How to treat vertical strabismus. Causes and treatment of vertical strabismus

Constant or periodic deviation of the visual axis of the eye from the point of fixation, which leads to impaired binocular vision. Strabismus is manifested by an external defect - deviation of the eye/eyes towards the nose or temple, up or down. In addition, a patient with strabismus may experience double vision, dizziness and headaches, decreased vision, and amblyopia. Diagnosis of strabismus includes an ophthalmological examination (visual acuity test, biomicroscopy, perimetry, ophthalmoscopy, skiascopy, refractometry, biometric studies of the eye, etc.), and a neurological examination. Treatment of strabismus is carried out using spectacle or contact correction, hardware procedures, pleoptic, orthoptic and diploptic techniques, and surgical correction.

General information

The development of acquired strabismus can occur acutely or gradually. The causes of secondary concomitant strabismus in children are ametropia (astigmatism, farsightedness, myopia); Moreover, with myopia, divergent strabismus often develops, and with hypermetropia, convergent strabismus develops. Stress, high visual stress, childhood infections (measles, scarlet fever, diphtheria, influenza) and general diseases (juvenile rheumatoid arthritis) that occur with high fever can provoke the development of strabismus.

At an older age, including in adults, acquired strabismus can develop against the background of cataracts, leukoma (cataract), optic nerve atrophy, retinal detachment, macular degeneration, leading to a sharp decrease in vision in one or both eyes. Risk factors for paralytic strabismus include tumors (retinoblastoma), traumatic brain injury, paralysis of the cranial nerves (oculomotor, trochlear, abducens), neuroinfections (meningitis, encephalitis), strokes, fractures of the wall and floor of the orbit, multiple sclerosis, myasthenia gravis.

Symptoms of strabismus

An objective symptom of any type of strabismus is the asymmetrical position of the iris and pupil in relation to the palpebral fissure.

With paralytic strabismus, the mobility of the deviated eye towards the paralyzed muscle is limited or absent. There is diplopia and dizziness, which disappear when one eye is closed, and the inability to correctly assess the location of an object. With paralytic strabismus, the angle of primary deviation (squinting eye) is less than the angle of secondary deviation (healthy eye), i.e., when trying to fix a point with a squinting eye, the healthy eye deviates by a much larger angle.

A patient with paralytic strabismus is forced to turn or tilt his head to the side in order to compensate for visual impairment. This adaptation mechanism contributes to the passive transfer of the image of an object to the central fovea of the retina, thereby eliminating double vision and providing less than perfect binocular vision. Forced tilting and turning of the head in paralytic strabismus should be distinguished from that in torticollis and otitis media.

In case of damage to the oculomotor nerve, there is ptosis of the eyelid, dilation of the pupil, deviation of the eye outward and downward, partial ophthalmoplegia and paralysis of accommodation occur.

Unlike paralytic strabismus, with concomitant heterotropia, diplopia is usually absent. The range of movement of the squinting and fixating eyes is approximately the same and unlimited, the angles of primary and secondary deviation are equal, the functions of the oculomotor muscles are not impaired. When fixing the gaze on an object, one or alternately both eyes deviate in any direction (towards the temple, nose, up, down).

Concomitant strabismus can be horizontal (convergent or divergent), vertical (supervergent or infravergent), torsional (cyclotropia), combined; monolateral or alternating.

Monolateral strabismus leads to the fact that the visual function of the deviated eye is constantly suppressed by the central part of the visual analyzer, which is accompanied by a decrease in visual acuity of this eye and the development of dysbinocular amblyopia of varying degrees. With alternating strabismus, amblyopia, as a rule, does not develop or is only slightly expressed.

Diagnosis of strabismus

In case of strabismus, a comprehensive ophthalmological examination is necessary, including tests, biometric studies, examination of eye structures, and refraction studies.

When collecting anamnesis, the timing of the onset of strabismus and its connection with previous injuries and diseases are clarified. During the external examination, attention is paid to the forced position of the head (with paralytic strabismus), the symmetry of the face and palpebral fissures, and the position of the eyeballs (enophthalmos, exophthalmos) are assessed.

To study binocular vision, a test is performed with covering the eye: the squinting eye is deviated to the side; Using the synoptophore apparatus, fusion ability (the ability to merge images) is assessed. The angle of strabismus (the amount of deviation of the squinting eye), the study of convergence, and the determination of the volume of accommodation are measured.

If paralytic strabismus is detected, consultation with a neurologist and additional neurological examination (electromyography, electroneurography, evoked potentials, EEG, etc.) are indicated.

Treatment of strabismus

With concomitant strabismus, the main goal of treatment is to restore binocular vision, in which asymmetry in eye position is eliminated and visual functions are normalized. Activities may include optical correction, pleoptic-orthoptic treatment, surgical correction of strabismus, pre- and postoperative orthoptodiploptic treatment.

During optical correction of strabismus, the goal is to restore visual acuity, as well as normalize the ratio of accommodation and convergence. For this purpose, glasses or contact lenses are collected. With accommodative strabismus, this is enough to eliminate heterotropia and restore binocular vision. Meanwhile, spectacle or contact correction of ametropia is necessary for any form of strabismus.

Pleoptic treatment is indicated for amblyopia to increase visual load on the squinting eye. For this purpose, occlusion (exclusion from the vision process) of the fixating eye can be prescribed, penalization can be used, and hardware stimulation of the amblyopic eye can be prescribed (Amblyocor, Amblyopanorama, software-computer treatment, accommodation training, electrooculostimulation, laser stimulation, magnetostimulation, photostimulation, vacuum ophthalmic massage). The orthoptic stage of strabismus treatment is aimed at restoring coordinated binocular activity of both eyes. For this purpose, synoptic devices (Synoptophore) and computer programs are used.

At the final stage of strabismus treatment, diploptic treatment is carried out, aimed at developing binocular vision in natural conditions (training with Bagolini lenses, prisms); Gymnastics are prescribed to improve eye mobility, training on a convergence trainer.

Surgical treatment of strabismus can be undertaken if the effect of conservative therapy is absent within 1-1.5 years. Surgical correction of strabismus is optimally performed at the age of 3-5 years. In ophthalmology, surgical reduction or elimination of the strabismus angle is often performed in stages. To correct strabismus, two types of operations are used: weakening and strengthening the function of the extraocular muscles. Weakening of muscle regulation is achieved through muscle transfer (recession) or tendon transection; Strengthening the action of the muscle is achieved by resection (shortening).

Before and after surgery to correct strabismus, orthoptic and diploptic treatment is indicated to eliminate residual deviation. The success rate of surgical correction of strabismus is 80-90%. Complications of surgical intervention may include overcorrection and undercorrection of strabismus; in rare cases - infections, bleeding, loss of vision.

The criteria for curing strabismus are symmetry of eye position, stability of binocular vision, and high visual acuity.

Forecast and prevention of strabismus

Treatment of strabismus must begin as early as possible so that by the start of school the child is sufficiently rehabilitated in terms of visual functions. In almost all cases, strabismus requires persistent, consistent and long-term complex treatment. Late and inadequate correction of strabismus can lead to irreversible vision loss.

The most successfully correctable type is concomitant accommodative strabismus; with late-diagnosed paralytic strabismus, the prognosis for restoration of full visual function is unfavorable.

Prevention of strabismus requires regular examinations of children by an ophthalmologist, timely optical correction of ametropia, compliance with visual hygiene requirements, and dosage of visual stress. Early detection and treatment of any eye diseases, infections, and prevention of skull injuries are necessary. During pregnancy, adverse effects on the fetus should be avoided.

Strabismus is a deviation of the eye muscle that is unable to function properly and keep the eye level. Depending on the causes and symptoms, strabismus is divided into several forms.

Vertical strabismus is always more pronounced than other types of this disease, but no difficulties arise in treatment, treatment procedures have the same effectiveness, and the recovery process takes the same time.

This strabismus, like others, causes a number of complications if left untreated. However, with an incorrectly selected treatment method, the risk of relapse or blindness increases. Thus, any work on the eyes must be carried out by classified specialists.

Vertical strabismus in children

Vertical strabismus Source: medceh.ru

Vertical strabismus can be caused by: insufficiency or hyperfunction of the superior oblique muscle.
Superior oblique muscle deficiency syndrome is characterized by upward deviation of the eye, a forced tilt of the head to the shoulder opposite the side of the lesion, and impaired motor and sensory visual functions.

In some cases, complex forms of diplopia (cyclodiplopia) are observed. A positive Bielschowsky sign is revealed: when the head is tilted to the shoulder in the direction of the lesion (paretic muscle), an increase in vertical deviation is noted.

