Something about squint... Non-permanent strabismus of one eye Treatment for non-permanent strabismus

Strabismus is easy to recognize visually, since there will be an unusual placement of the eyes relative to each other.

It is also possible for the squinting eye to shift upward or downward.

Causes of strabismus

According to etiology, strabismus can be classified into 2 groups.

1. Friendly – mows That one eye. then the second one. Arises this pathology due to the fact that the “quality” of the image that one of the eyes supplies to the brain is very different from the other. In this case, the brain seems to turn off the image from one eye, vision ceases to be stereoscopic, and the “disconnected” eye begins to squint.

The main cause of concomitant strabismus is accommodation disorders - myopia (myopia), farsightedness (hypermetropia) and astigmatism. Moreover, with myopia, divergent strabismus most often occurs, and with hypermetropia, convergent strabismus occurs. This type of concomitant strabismus is called accommodative.

Also this type strabismus can cause any other pathologies that lead to a significant difference in visual acuity between the eyes: cataracts, leukoma (corneal cataract), retinal dystrophy or detachment, macular degeneration, hemorrhage in vitreous etc. This type of concomitant strabismus is called non-accommodative.

With concomitant strabismus, the range of motion of the eyeballs is not impaired, and there is no double vision (diplopia).

2. Paralytic - occurs as a result of damage or paralysis of one of the extraocular muscles.

Causes of strabismus in this case there may be the following:

With paralytic strabismus, the range of motion of the affected eye is reduced, and diplopia is present.

Diagnostics

Pronounced strabismus is always noticeable to the patient himself when looking in the mirror, as well as to those around him. Don't think that it will go away on its own. A rhetorical question: " One eye squints. what to do?" - has only one answer - immediately contact an ophthalmologist. The earlier treatment is started, the higher the chances of success.

The patient himself does not feel hidden strabismus, but it can be detected using special ophthalmological tests. Therefore, people at risk (who have a pronounced difference in visual acuity between the eyes) should regularly undergo in-depth examination by an ophthalmologist.

Paralytic strabismus in adults. as already mentioned, it can be a symptom or complication of other diseases. Therefore, if you suddenly experience double vision and severe strabismus, you should urgently consult a neurologist, as this may be a sign of nerve inflammation, a brain tumor, a stroke, or the spread of an infection from the middle ear to the cranial cavity.

Treatment of strabismus in adults

1. With concomitant strabismus, the goal of treatment is to restore normal visual acuity.

Accommodative disorders are corrected with glasses, contact lenses or laser correction. Contact lenses are most preferable in this case. With severe nearsightedness or farsightedness, glasses lenses reduce or increase the size of the image on the retina. Accordingly, if the optical power of the lenses is different, then the image on the retina of the eyes different sizes, which misleads the brain and it is forced to use the picture of only one eye, while the second one begins to squint.

Non-accommodative disorders (cataracts, cataracts, retinal detachment, etc.) can be treated surgically. For cataracts, lens prosthetics is performed, corneal cataracts are corrected by transplanting them from a donor, hemorrhages in the vitreous can be eliminated surgically. The situation is more complicated with pathologies of the eye vessels or retina. But even here, ophthalmology has a number of technical innovations, such as laser correction. People predisposed to eye pathologies (hypertension, diabetes mellitus) require regular courses of drug treatment aimed at preventing vision deterioration.

2. With paralysis strabismus in adults possibilities treatment extremely limited. If the cause, mainly neurological, cannot be eliminated, surgery is performed to eliminate the cosmetic defect. Binocular vision is not restored.

Recommended by some " traditional healers"or at private ophthalmology clinics, eye gymnastics and hardware eye training methods can correct strabismus in children and adolescents under 14 years of age. In adults they are ineffective.

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Strabismus is a clear deviation in the functioning of the visual organ. A person sees the world around him in a distorted form.

Divergent strabismus is a violation of the synchronicity of the location of the eyeballs. Thus, when viewing a certain object, the optical axes do not converge. The eyes seem to be tilted away from each other. Strabismus can spread to both eyes, or to one.

Divergent strabismus can be congenital or acquired.

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What is strabismus?

– this is another name for the condition preceding strabismus. The condition is a lack of coherence in the activity of the muscle tissue of the eyes. Most often, the condition begins in early childhood, when both eyes function differently. In the absence of timely treatment, progressive strabismus develops. In rare cases, strabismus is diagnosed in newborns.

REFERENCE! Divergent strabismus is characterized by the divergence of the eyes from the midline towards the temples. This strabismus may spread to one or both eyes.

Useful video

Exotropia:

Causes of exotropia

Another name for divergent strabismus is exotropia. For reasons of occurrence, it can be congenital or acquired.

Congenital pathology develops as a result of the following reasons:

1. Compounded heredity refers to cases where close relatives have diseases such as myopia, farsightedness, glaucoma, cataracts and other eye ailments.
2. Presence of cerebral palsy (cerebral palsy).
3. The birth of a child ahead of schedule, when the nervous and eye systems have not yet had time to form.
4. Congenital anomalies of the visual organs.
5. Impact of negative factors on the fetus - a pregnant woman taking alcohol, psychotropic or narcotic substances, infectious diseases, such as measles, diphtheria, rubella, chickenpox, influenza, cytomegalovirus, herpes virus, etc.

