Strabismus in children: causes of occurrence and methods of diagnosing it. Heterophoria: what it is, causes of development, symptoms and treatment tactics

Heterophoria (hidden strabismus) is a pathology of the visual apparatus, which is characterized by malfunction eye muscles when saving binocular vision. The disease can manifest itself when a person completely relaxes and does not focus his gaze on any object. The opposite condition is called orthophoria, but in our time this pathology is extremely rare.

Eyes with heterophoria

Regarding age, latent strabismus most often occurs in children than in adults.

Accurate determination of heterophoria is possible only with the help of special diagnostic techniques, and at home, heterophoria is determined conditionally.

Almost every child has hidden strabismus. Heterophoria appears in children due to the fact that the baby’s oculomotor muscles are just forming, they cannot yet control movements eyeballs, the eye muscles are weak, inelastic and lack tone.

As a rule, the disease goes away three to four months after birth. During this period, the eye muscles strengthen, become elastic and can control the eyeballs.

Since there are no significant changes in the functioning of the organ of vision, therapeutic therapies in this case are not required. However, in case of large angular indices between the eyes and only with the consent of the parents, surgery is performed.

Classification of pathology

With heterophoria, one of the eyes deviates when it relaxes. At the same time, the mechanism is preserved.

Due to the fact that the eyes can be directed in different directions, the disease has several varieties:

• exophoria (hidden divergent strabismus) – the divergent type is characterized by deviation of the eye directed to the temporal region;
• esophoria - in the presence of this type of disease, the eye deviates in the direction of the bridge of the nose;
• hyperphoria – characterized by an upward gaze direction;
• hypophoria is the opposite of hyperphoria, that is, the gaze of the eye is directed downwards.

The presented types of deviations are complemented by increased tone of antagonist muscles, which allows preserving the mechanism of binocular vision.

If the balance of the eye is disturbed motor muscles There are no large angles between the eyes. They can reach values ​​of three to four degrees. Thanks to such small angles, the performance of the organ of vision is not reduced and, as mentioned above, does not require medical intervention.

Each type of heterophoria is characterized by certain ranges of dioptric indicators in which decompensation does not occur (uncontrollability of eye movements):

1. for hyperphoria and hypophoria up to 1.0 prismatic diopter;
2. for esophoria up to 3.0 prismatic diopters;
3. for exophoria up to 6.0 prismatic diopters.

Causes of hidden strabismus

The main reasons that provoke the appearance of heterophoria are:

• Anatomical features of the location of the eyes. The disease can occur due to the size of the orbital sockets and the skull as a whole.
• Differences in the strength of the muscles that control the movement of the eyeballs. It can be triggered by problems with refractive ability (,), since due to constant tension, some muscles relax and lose strength, while others spasm.
• Problems with the endocrine system. Quite often, the development of heterophoria is a consequence of diseases of the thyroid gland.
• Frequent defeat infectious diseases. Infections often have a profound effect on the nervous system. Disruption in work nervous system may also affect the functionality of the visual apparatus.
• Constant stress and frustration mental health. All systems of our body are interconnected with each other, therefore, with a disorder of the nervous system, deterioration in work may occur oculomotor muscles.
• Muscular paralysis of the eye. With this type of paralysis, eye movement is limited and leads to weakening of other muscles.
• Receiving injuries, damage, tumors during internal parts eyes. All this can lead to damage to the eye muscles, which will affect their function and tone.

Symptoms of the disease

A slight deviation in the strength of the eye muscles, in both children and adults, usually passes without pronounced symptoms. This may be due to the action of the fusion mechanism, which is responsible for the formation of a single three-dimensional image in front of the eyes by merging individual images from each eye.

With significant disruption of eye function, neuromuscular tension occurs, which is reflected in well-being in the form of:

• fatigue (asthenopia);
• headaches;
• and (double images before the eyes);
• attacks of nausea;
• pain when closing the eye.

If these symptoms are detected, you should contact your doctor for diagnostic procedures, since the exact presence of hidden strabismus can only be established in laboratory conditions.

