Strabismus in children: types, signs, treatment methods. Strabismus in children: how to identify and correct (hardware, surgical and home treatment) Wandering squint in a child

Infants' eyes often squint rather cutely. And there’s nothing wrong with that – at first glance. Moreover, it touches the parents. However, several months pass, the child grows, and his eyes continue to squint, which cannot but alert adults. With suspicions of strabismus, parents most often turn to ophthalmologists. This is the most popular reason for an unscheduled visit to a pediatric ophthalmologist. You will learn about the causes and treatment of strabismus in children by reading this article.

What it is?

The disease, which is popularly called strabismus, in medicine has quite complex names - strabismus or heterotropia. This is a pathology of the visual organs in which the visual axes cannot be directed towards the object in question. Eyes with differently located corneas cannot be focused at the same spatial point.

Quite often, strabismus is found in newborns and children in the first six months of life. However, in most cases, such strabismus is physiological in nature and goes away on its own after a few months. Often the disease is first detected at the age of 2.5-3 years, since at this time the work of children’s visual analyzers is actively developing.

Normally, the visual axes should be parallel. Both eyes should look at the same point. With strabismus, an incorrect picture is formed, and the child’s brain gradually “gets used to” perceiving the image from only one eye, the axis of which is not curved. If you do not provide your child with timely medical care, the second eye will begin to lose visual acuity.

Strabismus is not only an external defect, a cosmetic defect, the disease affects the functioning of all components of the organs of vision and the visual center.

Causes

In newborns (especially premature) children, strabismus is caused by weakness of the eye muscles and optic nerve. Sometimes such a defect is almost invisible, and sometimes it catches your eye right away. As all parts of the visual analyzers actively grow, physiological strabismus disappears. This usually happens around six months or a little later.

This does not mean at all that parents of a six-month-old baby who squints his eyes need to sound the alarm and run to the doctors. It is, of course, worth visiting a doctor, but only to make sure that the child does not have other vision pathologies. If the baby sees well, then strabismus continues to be considered physiological until he reaches one year old.

Strabismus, which persists to one degree or another after a year, is not considered the norm, and is classified as a pathological disorder. There can be many reasons for the occurrence of pathological strabismus:

Genetic predisposition. If close relatives of the child or his parents have strabismus or had it in childhood.
Other diseases of the organs of vision. In this case, strabismus acts as an additional complication.
Neurological diseases. In this case, we can talk about dysfunction in the activity of the brain in general and the subcortex in particular.
Skull injuries, including birth injuries. Typically, such strabismus occurs as a result of acquired problems in the central nervous system.
Congenital factors. These include intrauterine malformations of the visual organs, which could have formed as a result of infectious diseases of the mother or genetic “errors,” as well as as a consequence of fetal hypoxia.
Negative external influence. These reasons include severe stress, fear, psychological trauma, as well as poisoning with toxic substances, chemicals or severe acute infectious diseases (measles, diphtheria and others).

There are no universal reasons that can explain the occurrence of pathology in a particular child. Usually this is a complex, a combination of various factors - both hereditary and individual.

That is why the occurrence of strabismus in each specific child is considered by the doctor on an individual basis. Treatment of this disease is also purely individual.

Symptoms and signs

Signs of strabismus may be visible to the naked eye, or they may be hidden. One eye or both may squint. The eyes may converge toward the nose or be “floating.” In children with a wide bridge of the nose, parents may suspect strabismus, but in reality there may not be a pathology; simply the anatomical features of the structure of the child’s face will create such an illusion. As they grow (during the first year of life), this phenomenon disappears.

Symptoms of strabismus usually look like this:

in bright light the child begins to “squint” more strongly;
the baby is unable to focus his gaze on an object so that the pupils move synchronously and are in the same position in relation to the corners of the eyes;
to look at an object with a squinting eye, the child has to turn his head at an unusual angle;
While crawling and walking, the baby bumps into objects - especially if they are located on the side of the squinting eye.

Children older than one year may have complaints of headaches and frequent fatigue. Vision with strabismus does not allow you to see the picture clearly; it may be blurry or double.

Children with strabismus often have increased sensitivity to light.

Kinds

Strabismus can be congenital or acquired. Doctors talk about congenital pathology when obvious signs of the disease are visible immediately after the baby is born (or appear during the first six months).

Usually the pathology develops horizontally. If you mentally draw a straight line between the pupils across the bridge of the nose, then the mechanism for the occurrence of such a violation of visual function becomes clear. If the child’s eyes seem to be moving towards each other along this straight line, this indicates convergent squint. If they move in different directions in a straight line, then this is divergent strabismus.

Less commonly, pathology develops vertically. In this case, one or both organs of vision may deviate upward or downward. Such a vertical “departure” upward is called hypertropia, and downward - hypotropia.

Monocular

If only one eye deviates from the normal visual axis, then they speak of a monocular disorder. With it, the vision of the squinting eye is reduced in most cases, and sometimes the eye completely ceases to participate in the process of looking and recognizing visual images. The brain “reads” information from only one healthy eye, and “turns it off” as it is not needed.

This pathology is quite difficult to treat, and the functions of the affected eye cannot always be restored. However, it is almost always possible to return the eye itself to its normal position, thereby eliminating the cosmetic defect.

Alternating

Alternating strabismus is a diagnosis that is made if both eyes squint, but not at the same time, but in turn. Either the right or the left organ of vision can change the axis both horizontally and vertically, but the angle and magnitude of deviation from the straight line are always approximately the same. This condition is easier to treat, since both eyes still take part in the process of perceiving images of the surrounding world, albeit alternately, which means that their functions are not lost.

Paralytic

Depending on the reasons that triggered the formation of strabismus, there are two main types of strabismus: paralytic and friendly. With paralysis, as the name implies, paralysis occurs of one or more muscles responsible for eye movement. Immobility can be a consequence of disorders of the brain and nervous activity.

Friendly

Concomitant strabismus is the simplest and most common form of pathology, which is usually characteristic of childhood. The eyeballs retain full or almost full range of motion, there are no signs of paralysis or paresis, both eyes see and are actively involved, the child’s image is not blurry or double. A squinting eye may see slightly worse.