Acquired strabismus can develop as a result of the following conditions:

1. Paralysis and paresis.
2. Deterioration in visual acuity that occurred suddenly.
3. Pathologies of the central nervous system can also develop as a result of neuroses or fear.
4. Frequent stress.
5. In children, strabismus can develop as a result of severe fright.
6. Infections such as measles, flu, etc.
7. Anomalies in the development of the eye organ, or injury.
8. Endocrine disorders.

Classification of exotropia

Doctors divide exotropia into the following types.

Intermittent

In this condition, there is an alternation with a regular period of convergent bilateral strabismus. This can happen during the day at the same time, or after 1-2 days. At the same time, binocular vision is preserved.

The condition is observed in children. If factors appear that inhibit the functioning of the central nervous system, then intermittent (periodic) strabismus will become permanent, with loss of binocular vision.

The main pathogenetic factor in intermittent exotropia is damage to the central nervous system.

Monolateral

This is unilateral exotropia. Vision inevitably decreases, and rapid blindness can occur on the side of the diseased eye. The brain, receiving a double image, completely eliminates the work of the affected eye, its visual perception gradually goes out of order.

Expert opinion

Kim Oksana Alexandrovna

Head of the ophthalmology clinic. Ophthalmologist with more than 10 years of experience.

If the diseased eye is not involved in work, then its functions will be completely lost and even advanced treatment methods will be powerless. There can be only one way out - it is necessary to completely exclude the cause of monolateral strabismus. This is the only way to maintain binocular vision even with progressive unilateral strabismus.

Friendly

With this type, one or the other eye squints. With concomitant strabismus, farsightedness predominates, and myopia is combined with divergent strabismus.

Concomitant exotropia is characterized by preserved movement of the eyeballs, absence double vision, however, binocular vision is impaired.

REFERENCE! Acquired concomitant strabismus can develop against the background of diseases such as astigmatism, farsightedness, myopia, cataracts and others.

Alternating

The condition is manifested by an alternating displacement of the pupils from the central axis. Such strabismus occurs mainly in children, and in 2.5% of cases - up to 3 years of age.

Fickle

This is the most light form strabismus It appears only in certain situations, and then goes away on its own. Non-permanent strabismus can occur due to the following factors:

1. With strong feelings.
2. During or after stress.
3. For a number of ophthalmological problems.

The non-permanent form of divergent strabismus tends to progress in the presence of a hereditary factor.

Often the condition goes away after the emotional background has stabilized.

Symptoms

A common symptom of the disease will be the asymmetrical position of the iris and pupil in relation to the palpebral fissure. With divergent strabismus, they are directed towards the temples.

In children

An early sign of incipient strabismus is the deviation of the pupil outward. First, this condition is observed in a child after heavy stress, mental or physical, or during a period of illness. You can notice strabismus in a baby at the moment when he looks into the distance and tries to see something.

A characteristic symptom may be squinting and constant rubbing of the eyes. Double vision can be suspected if a child tries to close one eye to look at an object.

As the disease progresses, divergent strabismus will manifest itself more clearly. Now it is already observed both at a distance and at a near glance.

In adults

In adults, the symptoms are similar to those in children; they manifest themselves as follows:

1. When trying to focus the gaze on an object, the pupils, one or both, are directed towards the temple.
2. Double vision and binocular vision are absent.
3. Visual acuity is reduced in the squinting eye.
4. Often there is paralytic strabismus, when it is impossible to turn the eye to the side.
5. Stable absence of eye movement in one direction.
6. The appearance of dizziness and orientation in space.

IMPORTANT! As a rule, congenital strabismus is bilateral, and acquired strabismus affects only one eye.

Possible complications

You should not assume that divergent strabismus is only an external defect. Without treatment, there is a loss of binocular vision, thanks to which a person can navigate the space and objects surrounding him.

Also in case of malfunction visual analyzer there is a delay mental development, which is extremely dangerous for children.

Diagnostics

If divergent strabismus is suspected, a complete ophthalmological examination. These include tests, biometric studies, examination of the eye structure, and diagnostics of refraction.

When collecting anamnesis, the doctor must clarify the time of onset of strabismus and associate the disease with possible injuries and pathologies. During an external examination, attention is paid to the forced position of the head, the symmetry of the face and palpebral fissures is assessed, as well as how the eyeballs are located.

Quite a lot important role Testing visual acuity with trial lenses plays a role in diagnosing exotropia. Skiascopy and computer refractometry are used to study clinical refraction.

Biomicroscopy and ophthalmoscopy are used to examine the fundus, anterior parts of the organs of vision and the transparent environment of the eyes.

There are other diagnostic methods, which will depend on the type of strabismus.

Treatment

The doctor prescribes it based on the type of disease and the stage of its development.

Medication

Cycloplegic drops are instilled into a normal eye, they dilate the pupil and vision becomes blurred. As a result, the work of the affected eye increases. Some patients with strabismus are given miotic drops, which prevent the pupil from constricting. Similar methods will be effective for young children.

After vision in one eye improves, measures are taken to work both eyes in parallel. To do this, glasses are prescribed or surgery is performed.

Gymnastics

To oculomotor muscles worked better, special gymnastics for the eyes are prescribed. She not only trains visual organs, but also relieves fatigue, improves visual acuity, and strengthens the extraocular muscles.