Carrying out diagnostics

All methods for diagnosing heterophoria are based on the principle of excluding one eye from the mechanism of binocular vision.

This method is the simplest. At the request of the doctor, the patient begins to carefully examine an object located far from him. The ophthalmologist alternately closes one or the other eye of the patient and records which of them performed the installation movement and which had the primary condition recorded.

If there is a disease, opening each eye, the doctor will observe the slow movement of only the diseased eye. The installation movement always occurs in the opposite direction relative to the type of hidden strabismus. That is, when moving outward, the patient is diagnosed with esophoria and vice versa.

At close range, heterophoria is diagnosed in a similar way.

Maddox Cylinder Study

This method is more accurate compared to the previous one.

• The patient focuses his gaze on a point light source (lamp), which is five meters away (when assessed at a distance) or thirty-three centimeters (when assessed at a close distance).
• The patient is put on a frame into which a Meddox cylinder is inserted in front of the right eye and a prismatic compensator is inserted in front of the left eye.

Horizontal phoria

• The cylinder is inserted horizontally into the frame, and the prismatic compensator is inserted vertically.
• With the right eye, in front of which the cylinder is located, the patient sees a vertical red line.
• Both eyes are open and the patient is asked to say which side of the light bulb the red line is on. If the line runs straight through the light bulb, then the heterophorium is absent, i.e. complete muscular balance is observed horizontally (horizontal orthophoria). If the line runs on the side of the light bulb on which the cylinder is located, then the doctor diagnoses esophoria (i.e., inward deviation of the eye), if on the opposite side, then exophoria (i.e., outward deviation of the eye).

To determine the degree of horizontal heterophoria, the doctor rotates the prismatic compensator roller until the line reaches the light bulb. When this happens, the compensator will show the degree of hidden strabismus in prism diopters.

Vertical phoria

• To measure the vertical phoria, the cylinder must be directed with its axis vertically, and the prismatic compensator with its handle vertically.
• If the line passes through the light bulb, then the patient has vertical orthophoria (i.e., complete muscular balance vertically). If the patient has hidden strabismus, then the line will pass for him above or below the light bulb. In the first case, hypophoria is diagnosed, and in the second, hyperphoria.

How to treat hidden strabismus

As a rule, treatment of hidden strabismus with a slight deviation is not carried out. We are talking about heterophoria, which does not exceed three to four prismatic diopters. This is due to the fact that the person does not experience problems with visual function.

However, with a more severe deviation, doctors recommend the following therapy.

Conservative method

To correct the functioning of the eye muscles it is used conservative treatment:

• glasses or contact lenses;
• exercises to strengthen the extraocular muscles.

Often the disease is accompanied by ametropia - one of the most unpleasant complications in which there is a violation of the refractive power of the eyes. When it occurs, use:

• Pleoptic methods for incorporating the squinting eye into work. Pleoptics is most often used in children (on healthy eye adhesive is applied for a certain time);
• Wearing decentered lenses to correct vision.

At big difference in the strength of the eye muscles and the manifestation unpleasant symptoms, the doctor prescribes glasses with prismatic lenses.

Surgery

The surgical method is used only for large angular values ​​between the eyes or if other methods have failed. If we're talking about about children, the operation can only be performed with the consent of the parents and the attending physician.

The operation itself involves changes in the length of the eye muscle to normalize the balance in the functioning of both eyes.

Prevention of heterophoria

Prevention of hidden strabismus is based on the creation comfortable conditions for the proper functioning of the eye muscles. It is important to always keep them in good shape and not overexert them.

To do this you need:

• periodically perform gymnastic exercises aimed at their development;
• observe the work and rest regime during long-term work;
• properly equip your workplace(lighting brightness, light direction, angle of incidence);
• Visit an ophthalmologist several times throughout the year.

Hidden strabismus a fairly common disease that can appear at any age, but most often it affects children. Despite the fact that such strabismus can go away without medical intervention, it is necessary to visit an ophthalmologist when the first symptoms appear.