Concomitant strabismus can be accommodative and non-accommodative, as well as partial. Accommodative pathology usually appears in early childhood - before one year or at 2-3 years. It is usually associated with high or significant myopia, farsightedness, and astigmatism. Such a “childhood” eye disorder is usually treated quite simply - by wearing glasses prescribed by a doctor and sessions of hardware therapy.

Partial or non-accommodative visual impairment also appears at an early age. However, myopia and farsightedness will not be the main and only reasons for the development of these types of strabismus. Surgical methods are often chosen for treatment.

Strabismus in children can be constant or intermittent. Non-permanent divergence is found quite often, for example, in infants, and it does not cause much concern among specialists. Permanent divergence almost always causes congenital malformations of the visual analyzers and requires serious treatment.

Hidden

Hidden strabismus is quite difficult to recognize. With it, the child sees normally, with two eyes, which are positioned absolutely correctly and do not deviate anywhere. But as soon as one eye is “turned off” from the perception of visual images (for example, covered with a hand), it immediately begins to “float away” horizontally (to the right or left of the bridge of the nose) or vertically (up and down). To determine such a pathology, special ophthalmological techniques and devices are required.

Imaginary

Imaginary strabismus occurs due to completely normal features of eye development in a particular child. If the optical axis and the visual line do not coincide, and this discrepancy is measured at a fairly large angle, then a slight false strabismus may occur. With it, vision is not impaired, both eyes see, the image is not distorted.

Imaginary strabismus does not require correction or treatment at all. False strabismus includes cases when a child begins to squint a little due to some structural features of not only the eyes, but also the face - for example, due to the size of the orbits, the shape of the eyes or the wide bridge of the nose .

Treatment

Such a vision defect can be corrected in almost all cases; the main thing is that parents contact an ophthalmologist in a timely manner, without delaying the visit to the doctor. If after six months or a year the baby’s strabismus does not go away, treatment should be started.

There is no need to be afraid of therapy; in most cases it is possible to do without surgery. Surgical intervention is prescribed only when all other methods are unsuccessful.

Modern medicine offers many ways to correct strabismus. This includes hardware treatment, physiotherapy, and special gymnastics to strengthen the oculorotator muscles and the optic nerve.

The treatment schedule is prescribed strictly individually, taking into account all the circumstances and reasons that led to the development of strabismus. ABOUT however, each therapeutic plan includes key points and stages that will need to be completed in order for the correction of the visual defect to be most successful:

First stage. Includes treatment of amblyopia. The goal at this stage is to improve vision, increase its acuity, and bring the acuity values to normal. To do this, they usually use the method of wearing glasses with a sealed lens. In order not to frighten the child with such a medical device, you can use special children's adhesives (occlusions). At the same time, several courses of hardware treatment are prescribed.

The strabismus itself does not go away at this stage, but vision usually improves significantly.

Second phase. Includes procedures that are aimed at restoring synchrony and communication between the two eyes. For this purpose, special instruments and devices are used, as well as corrective computer programs.
Third stage. It consists of restoring the normal muscular balance between the organs of vision. At this stage, surgical treatment may be prescribed if the muscle damage is sufficiently severe. However, in children's practice it is often possible to get by with techniques that parents can practice at home - gymnastics, eye exercises and procedures that physical therapy rooms in clinics can offer.
Fourth stage. At the final stage of treatment, doctors will try to do everything possible to fully restore the child’s stereoscopic vision. At this stage, as a rule, the eyes are already symmetrical, occupy the correct position, vision can be improved, and the child is able to see clearly without glasses.

Based on this sequence, the doctor will individually select a program for correction.

After 2-3 years of treatment according to the prescribed regimen, the doctor will be able to conclude whether the baby was cured - or whether surgery is indicated for him.

You can read more about some modern strabismus treatment methods below.

Hardware

Hardware treatment accompanies almost all stages of strabismus treatment, from the first, aimed at improving vision, and ending with the last, the development of stereoscopic vision. To correct the problem, there is a fairly large list of devices that a child can use in a clinic or at home - if parents have the opportunity to buy such equipment:

Amblyocor device. Used to improve vision. It is a monitor and a system of sensors that record nerve impulses during the operation of the visual organs. The child simply watches a movie or cartoon, and the sensors create a complete picture of what is happening inside his visual analyzers. Special video programs allow you to send the “correct” impulses to the brain and restore visual function at the finest (nervous) level.
"Synoptophore" apparatus. This is an ophthalmological device that allows a child to view parts of pictures (both two-dimensional and three-dimensional) and combine them. This is necessary for the development of binocular vision. Exercising on such a device trains the eye muscles well. For each eye, the child receives only parts of the image; attempts to combine them will be an effective correction for strabismus at one of the final stages of treatment.

Amblyopanorama. This is a simulator with which you can begin to treat strabismus even in infants, because no effort is required on the part of the child. It is enough for him to look at the disk with blinding fields, wearing glasses with corrective lenses prescribed by the doctor, and try to examine the objects. From time to time, the so-called retinal flare will occur. The simulator is very useful at the initial stage of strabismus treatment.
Apparatus "Rucheek". This device can be very helpful at the stage of training the extraocular muscles and learning to control accommodation. The child will have to track approaching and receding figures with his eyes, and also make various movements with his eyes, as light points will flash in a variety of directions in the field.

Hardware treatment can be carried out both in a clinic and at home.

Due to the emergence of a large number of private clinics and ophthalmology offices that offer paid hardware treatment, but practically do not examine the child, many negative reviews have appeared about such treatment. Parents claim that the procedures and training did not help the child.

This once again proves that any therapy should be prescribed by the attending physician. If he sees that the degree and nature of the eye damage is such that hardware treatment is not enough, he will definitely choose other methods for the child.

Eye gymnastics and exercises

In some cases, with minor strabismus of non-paralytic origin, special exercises help at the stage of strengthening the oculomotor muscles. This is a treatment that does not require large expenses, but requires mandatory and strict adherence to the principle of systematic training.

Gymnastics with a child is best done in the daytime, in daylight. It is better to perform exercises with glasses. Gymnastics should become daily; it is advisable to repeat a set of exercises with the child 2-4 times a day. The duration of each lesson is from 15 to 20 minutes.

It is impossible to explain the essence of gymnastics to the youngest patients, and therefore it is recommended to simply play with them - moving balls, bright cubes and other objects in front of them, blindfolding one eye or the other.