The most common exercises:

1. Closing your eyes.
2. Reproduction of various geometric shapes with the eyeballs - circle, square, triangle, etc. These can be other designs: letters, numbers, Christmas trees, zigzags, bows.
3. Looking at the pencil in front of you and following its movement without turning your head.
4. You need to tilt your head up and focus your gaze on the tip of your nose; you need to stay in this position for 30 seconds.
5. Rotate the eyeballs clockwise and then counterclockwise.

ATTENTION! All such exercises are performed slowly. You need to do them every day for 3-4 approaches for 10 minutes.

Traditional methods

Traditional therapy is carried out only after consulting a doctor. Basically, it allows you to replenish the loss of essential microelements, improve blood supply and nutrition to the eyes. It is recommended to drink rosehip decoction, infusions of calamus and pine needles. At night, it is recommended to make lotions from chamomile infusion.

The doctor may also prescribe multivitamins that will improve the functioning of the visual organ.

Surgical method

In severe cases, surgery may be required.

Indications for surgery

Surgical intervention is indicated in two cases:

1. The first is if divergent strabismus occurs in a severe form.
2. The second is if treatment for 1-1.5 years has not produced a positive change.

In this case, the length of the extraocular muscles is surgically corrected.

Anesthesia is selected depending on the age of the patient. Done in childhood general anesthesia, adults can use local anesthesia.

Sometimes adult patients undergo surgery voluntarily to eliminate a cosmetic defect.

Recovery postoperative period

After surgical intervention a rehabilitation period will follow, during which it is imperative to do everything medical recommendations and reduce excessive eye strain. Doctor in mandatory will prescribe rehabilitation exercises that must be performed conscientiously.

At this time, for 7-10 days it is possible discomfort, such as dry eyes, burning sensation, temporary blurred vision, redness. To cope with these unpleasant symptoms, anti-inflammatory and moisturizing drops are used, such as Systane, Oftagel, Indocollir.

Possible postoperative complications

Complications are rare. They manifest themselves as bleeding, insufficient correction or, on the contrary, overcorrection, infection.

Prevention

Prevention is important primarily for children whose family has a history of strabismus or other ophthalmological problems. It consists of the following steps:

1. Regular visits to the ophthalmologist.
2. Timely optical correction ametropium.
3. You should definitely pay attention to visual hygiene.
4. Load your eyes in dosed form.
5. Conduct timely treatment eye injuries, infectious diseases.
6. Prevent skull injuries.
7. Pregnant women should be attentive to their health.

Conclusion

Divergent strabismus can be eliminated, the main thing is to start treatment in a timely manner. In mild cases, the wearing of special prismatic glasses or soft contact lenses is prescribed. The disease should not be neglected, otherwise strabismus cannot be eliminated without surgery. And in more advanced cases, a person may remain disabled forever.

Anastasia Zharova

Internet journalist, copywriter.

Articles written

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Children's strabismus, detected before the age of 1 year, cannot be cured on its own. And one cannot hope that the child will simply outgrow this illness. This pathology is not as easy to get rid of as many parents think.

In the presence of this disease, a number of characteristic symptoms, and if they are detected, treatment should not be delayed. If you treat strabismus carelessly, you can lead to the child going blind in one eye or suffering from amblopia (lazy eye syndrome) or farsightedness.

If the visual apparatus works in harmony, the eye muscles work properly and the gaze focuses on a specific point. When one or both eyes squint, the eye muscles cannot work in coordination, so the eyes move inconsistently.

The eyes are directed in their own direction, and divergent or convergent strabismus is diagnosed. This leads to the fact that the brain is not able to properly process the information coming from the eyes, forming a holistic picture of what it saw.

Convergent strabismus in children under one year of age is a common occurrence.

There are several reasons for the appearance of convergent strabismus and children:

• non-permanent or congenital divergence of the eyes is present from birth or occurs during the first months of a child’s life due to intrauterine processes such as infectious diseases or microscopic hemorrhages;
• By various reasons visual acuity is impaired, which in some cases also leads to strabismus;
• disruption of the central nervous system due to hydrocephalus or cerebral palsy;
• severe stress or fear;
• bruise, fracture or other injury.

Parents are often frightened when they hear the diagnosis “ablyopia”, indicating strabismus in a child under the age of one year, although this phenomenon is often only temporary. It is caused by incomplete development of the visual apparatus, nerve endings and conductive channels.

The following video will familiarize you with the causes of strabismus:

Symptoms of strabismus

There are only a few symptoms of descending strabismus and they are very easy to determine even on your own:

• the baby does not direct both eyes at the same time to one point (this symptom is characteristic of all types of strabismus);
• eyes move scatteredly;
• one eye squints or closes from bright light;
• the child constantly strives to tilt his head and hold it at an angle in order to examine the object;
• the child has impaired perception of the depth of the space around him (he bumps into objects or falls).

In more often at age Children who are later diagnosed with strabismus may complain of blurred vision, strained or painful eyes, increased perception of light, or seeing objects in two.

Symptoms tend to appear, become more frequent and intensify under the influence of certain factors (fatigue, stress, illness, etc.). Newborns and babies quite often they suffer from minor intermittent strabismus or farsightedness, but usually after a few months (4 to 5) vision returns to normal.

