish their localization.

Treatment of penetrating wounds consists in urgent surgical debridement under general anesthesia. In modern conditions, wound treatment is carried out using microsurgical techniques. During the surgical intervention, foreign bodies are removed and the damaged structures are reconstructed (removal of the lens, excision of the vitreous hernia, suturing the damaged iris and ciliary body, etc.) dressings are done daily. From the 3rd day, absorbable therapy is prescribed (lidase, trypsin, pyrogenal, autohemotherapy, oxygen, ultrasound, etc.).

The outcomes of penetrating wounds are different depending on their type and localization. Recovery good vision(1.0-0.3) after any penetrating wounds are achieved in approximately 65% ​​of patients, blindness occurs in 5% and the eye is enucleated in 4%, in the rest, vision remains within 0.08 - light perception.

Treatment of non-penetrating wounds is predominantly medical: instillations are carried out, as with penetrating wounds of the eyes.

Of the complicated penetrating wounds of the eyes, infectious and autoallergic processes are most common, less often - metallosis, and even less often - the so-called sympathetic ophthalmia.

Treatment of metallosis is etiological - (removal of foreign bodies by surgery or dissolution, excretion by physiotherapeutic methods), as well as symptomatic medical, absorbable and surgical.

Sympathetic ophthalmia is the most difficult complicated process. This is a sluggish non-purulent inflammation that develops in a healthy eye with a penetrating injury to the fellow eye. To prevent its development, first of all, it is necessary to start early, correctly and for a long time, medical and surgical treatment of a penetrating wound. Most radical operation, which allows you to almost completely eliminate the possibility of developing ophthalmia, is the enucleation of the damaged blind eye.

Eye burns.

Of all the damage to the organ of vision in children, eye burns are observed infrequently - in 7% of patients; they are usually of a domestic nature. Depending on the cause, a distinction is made between chemical and thermal burns, as well as those caused by radiant energy (ultraviolet, x-ray, electrical, radioactive).

The most common in children are thermal burns with alkalis (40%), acids (5%) and others. chemicals (5%).

The severity of the burn is assessed in relation to each part of the auxiliary apparatus and the eyeball. In this case, two main factors are taken into account - the depth and area of ​​\u200b\u200bthe lesion.

According to the severity of the process, four stages of burns are distinguished:

I is characterized by hyperemia of the skin, mucous membrane of the eyelids and the eyeball, damage to the corneal epithelium;

in stage II, blisters form with perifocal hyperemia of the skin of the conjunctiva, edema of the eyelids occurs, the integrity of the conjunctiva, superficial and middle layers of the cornea is disturbed, a pericorneal injection appears;

Stage III differs in that the skin, conjunctiva and cornea become necrotic and there is a significant change in the surrounding tissues;

Stage IV is characterized by deep necrosis of all eye tissues.

Assessing the severity of the burn, they also determine such a criterion as its area (length).

Thermal and chemical eye burns in children are more severe than in adults, which to a certain extent is explained by the high content of fluid in the tissues of the eye, the increased permeability of the membranes of the eye, and also by a small amount of subconjunctival tissue.

The most severe alkali burns, which cause the so-called coliquational necrosis. Acid burns cause coagulative necrosis, so the depth of the lesion is less than with alkali burns.

By severity, burns in children are more often distributed as follows: I degree in 30%, II - in 65%, III - in 5%, IV degree burns of the eyes in children are extremely rare. The frequency of burns, like other eye injuries, increases in March-April and September-October.

Burn treatment:

• 1) alkali - immediate and prolonged washing of the eye with water, instillation of anesthetics (dikain, novocaine), removal of damaged corneal epithelium along with alkali residues,
• 2) quicklime - immediate removal of lime particles, prolonged washing with water and the introduction of anesthetic solutions, glucose or glycerin, ammonium tartrate, 10% ammonium chloride with 0.1% tartaric acid into the conjunctival cavity,
• 3) chemical pencil - removal of pencil residues and prolonged rinsing with water, followed by instillation of a 3-5% solution of tannin, which forms insoluble compounds with aniline dyes and blocks their cauterizing effect.