For older children, it is advisable to use an occlusion or an eye patch only if the strabismus is monocular in nature. Children over 3 years old are encouraged to look for differences in the pictures every day. Today on the Internet there are many such tasks that parents can print on a color printer and offer to their child. To begin with, it is recommended to take simple pictures with a small number of differences, but gradually the complexity of the puzzle should increase.

It is useful for kindergarten-age children with strabismus to decide every day maze puzzles. These are drawings. The child is asked to take a pencil and lead the bunny to the carrot, the dog to the booth, or the pirate to the ship. Such pictures can also be downloaded from the Internet and printed.

Gymnastics for the eyes in the treatment of strabismus is very useful at the stage of formation of stereoscopic vision. To do this, you can use ready-made programs compiled by Professor Shvedov or Doctor of Psychology, non-traditional healer Norbekov. However, in no case should you choose a method yourself. Incorrectly chosen and used exercises can lead to vision loss.

Any gymnastics should be discussed with your doctor.

The ophthalmologist will show and teach you how to do many exercises that are suitable for a particular child.

Surgical method

The help of surgeons has to be resorted to when conservative treatment has not been successful, when there is a need to restore the normal position of the eye, at least cosmetically, and also at the treatment stage, when there is a need to strengthen the muscles responsible for eye movements.

There are not many options for intervention for strabismus: surgically they either strengthen the muscle that is weak and poorly holding the eyeball, or relax it if it stably fixes the eye in the wrong position.

Today, most of these operations are performed using laser machines. This is a bloodless and gentle method that allows you to leave the hospital ward the very next day and go home to a familiar and understandable environment for the child.

For young children, the operation is performed under general anesthesia.

For older boys and girls - under local anesthesia. Surgical intervention is considered most effective at the age of 4-6 years; at this age, correction using surgical techniques provides the best results.

During the rehabilitation period, children are prohibited from swimming (for a month). The ban on other sports also applies for almost the same period of time. After the operation, for several weeks you should not rub your eyes with your hands or wash your face with water, the quality and purity of which are highly questionable.

The following types of strabismus in children are distinguished: strabismus in newborns, imaginary, hidden and true strabismus.

Strabismus in newborns

It occurs due to low visual acuity and the baby’s lack of ability to fix an object with both eyes (binocular vision).

Remember that a newborn's eye begins to function only after birth. The small size of the structures and the physiological characteristics of the formation and analysis of images cause strabismus in infants.

By 2 - 3 months, the baby is able to recognize close people who spend a sufficient amount of time with him. It is likely that the recognition process in this case is due to the first attempt to combine information from all senses, since visual acuity is still low.

By 4 - 5 months, when the child begins to actively and for a long time follow the object of interest to him, strabismus in infants gradually decreases and disappears.

Unlike newborns, in children older than 6 months, the first attempts to fix an object with both eyes begin to appear, and, consequently, the ability to three-dimensional vision. The brain merges the images received from the eyes into one picture, which allows us to talk about binocular vision. It is believed that when strabismus completely disappears in newborns, the eye begins to function fully.

If after 6 months strabismus does not go away, but on the contrary, begins to increase, then you should consult an ophthalmologist.

To correct strabismus in children 4-5 months old, it is recommended to use mobiles, bright large toys, following the movements of which the child himself begins to try to fixate on the object for as long as possible.

Imaginary strabismus

Imaginary strabismus is a variant of the norm. It is associated with asymmetrically located eye sockets, features of the facial skull, the presence of a one-sided fold of skin in the corner of the eyes (epicanthus), as well as individual characteristics of the relationship between the optical and visual axis of the eye. Visual functions are not impaired. In this case, strabismus in children is not treated.

Orthophoria, or the ideal balance of both eyes, ensured by the eye muscles, occurs in only 20% of cases, the remaining 80% are characterized by heterophoria. This occurs due to the individual anatomical structure of the eye muscles, the position of the eyeballs, and the characteristics of innervation.

It should be noted that the visual analyzer creates one common image by merging the pictures received from the two eyes separately. Therefore, the balance of the extraocular muscles is usually not disturbed, and strabismus may not be detected.

Prolonged work near the eye requires high tension in the eye muscles, which leads to deterioration of health and the appearance of migraine-like pain. Typically, the appearance of such conditions occurs in children 6–7 years old who have started school.

Since it is sometimes quite difficult to determine whether a child has strabismus or heterophoria, they must use methods that allow them to study binocular vision. With strabismus such vision is absent, but with heterophoria it is preserved.

If the measures were unsuccessful, and the condition progressively worsens, surgery is performed to correct strabismus in children.

True strabismus in children

True strabismus exists in two forms - concomitant and paralytic.

Concomitant strabismus

The study of genetic predisposition to the disease concomitant heterotropia showed that it is not strabismus itself that is inherited, but the structural features of the eye structures that lead to strabismus.

With this type of strabismus, divergent and converging concomitant strabismus are distinguished. The difference between the two forms lies in the location of the so-called visual axis of one eye in relation to the point of fixation. Thus, divergent strabismus in children manifests itself when the visual axis of the squinting eye shifts from the point of fixation to the temple.

Then a visible divergence of the eyes occurs. Convergent strabismus in children occurs when the visual axis of the converging eye moves away from the point of fixation towards the nose. The visible difference in forms makes it possible to establish the causes of strabismus in children, as well as the characteristics of clinical manifestations, which must be taken into account by the attending physician.

Remember that external and internal environmental factors in conditions of unstable binocular vision can provoke concomitant strabismus in children under one year of age.

Causes

The main reason for the development of such a pathology is considered to be a pronounced difference in visual acuity between the organs of vision, as a result of which the brain begins to move the eye with low vision to the side. A child may also develop strabismus when the images obtained on the retina of the eyes are of different sizes.

In the case of certain refractive errors that were not treated and corrected by prescription of glasses or lenses, heterotropia can also develop. So, with a violation it is represented by divergent, and with farsightedness - convergent strabismus.

All strabismus treatment methods applied to a child are aimed at achieving binocular vision.

It should be understood that you should begin to treat strabismus by identifying the problem that led to it.

The ability to merge images obtained from both eyes, achieving high visual acuity (both with and without correction), the absence of amblyopia, the presence of sufficient mobility of the eyeballs, the symmetrical position of the eyes in the sockets - these are the criteria by which the effectiveness of treatment is judged.