Possible treatments for strabismus

Treatment of non-permanent divergent or convergent strabismus is a much simpler and faster process than treatment of advanced forms of strabismus. Therefore, treatment must be started in a timely manner. There are several treatment options:

• therapy (conservative method);
• surgical intervention.

The first method involves performing special exercises. Therapeutic treatment protracted and performed in a complex manner. And in many cases it helps avoid surgery. It is divided into several main stages:

1. to identify causes;
2. carrying out preliminary correction using glasses or contact lenses;
3. orthoptic and diploptic treatment using hardware methods to restore binocularity;
4. ridding the patient of “lazy eye syndrome”;
5. consolidation of the effect.

Surgical intervention is used only in cases where all possible therapeutic methods have not brought the desired result.

It is recommended to carry out the operation at the age of 4 to 5 years, since at this age it will be most effective, because it is much easier for a child who does not attend school to follow all the recommendations and devote time to the necessary exercises.

For children with congenital paralytic strabismus, accompanied by a significant deviation, especially in the vertical direction (an extreme case is divergent strabismus with vertical displacement), surgery is performed at more different ages due to the severity of this form of the disease.

Surgery is performed in one of two ways possible ways. The first involves weakening the muscle responsible for eye movement if it is overstrained. In this case, the muscle can be partially excised.

The second method involves surgery to strengthen the weakened muscle and fix it. These methods are extremely rarely used alone, since in the vast majority of cases it is required complex treatment.

The effect may not be achieved after the first operation. It depends on the complexity of the particular case. If the desired effect is not achieved, doctors prescribe repeat operation. It can be carried out no earlier than 6-8 months after the first.

The first stage may only include the elimination of a cosmetic defect, that is, treatment of the noticeability of strabismus, which has a negative impact on the child’s psyche. At the second stage, more serious treatment is carried out, including eliminating problems with the eye muscles.

In some cases, surgical treatment leads to the appearance of overcorrection. The reason for this is errors in calculations. After identifying this symptom, repeated surgery is prescribed.

Gymnastic exercises

Strengthening the eye muscles is one of the most important components of the comprehensive treatment of strabismus. The most recommended and effective are the following exercises:

1. You need to raise your hand up, stretch it out forefinger, and then lower your hand vertically down so that your finger approaches the tip of your nose. Then the same exercise is repeated again, but with the arm moving horizontally to the side.
2. Writing with the eyes of a figure eight, implementation circular movements. After this, you need to look down and up, left and right.
3. It is useful to play with a shuttlecock or ball. When playing football, volleyball, tennis or table tennis, a child trains his eyes, as he is forced to constantly monitor a moving object that changes direction, moves away and approaches.
4. When working at a computer, it is important to distract yourself from the monitor from time to time (look at distant objects, peer out of the window, focus your gaze alternately on distant and close objects.

All these exercises must be performed 10-15 times every day, during the day or evening time. If you force yourself to do them regularly, you can not only avoid many eye diseases, but also cure their early forms.

A persistent person who wants to recover and does everything necessary for this will certainly get rid of strabismus.

Prevention methods

There are several mandatory rules, the implementation of which helps to correct strabismus in children, schoolchildren and preschool children:

• It is impossible to place objects near the child’s crib that attract his attention if these objects are placed at one point (it is necessary to provide access to the crib from the maximum number of sides;
• To prevent imaginary strabismus and farsightedness, rattles must be hung in such a way that they are located at a distance of approximately equal to length baby's outstretched arm;
• it is important to ensure uniform load on children’s eyes, giving the brain the opportunity to process information evenly;
• Before the age of three, it is not advisable to introduce a child to television, and before of a certain age it is necessary to limit its viewing;
• the child must have correct posture;
• you should remember that small fonts (on computers and in books) are harmful to the eyes;
• if available hereditary factor, it is necessary to regularly visit an ophthalmologist for preventive examination. This is one of the mandatory factors that cannot be neglected.

A disease that has affected a baby should not be left to chance. You can only not be afraid of imaginary strabismus, which will 100% go away a few months after the birth of the child.

Only a qualified pediatric ophthalmologist can determine whether strabismus is imaginary, or whether the child has a more serious problem, so it is important to turn to specialists at the first doubt, and not try to independently diagnose the disease and try to get rid of it on your own, because such approach may do more harm than good, and the harm may be irreparable.

Strabismus or strabismus is a pathology in which the eyes move uncoordinated and are in an asymmetrical position. Incorrect position of the eyeballs does not allow the optical axes to converge when viewing objects, which leads to visual impairment. When the eyes look to the sides, and when converging they are turned towards the nose. It is noteworthy that convergent strabismus can be observed only in one eye, or alternately.

Types of convergent strabismus

1. Monocular convergent strabismus, when the defect affects only one eye. Monocular strabismus is often combined with (syndrome). The complication is due to the fact that with strabismus the activity of the eye decreases and visual acuity decreases. The brain receives different information from the eyes, so it turns off the patient to eliminate discomfort.
2. Right-handed or left-handed alternating. This type of convergent strabismus is also called alternating. The defect is observed in both eyes, but in different periods. With alternating strabismus, amblyopia also develops, but to a lesser extent, since the eyes work in approximately the same mode. Visual acuity, as a rule, does not decrease.
3. Paralytic convergent strabismus. This type of strabismus develops with atrophy of the extraocular muscles, optic nerves or brain.