For lately cases of strabismus have become more frequent, especially in children. If in infancy the defect does not look repulsive, but on the contrary it looks funny, then in older years there is every reason to get rid of the disease. It is unpleasant not only from an aesthetic point of view, but also from a medical point of view. Doctors strongly recommend getting rid of congenital strabismus as quickly as possible. It is much easier to get rid of pathology in infancy, especially if timely treatment. Congenital strabismus causes a child many problems; he experiences discomfort not only psychologically and emotional pressure, a diseased eye can completely fail and become uncontrollable if treatment is not taken on time.

It is easy to determine pathology thanks to characteristic features. Today, there are many methods for treatment, ranging from conservative ones - wearing corrective glasses, performing exercises for the visual organs; and ending with surgical intervention and surgical “leveling” of the diseased eye. Usually, surgery is resorted to when other methods of treatment are powerless; there are also several characteristic species pathologies that cannot be treated without surgery.

Pay attention! According to statistics, 1 in 50 children suffers from strabismus. This is one of the most common childhood eye diseases. By prevalence this pathology can be equated to myopia, which also often occurs in childhood.

Pathology is formed due to inconsistency in the work of the eye muscles. With normal functionality of these muscles, the eye focuses on a specific object. And with strabismus, one eye loses focus due to muscle weakness. The brain receives different information from both organs of vision, as a result of which the nervous system cannot create a three-dimensional image. The affected eye does not participate in the visual process at all. Over time, he stops “working” and begins to mow. This pathology in children is also called “lazy eyes”.

Why does strabismus occur? Six muscles are responsible for moving and focusing the eye. If at least one of them is affected, the child begins to develop strabismus. There are many reasons for the appearance of pathology. They depend primarily on the type of strabismus, which can be congenital or acquired. Let us consider in more detail the features of the appearance of congenital strabismus.

Causes of congenital strabismus

Unlike acquired strabismus, congenital strabismus is quite rare. Its appearance at birth is due to the following reasons:

• genetic predisposition;
• birth defects (Down syndrome);
• transmitted from parents if both suffered strabismus;
• improper carrying of the child;
• untimely birth;
• maternal use of drugs and alcohol, smoking during pregnancy;

Pay attention! Muscle tissue can also be damaged at birth if the mother, while carrying the child, suffered from certain infections, including measles and ARVI.

These and many other reasons can cause the disease to appear in the womb. A child may be born immediately with severe strabismus. It needs to be treated as early as possible, otherwise it will lead to complications.

Pathology is divided into two types: friendly and unfriendly strabismus.

Friendly means equal magnitude of deflection angles. That is, in this case, the functioning of the eye muscles is incorrect, but mobility is maintained, which means that the child does not see a double image.

In addition to this pathology, a child may develop other diseases against its background. Among them are myopia, farsightedness and others, this happens if it is not done in time. It is possible to restore vision with corrective glasses.

Strabismus at birth can be caused by muscle paralysis. In this case, it is impossible to cure the pathology with glasses for correction; only surgery.

The organ of vision can squint either to the side, or up or down. Strabismus also happens. There are also mixed types. Often, pathology affects visual acuity: the affected eye may begin to see poorly over time. There is a type of strabismus when the eyes squint with a certain frequency. This indicates a disruption in the proper functioning of the nervous system. The disease may appear again after full correction with glasses - this is secondary strabismus. There is a type of pathology when the direction of the eyes changes when looking into the distance.

Heterotropia is divided according to the degree of severity depending on the angle at which the eye squints. There is obvious strabismus, moderate and less noticeable.

Unfriendly strabismus. In this case, there is a mismatch of angles, as a result of which eye mobility in one direction or another is lost. Typically, strabismus at birth is of this type. A child is born with complete or partial absence eye mobility. The reason for this phenomenon is genetic predisposition and developmental abnormalities. Sometimes this type of strabismus is affected by damage to the nerves responsible for eye movement.

In addition to true strabismus, young children may develop so-called squint. This means that the baby has not yet learned to focus on objects. There is no cause for concern, since the imaginary strabismus disappears over time. But it’s better to get examined by a doctor.