Treatment of strabismus at home is aimed at combating amblyopia by eliminating the eye that sees better from the act of vision, as well as conducting a special program of orthoptic exercises.

The synoptophore apparatus, used for both treatment and examination of patients, allows one to establish the ability to merge images. For diagnostic purposes, you can even determine the width of the fusion reserves. The synoptophore makes it possible to establish both subjective and objective features of the visual analyzer.

Orthoptic exercises are indicated if amblyopia is absent, or the visual acuity of the worse-seeing eye begins to steadily increase through pleoptic exercises. Synoptophore allows you to carry out exercises aimed at improving eye mobility, which is especially important for eliminating problems with visual fixation.

A special muscle trainer can also be used to train children in a playful way. The synoptophore apparatus can be used in children over 4 years of age who have a pronounced lack of binocular vision. Diploptic exercises are used in children aged 2-3 years.

Surgical treatment of strabismus is indicated for children over 3 years of age if conservative therapy is insufficiently effective. Surgeries on the extraocular muscles are aimed at achieving symmetry in the position of the eyes, which should stimulate the establishment of binocular vision.

If after strabismus surgery the deviation of the eye remains, it is recommended to carry out the next stage of surgical treatment after 6 months.

Paralytic strabismus in children

Damage to the oculomotor, trochlear and abducens nerves, which innervate the extraocular muscles.

The onset of symptoms is usually preceded by:

If one muscle is affected, the eye usually turns in the opposite direction. Fixing an object with both eyes is difficult. Paralysis completely blocks the response of the muscle, so there is no eye movement in its direction or it is very limited.

There is double vision and dizziness, which goes away if one eye is closed. A forced position of the head may occur, which can slightly reduce symptoms.

An ophthalmologist, taking into account the peculiarities of fixation of objects, can determine the affected muscle or group and determine which nerve was hit.

Remember that before treating strabismus, you should establish what causes the main process, determine its course and dynamics.

Treatment involves electrical stimulation of the affected muscle and exercises. Double vision is eliminated with prismatic glasses, and occluders are used in those parts of the visual field where double vision is observed.

Correction of strabismus in children by surgery is possible only 6–7 months after the main process has stabilized. In the case of congenital paralytic strabismus, intervention is recommended for children over 3 years of age.

Strabismus in a child is a pathology that parents are able to recognize without the help of a specialist. Visual impairment occurs in every 50 children. Modern medicine offers many treatment methods. The key to success is a timely visit to an ophthalmologist.

Description of the disease

Strabismus (strabismus) is the inability to focus on an object of interest with both eyes at the same time. Normally, the eye muscles should move together, which allows you to focus your gaze in one place. With strabismus, muscle function is impaired, one or both eyes deviate from the central axis, that is, they look in different directions, and the brain fails to combine two visible images into one.

Minor deviations are observed in almost all infants. Newborns and infants up to 2–3 months cannot yet fix their gaze due to weakness of the eye muscles and insufficient control over them, so a slight squint at this age is a variant of the norm. By 3–6 months, the baby begins to coordinate eye movements.

If a six-month-old child’s eyes continue to “float” and look in different directions, you need to show the baby to a specialist.

At the age of two or three years, when the formation of friendly eye functioning occurs, there is a danger of developing true strabismus. The first signs of the disease that parents should pay attention to are a wandering gaze, an unnatural tilt of the baby’s head. Sometimes you can notice an anomaly in photographs of a child taken with a flash.

In older age, the occurrence of pathology can be triggered by previous injuries, infectious diseases, and inflammatory eye diseases. Sometimes strabismus develops again. After surgery to correct the defect in childhood, the muscles that were involved in the pathological process weaken again and the disease returns.

Strabismus negatively affects the psyche and character of the child. In the absence of binocular vision (perception of the surrounding world with two eyes), the baby cannot determine the location of surrounding objects, and this often provokes a delay in physical and mental development.

Children's strabismus - video

Classification of strabismus: divergent, vertical, convergent, paralytic, concomitant, etc.

According to the time of occurrence, congenital and acquired strabismus are divided. Congenital pathology is rare. An acquired disease is considered to be a disease that occurs in a child aged 1–3 years.

According to the stability of the manifestation, constant (75–80%) and periodic strabismus are distinguished. In the periodic form, signs of the disease appear under certain conditions, for example, during the baby’s illness, or during emotional experiences. Sometimes periodic strabismus becomes permanent.

Depending on the involvement of the eyes, the pathology can be monolateral (one-sided) or alternating (the baby squints with both eyes).

According to the type of deviation, strabismus is:

convergent (esotropia) – the eyes squint towards the nose;
diverging (exotropia) - the gaze deviates towards the temples;
vertical (deviation downwards or upwards);
mixed.

Based on their occurrence, strabismus is distinguished between friendly and paralytic. In the first case, the eyes deviate to the same extent from the straight position, the movements of the eyeballs are not limited, binocular vision is impaired, and double vision does not appear. The paralytic form occurs as a result of injuries, infections or vascular diseases, while the mobility of the diseased eye is impaired or completely absent, and double vision occurs.

In addition to the types of anomaly described above, which are true, there is also imaginary (false) strabismus. The pathology occurs in infancy, the reason lies in the inability and inability of the baby to focus his gaze on a specific object. The main difference between the imaginary form of the disease and the true one is the preservation of binocular vision. The child perceives the world around him fully, without distortion.

Types of strabismus - gallery

Divergent strabismus - the gaze deviates to the temples
Vertical strabismus - the eye squints upward or downward Convergent strabismus - eyes squint towards the nose

Causes of the development of the disease in newborns, infants and older children

It is possible to determine the cause of strabismus in a child after a special ophthalmological examination.

The cause of a congenital disease can be:

difficult childbirth;
illnesses suffered during pregnancy;
use of certain medications and drugs by the expectant mother;
genetic abnormalities (Down syndrome);
heredity;
prematurity;
congenital eye abnormalities;
cerebral palsy;
hydrocephalus.

Acquired strabismus develops acutely or gradually. The following factors contribute to this:

farsightedness, myopia. In order to see objects that are far or close, the child has to strain his eyes, as a result of which strabismus occurs over time;
past infectious diseases (measles, scarlet fever, influenza);
injuries;
stress, severe psychological shock;
high eye strain;
diseases of the nervous system that lead to disruption of communication between the brain and eyes.