Concomitant convergent strabismus is diagnosed mainly in children. It must be remembered that the functionality of the visual system can only be restored until the age of 25, when the body is still developing. The best results are observed with early treatment of strabismus.

Causes of strabismus

The exact causes of strabismus are unknown. Pathology can be congenital or acquired. Congenital strabismus, as a rule, manifests itself already in the first six months of life. Since it is not possible to accurately establish a diagnosis during this period, it is recommended to monitor the patient.

Acquired strabismus occurs early, that is, it occurs in the first year of a child’s life. However, most often the causes of strabismus are diagnosed in children older than 2-3 years. It is generally accepted that heredity plays an important role in this process. Congenital strabismus results intrauterine infections. A child may be born with a defect if the mother suffered severe intoxication during pregnancy.

Other causes of strabismus:

• “childhood” diseases (scarlet fever, measles, colds);
• underdevelopment of the oculomotor muscles;
• pathologies of the muscles of the eyeball;
• refractive errors (astigmatism, farsightedness, myopia).

Convergent strabismus can be an independent disease or a sign of another pathology. Eye defects occur with the development of tumors in the brain, Down syndrome, cerebral palsy, microcephaly, hydrocephalus, congenital cataract. Strabismus also appears with neuralgia and trauma, including psychological.

Examination for strabismus

It is noteworthy that most infants squint a little in the first six months of life. This is due to the peculiarities of the development of the visual system during this period. From time to time, the baby's eyes bunch up, reminiscent of the symptoms of convergent strabismus. There is no need to panic, but you still need to show your baby to an ophthalmologist.

When the child reaches six months, he should stop squinting his eyes. If symptoms continue, parents should address the issue and have the baby checked.

Examination methods for strabismus:

1. Interviewing parents if the patient is a child. The doctor must find out the supposed cause and period of occurrence of strabismus, the features of its development and accompanying illnesses eye.
2. Determination of visual acuity (). It is important to evaluate the vision of each eye separately and both at once, as well as visual capabilities with and without correction.
3. Determination of the nature of strabismus.
4. Determination of the type of defect by direction.
5. Measuring the amount of deviation. For these purposes, the Hirshberg method is used: the patient looks at the mirror of a special device, and the ophthalmologist studies the light reflexes of the cornea.
6. Study of simultaneous and monocular vision.
7. Study of eye mobility. The disadvantage of this method is that it can only detect severe limitations in mobility.
8. Determination of fusion ability on.
9. Study of eye refraction using a skiascope.
10. Analysis of visual fixation (if vision deteriorates). The study can be carried out using a vizoscope and an ophthalmoscope.
11. Checking the optical environment (biomicroscopy, campimetry, ophthalmochromoscopy, photostress test). Sometimes strabismus develops due to anatomical changes eyeball.
12. Electrophysiological studies.
13. Determination of retinal visual acuity.

A child with strabismus may need additional consultation with a pediatrician, otolaryngologist, neurologist and other specialists.

Is it possible to cure convergent strabismus?

If the problem is identified in a timely manner, the treatment prognosis is favorable. It is recommended to carry out strabismus therapy until 18-25 years of age, until visual system completely stabilized. It must be remembered that strabismus does not go away on its own, so the problem cannot be ignored. Without treatment, strabismus is complicated by amblyopia, decreased visual acuity, and even developmental delays.

Even if the course of strabismus occurs without complications, the pathology constitutes a serious cosmetic defect that can greatly complicate the life of even an adult. Children with strabismus are often withdrawn and complex.

If you have strabismus, you cannot hold positions that require prolonged strain on the visual system. This includes control of transport and potentially dangerous equipment, rifle units of troops, etc. Pathology disrupts (connection of images from different eyes into a single picture), which helps a person to see the three-dimensional world, correctly determine the distance between objects, perceive the physicality and depth of the environment.

A person with strabismus, who lacks binocular vision, cannot work with moving objects when it is necessary to instantly assess the depth of something. If you do not treat strabismus in a child, you can block his path to becoming a pilot, machinist, athletes, artist, surgeon, and even dentist.

How is convergent strabismus treated?

It is possible to cure convergent strabismus only with a combination of conservative treatment and hardware. Courses hardware treatment carried out 3-4 times a year. This periodicity allows you to smoothly restore the connection between the eyes and teach the child to perceive a single image of the world around him. Sometimes surgical treatment of strabismus is required.

Methods for correcting strabismus:

1. Pleoptic therapy. Pleoptics studies methods of stimulating the macula of the retina. In case of strabismus, it is recommended to increase the load on the affected eye, so children are prescribed computer training and laser stimulation.
2. Orthoptic therapy. Orthoptics refers to ways to restore and improve binocular vision. Training takes place on a computer and weather forecasters.
3. Diploptic therapy. Techniques for restoring visual function using various lenses form part of orthoptics.
4. Convergence trainer. Exercises on this device help improve the functionality of the oculomotor muscles.
5. Spectacle correction.
6. Occlusion.