Such imaginary strabismus can be found not only in children, but also in people in a condition alcohol intoxication, when it seems that the eyes are squinting.

Treatment of congenital strabismus

At birth it is not immediately noticeable, whereas in an adult the pathology is visible to the naked eye. If parents notice any deviations from normal functioning eye, the baby is shown to the doctor. He identifies pathology and, depending on this, he prescribes effective treatment.

Restoration underway correct position eyes, it should match the direction of the adjacent eye and be placed stably. Treatment should be carried out systematically and intensively if strabismus appeared immediately at birth. The best way to restore vision in this case is to wear corrective glasses. However, write out points for complete treatment not enough, there must be systematic approach to recovery.

Besides constant wearing glasses, therapeutic corrective exercises for the eyes should be carried out. You need to prescribe glasses as early as possible, this will increase the chances of getting rid of the pathology. Usually, by the 8th month of life, corrective glasses are allowed to be worn. This treatment method prevents the development of accommodative strabismus.

If a child is diagnosed with amblyopia, treatment should be started immediately. It consists of restoring the eyeball of the diseased eye by closing the healthy one. An eye that sees well can be in a closed position long months until the diseased organ of vision is in the correct position. You should periodically check your vision, monitor the progress of treatment and the condition of both eyes.

So, to restore vision they carry out various techniques: eye exercises, correction with glasses. Effective for kids play activities to develop correct eye position. Depending on age, some are selected active species exercises. For example, children play with soft parts, make them up, take them apart and sort them. Effective drawing, tracing, cutting out paper, working with plasticine. Children are taught to read very small letters so that their eyes can focus on them.

Pay attention! These correction methods can help to at least partially restore vision. However, if they do not produce results at all, all that remains is surgical method treatment.

Surgical treatment cannot be performed in infancy. You can go under the surgeon’s knife only at the age of three years. After the operation, you must continue to work on restoring your eyes, performing strengthening exercises and games presented above.

You need to be patient, because for complete deliverance Strabismus may take years to resolve. But only long-term complex treatment will help you forget about pathology once and for all. The speed of recovery depends on the age of the child, the type of pathology, and also on how long the child has suffered from strabismus. The child’s visual acuity influences the course of treatment, general condition health, as well as the method of chosen treatment.

Work with the eyes must be carried out in a complex manner. The child should be cared for by a pediatrician, eye doctor, teacher, psychologist. Timely and regular treatment is the key quick recovery. With such a pathology, jokes are bad; treatment cannot be neglected even in infancy, because in further illness will develop into more serious forms, and getting rid of it will be much more difficult.

Use of medications

In addition to eye correction using glasses and performing exercises, they are used in treatment for additional results. medicines. Selecting medications that can restore functionality muscle tissue, reduce eye strain and improve vision.

Surgical intervention

This method of restoring the affected eye is used if conservative treatment does not help, as well as with some types of congenital strabismus: paralytic and non-accommodative. The essence of the treatment is to restore the functioning of the affected “failed” muscles. When the pathology manifests itself very strongly, sometimes not one, but several operations are used with intervals of six months.

Surgical intervention can be of two types:

One of two types of surgery is chosen depending on the type of pathology and the angle of the lesion. Sometimes they carry out mixed operation using both methods of vision restoration simultaneously.

As already mentioned, the optimal and safe age for eye surgery is from three years. However, when congenital strabismus in particularly severe cases surgical treatment carried out at an earlier age.

After surgery, treatment does not stop. The child is prescribed corrective glasses. For full recovery carry out complex therapy, which is usually quite long.

Pay attention! not cheap. You need to be prepared for big expenses. In Moscow, surgical intervention costs from 20 thousand rubles per eye. This is the initial cost; in severe cases of pathology, the price will be higher.

In addition to the cost of the operation, a lot will be spent on long-term rehabilitation period, conducting examinations and consulting doctors.