Symptoms of the disease in children and adolescents

The main sign of pathology is visible strabismus, when the disorder is determined visually.
The child involuntarily tilts his head at a certain angle, looking at something, and squints one eye.
The baby's perception of the depth of space is impaired, he bumps into objects and falls.

Preschoolers and adolescents may complain of blurred images, headaches, a feeling of tension in the eyes, light intolerance, and double vision. These signs occur periodically and intensify during illness or fatigue.

Diagnostic methods: how to determine congenital and acquired strabismus

For the purpose of prevention, it is recommended to visit an ophthalmologist when the baby is three months old. The doctor will examine the patient’s eyelids through an ophthalmoscope, assess the size and position of the eyeballs, palpebral fissure, and determine the condition of the cornea and pupils.
When a child turns one year old, hidden strabismus can already be diagnosed. To identify pathology, a cover test is performed. The baby is covered with one eye and shown an object. With strabismus, one eye will begin to deviate to the side.
After a child reaches three years of age, his visual acuity can be checked using a special table. To determine the state of binocular vision, a color test is used, on the disk of which there are 4 luminous circles (2 green, 1 white and 1 red). The baby is given glasses with lenses of different colors. The baby looks through the red glass with his right eye, and through the green glass with his left. Results:
A child with strabismus is also examined using a synoptophore. A child wearing glasses sits in front of the device. A division is set on the scale of the device, which corresponds to the distance between the baby’s pupils. The cassettes of the device contain special drawings illuminated by the lamps of the device. When the lamps are turned on and off, certain loads occur on the visual apparatus. With the help of such a study, the doctor can establish the objective and subjective angle of strabismus, the possibility of binocular fusion.

To determine the causes of the disease, you may need to consult other specialists, in particular a neurologist.

Treatment methods in hospital and at home

Depending on the causes of the disease and the severity of its course, the doctor will prescribe appropriate treatment. It is carried out both in a hospital setting (if strabismus is accompanied by other eye pathologies) and at home.

Conservative therapy

It is necessary to begin treatment of the pathology as early as possible, because the eye that deviates to the side begins to see worse and worse over time. With a mild form of strabismus, you can try to eliminate the problem using conservative therapy.

Occlusion

To correct the trajectory of the gaze of the affected eye, in some cases it is enough to increase the load on it. For this purpose, the healthy eye is temporarily closed with a special shutter (occluder) so that the baby begins to actively use the squinting eye. With bilateral strabismus, both eyes are glued alternately.

For the same purpose, special eye drops can be prescribed. Such drugs, when instilled, worsen vision in the healthy eye, and the affected one begins to work harder. But in most cases, such treatment is not enough, so it needs to be combined with other methods.

Special glasses

If the cause of the disease is farsightedness, nearsightedness or astigmatism, it is necessary to wear special glasses. If they are selected correctly, the problem can be completely solved.

Medications

In complex therapy for strabismus, specialists often use blueberry-based medications with vitamins and minerals. In addition, we need nootropic drugs that nourish and activate brain cells. A neurologist should prescribe such medications.

Hardware treatment

There are several methods of hardware treatment, which are selected on an individual basis. Therapy is carried out in courses of 5–10 procedures.

To consolidate the positive effect, it is worth repeating the course of treatment after a few months.

This therapy is suitable even for the youngest patients.

Amblyocor. Used to correct lazy eye syndrome and promotes the development of binocular vision. Recommended for children aged four years and older. During the session, the baby watches a video on the screen, while at the same time special sensors record information about the functioning of the eyes and the encephalogram of the brain. The video is played only with “correct” vision, and disappears when its acuity decreases. At the same time, the brain subconsciously strives to reduce periods of blurry vision. This method optimizes the activity of neurons in the visual cortex, resulting in improved vision.
Synoptophore. The device helps restore binocular vision and trains the child’s eye mobility. During the session, a separate image is presented for each baby's eye. The child must visually combine these objects. For example, one eye sees a car that needs to be moved into a garage that is visible to the other eye. This muscle training helps reduce the angle of strabismus, develops resistance to visual stress, and restores binocular vision.
Amblyopanorama. The child is in front of the device screen with the occluder closed with the healthy eye. The patient’s task is to fixate with the eye that sees worse one figure located on the screen, and with subsequent stimulation - any other figure. Then the retina is illuminated by pressing the synchro contact button.

Eye exercises

Strabismus at an early stage can be treated with special exercises that help strengthen the eye muscles:

Slowly move the index finger of the raised hand towards the nose. In this case, you need to carefully observe the movement of the finger with your eyes.
Write figure eights with your eyes, draw circles, move your gaze from side to side, up and down.
Look out the window for a while, then focus your gaze on nearby objects.
A good workout for the eye muscles is playing games with a ball. While playing, the baby has to watch with his eyes an object approaching and moving away.
You can draw a sheet of paper into cells, draw an animal or object in each cell. Images should be repeated periodically. The baby's task is to find and cross out identical pictures. You can use special pictures that show the same thing, but one of the pictures is missing some details. The child must find them. Activities with cards like “Find 10 differences” are also useful.
The little ones will benefit from activities with a rattle. With one eye blindfolded, the toy is moved in front of the child's face, while the baby, without turning his head, must keep his gaze on the object. After a minute, close the other eye. To maintain the interest of the baby, the toy needs to be changed from time to time. When finishing the exercise, the bandage should be removed, bringing the toy closer to the child’s face. Both eyes should meet on the bridge of the nose.
Make ten holes in the plastic plate. The child is given a lace and asked to thread it through the holes.
To improve visual acuity in the affected eye, it is recommended to perform the light bulb exercise. For this lesson you will need a lamp with a frosted bulb. A plasticine ball is attached five centimeters from the lamp. They turn on the lamp, close the baby’s healthy eye and ask him to look at the ball for 30 seconds. The child should see a dark circle with a light center. After the lamp is turned off, the baby looks at the lotto pictures until the image disappears.

With regular training, a positive effect is observed already after 2-3 months of training, but they must be continued until complete recovery.

Eye gymnastics - video

Surgical treatment: features, indications for surgery, rehabilitation after surgery

If conservative treatment does not produce results, the doctor may suggest surgery. The operation is indicated for children who have reached the age of three.