Goals of strabismus therapy:

1. Improved visual acuity. You can affect your vision by wearing a regular bandage on your healthy eye (glue,). The duration of therapy is determined by the doctor depending on the severity of the pathology. The patch helps block the healthy eye and activate the affected eye to train the extraocular muscles and prevent the brain from blocking it.
2. Establishing connections between the eyes. It is very important to achieve synchronous work of the eyeballs.
3. Maintaining muscle balance. The muscles that move the eye can be restored to balance through surgery. This measure is not always implemented.
4. Improvement of stereoscopic and binocular vision. This stage is considered final, when there is already normal vision without spectacle correction with correct eye position.

Surgical correction of strabismus is indicated only if conservative treatment fails. If after a year of treatment there is no improvement, it is necessary to evaluate the feasibility of surgery. Often, surgical treatment is prescribed to eliminate a cosmetic defect. It must be remembered that surgery does not stop the treatment of strabismus. Vision restoration should continue even after surgery.

Conservative methods for eliminating strabismus

Treatment of strabismus is carried out in several stages. Each of them allows you to eliminate certain disorders and allow the visual system to develop normally. Often, for strabismus, glasses are prescribed for constant use. After three weeks, you can begin pleoptic therapy. At this stage, you need to level out the visual acuity in your eyes.

As part of pleoptic therapy, the doctor may suggest a technique for deteriorating vision in the healthy eye. This is necessary so that the patient can become more active. For these purposes, the patient is prescribed special drops for a healthy eye that will depress vision. In parallel with this, you need to wear glasses in which the lens on the affected side will be strengthened.

The next stage of treatment is occlusion. The healthy eye is covered with a bandage to allow the patient to function at full capacity. Depending on the degree of strabismus, the bandage may be prescribed for one day or for several hours. In severe cases, occlusion must be carried out within a year. After occlusion, local illumination of the retina is shown. The method involves the use of special tools and apparatus.

When vision improves to the desired level, they move on to the next stage - orthoptic correction. During this period, the child is taught to merge images from different eyes into one. This can be done using devices with eyepieces and a computer. The child is asked to connect pictures of animals and other entertaining exercises.

The last stage of strabismus treatment will be diploptics. This is one of the most difficult steps, since it requires restoration of binocular vision. However, diploptic techniques are indicated only for strabismus up to 7 degrees.

Surgical correction of convergent strabismus

You can achieve correct eye position surgically. The operation is scheduled for a year or two, but only after amblyopia has been eliminated and refractive errors. The procedure involves correcting the position of the extraocular muscles.

For strabismus, three types of operations are performed:

• weakening, which reduce the traction force;
• enhancing;
• changing the direction of muscle work.

The extraocular muscles can be weakened by recession, myectomy, and posterior fixation sutures. Recession involves moving the posterior insertion of a muscle closer to its origin. The procedure is carried out on all muscle groups of the eye (except for the superior oblique).

Myectomy consists of cutting off the muscle at the attachment site without subsequent connection. Most often, this technique is used to weaken the inferior oblique muscle, but the rectus muscles are rarely operated on. When using posterior fixation sutures, muscle strength is reduced without changing the attachment. Typically, this method is used to operate on the horizontal rectus muscles.

Enhancing operations:

1. Muscle resection. The operation is performed only on the rectus muscles.
2. Formation of a fold. The procedure allows you to strengthen the direction of the superior oblique muscle.
3. Moving. Performed after recession of the rectus muscle to increase its tension.

If the degree of pathology warrants surgery, doctors may recommend operating on the muscles of both eyes, even if the other is completely healthy, or just one when the problem seems to affect both. However, a decision about whether to operate on one or both eyes cannot be made based on visual assessment.

The specifics of the operation are determined depending on many factors. The doctor must understand whether the pathology worsens when viewing objects at different distances. If it gets worse, you need to assess the degree of deterioration when looking to the sides. It is also worth considering a history of ophthalmic surgery, especially intervention in the extraocular muscles.

Therapeutic exercises for strabismus

With convergent strabismus, the results of the main treatment can be improved with the help of special gymnastics. For exercise to be beneficial, you need to do it correctly and regularly. It is very important not to do gymnastics when you are tired.

The effect will be noticeable if you devote up to two hours a day to this (20-25 minutes several times). However, the exact time should be determined by the doctor depending on the severity of the strabismus.

Exercises to help correct the defect are quite simple. To train the eyes, plastic plates with holes of different shapes are used, through which the child must pull the cord. You can print out various shapes on a regular sheet of paper and ask your child to color in similar ones. To achieve the effect, it is enough to depict stars, balls, houses and other figures.

To treat strabismus, use a regular musical top. You need to unwind it and allow the child to examine and describe the emerging shapes. After several months of implementation home therapy You need to see a doctor and check the results.

Unconventional methods for treating strabismus

For patients with strabismus pleasant surprise The news comes out that illness can be treated with chocolate. The black type of sweet, which does not contain milk or filling, is considered healthy. Only chocolate with a large amount of cocoa will be effective for vision pathologies.

Sweets containing more than 40% sugar can be harmful. Before “sweet” treatment you need to check allergic reaction The child has. It is allowed to give the patient four pieces of chocolate for breakfast and lunch. Dark chocolate helps strengthen the eye muscles.