Paresis of the superior oblique muscle is one of the main causes of combined vertical-horizontal lesions of the oculomotor system. Hyperfunction syndrome of the inferior oblique muscle is the main cause of upward deviation of the eye in concomitant convergent strabismus.

Conventionally, primary and secondary hyperfunction of the inferior oblique muscle are distinguished. Among the causes of primary hyperfunction are a congenital anomaly of the ligamentous apparatus of the muscle, an oblique attachment to the sclera of the internal rectus muscle, which promotes elevation of the eye when it is adducted, and an abnormal function of the vestibular apparatus.

Secondary hyperfunction of the NCM develops as a result of paresis of the superior oblique muscle and is characterized by a more significant upward deviation of the eye. Bilateral hyperfunction of the inferior oblique muscle is somewhat more common than unilateral hyperfunction.

Bilateral hyperfunction is more characterized by hypertropia only in the state of adduction of the eye and less preservation of fusion ability than with unilateral hyperfunction of the inferior oblique muscle.

Vertical deviation is not, strictly speaking, a special type of strabismus, since it is caused by the same reasons as horizontal deviation.

However, vertical strabismus (due to the weakness of the vertical fusion (3.0-4.0 diopters) is very difficult to respond to orthoptic treatment methods, usually requiring surgical intervention, and is accompanied in some children by false ptosis (ptosis disappears if the eye fixes the object ), torticollis, diplopia.

Therefore, we highlight it in a separate section. Vertical strabismus is most often a consequence of paresis (or paralysis) of the muscles of vertical action (superior and inferior rectus, superior and inferior oblique), caused by congenital, including anomalies of attachment of these muscles, and acquired factors.

In general, it occurs in at least a third of children with strabismus (30-70%), and with congenital strabismus, vertical deviation is recorded in 90% of cases.

Secondary vertical strabismus is also possible, appearing after operations for horizontal heterotropia when the plane of muscle attachment is displaced up or down from the original level.

It should be remembered, however, that the occurrence of vertical deviation after operations on the horizontal muscles can also be associated with primary paresis of the superior rectus muscle, when it is not detected if the affected eye is not fixating, and the convergent strabismus is significant.

This is due to the fact that the lifting effect of the superior rectus muscle is more pronounced when the eye is abducted, while the non-fixing eye is in a state of strong adduction. It is necessary to establish the pattern of eye movement during variable fixation (Scobie), which will allow the correct diagnosis to be made.

Manifestation statistics

Vertical strabismus is one of the types of this disease; a characteristic feature of this variety is that with it the eye moves not to the side, but up or down. An upward displacement (deviation) of the eye is called hypertropia, and a downward displacement is called hypotropia.

This type of strabismus is not special; it is caused by the same reasons as horizontal strabismus. The main causes of vertical strabismus are factors such as:

Damage and paralysis (paresis) of the ocular motor (vertical) muscle.
Incorrect (abnormal) development of the eye muscle.
Past infectious diseases.
Injuries to the eyes, brain and nervous system.

This type of disease occurs quite often from 30 to 70% in cases of strabismus. Among the congenital types of strabismus, vertical, is diagnosed in 10 - 20% of children. So you should be very careful and carefully monitor the manifestation of this disease.

What treatment methods are used for vertical strabismus?

As the experience of oculists (ophthalmologists) and statistics shows, treatment of vertical strabismus with therapeutic methods for the most part does not give a positive result. For these reasons, such ailment is treated surgically, an operation is performed.

Carrying out such a radical intervention is necessary and absolutely safe for the patient. And the recovery period after surgery is on average only one week or 10 days. Next, the patient will only have to carry out a special set of exercises to strengthen and develop the ocular motor muscle.

In modern times, curing a disease such as strabismus is quite a simple task. For this purpose, ophthalmology clinics and offices have the most modern equipment that allows them to diagnose the nature of strabismus and provide appropriate treatment.

Among the conservative methods of treatment, physiotherapy is used. Eye training is also carried out by increasing the load on the sore (affected) eye. And the radical method is surgical intervention (operation). Your doctor will tell you which one is right for you.

Vertical strabismus accompanied by horizontal

A large percentage of people suffering from esotropia (convergent strabismus) or exotropia (divergent strabismus) also develop vertical eye shift as an associated problem. Sometimes the vertical shift develops at the same time as the horizontal strabismus, and sometimes it occurs years later.

Vertical strabismus, which accompanies horizontal strabismus, is usually caused by either over- or underaction of one or more vertical muscles of each eye. This is most often characterized by a deviation of the eyes either up or down when the child looks to the side.

If this upward or downward deviation is significant, eye muscle surgery is usually required to correct it. A child with vertical asymmetry (upward deviation) of the left eye, which is only present when she looks to the side.

Another common form of vertical strabismus that accompanies horizontal strabismus is called dissociated vertical deviation, or DVD for short. The latter is quite common in children who suffer from infantile esotropia, but often does not appear until children reach one year of age.

It is characterized by a transient upward deviation of one eye (or both), especially when the child is tired. Sometimes this becomes more obvious under visual strain, such as when reading small print.

This defect also requires surgical intervention if the upward displacement of the eye is significant enough to justify such treatment. Vertical strabismus as a result of an imbalance of the eye muscles.

When the sole cause of hypotropia or hypertropia is muscle imbalance, the cause is often weakness (paresis) of one of the vertical eye muscles. An alternative cause may be abnormal tightness of one of the muscles, which is a consequence of loss of normal muscle elasticity.

The tight muscle can restrict the movement of the eyes as they move vertically, as if the eye is tied on a leash. When vertical strabismus becomes apparent in children and young adults, it is usually caused by a birth defect in which the nerve to the eye muscle is affected.

It can also occur as a result of a head injury or, less commonly, a neurological disease that can affect the nerves to the eye muscles. If it occurs after adolescence, medical conditions such as diabetes or thyroid disease can sometimes cause the defect.

If the hypertropia or hypotropia is mild, it can sometimes be treated by placing prisms in the glasses. When the defect is larger, or if prisms are not successful, surgery is necessary.

Additional information: Our brain receives a lot of information to control the vertical position of the eyes from the balance mechanism, which is located in the middle ear.

Tilt of the head to the right or left sends different signals to our “vertical” eye muscles, causing them to relax or contract, thus adjusting the vertical position of the eyes.

Accordingly, a person who has weakness in one of the “vertical” eye muscles can compensate for this defect by tilting the head towards one of the shoulders. At the same time, he tilts his head in a position in which the weak muscle cannot function properly.

Head tilt is a means of compensating for hypertropia as it reduces ocular displacement and facilitates control. Many children with vertical strabismus are suspected of having congenital stiff neck.

It is referred to as torticollis, and before the oculomotor problem is diagnosed, they are given unnecessary physical therapy to the neck muscles.

Important point: A child who always tilts his head towards one of his shoulders may have a defect in the vertical eye muscle rather than suffer from a stiff neck.

Forms of strabismus

In medical practice, it is customary to divide strabismus into two forms: concomitant and paralytic.
Concomitant strabismus - squints either the right or the left eye with approximately the same amount of deviation from the correct position.

Practice reveals that strabismus usually occurs in people with ametropia or anisometropia, and farsightedness, as a rule, prevails. It is significant that with farsightedness the most common cases are convergent strabismus, and with myopia - divergent strabismus.

In any case, the main cause of concomitant strabismus is ametropia, and the greater its severity, the greater the likelihood of this pathology occurring. The reasons influencing the occurrence of concomitant strabismus also include:

significant difference between visual acuity of the right and left eyes;
diseases of the visual system that threaten blindness or a sharp decrease in vision;
uncorrected ametropia (myopia, hypermetropia, astigmatism);
change in the transparency of the refractive media of the organ of vision;
diseases of the retina or optic nerve;
some pathologies of the central nervous system;
genetically determined differences in the anatomy of both eyes.

The main symptoms of concomitant strabismus:

when looking at a stationary object, one eye deviates in some direction (up, down, towards the nose or temple);
there may be an alternating deviation of the left and then the right eye;
the angle of deviation (primary) of the squinting eye included in the act of vision is, as a rule, equal to the angle of deviation (secondary) of the fellow eye;
the field of view (eye mobility) is preserved in all directions in full;
there is no double vision;
binocular (3D) vision is absent;
in a squinting eye, decreased vision is possible;
During diagnosis, various types of ametropia (farsightedness, myopia, astigmatism) of varying magnitude (anisometropia) are usually detected.