Self-medication is strictly prohibited. At the first manifestations of strabismus, you need to consult an ophthalmologist promptly. He will diagnose the pathology and choose the type of treatment. This is either restoration of vision using hardware, or referral for surgery. The doctor will give recommendations and tell you when it is best to start treatment so as not to harm the baby and speed up the recovery process as much as possible.

Strabismus can be cured in special eye centers, where there are all the conditions and equipment for this. Don't forget that strabismus is more dangerous in infancy. Despite the fact that such strabismus occurs in in rare cases, its treatment still needs to be approached seriously and responsibly. Most often, the pathology is associated with muscle paralysis, and the only way treatment is surgery. However, with timely and properly structured treatment and rehabilitation, it is quite possible to get rid of the defect forever.

108 02/13/2019 5 min.

Hidden strabismus is not the most common disease; it cannot be seen with the naked eye; only an ophthalmologist can diagnose the disease. The pathology does not manifest itself constantly. The deviation is noticeable only when the patient's gaze is not focused on any object. IN medical practice pathology is designated by the term heterophoria. Next, we will talk about the main signs, methods of diagnosing and eliminating this pathology.

Definition

Heterophoria refers to a vision pathology in which the directions of movement of the eyeballs are mismatched with each other exclusively at rest. There are no conditions for binocular vision in this case. The disease code according to ICD-10 is H50.5.
Hidden strabismus can be visually diagnosed as follows: The patient should look at the object and close one eye. The presence of pathology is indicated by a rapid shift in the direction of gaze of the eyeball after it is opened.

In most cases, heterophoria with slight weakening of the visual muscles is asymptomatic.

Reasons

Heterophoria develops most often for the following reasons:

• anatomical features of the location of the eyeballs;
• differences in the strength of the muscles that control eye direction, this phenomenon increases with myopia, farsightedness (under the influence of constant tension, some muscle groups relax and weaken, others spasm);
• dysfunction endocrine system- observed quite often due to diseases of the thyroid gland;

• frequent lesions infectious diseases, which provide strong impact on the central nervous system, disorders affect the functionality of vision;
• constant stress conditions, mental health disorders. Since all body systems are in constant interconnection, failures lead to dysfunction of the oculomotor muscles;
• muscular paralysis of the eyeball - movements are limited, which leads to weakening of the muscles;
• receiving injuries, tumors, damage inside the eyeball, this threatens degradation of the eye muscles and a decrease in their tone.

Species

The following types of heterotrophy are distinguished according to the direction of deviation:

• hypophoria (gaze directed downwards);
• hyperphoria (up);
• exophoria (outward);
• esophoria (inside).

In some cases, a deviation of the upper part of the vertical meridian of the cornea is observed, and incyclophoria (gaze directed inward) and excyclophoria (outward) are simultaneously diagnosed. Minor deviations in the angle of heterophoria do not affect the performance and quality of visual function.

Types of Heterophoria.

Conventional boundaries at which compensation for violations is required:

• exophoria – up to 6 diopters;
• esophoria – up to 3 diopters;
• hyper-/hypophoria – up to 1 diopter.

The above types of violations have been supplemented increased tone antagonist muscles, against which binocular vision is preserved. If the balance of muscle functioning is disturbed, the angles between the eyes do not exceed 3-4 degrees. Performance visual organs remains, the need for medical intervention absent.

When deviations are within the specified limits, the violations are invisible. This condition accompanied by neuromuscular tension, which leads to accelerated eye fatigue (asthenopia), which is more pronounced in childhood.

Symptoms

Strong deviations (from 7-8 diopters) and a weakened fusion system lead to decompensated heterophoria of the eye, this condition is accompanied by the following symptoms:

• nausea;
• double vision;
• increased fatigue;
• headache.

Pathological symptoms are observed against the background stress conditions, mental fatigue, eye strain. Decompensated heterophoria can provoke severe strabismus.

Diagnostic methods

For precise setting In addition to standard visual acuity testing, specialized tests may be used to make a diagnosis. These include the carpet test and the Maddox cylinder study. More about them below.