Regardless of the nature of the substance that caused the burn, it is always necessary to administer tetanus toxoid. It is often necessary to lay fortified ointments.

The outcomes of treatment of thermal and chemical burns are as follows: in 60% it is possible to achieve visual acuity of 1.0, in 10% - 0.9 - 0.7, in 15% - 0.6 - 0.3, in 10% - 0.2 - 0.05, in 5% - below 0.05 up to light perception. The average bed-day stay of children in the hospital due to eye burns is about 10 days. The outcomes of burns must be assessed not only by visual acuity, but also by the cosmetic and functional state of the eyeball and its auxiliary apparatus.

Damage prevention.

Preventive work is effective when it is specific, time-based, age-specific, and addresses the most common causes of eye injury, and when it is not only medical workers but also teachers, sociologists, etc.

A long-term study of children's eye injuries showed that more than 2/3 of eye injuries are observed in boys. However, eye injuries are observed approximately equally often in boys and girls. The greatest number of injuries occurs in children aged 8-12, then it decreases, and is more noticeable in girls.

Injuries in children under one year most often occur due to careless handling of objects around them and neglect of parents. Children often scratch their eyes with nails, hard underwear, pointed objects, etc. In addition, eye burns are often observed with solutions and crystals of potassium permanganate during their careless storage and careless preparation of a bath for bathing a child, as well as with an alcoholic solution of iodine, which is mistakenly instilled instead of collargol solution in the treatment of conjunctivitis.

Eye injuries, mainly of the auxiliary apparatus, in children 2-3 years old, as a rule, occur when falling, hitting furniture, toys.

Children aged 4-5 years are already trying to actively use the objects they pick up. Most often, they inflict eye injuries on themselves with a knife, fork, or a piece of glass. This age is characterized by damage to the conjunctiva, non-penetrating wounds of the eyeball.

At the age of 6-7, children acquire labor skills, try to make this or that craft on their own. At this age, chemical burns are often observed due to clerical glue, ammonia solution, and vinegar essence getting into the eyes. In addition, mechanical damage to the organ of vision by scissors, needles, knitting needles, etc. is not uncommon. As a rule, children of this age cause damage to their own eyes.

From the above, it can be seen that eye damage in young children occurs due to the fact that their physical activity significantly prevails over self-preservation skills.

The age of 8-12 years is the most "traumatic" for both boys and, to a large extent, for girls. This is explained by the fact that children, starting to study at school, are more left to themselves. Most often, children of this age cause eye damage to each other in the process of uncontrolled games associated with the process of throwing and throwing various objects. The types of injuries are varied, but eyelid injuries and blunt eye injuries predominate.

At the age of 13-15 years, the frequency of eye injuries begins to decrease, and more sharply in girls. The main cause of damage is uncontrolled play with improvised weapons, chemicals and explosives.

It can be assumed that the main cause of eye damage in older children is the predominance of increased intellectual activity and curiosity over caution.

The main number of injuries of the organ of vision (65%), children receive on the street, 25% - at home, the remaining 10% - in children's institutions.

Basically, the forms of preventive work can be divided into sanitary and educational (lecturing, publishing leaflets, posters, tablets, booklets, designing wall newspapers, stained-glass windows, stands, showing films, filmstrips, etc.), organizational and practical (improvement of courtyards, playgrounds, organization of children's leisure and control over its conduct, as well as the proper storage and use of combustible, explosive and chemically active materials, compliance with safety regulations, professional selection of students, alarm emergency notifications to institutions that caused damage to the child's eye.

It is necessary to systematically carry out not only the prevention of damage, but also the prevention of complications of penetrating eye injuries.

Assignment for independent work: (1 hour)

• 1. Self-acquaintance with the content of the lecture.
• 2. Clarification of concepts from the dictionary.

Make an outline