Paralytic strabismus - always squints one eye. The main symptom of such strabismus is the limitation or complete absence of motor abilities of the eye in the direction of the affected muscle, which results in impaired binocular vision and double vision.

The causes of paralytic strabismus are damage to the corresponding nerves, as well as a violation of the morphology or functions of the muscles themselves. Such changes, as a rule, are congenital in nature or occur as a result of infectious diseases, injuries, vascular diseases, or tumors.

Signs of paralytic strabismus are:

limitation or lack of ability to move the eye towards the affected muscles (muscles);
the primary angle of deviation (deflection) is less than the secondary angle;
lack of binocular vision; double vision;
forced tilt of the head towards the affected muscle;
dizziness.

This type of strabismus affects people of any age. It is often caused by damage (trauma), poisoning, toxicosis, etc.

Types of strabismus

Convergent strabismus (usually combined with farsightedness), with the eye directed towards the bridge of the nose;
Divergent strabismus (usually combined with myopia), with the eye directed towards the temple;
Vertical strabismus with the eye directed upward or downward.

Convergent strabismus is characterized by deviation of the visual axis of one eye towards the nose. This type of strabismus often develops at a very early age and is often intermittent at first.

Its distinctive feature is its combination with hyperopia of high and moderate severity. Divergent strabismus is caused by a deviation of the visual axis towards the temple. This type of strabismus often accompanies congenital or early-onset myopia.

The causes of its appearance can also be injuries, fright, infectious diseases, and brain diseases. At the same time, there are other combinations of different provisions. Strabismus can be periodic or permanent.

Sometimes there are also atypical types of strabismus caused by physiological developmental abnormalities (Down, Brown syndromes, etc.)

Characteristic features of the disease

Source: o-glazah.ru

Ophthalmologists note that vertical strabismus has a rather complex clinical picture. In a person, each eye alternately begins to deviate in the same direction (either up or down).

A similar phenomenon occurs when the eyes focus on a front object or when the pupil moves into the distance. Experts point out that with such an eye pathology, syndrome V may appear (when strabismus only increases when looking up).

Syndrome A occurs when a person looks down. There are several main types of vertical strabismus. Most often, strabismus in adults (as well as children) is of the following types:

Mixed. With an eye disease, general symptoms appear that are characteristic of convergent, divergent and concomitant strabismus (with a vertical component);
Friendly;
Atypical varieties;
Paralytic or paretic strabismus. In such a case, the rectus, oblique, or both rectus and oblique muscles of vertical action may be affected.

Experts believe that the main cause of vertical strabismus is damage to the rectus or oblique eye muscles.

Factors that provoke strabismus

In most cases, pathology of the oculomotor system develops in childhood. Newborns are most susceptible to eye disease. It is during this period that babies cannot independently control the movement of their eyeballs.

The structure of the visual organs

For this reason, one eye sometimes begins to focus in an upward or downward position. The main factor causing strabismus is weakness of the eye muscles. Ophthalmologists say that the manifestation of vertical strabismus in infants is not a dangerous phenomenon.

Over time, the pathology disappears. Ophthalmologists recommend that parents carefully monitor their child's condition. Vertical strabismus should resolve on its own before the child is 6 months old.

If after this age the pathology has not disappeared, then it is necessary to seek qualified help. Strabismus disappears because the eye muscles begin to strengthen as the baby grows up, which is why the child learns to independently control the position of the eyes.

The following are the most common causes of strabismus in children:

genetic predisposition;
congenital pathologies;
diseases of the central nervous system;
brain pathologies;
weakening of the body’s protective functions due to viral diseases;
maternal illness during pregnancy;
the presence of tumors in the eye muscles;
inflammatory changes in the eye muscles.

Do not forget that too close placement of toys, as well as other objects above the crib or stroller, can cause strabismus. Experts recommend not to delay treatment of the disease, as this can lead to irreversible consequences in the future.

The highest chance of recovery is for those children who were treated when the disease was first detected. Strabismus in adults occurs due to other reasons. Patients who suffer from heteropia are most prone to this pathology.

In this case, paralysis of the upper or lower eye muscles may occur, which provokes the formation of an ocular anomaly. Injuries and operations performed on the eyes are another cause of vertical strabismus.

Vertical strabismus occurs much less frequently than horizontal strabismus, however, its treatment is more difficult. In 90% of cases, vision correction with glasses and lenses does not give the desired effect, which is why surgery is necessary.

Causes

The main reason why a person may develop strabismus is weakness of the eye muscles. Strabismus most often appears at an early age. Newborn babies are not yet able to control eye movement, and therefore one eye may diverge in the other direction.

In the first months of life, some squinting is quite normal in a newborn, and it should go away over time. A baby may have squinting eyes until about 6 months, but if after this time the position of the eyes has not returned to normal, then the child should be shown to an ophthalmologist.

With age, the eye muscles gradually strengthen, and the baby learns to independently control their movement. But it happens that in some children, strabismus may persist even after infancy. There are certain reasons for this:

very close placement of objects above the crib or stroller;
illnesses suffered by the mother of the baby during the period of pregnancy;
decreased protective function of the body due to viral diseases and various inflammations;
birth injuries of the baby;
congenital diseases;
tumor or inflammatory changes in the eye muscles;
brain injury;
diseases of the nervous system;
hereditary predisposition.

It is strictly forbidden to ignore the manifestation of strabismus in a child, because in the future this can lead to more complex vision problems that will be much more difficult to correct. The recovery process directly depends on whether the child was taken to an ophthalmologist in a timely manner.

Symptoms

Due to the noticeable asymmetry that is observed when comparing both eyes, it is easy to determine the presence of strabismus visually. Strabismus in children is detected due to obvious symptoms. The picture before the child’s eyes is bifurcated.

Migraines and dizziness in a baby are also not uncommon in the presence of pathology. The child involuntarily turns his head towards the opposite eye, which is squinting. If the baby begins to squint, then this is another reason to pay attention to his health condition.

It is possible to find out that a child has an eye pathology by paying attention to how he holds his head. Quite often, children involuntarily begin to tilt their heads to the side when they look. This phenomenon is easy to notice when the baby is watching TV, looking at his toys, or reading a book.

If a child does not like bright light and constantly complains that it gives him discomfort. This is another reason to take your baby to an ophthalmologist. During vertical strabismus, the image in front of the patient's eyes blurs.

If a person (child or adult) is not able to assess the correct distance at which things are located from him, then this is another symptom of the disease. The patient may sometimes bump into objects around him. The following feature may indicate vertical strabismus.

When, during visual fixation on an object, the other eye tilts (down or up), and when focusing the second eye, the same effect is observed in the second eyeball. With paralysis of the eye muscles that provoke this pathology, ocular torticollis sometimes appears.

This term implies an involuntary tilt of the head to the opposite side of the affected eye. Many people mistakenly mistake this phenomenon for a curvature of the neck, however, this is not the case. A visit to an orthopedist will not give the desired effect, since an ophthalmologist should be involved in correcting the disease.

It is not always possible to detect strabismus visually. The deviation of the pupils from the main axis can be completely insignificant or periodic, and if an adult can immediately notice this defect in himself, then children need to be carefully monitored. You should immediately contact an ophthalmologist if:

The baby incorrectly estimates the distance to objects and bumps into them when walking.
Doesn't like bright light and complains that it blinds him.
The child complains that objects blur before his eyes.
The baby often tilts his head when looking at toys, books or the TV screen.

Having noticed at least one of these signs, you need to carefully observe the baby and if your suspicions are confirmed, then immediately go to the ophthalmologist. The sooner treatment is started, the greater the chances of successfully correcting this defect.

Treatment

Many people mistakenly believe that vertical strabismus is a very complex disease and it is not possible to cure it. But that's not true. Today, strabismus is quite easy to cure. But before treatment, it would be useful to find out what this disease is.

Strabismus in children is very easy to recognize on your own and there is no need to visit a specialist. Strabismus, or strabismus, is a pathology of the oculomotor system in which the axes of the eyes are disrupted.

Due to this pathology, the child’s gaze becomes asymmetrical and is unable to correctly focus on a specific object. The vertical type of strabismus, as a rule, is less common, and is characterized by a shift in the axis of one of the eyeballs above or below the point of gaze fixation.

Causes of vertical strabismus

In the first months of life, some symptoms are quite normal and should go away over time. A baby may have squinting eyes until about 6 months, but if after this time the position of the eyes has not returned to normal, then the child should be shown to an ophthalmologist.

very close placement of objects above the crib or stroller;
illnesses suffered by the mother of the baby during the period of pregnancy;
decreased protective function of the body due to viral diseases and various inflammations;
birth injuries of the baby;
congenital diseases;
tumor or inflammatory changes in the eye muscles;
brain injury;
diseases of the nervous system;
hereditary predisposition.