Carpet test

The test is considered the simplest. The ophthalmologist asks the patient to carefully examine an object located at a distant distance. Alternately closing one and the second eye makes it possible to determine which of them is performing the installation movement and which is recording the primary state. With heterotrophy, slow movement of one affected eyeball is observed. The adjustment movement occurs in the opposite direction relative to the type of hidden strabismus. Outward movement of the eyeball indicates esophoria and vice versa.

Maddox cylinder

The technique is considered more accurate. As part of the procedure, the patient focuses his gaze on the lamp. The light source should be at a distance of 5 m (for distance) or 33 cm (for close-up assessment). The doctor puts a special frame on the patient, a prism compensator is installed in front of the left eye, and a Meddox cylinder is installed in front of the right eye. Horizontal phoria The cylinder is installed horizontally in the frame, the prismatic compensator is installed vertically. There is a vertical red line in front of the patient's right eye. The patient is with with open eyes, he must say on which side of the light source the red line is located.

The Maddox cylinder study is the most exact method Diagnosis of Heterophoria.

By passing a line directly across the lamp, the doctor diagnoses the absence of hidden strabismus. The location of the line on the side of the cylinder indicates esophoria (inward deviation of the eyeball); if it is located on the opposite side, exophoria (outward deviation) is diagnosed.

The disease most often manifests itself in childhood, timely treatment for medical care will help prevent negative consequences diseases.

Treatment

For the treatment of heterophoria they are used conservative methods treatment: glasses, Synoptophore apparatus and visual gymnastics. Next, let's look at each of them in more detail.

Glasses

Synoptophore apparatus

A synoptophore is an ophthalmological device whose functions are to diagnose and treat the organs of vision. The motor muscles of the eyes are corrected. Exercises with the device ensure restoration and stabilization of binocular vision.

The device consists of two movable tubes equipped with eyepieces and mirrors with lenses on the other side and sockets on the other. Observation objects are installed in the nests - ordinary paired patterns.
The device sockets are equipped with special lamps, the light from which is directed to illuminate the observed objects.

The Sinoptofor device is used for therapeutic and prophylactic purposes.

The mechanism of the device is based on automatic or manual alternating switching on and off of light bulbs, as a result of which certain loads are placed on the visual apparatus. Each eye receives half of the object. The exercise allows you to identify the fact of strabismus and its degree.

Gymnastics for the eyes

Gymnastics ensures clear focusing of the squinting eye on an object, the patient begins to see the image with 2 eyes.

Video

This video will tell you how to identify Heterophoria.

Conclusion

1. Heterophoria is a hidden strabismus in which there is a defocus of the eyes.
2. The causes of the disease are very different; only a doctor can make a diagnosis.
3. The treatment uses glasses, hardware techniques, high efficiency shows gymnastics.

Heterophoria or hidden strabismus often occurs without obvious symptoms. But when diagnosing a disease, it is necessary to undergo full examination and course of treatment. Lack of therapy will lead to obvious strabismus, which is not so easy to treat.

Hidden strabismus or heterophoria can be diagnosed only after certain manipulations. This is due to the fact that the normal visual process proceeds without pathologies: while examining an object, synchrony is observed in the eyeballs. But when you close one eye, the second one will be slanted.

Hidden strabismus can be either congenital or acquired

Orthophoria is characterized by ideal muscular balance in both eyes. In medicine, this implies parallelism of the axes, the location of the centers of the corneas at the level of the middle of the palpebral fissures.

When one eye is deliberately closed, their symmetry remains the same. This state allows you to create favorable conditions for binocular vision, in which the object merges into a single whole. In this case, a person makes little effort during visual work.

With heterophoria, binocular fixation is disrupted, and the visual line closed eye deviates from the norm. The separation of both eyes is manifested by weakness of any muscle. It is detected by covering or applying a glass prism to the eyeball. Most often, with heterophoria, the optical axes of both eyes simultaneously shift.

If we talk in simple words, then one or both eyes cannot focus on a specific object. But the body corrects this error with the help of the fusional vergence system.