An additional measure for convergent strabismus can be considered the technique healing tinctures. On initial stage The development of pathology is helped by rosehip infusion. To prepare the product, you need to pour boiling water over the berries and leave for 5-6 hours. Before use, the tincture must be filtered. It is allowed to add honey to improve the taste. For strabismus, it is recommended to drink a glass of tincture before each meal.

Traditional medicine suggests cabbage leaves to treat strabismus. The method is considered absolutely harmless. To prepare the product, boil several leaves of the plant and then turn them into a paste. Take 3-4 times a day.

It's no secret that currants have a beneficial effect on the visual system. When correcting strabismus, you can also use clover, pine needles, calamus root, and carrot juice. By regularly consuming cucumber or beet juice, you can prevent ophthalmic pathologies.

A healing effect is observed when using phytodrops. The simplest option is dill drops. To prepare them, just brew 10 g of greens in a glass of boiling water and strain thoroughly. For strabismus, drops are used three times a day. You can also use lotions with phytodrops made from apples, onions and honey. However, we must remember that honey is a strong allergen and is often contraindicated for children.

Prevention of strabismus

It is impossible to protect a child from strabismus 100%, but parents can minimize the risk by implementing prevention. The basis for preventing strabismus is visual hygiene. Toys can only be hung at a sufficient distance from the child’s eyes. You must constantly ensure that the baby does not get injured. It is important to avoid shocks and impacts.

If symptoms do not disappear when the child reaches six months of age, you should consult an experienced ophthalmologist. If symptoms of an infectious disease occur, you should consult a doctor and prescribe full treatment, because often convergent strabismus becomes a complication of infection.

Children over three years old should be prohibited from squinting their eyes: during deliberate squinting, a muscle spasm occurs, which provokes a violation. It is necessary to protect the baby from fear and stress, as well as from certain types of games.

You need to start treatment for strabismus only with the permission of your pediatrician. You should make sure that the child has no contraindications from other body systems. This is especially true for herbal treatment, since children often develop allergies.

Igor Aznauryan
Pediatric ophthalmologist, academician of the Academy of Medical and Technical Sciences of the Russian Federation

Strabismus - this is a position of the eyes in which the visual axes do not converge on the object in question. Outwardly, this is manifested by the fact that the eye deviates in one direction or another (to the right or left, less often up or down, and various combined options are also found). If the eye is brought to the nose, strabismus called convergent (more common), and if towards the temple - divergent. One eye or both may squint. Most often, parents turn to a pediatric ophthalmologist after noticing that the child’s eyes are looking “wrong.”

Strabismus- this is not only a problem appearance. Effect strabismus is a consequence of disturbances in perception and the conduction of visual information throughout the child’s visual system. At strabismus Visual acuity decreases, connections between the right and left eyes are disrupted, as well as the correct balance between the muscles that move the eyes in different directions. In addition, the ability for three-dimensional visual perception is impaired.

Strabismus may be congenital, but more often it occurs in early childhood. If the pathology appears before 1 year of age, then it is called early acquired. The disease may also appear at 6 years of age. But more often strabismus develops between the ages of 1 and 3 years. At birth, the child does not yet know how to look with “two eyes”; the ability to binocular vision develops gradually up to 4 years of age. In this case, any deviation of the visual axis from the point of fixation must be qualified as strabismus and under no circumstances should it be considered as a variant of the norm. This applies even to such seemingly cosmetically less pronounced cases as strabismus with a small angle and unstable strabismus.

Most often, strabismus develops in children with farsightedness– when the baby has difficulty seeing objects that are nearby. Strabismus may also develop in children with astigmatism. At astigmatism Some areas of the image may be focused on the retina, others behind or in front of it (there are also more complex cases). As a result, a person sees a distorted image. You can get an idea of ​​this by looking at your reflection in an oval teaspoon. The same distorted image is formed with astigmatism on the retina. But although the picture itself with astigmatism may be blurry and indistinct, a person is usually not aware of this distortion, since the brain “corrects” his perception. Strabismus may also occur with myopia– when a child has difficulty seeing objects located at a distance.

At strabismus in a constantly squinting eye, visual acuity gradually decreases - amblyopia. This complication is due to the fact that the visual system, in order to avoid chaos, blocks the transmission to the brain of the image of the object that the squinting eye perceives. This condition leads to an even greater deviation of this eye, i.e. strabismus intensifies. The process of vision loss depends on the age of onset of the pathology. If this happened in early childhood, in the first year of life, then the decrease in visual acuity can be very, very rapid.

Reasons The occurrence of strabismus can be:

• hereditary predisposition, when close relatives (parents, uncles, aunts, etc.) have the disease;
• the presence of one or another optical defect (defocusing) of the child’s organ of vision, for example, with farsightedness in children;
• various intoxications (poisonings) of the fetus during pregnancy;
• severe infectious diseases of the child (for example, scarlet fever, diphtheria, etc.);
• neurological diseases.

In addition, the impetus for the emergence strabismus(against the background of prerequisites) can serve heat(over 38°C), physical or mental trauma.

Treatment

There are more than 20 various types strabismus. Outwardly, all of them are manifested by deviation of the visual axis from the point of fixation, but in their causative factors and development mechanism, as well as in the depth of the disturbances, they differ greatly from each other. Each type strabismus requires an individual approach.