Symptoms

First of all, strabismus can be seen visually, but in addition to the asymmetrical gaze, the child may develop symptoms such as:

squint;
headaches and dizziness;
slightly turned head.

Treatment

In modern medicine there are many different ways to treat vertical strabismus. Most often, the ophthalmologist prescribes complex treatment, as it will help combat this pathology more effectively.

The duration of treatment is determined by the ophthalmologist himself, and it can last several months, depending on the severity of the pathology. The prescribed treatment will be faster if it is taken immediately after the symptoms of the disease are detected.

As a rule, the following methods are used to treat strabismus:

occlusion;
glasses with one lens sealed;
special operation;
a set of exercises for the eyes.

The occlusion method involves wearing a patch over one eye for the allotted time. This bandage covers the normal eyeball and is worn so that the diseased eye can develop independently.

If the child is not able to see normally with the healthy eye, then, as a rule, the squinting eye is also connected, gradually forming neural connections. Over time, thanks to this procedure, the axes are aligned and the strabismus disappears.

But it should be borne in mind that wearing a bandage must be strictly supervised by the attending physician. Parents must learn how to attach this bandage correctly and independently.

It should also be remembered that this bandage cannot be attached to spectacle lenses. At first, parents will be faced with the fact that the child will categorically refuse to wear a bandage due to the fact that it will cause him some discomfort.

Therefore, it is imperative to convince the child not to remove this bandage on his own. Moreover, there is no need to wear it all the time. A few hours a day will be enough, but only an ophthalmologist can determine the exact time to wear it.

In some cases, the ophthalmologist prescribes special glasses for the child, which will need to be worn constantly. These glasses are needed because the visual acuity of the affected eye is greatly reduced, and in most cases, strabismus can be accompanied by farsightedness, myopia or astigmatism. Special glasses can help a child see better in a fairly short time.

The selection of these glasses is made individually, in several sessions and taking into account certain features of this pathology. If you choose them incorrectly, the opposite effect will occur, and your vision will deteriorate even more.

It is equally important to choose the right frame. It should not put pressure on the nose or ears and ensure the correct position of the glasses in front of the eyes. You will have to wear the selected glasses all day, taking them off only at night.

In more complex cases, surgery may be prescribed. Surgical intervention will help relieve the manifestations of strabismus, but it cannot be guaranteed that after surgery the child will begin to see clearly.

Operations for are divided into 2 types:

Strengthening.
Weakening.

During augmentation surgery, the muscle is shortened by removing part of it. The attachment point of the muscle remains the same, but the action of the weakened muscle begins to intensify. This type of surgery can restore muscle balance, strengthen and weaken one muscle that moves the eye.

During weakening surgery, the attachment site of the muscle is changed, transplanted away from the cornea, and it is weakened.

Sometimes the ophthalmologist prescribes special exercises for the eyes, which must be performed several times during the day, for 20-25 minutes.

You need to devote an average of a couple of hours to exercise per day, and they must be performed with glasses. To make it more interesting for your child to perform them, you can make them in the form of a game.

Possible complications

In some cases, as a result of this pathology, a child may develop complications that complicate treatment.

In many cases, scotomas of inhibition significantly complicate the treatment of vertical strabismus. In this case, the image in one eye is suppressed. The main signs may be the appearance of characteristic dark spots and floaters flashing in the eye.

Sometimes colors may fade. It is very difficult to identify this symptom in a newborn child, because fixation in such young children is already absent.

Abnormal correspondence of the retinas, as a rule, appears due to the formation of extraneous abnormal connections caused by changes in the position of the eyes. This phenomenon can occur from early childhood.

- a fairly common complication, the cause of which is strabismus. It is characterized by a sharp decrease in vision of the affected eye.

Disease prevention

To prevent the occurrence of vertical strabismus, you need to follow certain simple rules. First of all, you should not hang objects above the newborn’s crib that will attract a lot of unnecessary attention, because as a result, the child’s gaze will be constantly directed to the point of interest to him.

It is best to place objects at arm's length from the child himself. You should also avoid making sudden movements with your arms or making any movements near his crib or stroller.

It should be remembered that a child should not watch TV or sit him in front of a computer monitor until he reaches the age of three. The font of books must be large.

If a child’s family, parents or one of the blood relatives has or had this pathology, then it is necessary to visit an ophthalmologist much more often.

Video

Vertical strabismus is usually associated with paresis of the muscles of vertical action, often accompanied by ocular torticollis; To eliminate such strabismus, surgical intervention is usually required. If there is a constant forced position of the head, surgery is indicated at the age of 3-4 years.

It is advisable to compensate for a small vertical deviation (up to 5-7°) by wearing prisms, if this helps. As you know, vertical eye movements are provided by 2 rectus and 2 oblique muscles. The mechanism of the combined action of these muscles is very complex and depends on the initial position of the eyes, therefore, in the surgery of vertical strabismus, the correct choice of the muscle or muscles on which the operation should be performed is of paramount importance. It should be remembered that the superior and inferior rectus muscles exert their maximum lifting and descending action in the abduction position, and the superior and inferior oblique muscles in the adduction position. This feature easily makes it possible to identify the affected muscle through a simplified or photographic determination of the field of view in eight directions. In difficult cases, it is necessary to use the methods of coordimetry and “provoked” diplopia.

Operations on vertical muscles

Affected muscle	Possible ways to eliminate deviation
Superior oblique	Strengthening of the affected superior oblique muscle, weakening of the inferior oblique muscle of the same eye, strengthening of the superior rectus muscle of the other eye, weakening of the inferior rectus muscle of the other eye
Top straight	Strengthening of the affected superior rectus muscle, weakening of the inferior rectus muscle of the same eye, strengthening of the superior oblique muscle of the other eye, weakening of the inferior oblique muscle of the other eye
Inferior oblique	Strengthening of the affected inferior oblique muscle, weakening of the superior oblique muscle of the same eye, strengthening of the inferior rectus muscle of the other eye, weakening of the superior rectus muscle of the other eye
Bottom straight	Strengthening of the affected inferior rectus muscle, weakening of the superior rectus muscle of the same eye, strengthening of the inferior oblique muscle of the other eye, weakening of the superior oblique muscle of the other eye

The general rules for performing operations are as follows. Elimination of vertical strabismus should begin with an operation that enhances the action of the paretic muscle. If there is significant deviation (more than 10°) or hyperfunction of the homolateral antagonist, it is advisable to simultaneously weaken it. In case of true contracture of the homolateral antagonist (study of passive eye movements under anesthesia), only its weakening is indicated.

If the effect of surgical intervention on the affected eye turns out to be insufficient, then after 6-8 months you can perform surgery on the muscles of the other eye: weakening the contralateral synergist if it is excessively active or strengthening the contralateral antagonist. It is better to begin with these operations to correct vertical strabismus in cases where the affected eye is the fixing eye.

The superior and inferior rectus muscles begin deep in the orbit from the tendon ring and are attached to the sclera at a distance of 7.2-7.6 and 6.5-6.9 mm from the limbus, respectively. The plane of these muscles forms an angle of 19-23° with the sagittal plane of the eye, open towards the temple. The technique of operations on the upper and lower muscles is the same as on the horizontal rectus muscles. It is permissible to move them by 3-4 mm and shorten them by 5-7 mm. If they weaken or strengthen more, the normal position of the eyelids may change.

In vertical strabismus surgery, the most difficult operations are on the oblique muscles of the eye. This is explained by their anatomical and topographical features. The angle between the plane of the oblique muscles and the sagittal plane of the eye is open medially and is 54-66°.

Superior oblique muscle originates at the tendon ring, passes through the block at the superior-inner edge of the orbit, turns into a tendon here, runs posteriorly and outward and attaches to the sclera under the superior rectus muscle behind the equator at a distance of 15.2-17.4 mm from the limbus. The line of attachment of the superior oblique muscle is located obliquely to the muscle plane. The width of the tendon at the insertion site varies from 5.3 to 7.5 mm or more.

Inferior oblique muscle , starting from the lower inner edge of the orbit, goes posteriorly outward, passes under the inferior rectus muscle and attaches to the sclera, almost without forming a tendon, at the level of the lower edge of the external rectus muscle behind the equator at a distance of 17.5-19.1 mm from the limbus. The shape of the muscle attachment line is varied, the width of the attachment line is 6.5-8.7 mm.