If the baby's vision is too weak, surgical intervention is not performed until the age of 12, since the poorly seeing eye may begin to squint again.

The essence of the surgical intervention is to influence the eye muscles, cutting and altering which the doctor achieves a symmetrical arrangement of the eyes. The procedure takes 1 day. For young children, the procedure is performed using mild anesthesia; for older children, local anesthesia is recommended.

Surgical intervention can be weakening or strengthening. In the first case, the purpose of the operation is to weaken the action of a strong muscle towards which the eye deviates. To do this, it is transplanted further from the cornea. During augmentation surgery, a weak muscle is shortened by removing part of it. After surgical treatment, it is necessary to restore deep vision and binocular functions of the eyes.

Contraindications to surgery are infectious diseases of the respiratory system, dental diseases, severe somatic pathologies, and viral eye infections.

In the postoperative period, you must adhere to some recommendations:

Instill drops with anti-inflammatory properties into the eyes. Carry out the procedure three times a day for two weeks;
do not visit the pool, do not swim in open water for a month after the intervention;
prevent eye contamination;
refrain from heavy physical activity for two to three weeks;
You can visit child care facilities after 14 days.

Treatment prognosis and possible complications

To achieve a positive effect, treatment of the pathology must begin as early as possible, otherwise irreversible vision loss may occur. The most favorable prognosis is observed with the concomitant form of strabismus; late-diagnosed paralytic strabismus is the most difficult to correct.

In the absence of treatment, in addition to a cosmetic defect, more serious complications may develop, in particular amblyopia - a sharp decrease in vision in a squinting eye, without signs of organic lesions of the fundus. Such a process may be irreversible. In addition, there is a possibility of complete dysfunction of the diseased eye.

Doctor Komarovsky about strabismus - video

Lifestyle during illness

Excessive eye strain is contraindicated for a child with strabismus. Children under five years old should not be allowed to watch TV for more than half an hour a day; children under eight years old can increase their viewing time to 40 minutes. Don't rush to introduce your child to the computer too early.
Eye strain usually increases as school starts. It is important to monitor the child’s correct posture and not allow him to bend low over notebooks or books. When reading, it is better to place the book on a stand. When doing homework, you need to take breaks every half hour.
It is useful for your child to play table tennis and badminton, which also trains the eye muscles. You should not engage in strength sports or wrestling, as a head injury received during training can aggravate the situation.

Prevention

Simple rules will help protect your baby’s eyes from squint:

You cannot hang toys over the crib that attract too much attention from the child, as his gaze will be focused on one point;
rattles in the stroller are hung at arm's length for the baby;
in a supine position, both eyes of the child must experience the same load, otherwise the brain will lose the ability to receive signals from both eyes;
acquaintance with television should take place no earlier than 3 years, with a computer - no earlier than 8. The time for watching TV shows should be limited;
It is necessary to monitor the correct posture of the baby, especially at the desk.
protect your baby from stress and emotional turmoil;
Get regular checkups with an ophthalmologist.

When treating strabismus in a child, parents must show great endurance and patience, as this process can last several months and even years. The main thing is not to stop halfway and follow all the recommendations of the ophthalmologist.

Strabismus in children - causes and treatment

Strabismus in children is one of the few pathologies that can be recognized without the help of a specialist. Strabismus (heterotropism, strabismus) is characterized by asymmetry of both or one eye relative to the central axis and the inability to focus on a specific object.

The disease is most common in children 2–3 years old, since at this age the friendly functioning of the eyes is formed. Strabismus often occurs in newborns, but it is temporary and goes away.

Strabismus is not only a cosmetic defect, but also a dangerous pathology. A squinting eye sees worse and develops poorly. If strabismus is not corrected before age 7, the strain on the healthy eye will increase and vision will deteriorate.

In newborns and infants in the first months of life, strabismus is a physiological feature and is transient in nature. It is explained by weakness of the optic nerve and the baby’s lack of control over his vision. Such squint should not worry parents. Strabismus in newborns usually goes away by 6 months.

In addition, in the absence of other ophthalmological pathology, strabismus in children under one year of age is considered normal. But in a 2-year-old child, strabismus does not fit into the norm and requires correction.

Pathological strabismus in infants can be caused by too close placement of toys above the crib.

In a one-year-old child and in older children, strabismus is provoked by many reasons:

genetic predisposition;
the presence of other ophthalmological diseases (farsightedness, myopia, cataracts, stye on the eye, conjunctivitis in a child);
general diseases (juvenile rheumatoid arthritis);
severe infectious diseases (diphtheria, scarlet fever);
neurological diseases;
poisoning of various etiologies;
traumatic brain injuries and eye injuries;
birth injuries, fetal hypoxia;
excessive visual stress;
psychological trauma (fear).

Types of childhood strabismus

Depending on the time of appearance, strabismus can be:

congenital – occurs before the age of 6 months;
acquired - appears before 3 years.

Depending on the involvement of the eyes, it happens:

intermittent strabismus, when both eyes squint alternately;
unilateral strabismus, when one eye is asymmetrical.

Depending on the severity, the following types of disease are distinguished:

heterotrophy (hidden strabismus);
compensated strabismus (detected only during examination);
subcompensated strabismus (occurs when control is weakened);
decompensated strabismus (the disease cannot be controlled).

Depending on the direction of deviation of the eye, heterotropism occurs

Vertical:

with an upward shift;
with a downward shift.

Horizontal:

converging (the eye is deviated towards the bridge of the nose);
divergent (the eye is deviated towards the temple).

Mixed.

Because of its occurrence, strabismus is divided into:

paralytic (unfriendly), resulting from damage to motor muscles or ophthalmological diseases;
friendly, transmitted primarily by inheritance.

Depending on the mechanism of development, the disease is:

accommodative;
non-accommodative;
partial accommodation.

How to determine the disease

A sign of any type of heterotropism is the asymmetrical position of the pupil and iris relative to the palpebral fissure.

Signs of paralytic strabismus:

absence or decrease in mobility of the squinting eye;
dizziness that goes away after closing one eye;
double vision (typical of strabismus in a teenager);
problem with estimating the location of an object;
when trying to focus the squinting eye on an object, the healthy eye deviates;
tilting the head when looking at an object;
if the optic nerve is affected, dilation of the pupil, paralysis of accommodation and drooping of the eyelid occurs.