Causes of the disease

At typical form diseases of a person with hidden strabismus does not bother anything

Heterophoria is provoked by unequal force of action of the motor muscles of the left and right eyes against the background of some of the following factors:

1. Anatomical location of the eyes. For example, the orbital socket or skull may have a special shape or size.
2. or farsightedness, in which one muscle tenses and another relaxes. Due to the difference in the strength of the eye muscles, the pupils acquire a different axis of location.
3. Problems with thyroid gland often provoke the development of the disease.
4. Infectious diseases can affect the functioning of the central nervous system. Visual apparatus in turn, it functions correctly due to it.
5. The systems and organs of the human body are closely related to each other. For this reason, frequent stressful situations mental disorders may affect the functioning of the extraocular muscles.
6. Ocular paralysis can limit the movement of the eyeball, leading to loss of muscle tone.
7. Injury, damage to the inside of the eye, or a tumor makes it difficult for the muscle to work, causing it to weaken.

Symptoms of heterophoria

Unlike ordinary strabismus, with heterophoria it will not be noticeable to others

If the disease has slight deviation, then a person may not even know about its presence. The reason for this is the work of the fusion system, whose responsibilities include connecting two objects into one due to small reflex movements.

If there is a significant difference (decompressed heterophoria) in the location of the pupils of the eye in the orbits, the patient may complain of:

• headaches;
• fatigue;
• nausea;
• double vision.

Symptoms are most pronounced during stress, weak immunity, mental overstrain. The decompressed type of heterophoria can lead to obvious strabismus.

Diagnostic measures

The state can only be verified using additional methods examinations

When contacting an ophthalmologist, two types of diagnostic measures are carried out:

1. When performing a carpet test, it is necessary to exclude conditions for a clear vision of the object, while observing the movement of the pupils of both eyes.
   To do this, the patient concentrates his attention on examining a specific object. After which one eye is closed for a short time, and then the other. And the doctor records the presence of installation and primary movements in the eyes. If there is hidden strabismus in the problematic eye, movement will be slow.
   The installation movement has its own peculiarity: it has the opposite direction relative to heterophoria. In other words, if the eyeball moves to the outer part of the palpebral fissure, then the ophthalmologist will diagnose esophoria.
2. The disease is more accurately diagnosed using a study using a Maddox cylinder. The essence of the procedure is to fix your gaze on a light bulb, which is placed at a distance of five meters. The frame that the patient must wear consists of a vertical compensator and a horizontal cylinder.
   The right eye of a patient with a cylinder sees a red, vertical line. If it is located directly on the lamp, then the presence of the disease disappears.
   Passing the line with right side speaks of deviation towards inside palpebral fissure, and from the opposite – about exophoria.

To identify vertical phoria, the axis is placed in a similar position. The passage of the beam through the light bulb indicates the absence of disease. If it moves up or down, hypophoria or hyperphoria is diagnosed.

Therapy for hidden strabismus

A slight deviation of latent strabismus from the norm does not require specific therapy. In other cases, it is recommended to undergo examination and treatment.

Conservative treatment

1. To correct the muscles of the eye, glasses or glasses are used. In this case, the patient is recommended to carry out daily special gymnastics aimed at strengthening muscles.
2. If the refractive power is impaired during heterophoria, the problematic eye is covered with a special sticker.

The attending physician corrects large differences in the strength of the eye muscles with the help of glasses, into the frames of which prismatic glasses are inserted.

Surgery

Surgical treatment to correct vision is prescribed only in cases where there is a gap between the eyes. big difference between angular indicators or in case of ineffectiveness of conservative treatment.

During surgical intervention The surgeon shortens the eye muscle to normalize the balance of both eyeballs.

Prevention of heterophoria

You should always keep your eyes alert and try not to overstrain them. Only in this case can the development of heterophoria be prevented. To do this you need:

• periodic exercises to strengthen the eye muscles;
• adjust work and rest time;
• the workplace must be properly lit;
• Consult an ophthalmologist several times a year.

Most often, children suffer from hidden strabismus, but it is also a common disease among adults. Heterophoria can go away on its own, but if any symptoms appear, you should consult a specialist.