The inferior oblique muscle is connected to the inferior rectus muscle by a fascial band - the Lockwood ligament. This does not affect the degree of muscle tension after its moderate strengthening or weakening as a result of surgery. When performing operations on the inferior oblique muscle, it should be borne in mind that the optic nerve, the area of the macula of the retina and the vorticose veins are located close to the site of its attachment. Depending on the magnitude of the vertical deviation, the movement or shortening of the oblique muscles is carried out within 5-10 mm.

Surgeries on the superior oblique muscle

Strengthening

To enhance the action of the superior oblique muscle, resection and tenorrhaphy are usually used. They prefer to make a fold on this muscle because the part of it going from the block to the eyeball consists entirely of tendon.

An incision of 12-15 mm in length is made in the conjunctiva and vagina of the eyeball parallel to the upper edge of the limbus and at a distance of 5-6 mm from it. A hook is placed under the superior rectus muscle. It is either crossed, having previously placed two sutures along the edges for subsequent attachment to the previous place, or taken to the side and held in this position. The conjunctiva and vagina of the eyeball are bluntly widely freed from the sclera. Using fixation tweezers or a suture placed on the tendon strip remaining after crossing the superior rectus muscle, the eyeball is turned downward and inward. If the muscle has not been crossed, then a traction suture is placed on the episclera at the upper edge of the limbus.

A pointed (or blunt-pointed in the shape of the letter P) hook, drawn flat along the surface of the sclera posteriorly 10-12 mm from the attachment site of the superior muscle and then turned upward, grasps the tendon of the superior oblique muscle. It is freed from adjacent tissues and stretched on two hooks.

A special instrument is placed on the tendon of the superior oblique muscle closer to the insertion site, with the help of which a fold of the required size is formed. It is stitched at the base on one and the other edge with two synthetic seams. After removing the tool, the fold is flattened. If the superior rectus muscle is temporarily cut, it is fixed with sutures in its original place. A continuous suture is placed on the conjunctiva.

J. M. McLean (1949) recommends forming a fold at the very point of attachment of the superior oblique muscle to the sclera, placing the fold on the temporal side and attaching it to the episclera with sutures. In this way, the muscle moves posteriorly to form a fold.

More complex in technology resection of the superior oblique muscle . It is very important here to firmly strengthen the resected muscle. When performing this operation, it is better to temporarily cut the superior rectus muscle.

The superior oblique tendon is isolated as described above. Pull it out with a crochet hook. Measure the amount of expected shortening and mark the location of the sutures with aniline paint. Two synthetic sutures are passed through this place at one and the other edge, capturing 1/3 - 1/4 of the width of the tendon with them. The latter is crossed lateral to the sutures and at the site of attachment to the sclera, leaving a narrow strip. Through it, capturing the superficial layers of the sclera, two sutures previously applied to the tendon are passed. The stitches are tied. The superior rectus muscle is strengthened in its original place. The conjunctiva is sutured with a continuous suture.

Resection of the superior oblique muscle is also performed using another method. Thus, E. S. Avetisov (1969) proposes the following method: form a fold from the muscle tendon, stitch it several times at the base, tie the seam into a strong knot and cut off part of the fold over the knot. When vertical deviation is more than 10°, the author combines this operation with recession of the superior rectus muscle.

Weakening

Of the operations that weaken the action of the superior oblique muscle, tenotomy is most often used. The muscle tendon is exposed in the usual way and pulled back with a hook. For 4-5 mm, the fascia covering the tendon is incised from above in the longitudinal direction, grabbed with a hook and cut. If there is a significant deviation of the eye, 3-6 mm of the tendon is excised to obtain a greater effect. A suture is placed on the conjunctiva.

McGuire (1953) uses recession of the superior oblique muscle: crosses it at the insertion site, moves it anteriorly and strengthens it with episcleral sutures.

Surgeries on the inferior oblique muscle

Strengthening

To enhance the action of the inferior oblique muscle, it is most often not only shortened, but also transplanted posteriorly. This is due to the fact that the named muscle has a very short tendon, therefore, when resecting, even within normal limits, the belly of the muscle is also captured, which is undesirable. Shortening the muscle alone is indicated for small deviations.

At a distance of 10-12 mm from the outer edge of the limbus, a vertical incision of 12-15 mm in length is made in the conjunctiva and vagina of the eyeball. It begins at the upper edge of the external rectus muscle and is carefully guided downward so as not to injure it. This muscle is released and pulled upward. The inferior oblique muscle is grasped with a hook. The amount of resection is determined, starting from the attachment site, and the suture line is marked with aniline dye.

Two sutures are made: one at the upper, the other at the lower edge of the muscle. The suture threads are tied firmly. If a muscle transplant is also planned, then the corresponding points are marked further than the place of its anatomical attachment. Holding the muscle with tweezers or an additional suture, the area between the attachment site and the previously applied sutures is resected. The latter are passed through the superficial layers of the sclera at the designated points, tied and cut off. If only shortening of the muscle is planned, then it is sutured to the site of its anatomical attachment. A suture is placed on the conjunctiva.

Weakening

Recession is used to weaken the action of the inferior oblique muscle. The surgical field is exposed using the same technique as during resection of this muscle. The external rectus muscle is pulled upward. Grab the inferior oblique muscle with a hook. At a distance of 2-3 mm from the attachment site, two synthetic sutures are placed on it from above and below.

Each seam covers 1/3 - 1/4 of the width of the muscle. It is crossed at the point of attachment. Down and anteriorly along the muscle plane, measure the intended amount of muscle movement and, accordingly, mark two points with aniline dye at a distance of 6-7 mm from each other. It is necessary to ensure that these points do not coincide with the exit site of the inferior vorticose vein.

Using fixation tweezers, grasp the tendon strip remaining after crossing the muscle and hold the eye in a stationary position. The sutures previously placed on the muscle are passed through the superficial layers of the sclera at the designated points, tied and cut. The external rectus muscle is released. The conjunctiva is sutured.

Tenotomy can also be used to weaken the action of the inferior oblique muscle.

In the first few years of a child's life, he or she may develop strabismus. Parents should pay close attention to the baby’s health at this time. You should not allow your child to get carried away with drawing or crafts while being close to the object.

Strabismus can also be caused by fear, head injury or shock. Try to protect your child from this. Correction of strabismus in children is carried out in several ways. And remember that only a doctor can choose a treatment method, depending on the course of the disease.

There are various exercises and gymnastics to correct strabismus in children. If you start treatment on time, it is quite possible to get rid of this disease without surgery.

General information about childhood strabismus

At birth, the child does not yet know how to see with both eyes. The ability for binocular vision develops gradually in a child and continues until the age of 4-6 years. All newborns have farsightedness of about 3 diopters. In this case, the focus does not fall on the retina, but is located behind it.

As the child grows, the eyeball increases in size, and the optical focus moves to the retina. Some children, for various reasons, have farsightedness greater than 3 diopters. To see objects clearly, they have to strain their eyes.

This tension is the main prerequisite for the occurrence of convergent strabismus in children, that is, when one of the eyes squints toward the nose. Binocular connections in the child’s visual system mature gradually and are therefore easily disrupted. The impetus for the occurrence of childhood strabismus against the background of prerequisites can be high temperature, physical or mental trauma.

Most often, strabismus occurs in children at the age of 2-3 years. Convergent strabismus in children is more common than divergent strabismus. When children have strabismus, visual acuity gradually decreases in the squinting eye, that is, amblyopia develops.

This complication is due to the fact that the visual system, in order to avoid chaos, blocks the transmission to the brain of an image of an object that is perceived by a squinting eye. This, in turn, leads to a permanent deviation of the eye, in which vision is reduced. Thus, a vicious circle starts.

Treatment of strabismus in children is complex. If there is farsightedness or nearsightedness, according to indications, the child is prescribed glasses. Sometimes glasses completely correct children's strabismus. However, even with this state of affairs, wearing glasses alone is not enough.

For strabismus in children, conservative treatment is carried out using hardware methods. They are aimed at curing amblyopia (if any) and restoring “bridges” between the eyes, that is, the child is taught to merge images from the right and left eyes into a single visual image.

During the treatment of childhood strabismus, at a certain stage, if indicated, surgical intervention is performed on the eye muscles. The operation is aimed at restoring the correct muscular balance between the muscles that move the eyeballs, rotating it in the socket.

After surgery, conservative treatment of strabismus in children is also mandatory. It is aimed at complete rehabilitation of visual functions.