Signs of concomitant heterotropia:

alternate deviation of the eyes to the side;
decreased visual acuity.

Strabismus towards the temple may be accompanied by myopia, and towards the nose – farsightedness.

Read also: Is it possible to correct farsightedness in children without surgery?

In young children, the reason for contacting a doctor should be squinting, as well as turning or tilting the head when trying to look at an object.

Why correct squint?

the squinting eye does not develop and sees poorly;
the eye may get used to the incorrect location of the image on the retina and it will be more difficult to eliminate the defect;
if the position of the eyes is not corrected in time, amblyopia may develop - lazy eye syndrome;
blurred vision.

Diagnostic methods

An ophthalmologist performs a detailed examination of the child. Diagnostics include:

Inspection. At this stage, the doctor will clarify the time of occurrence of the pathology, injury and illness of the child, pay attention to the position of the head, and evaluate the symmetry of the palpebral fissures and face.
Testing visual acuity with trial lenses.
Checking refraction using computer refractometry and skiascopy.
Examination of the anterior parts of the eye, transparent medium and fundus of the eye using biomicroscopy and ophthalmoscopy.
Test with covering the eye.
Measurement of the angle of heterotropism, volume of accommodation.

If paralytic strabismus is suspected, a consultation with a neurologist followed by neurological examinations (EEG, electroneurography, evoked potentials, electromyography) is indicated.

Is strabismus curable?

Many parents are concerned not only about how to cure strabismus, but also when to do it. Heterotropism needs to be corrected as early as possible. The attending physician can tell you how to correct strabismus in a particular case based on the examination and examination results.

Possible treatment options include:

diploptics (special exercises);
optical vision correction;
pleoptics;
hardware procedures;
surgical intervention.

Exercises for strabismus for kids

You can perform the exercises at home. Gymnastics for the eyes should be done with glasses, otherwise there will be no positive effect. The child should feel well and not be capricious. The total duration of classes is 2 hours a day (several approaches of 20 minutes each). During classes you can use lotto, cubes, colorful balls and other objects.

To improve visual acuity: turn on the table lamp and attach a bright small ball (up to 1 cm in diameter) at a distance of 5 cm from it. Close the child's healthy eye and sit him at a distance of 40 cm from the lamp. The baby needs to keep his gaze on the ball for 30 seconds. Afterwards, the baby is shown bright pictures until a consistent image is formed. During one approach, the lamp is turned on three times. Course of treatment – 1 month.
To increase muscle mobility and develop binocular vision: hang a bright ball on a small stick and move it from side to side in front of the child’s eyes, alternately closing the eyes. Bring the wand closer to your face and watch the reaction - your eyes should evenly move towards the bridge of your nose.
Divide a sheet of paper into cells and draw different figures in each. Several drawings should be repeated. The child’s task is to find and cross out a repeating figure.

How to cure a disease using optical correction?

This method involves the use of glasses and lenses to correct myopia and astigmatism. farsightedness. Used in children from 8 to 12 months. Under the influence of such treatment, strabismus disappears. The method also prevents the development of lazy eye syndrome, in which a squinting eye goes blind in the absence of visual stress.

What is pleoptics?

Pleoptics is a method of treating amblyopia (lazy eye syndrome). The technique involves turning off the seeing eye from the visual act. To do this, close one lens of the glasses or apply a bandage to the healthy eye. At the same time, the squinting eye is activated, and the entire load falls on it.

For bilateral strabismus, both eyes are glued alternately. The eye that sees worse is closed for one day, and the eye that sees better is closed for two or more. The duration of wearing the bandages depends on visual acuity.

Many are accustomed to thinking that strabismus is not a disease, but just a cosmetic defect, and, judging that a slightly squinting eye does not spoil the face of a girl, and even more so a boy, they either do not pay attention to it at all, or postpone treatment until the child will grow up. Ophthalmologists are very upset and worried about such judgments!

Strabismus 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, the strabismus is called convergent (more common), and if it is brought to 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 is not just a problem of appearance. The effect of strabismus is a consequence of disturbances in the perception and conduction of visual information throughout the child’s visual system.

You've probably noticed that strabismus varies from child to child. One has a converging pupil: the pupil faces the bridge of the nose. The other has divergent: the pupil is turned towards the temple. One has only the right eye squinting, the other alternates between the right and the left. Some people have permanent strabismus, while others have it appearing and then disappearing. There are many options, and this alone should give you the idea: no, it’s probably not that simple!

Let's go into the doctor's office together, listen and see what he will say and do.

The dialogue between the ophthalmologist and the parents is something like this:

When did strabismus occur?

Since birth. From four months. After a year. In ten years...

What do you attribute its occurrence to?

After he fell and hurt himself. I started mowing after measles. After a strong fright. I don't know what to connect with...

As you can see, everything is different again! The doctor further asks whether the squint is permanent and which eye squints more often. You can already imagine the possible answers - they are also not the same. And then the research begins.

The doctor determines visual acuity with great accuracy using special tables. In another patient, for example, the vision of the eye that rarely squints turned out to be good (1.0), while the vision of the eye that squints constantly turned out to be sharply reduced (0.1).

The mother is upset: she did not expect this. The doctor is surprised by something else: has she really never noticed that the child sees poorly? However, many mothers are not particularly observant. In approximately 70 percent of cases, the vision of a squinting eye is reduced, but most parents pay attention only to the external defect.

The doctor continues the examination. He is interested in the mobility of the eye.

“Come on, look at the mirror!” he says to the child and begins to slowly move his ophthalmoscope to the right, left, up, down.

The study is simple, but very important! Restriction or complete absence of mobility is a sign of so-called paralytic strabismus. It may be caused by damage to the eye muscles and nerves, or even some kind of brain damage. Then you will urgently need to consult many other specialists and, above all, a neurologist.

But the child’s eye is mobile, there is nothing to worry about in this regard. Why does the doctor peer so intently at his little patient? His attention is drawn to the difference in the color of the pupils: one is somewhat grayish, while the other is clearly black. Now when he tells his mother about it, she notices the difference too. I didn't pay attention before...