In the video below, doctors give useful tips on how to eliminate strabismus:

Normally, the position of both eyes is balanced. This condition is called orthophoria. Healthy eyes work in sync and move in the same way. The position of the pupils, corneas and axes always coincides.

If one eye is deliberately closed, the second will move in sync with the first. The process of merging images obtained by both eyes into a single whole is possible only with orthophoria. Orthophoria occurs several times less frequently than heterophoria. With heterophoria, the eyes begin to work asynchronously. One eye closes and does not observe. The visual lines of the eyes diverge.

Reasons

Heterophoria occurs due to different forces developed by the muscles of the right and left eyes. This may be accompanied by:

• different muscle tone
• inconsistency of accommodation and concentration of the visual axes of both eyes on the fixed object
• different positions of the eyeballs

Signs

Typically, heterophoria is expressed as slight differences in strength between the muscles of the right and left eyes. She has no symptoms. Images from both retinas merge due to reflex movements of the eyeballs and both eyes “fix” on the selected object.

This is a compensated type of heterophoria. When one eye is artificially excluded, binocular vision is disrupted, the muscles weaken and the visual line shifts.

Classification

According to the direction of deviation there are:

• hyperphoria (top)
• hypophoria (down)
• excyclophoria, exophoria (outward)
• incyclophoria, esophoria (inside)

Visual acuity and performance depend on the angles of heterophoria. Manifestations of exophoria are compensated by the body up to 6 prismatic diopters, hyper/hypophoria - up to 1, esophoria - up to 3x.

Within these limits, the disturbances are not noticeable, although with constant visual work the eyes quickly get tired.

If the deviations exceed 8 diopters, the body is not able to combine the image from both eyes into a single whole. Decompensated heterophoria is formed. It is manifested by nausea, double vision, fatigue and poor health.

The disease progresses under stress, severe fatigue, overwork, and insomnia. Decompensated heterophoria can cause obvious strabismus. Pathological signs manifest themselves under conditions of stress, general weakening of the body, mental fatigue, intense visual work. Decompensated heterophoria can lead to obvious strabismus.

Diagnostics

Basic research methods for heterophoria:

• Maddox cylinder
• alternative cover test or cross-cover test
• fusion reserve test

The Maddox cylinder is used to study binocular vision and the condition of the retina in cases of cataracts. This is a red glass lens assembled from several surfaces in the shape of a cylinder. The surfaces are aligned along the same axis, the lens is included in the set of trial lenses.

The test determines the signs of strabismus and the state of muscle balance in both eyes of the patient. The patient puts on a frame with trial lenses. You need to monitor a light point 5 meters away.

A Maddox cylinder is placed in the frame of one eye. The patient can observe the light source with one eye as a point, and with the other as a strip - depending on how the axis of the cylinder is located. The coincidence of the dot and stripe indicates normal binocular vision. The discrepancy indicates strabismus, the degree of which will be determined by the magnitude (degree of angle) using prisms.

The idea of ​​the cross-cover test is to limit binocular vision by observing the movement of the eyeballs. One eye is covered with a device, the lid of which is suddenly moved to the other eye. In persons with heterophoria, when moving the lid in the second eye, it is possible to see movement from the point of deviation.

Fusion reserves are examined with a synoptophore and variable prisms.

Treatment

Heterophoria is treated with therapy or surgery. If the deviations do not exceed 3-4 prisms. diopter, vision can be corrected by changing the daily routine and creating the right conditions for work.

Basic means of vision correction:

• prescription of corrective lenses with decentering;
• eye gymnastics to restore fusion.

If the strength of the motor muscles in both eyes differs, wearing prismatic glasses is indicated. The base of the prisms is opposite to the deviation of the eyes. If the therapy is unsuccessful, the patient undergoes surgery to balance the eye muscles of both eyes.

Forecast

At early treatment The prognosis for heterophoria is favorable.

Prevention

The patient is shown

• sets of exercises for the eyes
• changing eye conditions in the workplace
• periodic observation by an ophthalmologist