There is a statement that with age, strabismus in children can go away on its own. If we are talking about periodic deviation of the eye in children under 6 months, then this is a variant of the norm and by 7 months the child’s eyes will actually be straight.

If the eye continues to deviate after 7 months or strabismus occurs later, then there can be no talk of any independent cure. Strabismus is a disease that requires treatment. There are more than 15 types of strabismus and each of them is treated differently. In some cases, rehabilitation takes about 6 months, sometimes up to 3-4 years or more.

Kinds

Types of strabismus. Source: uglaznogo.ru

There are usually two forms of strabismus.

The first form is concomitant strabismus. In this case, the eyes are squinted alternately and we can say that the squint of both eyes is approximately the same. Research by doctors has proven that people with anomalies in the form of ametropia and anisometropia with pronounced myopia have a greater predisposition to the disease “strabismus”.

But here’s another interesting thing: convergent strabismus is characteristic of persons who have farsightedness, and divergent strabismus is characteristic of those who have severe myopia. The main cause of concomitant strabismus is ametropia, that is, nearsightedness or farsightedness.

The reasons for this form of visual defect are: strong differences in visual acuity of both eyes; diseases associated with vision and sooner or later leading to blindness or severe vision loss within a short period of time; all diseases of the central nervous system, optic nerves and retina; congenital differences in the structure of the eyeballs.

Signs of strabismus in this case:

when looking at a stationary object, one eye is directed towards the nose, temple, or the other eye;
the eye does not lose its mobility; there is no splitting of the picture before the eyes;
no binocularity;
As a rule, a squinting eye sees worse, etc.

The second form is paralytic strabismus. It differs from the first in that one eyeball is stable, while the other is squinting. In paralytic strabismus, the defective eye cannot move towards the affected muscle. In this case, you can also experience double vision, lack of binocular vision, dizziness, etc.

Among other things, there are also such types of strabismus as:

converging, characterized by direction towards the bridge of the nose and combination with farsightedness;
divergent when the eye looks towards the temple in combination with myopia;
vertical strabismus - the eyeball is directed up or down;
mixed, consisting of the three described above.

In addition, strabismus is distinguished:

permanent and impermanent;
acquired and congenital;
multilateral (monolateral) strabismus and alternating (intermittent) strabismus.

Signs of the disease

Signs of the disease. Source: newbabe.ru

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.

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.

Diagnostics

Diagnostics. Source: 3ladies.su

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.

The main types of treatment for strabismus in children

Regardless of the causes of strabismus, in the initial stages the disease is treated with one of three conservative methods:

Optical correction (wearing special glasses and, less often, contact lenses for a certain period).
Orthoptic and diploptic treatment (using the principle of closing one eye with a special bandage or glasses with an insert so that the squinting eye begins to work and perform its functions).
Hardware treatment (effective in combination with gymnastic exercises and optical correction).

Optical correction

If there is farsightedness or nearsightedness, according to indications, the child needs glasses. Sometimes they completely correct strabismus. However, wearing glasses alone is not enough.

It is very important to teach your child to combine images from the right and left eyes into one image. This is achieved through a set of therapeutic measures conducted in courses several times a year. The treatment is conservative and takes place in a playful way.

In addition, the occlusion method is used - covering the good eye with a bandage for a certain time every day, so that the child learns to rely more on the weak eye. It should be especially noted that the success of strabismus treatment depends on correctly selected individual treatment tactics.

Hardware

If gymnastics and medical optics do not help, and it is too early to proceed to surgery, hardware treatment of strabismus in children can be used to treat strabismus, which allows not only to eliminate strabismus, but also to increase visual acuity and restore binocularity.

Among the common means in this regard is a synoptophore, when used, the device generates two flashing images, which over time are combined into one. This helps to develop binocular vision during the course of treatment. Another popular option is video-computer auto-training, which in practice is watching a cartoon or children's program.

During viewing, an electroencephalogram is taken from the child’s brain, which records the activity of the visual system.

If such signals stop, this means that the child stops following the progress of the cartoon and does not focus his eyes on the characters and objects (which is what the doctors want), and the showing of the cartoon stops.

Sometimes light-laser therapy is used, during which a laser acts on the retina of the eye, activating blood circulation and other processes, during which the vision system works as usual. Regardless of the type of hardware treatment, courses last no more than ten days and can be repeated at intervals of no more than one once every six months.

Operational

The last step that specialists are taking is surgical treatment of strabismus in children, the essence of which is to shift the attachment areas of certain muscles of the eyeball. Despite the fact that many parents and children themselves are afraid of this procedure, it almost always ends successfully, and strabismus is completely and forever eliminated.

Such an operation can be strengthening or weakening, and each case has its own characteristics: In the process of enhancing surgery, the eye muscle (or group of muscles) is shortened by excision or removal of a segment, or by displacing the site of attachment of muscle tissue.

During an operation that requires weakening of the muscle, it is built up using plastic methods, excised in certain areas, or also displaced. Important! In any case, the eyeball assumes its normal position, which is where the surgeon’s work ends. The further task of ophthalmologists is to restore binocular vision.

The treatment complex often involves the use of both conservative and, in most cases, surgical treatment. At the same time, surgery should not be treated as an alternative to conservative treatment. Surgery is one of the stages of treatment, the place and time of which depend on the type of strabismus and the depth of damage to the visual system.

Before and after surgical treatment, conservative therapeutic measures should be carried out aimed at increasing visual acuity, to restore communication between the eyes and stereoscopic three-dimensional visual perception - this is achieved with the help of special exercises.

Techniques are used to improve the functional state of the visual part of the cerebral cortex, to force the visual cells of the cortex to work in normal mode and thereby ensure correct and clear visual perception. These techniques are stimulating in nature. Classes are conducted using special devices on an outpatient basis in courses of 2–3 weeks several times a year.

During treatment, at a certain stage, in the presence of high visual acuity, restoration of the ability to merge two images from the left and right eyes into a single visual image, in the presence of eye deviation, surgical intervention is performed on the eye muscles.

The operation is aimed at restoring the correct balance between the muscles that move the eyeballs (oculomotor muscles). It is important to understand that surgery does not replace therapeutic techniques, but solves a specific problem that cannot be solved conservatively.

To decide the timing of surgical intervention, it is important that the patient has sufficient visual acuity. The sooner you put your eyes in a symmetrical position with direct gaze, the better. There are no special age restrictions.

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. By school, a child with strabismus should be rehabilitated as much as possible.

If you treat the problem of strabismus comprehensively, then cure occurs in 97% of cases. Thanks to a timely treated disease, the child can study normally, get rid of psychological problems due to visual defects, and subsequently do what he loves.

Exercise sets

Sets of exercises. Source: detki.co.il

Gymnastics for children

Heterotropia is a condition in which a person is unable to coordinate both eyes and fixate their gaze on one specific object. If your child suffers from this defect, getting rid of it is quite problematic, but there is always a way out.

There are various techniques and exercises to correct strabismus. At the same time, eye gymnastics should be carried out daily, otherwise you will not see a tangible result. Spend approximately 20 minutes of your time 3 times a day to exercise your child's vision.

If you decide to start solving the problem early enough, experts have developed special exercises for strabismus for the youngest children. For this you will need bright rattles, one small colored ball, cubes with pictures and a blindfold.

Have your baby sit on a sofa or high chair and cover one eye. Take a rattle and move it in different directions in front of the child’s face at a distance of 30 cm from the eyes. The exercise should be carried out for a minute, and then replace the rattle with a cube or ball. This is done to attract attention, since the baby will quickly get tired of watching the same object.

After finishing the charging, bring the toy to the bridge of the child’s nose, while his gaze should be focused on the object in your hands, and his eyes should be focused on the bridge of the nose.

Other exercises are also suitable for kids. Take a plastic plate and make several holes of different sizes and shapes in it, being sure to grind off the sharp edges so that the child does not cut himself.

Give the resulting plate into the hands of the baby, and also give him a lace. Explain that the baby's goal is to thread the lace through each of the holes made. This activity does not get boring for children for a long time, and it gives excellent results after just a couple of months.

The following eye exercises for strabismus in children are suitable for children aged 3 years and older.

Take two pictures with the same image, and one of them should be missing some details. The child must carefully compare both images and answer which parts of the picture are missing.

Another method is as follows. Take a blank sheet and divide it into 4 parts. In each segment of the sheet, draw several types of animals, plants or geometric shapes. This must be done in such a way that some images are repeated in different parts of the sheet.

Then show the pictures to your baby and set him a goal - to find repeating images.

Exercises 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.

Examples of exercises:

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.
third
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.