Special studies confirm that the child, unfortunately, has a clouding of the lens - cataract - since one eye is affected, it is necessary to check the other one, although it is externally normal. Yes, there is a cataract here too, but one that can only be “revealed” to a doctor.

And here is the final diagnosis: congenital bilateral cataract, complicated by concomitant strabismus. As you can see, what might seem like just a cosmetic defect is actually a complication of a very serious disease. Of course, treatment should begin not with attempts to eliminate strabismus or increase visual acuity with glasses, but with the removal of cataracts.

Causes of strabismus in children under one year of age

Heredity: if any close relative has a similar disease.
The presence of a defect, that is, defocusing of vision: myopia (the child sees objects in the distance unclearly), farsightedness (the child sees objects close up unclearly), astigmatism (the child sees a distorted image).
Intoxication of a child in the womb.
Previous severe infectious disease (diphtheria, scarlet fever, etc.).
Neurological disease.
Against the background of the prerequisites for the occurrence of strabismus, a very high temperature or physical trauma can give an impetus.

With strabismus, there is a constant drop in visual acuity in the squinting eye, called amblyopia. This occurs because the visual system blocks the transmission of the image of the object to the brain, which is perceived by the squinting eye. Due to this, strabismus only intensifies, and vision will deteriorate over time.

Cataracts are rare as a cause of strabismus in children. A much more typical cause of strabismus is farsightedness or myopia.

When a farsighted child looks at nearby objects, his accommodative muscle inevitably tenses, which is responsible for changing the refractive power of the lens. But accommodation is always combined with convergence or another function of the eye muscles, expressed in the reduction of the visual axes and the rotation of the eyeballs towards each other. Due to such constant overstrain, strabismus eventually develops, predominantly convergent.

Myopic people, on the contrary, have little incentive to tense the eye muscles and bring the visual axes of the eye together. As a result, this important adaptive function gradually weakens, and the ocular axes seem to diverge. A squint appears, but this time it is divergent.

In both far-sighted and near-sighted people, the squinting eye is turned off from visual work and, due to inaction, the acuity of its vision begins to inevitably fall: this closes a vicious circle - the cause of strabismus becomes its consequence.

But what about infectious disease, fear, falling and other unfavorable factors that many parents associate with the occurrence of strabismus? This is just the “last straw”, the impetus that set in motion something that was long overdue.

This is what happened, apparently, to a four-year-old boy, whose mother told the doctor that her son began to noticeably squint a year ago, as it seems to her, after the flu. However, in a further conversation, she remembered that even before that the child had one eye squinting, but not always, but only during those hours when he was playing with toys, bending low towards them. Gradually, the squint became permanent, and now the other eye also squints occasionally.

As always, the doctor first determines visual acuity: 0.8 (an eye that began to squint later) and 0.6 (an eye that has been squinting for a long time). But all other studies give favorable results: the eye is mobile, its anterior section, deep media and bottom are absolutely normal.

It remains to check whether the child has myopia or farsightedness. And now the root of the evil has been found: the farsightedness of the “worst” eye is three times, and the “best” eye is twice as high as the age norm. Now the ophthalmologist, choosing one glass or another, finds out to what extent vision can be corrected with glasses.

If it weren't for the missed year, the results probably could have been better. In the meantime, they are not very comforting: vision improves quite a bit, the angle of strabismus remains the same. What will be the treatment plan?

Glasses, says the doctor, are necessary. But just wearing glasses, of course, will not help. It is necessary to ensure that the “worst” eye begins to see in the same way as the “best”. And for this he must work and train. He will be encouraged to be active by turning off his better eye, on which he will have to apply a sticker.

The doctor advises that the child engage more with small toys and objects:

Buy him a mosaic and teach him how to make patterns, pour different cereals into one plate and offer to sort them - in general, be creative and patient!

How long will it take to go to the clinic?

Yes, for a long time and often. At first, you need to check your visual acuity in both eyes every week. Let's hope that in 2-3 weeks vision will begin to improve, and after 4-6 months and, in any case, no later than a year, it will reach normal. At the same time, one-sided strabismus. Probably, it will firmly turn into intermittent - it will begin to alternately squint first one eye and then the other.

This is bad?

No, good, even necessary! After all, by working alternately, both eyes bear the same load, neither is idle, and, therefore, the main cause of decreased vision is eliminated.

Even before the onset of intermittent strabismus, the child will be prescribed exercises using special devices. Now this is the treatment of strabismus itself! In most cases it works. And if within a year or a year and a half it is not possible to achieve results, then surgical intervention is also an option.

While the doctor tells the mother about the essence of the operation and warns that after it again training on the same devices is necessary, we will probably leave his office...

You may be somewhat disappointed at the prospect of such a long treatment. But the game, as they say, is worth the candle: after all, we are talking not only about beauty (although it is worth fighting for!), but mainly about vision!

Most often, primary strabismus occurs at 3-4 years of age. And it is very important to begin treatment immediately so that the defect is eliminated by the time the child enters school.

The current level of our knowledge allows us to set a broader task: amblyopia (decreased vision) and strabismus can and should be prevented!

Every child aged 1-2 years (no later!) should be examined in an ophthalmology office to check whether he or she has visual impairment. Timely prescribed and correctly used glasses (for reading, for games, for distance viewing) will help to avoid amblyopia and strabismus.

Let us refer to the experience of the Moscow ophthalmological service. Since 1971, mass examinations of children aged 1-2 years have been carried out here. As a result, it was possible to reduce the incidence of strabismus and amblyopia from 2.5 to 1.5 percent.

And if such prevention is carried out everywhere, can you imagine what excellent results it will give? And in order to achieve them, at first it takes very little: take your son or daughter by the hand and go to the clinic, to the ophthalmologist.

Treatment for strabismus in children

In case of congenital strabismus, it is important to complete the surgical stage no later than 3 years, in case of acquired strabismus, depending on the timing of achieving good visual acuity at the conservative stage of treatment and restoring the potential ability to merge images from both eyes into a single visual image. Surgical treatment tactics are developed depending on the type of strabismus. From a surgical point of view, treating a permanent form of strabismus with a large squint angle, when the eye is significantly deviated, is not very difficult.

The effect of such operations is obvious to the patient. But for surgeons with certain qualifications it will not be difficult. It is difficult to operate on strabismus with unstable 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. The technique of operations for strabismus is 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), as a rule, one or two operations are 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.

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