Unfortunately, even among doctors there is an opinion that before the age of 6 a child with squint you don’t need to do anything and everything will go away on its own. This is the greatest misconception. Any deviation of the eye at any age should be considered the beginning of the disease. If no measures are taken, loss of visual acuity may occur, and then treatment will require much more effort and time, and in some cases the changes become irreversible.

Sometimes strabismus It can be imaginary: due to the wide bridge of the newborn’s nose, parents suspect the presence of this visual defect, but in fact it does not exist - it is just an illusion. In newborns, the eyes are set very close, and the bridge of the nose, due to the peculiarity of their facial skeleton, is wide. As the facial skeleton develops, the distance between the eyes increases and the width of the bridge of the nose decreases. It is precisely in this case that everything really goes away with age and there is no need to correct anything, but to determine whether it is imaginary strabismus or real, only a doctor can. Any suspicion of a deviation from the norm should alert parents and prompt them to visit a pediatric ophthalmologist as soon as possible.

Timing of preventive visits to an ophthalmologist in the first year of a child’s life. The first examination is advisable immediately after birth. It must be said that in maternity hospitals, all babies without exception are not examined by an ophthalmologist. A neonatologist at the maternity hospital or a local pediatrician may classify the baby as a risk group, and then he will be prescribed a consultation with an ophthalmologist already in the maternity hospital or immediately after discharge. The risk group includes children with a family history of eye diseases (if their parents have them), premature newborns, children born with pathological childbirth, as well as children whose parents have bad habits (alcoholism, smoking). Further, an examination by an ophthalmologist is necessary for the baby at the age of two months, at six months and at the age of one year. During this time, all children are referred to an ophthalmologist.

The specialist will identify the presence or absence of farsightedness (myopia) in the child, the acuity and nature of vision, the angle strabismus and, if necessary, refer you for consultation to other specialists, for example to a neurologist.

Only after a thorough examination can complex treatment be started strabismus, including conservative therapy And surgery. The conservative part of treatment includes methods aimed at increasing visual acuity. If there is farsightedness or nearsightedness, according to indications, the child needs glasses. Sometimes they fix it completely strabismus. However, wearing glasses alone is not enough. It is very important to teach your child to combine images from the right and left eyes into one image. This is achieved through a set of therapeutic measures conducted in courses several times a year. Treatment is conservative and takes place in game form. In addition, the occlusion method is used - covering the good eye with a bandage for a certain time every day, so that the child learns to rely more on the weak eye.

It should be especially noted that the success of treatment strabismus depends on correctly selected individual treatment tactics. The treatment complex often involves the use of both conservative and, in most cases, surgical treatment. At the same time, surgery does not need to be treated as an alternative. conservative treatment. Surgery is one of the stages of treatment, the place and time of which depend on the type strabismus and the depth of damage to the visual system.

Before and after surgical treatment, conservative therapeutic measures should be carried out aimed at increasing visual acuity, to restore communication between the eyes and stereoscopic three-dimensional visual perception - this is achieved with the help of special exercises. Apply techniques to increase functional state visual part of the cerebral cortex, force the visual cells of the cortex to work normally and thereby ensure correct and clear visual perception. These techniques are stimulating in nature. Classes are conducted using special devices on an outpatient basis in courses of 2–3 weeks several times a year.

During treatment, at a certain stage, in the presence of high visual acuity, restoration of the ability to merge two images from the left and right eyes into a single visual image, in the presence of eye deviation, surgical intervention on the muscles of the eye. The operation is aimed at restoring the correct balance between the muscles that move the eyeballs (oculomotor muscles). It is important to understand that surgery does not replace therapeutic techniques, but solves a specific problem that cannot be solved conservatively.

To decide the timing of surgical intervention, it is important that the patient has sufficient visual acuity. The sooner you put your eyes in a symmetrical position with direct gaze, the better. There are no special age restrictions. With congenital strabismus it is important to complete the surgical stage no later than 3 years, in case of acquired - depending on the timing of achieving good visual acuity at the conservative stage of treatment and restoration of the potential ability to merge images from both eyes into a single visual image.

Surgical treatment tactics are developed depending on the type strabismus. From a surgical point of view, treatment of a permanent form strabismus with a large angle strabismus when the eye is significantly deviated, does not present much difficulty. The effect of such operations is obvious to the patient. But for surgeons with certain qualifications it will not be difficult. Difficult to operate strabismus with variable and small angles. Currently, technologies have been developed for making an incision without the use of a cutting device (scissors, scalpel, laser beams). The tissues are not cut, but rather moved apart by a high-frequency stream of radio waves, providing bloodless exposure of the surgical field.

Technique of operations for strabismus microsurgical, general anesthesia with specific anesthesia is used, which allows you to completely relax the oculomotor muscles. Depending on the volume of the operation, its duration ranges from 20 minutes to one and a half hours. The child is discharged home on the second day after surgery. In the absence of a vertical component (when the eye is not displaced upward or downward), one or two operations are usually performed on one and the other eye, depending on the size of the eyeball and the type of strabismus. The sooner a symmetrical position of the eye is achieved, the more favorable the prospect of cure.

To school child with squint must be rehabilitated as much as possible. If you deal with the problem strabismus comprehensively, cure occurs in 97% of cases.

Thanks to a timely treated disease, the child can study normally, get rid of psychological problems due to visual impairments, subsequently do what you love.