Treatment with folk remedies

Treatment with folk remedies. Source: bezmorshchin.ru

Treatment of strabismus with folk remedies is effective only at the initial stage of its development. Folk remedies in this case have a special purpose, since strabismus can be cured at home by strengthening the eye muscles.

Bitter chocolate. But when purchasing such chocolate, you must take into account that the content of grated cocoa in it must be at least 60%. Milk, porous and filled chocolate are not suitable. This method of combating strabismus is contraindicated for diabetics and people with allergies to cocoa beans. Directions for use: eat 4 standard pieces of chocolate one hour after breakfast and lunch. The duration of the course is one month. The method is most effective for children 3–4 years old who have been diagnosed with strabismus.
Calamus root is a good remedy for strabismus. Dilute 10 g of calamus root in a glass of boiling water, then strain and take 1/4 glass three times a day 30 minutes before meals. Boil cabbage leaves until completely tender. Consume 4 times a day with cabbage broth.
Rosehip decoction. Pour 100 g of fruit with a liter of boiling water. It is recommended to boil over low heat, then leave for 5 hours and consume a glass before meals. You can add a little honey to the strained broth. Pine needles will also help cope with the disease. You need to place 100 g of pine needles in half a liter of boiling water and keep it in a water bath for some time, and then infuse it very well. Take 1 tablespoon after meals. The exact timing of the course has not been determined, but long-term use of this healing agent is recommended.
Clover infusion. You will need 1 cup of boiling water and 6 g of chopped clover. Let it brew well. Drink after meals twice a day. Blackcurrant infusion. Take 5 g of currant leaves and brew them in a glass of boiling water. Strain and take instead of tea.
Juice from carrots, beets and cucumbers. Drink half a liter a day. Alcohol infusions also help well in the fight against strabismus. You can prepare an alcohol infusion with Chinese lemongrass. To do this, you will need 100 g of crushed lemongrass fruits and 500 ml of vodka. Leave for ten days, shaking every day. Use tincture 20 drops, pre-mixed with water, twice a day before meals.
Phytodrops (drops made from plants) are also a means of preventing and treating strabismus at home. Here are just a few of the remedies: pour 10 g of dill powder with a glass of boiling water and let it brew for a while. During the day you need to drop it into your eyes 2-3 times. Mix fresh apple juice, May honey and onion juice in a 3:3:1 ratio. Place the resulting mixture in your eyes before going to bed for 10 days. After a break, the course can be repeated

Why is strabismus dangerous?

Why is strabismus dangerous? Source: heaclub.ru

Strabismus is not just a cosmetic defect. Normally, our eyes rotate in a coordinated manner, and the brain receives its own image from each of them.

The visual areas of the cerebral cortex have the ability to combine these two slightly different “pictures” into one, thanks to which a person receives a three-dimensional image of objects, determines their distance from each other, and distinguishes depth.

This is called binocular (stereoscopic) vision. With strabismus, the merging of two images into one three-dimensional one does not occur: one of the eyes deviates from the joint point of fixation, so the brain receives two images that are very different from each other and cannot combine them into one image.

The function of binocular vision with strabismus is impaired.

Often strabismus “coexists” with another dangerous disease - amblyopia (the so-called “lazy eye”), characterized by a persistent decrease in visual acuity in one or both eyes. Changes occur in the visual cortex of the brain, and in adults they are irreversible.

In this case, a “vicious circle” is formed: amblyopia is provoked by strabismus and, in turn, contributes to an even greater deviation of the eye from its normal position. If strabismus is left untreated, amblyopia and vision loss occur in approximately 50% of children.

Prevention

Considering that strabismus is often congenital rather than acquired, there are no special preventive measures for such visual impairment. But children under the age of six must follow certain instructions to avoid acquired strabismus, and some of the rules apply not only to children, but also to parents.

For example, before the age of one year, while the baby is sleeping in a crib, you should not hang toys too close to his face, since the baby needs distance between his eyes and objects to properly develop focus.

Children should not be allowed to become overly involved in drawing or reading between the ages of three and six, but if the desire of the future artist or scientist to spend their favorite pastime is too strong, it is necessary to control the distance from the eyes to the table surface.

It is necessary to provide the child with good lighting, in which there is no need to strain the eyes too much.

Sources: narmed24.ru; medicinform.net; doktordetok.ru; zrenie1.com; o-glazah.ru; 2mm.ru.

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 often accompanies eye diseases. More often it occurs as a concomitant diagnosis for farsightedness or astigmatism. Less often - with myopia.

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.

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 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 .

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.

Typically, a child at the initial stage is prescribed 3-4 courses, each of which includes at least 10 lessons. At subsequent stages of strabismus treatment, the duration and appropriateness of hardware treatment courses are determined exclusively by the doctor.

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 use 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.

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.

After such an operation, a child will be able to return to the children's group (to kindergarten or school) only 2-3 weeks after discharge. For half a month, you will have to carefully follow all the doctor’s orders and prescriptions, including daily eye drops with antibiotics or other anti-inflammatory eye medications.

Prevention

Preventive measures that will help protect a child from strabismus cannot be postponed until later. They should start on the same day the baby is brought home from the maternity hospital. You need to do the following:

You should make sure that the room where the baby will live is well lit and that there is enough artificial lighting in it for the evening.
Do not hang toys too close to the baby's face in a crib or stroller. The distance to the eyes should be at least 40-50 cm. Another big parental mistake that often leads to the development of strabismus is a single bright toy hung in the center in front of the child. It is best to hang two toys - on the right and on the left, so that the baby can switch his gaze from one to the other, thereby training the oculorotatory muscles.
Small toys are not suitable for babies not only because they can choke on them. He will definitely try to look at them, and to do this he will have to narrow his eyes tightly to the bridge of his nose, bend low over the toy, or bring it too close to his face. Such children's experiments are in no way useful for the eyes.
Learning, writing and reading too early (before 4 years of age) can also lead to the development of strabismus, since the unformed visual apparatus becomes very tired during activities that require maximum focus and concentration.
If a child is sick with the flu, scarlet fever or another infection, you should not keep him busy reading, drawing or cross-stitching. During such diseases, the risk of complications from a variety of organs and systems of the human body increases.

The child’s diet must contain foods and vitamins necessary for the formation of normal vision. To do this, you should choose products and vitamin complexes that contain large amounts of vitamins A, B1 and B2, as well as PP, C, and E.
You should be attentive to the fears and experiences of the little man, since the psychological factor is far from the least among the reasons for the development of pathology. It is very important that the baby grows up in a friendly atmosphere so that parents can protect him from all frightening factors. You should avoid making too sudden movements around a small child.
Children should strictly limit the amount of time they spend on the computer and watching television, and ensure that they do not use gadgets uncontrollably, especially while traveling on a bus or in a car.
If there is a genetic predisposition to strabismus, the child should be shown to the ophthalmologist more often, visiting the doctor’s office not only during scheduled appointments (at 1, 6 and 12 months), but also in the intervals between these periods - to make sure that the pathological process has not started .

For more information about strabismus, see the next episode of Dr. Komarovsky’s program.

Causes of vertical strabismus

In the first months of life, some squinting is quite normal in a newborn, and it should go away over time. A baby may have squinting eyes until about 6 months, but if after this time the position of the eyes has not returned to normal, then the child should be shown to an ophthalmologist.

very close placement of objects above the crib or stroller;
illnesses suffered by the mother of the baby during the period of pregnancy;
decreased protective function of the body due to viral diseases and various inflammations;
birth injuries of the baby;
congenital diseases;
tumor or inflammatory changes in the eye muscles;
brain injury;
diseases of the nervous system;
hereditary predisposition.

Symptoms

First of all, strabismus can be seen visually, but in addition to the asymmetrical gaze, the child may develop symptoms such as:

double vision;
squint;
headaches and dizziness;
slightly turned head.

Treatment

In modern medicine there are many different ways to treat vertical strabismus. Most often, the ophthalmologist prescribes complex treatment, as it will help combat this pathology more effectively.

As a rule, the following methods are used to treat strabismus:

occlusion;
glasses with one lens sealed;
special operation;
a set of exercises for the eyes.

The occlusion method involves wearing a patch over one eye for the allotted time. This bandage covers the normal eyeball and is worn so that the diseased eye can develop independently.

But it should be borne in mind that wearing a bandage must be strictly supervised by the attending physician. Parents must learn how to attach this bandage correctly and independently.

Operations to correct strabismus are divided into 2 types:

Strengthening.
Weakening.

During weakening surgery, the attachment site of the muscle is changed, transplanted away from the cornea, and it is weakened.

Sometimes the ophthalmologist prescribes special exercises for the eyes, which must be performed several times during the day, for 20-25 minutes.

Possible complications

In some cases, as a result of this pathology, a child may develop complications that complicate treatment.

Sometimes colors may fade. It is very difficult to identify this symptom in a newborn child, because fixation in such young children is already absent.

Dysbinocular amblyopia is a fairly common complication caused by strabismus. It is characterized by a sharp decrease in vision of the affected eye.

Disease prevention

It is best to place objects at arm's length from the child himself. You should also avoid making sudden movements with your arms or making any movements near his crib or stroller.

It should be remembered that a child should not watch TV or sit him in front of a computer monitor until he reaches the age of three. The font of books must be large.

If a child’s family, parents or one of the blood relatives has or had this pathology, then it is necessary to visit an ophthalmologist much more often.

Video

Strabismus is a problem that most often occurs in preschool children. Don't think that this is just a cosmetic defect. Often the visual acuity of a squinting eye is below normal. With strabismus, the eyes do not work together. The violation negatively affects the formation of the child’s character, and in the future it narrows the range of career choices and reduces the ability to work. Of course, we cannot discount the cosmetic side of the problem, especially for girls. Strabismus can cause no less problems for a person than other vision defects.

It has been proven that a person suffering from strabismus is able to get rid of this problem, or at least reduce its severity. How to correct squint?

What it is? Concomitant divergent strabismus

We all look at the world with two eyes, but the brain combines the two images into a single visual image. Vision with two eyes, as a result of which our consciousness receives one three-dimensional image, is called binocular. One of the primary conditions for binocular vision is the coordinated work of all eye muscles. Each eye has six muscles that work together to ensure synchronous eye movement. When the direction of gaze changes, both eyeballs make simultaneous movements in the same direction. According to ICD 10, strabismus has code H49.

Strabismus (strabismus) is a violation of the parallelism of the visual axes, which makes it difficult for both eyes to fixate on the object of vision.

With a symmetrical position of the eyes, images of objects fall on the central areas of each eye. In the cortical sections of the visual analyzer, they merge into a single binocular image. With strabismus, fusion does not occur, and the central nervous system, in order to protect itself from double vision, excludes the image obtained by the squinting eye.

If this state of vision continues for a long time, amblyopia develops (a reversible decrease in vision, in which one of the two eyes is partially or completely not involved in the visual process).

Types and forms of strabismus

There are two forms of strabismus: friendly and paralytic.

Concomitant strabismus

With this type of pathology, either the left or the right eye squints, and the magnitude of the deviation from the straight position is approximately the same. Statistics show that most often such strabismus occurs in persons with ametropia and anisometropia. In this case, farsightedness predominates in cases of convergent strabismus, and myopia is combined with a divergent type of strabismus.

Paralytic strabismus

With this disorder, one eye squints. The main sign of the pathology is the restriction or absence of eye movements in the direction of the affected muscle, as a result of which binocular vision is impaired and double vision occurs. The causes of paralytic strabismus may be due to damage to the nerves or a violation of the morphology and function of the muscles themselves.

These disorders can be congenital or occur as a result of infectious diseases, injuries, tumors, or vascular diseases.

A sign of paralytic strabismus is also the inequality of the primary angle of strabismus (squinting eye) to the secondary angle of deviation (healthy eye). Forms of strabismus

In addition, experts distinguish the following forms of strabismus:

converging (the eye is directed towards the bridge of the nose);
divergent (the eye is directed towards the temple);
vertical (the eye squints up or down);
mixed.

Convergent strabismus usually develops at an early age. Most often, this type of strabismus is combined with moderate and high farsightedness.

Divergent strabismus often accompanies congenital or early-onset myopia. The causes of its appearance may be injuries, brain diseases, fear, infectious diseases.

Strabismus may be permanent or appear periodically. There are also atypical types of strabismus, which are caused by anatomical developmental abnormalities (Down syndrome, Brown syndrome, DVD syndrome, etc.)

Strabismus is classified according to several criteria:

By time of occurrence: congenital or acquired;
According to the stability of deviations: constant or inconsistent.

Types of pathologies in strabismus Causes of strabismus Strabismus, heterotropia, stabismus

The causes of congenital strabismus can be:

heredity;
birth injury;
prematurity.

Acquired strabismus is usually associated with diseases of the central nervous system. Reasons also include:

nervous stress;
head bruises;
infectious diseases.

Symptoms

Concomitant strabismus is characterized by the following symptoms:

when fixating a stationary object, one of the eyes is in a state of deviation in any direction;
can alternately squint either the left or the right eye;
no binocular vision;
decreased vision in the deviated eye;
presence of ametropia.

In paralytic strabismus, only one eye is constantly squinting. The main symptoms of such strabismus are:

limitation or absence of movements of the oblique eye in the direction of the action of the affected muscles;
forced deviation of the head towards the pathological muscle;
the primary deflection angle is less than the secondary one;
the presence of constant or periodic dizziness;
lack of three-dimensional vision.

Sometimes strabismus does not appear immediately, but, for example, in the late afternoon, when the child is active. The defect can appear periodically, and parents, as a rule, think that the child is playing around and sometimes do not pay attention to it.

Strabismus requires immediate correction. Results depend on the timeliness of treatment.

Diagnostics

Strabismus in a child or adult can be determined during an ophthalmological examination by a doctor. Diagnostics include:

visual acuity test;
determination of eye refraction with wide and narrow pupils;
determination of range of movements, eye position and strabismus angle;
volumetric vision study;
examination of the fundus, anterior segment and conductive media of the eyes.

In the process of examining children, the ophthalmologist first conducts a survey of parents in order to determine when and under what circumstances strabismus was noticed, and how it manifested itself: suddenly or over a certain period of time. Congenital pathology is usually associated with fetal injuries during childbirth or diseases of the central nervous system. The acquired form is associated with refractive errors.

With strabismus, the ability to see normally is usually retained only by the eye that performs vision. An eye that squints to the side sees worse and worse over time, its visual functions are suppressed. Therefore, it is important to start treatment as early as possible.

Treatment of strabismus involves an integrated approach and may include:

optical correction (glasses, lenses);
treatment of amblyopia of the eye using hardware procedures;
development of binocular vision;
consolidation of achieved monocular and binocular functions;
surgery.

Surgery is used mainly to achieve a cosmetic effect, since by itself it rarely restores binocular vision. The surgeon determines the type of operation directly on the operating table, since here it is necessary to take into account the peculiarities of the location of the muscles in a particular person. One or both eyes are operated upon. Surgery is aimed at strengthening or weakening one of the muscles that moves the eyeball.

The operation to correct strabismus is performed in one day under local drip anesthesia. The recovery period takes about a week, but after such a surgical operation, doctors recommend a course of hardware treatment for optimal restoration of visual functions.

Exercises for strabismus

The tasks of eye gymnastics for strabismus (myopia, farsightedness and other types of vision deviations) include: complete relaxation of the eye muscles, focusing the gaze on one point, combining two pictures. If at the final stage it was possible to achieve the combination of two pictures, then we can talk about victory over strabismus.

Each of the exercises below should be repeated at least 16 times.

Extend your hand forward and fix your gaze on your index finger. Bring your finger closer to your eyes, without looking away, and remove it. Repeat the same thing, lowering your hand down and raising it up.
Move your eyes as far to the left as possible- to the right, then up and down, tracing figure eights with your gaze.
Follow moving objects with your eyes, for example, a ball when playing ping pong.
Look into the distance for a long time through the window. Then focus your gaze on nearby objects.
Stand with your back to the sun, cover your healthy eye with your palm. Then turn your head towards the squinting eye until it sees the sun's rays. Return to the starting position and start moving again in the same rhythm (at least 10 times). There is no need to turn your whole body or jerk your head, because the purpose of the training is to treat the eye, and not to strengthen the muscles of the body.
If your left eye squints toward the bridge of your nose, close your healthy right eye. Move your right leg forward and reach your toe with your hand. After this, bend over and raise your arm as if pointing to the sky on the left side of your body.
If your left eye is squinting towards your temple, move your left leg forward and reach with your right hand towards the toe of your left foot. Point your hand to where the affected eye should turn. If your right eye is squinting, you should put your left leg forward. Tilts are necessary to enhance blood movement in the eyeballs.

Gymnastics for strabismus

A necessary condition for obtaining the effect of eye exercises is their regular implementation.

Complications

Strabismus does not go away on its own. Moreover, if left untreated, serious complications can develop. That is why, when the first signs of strabismus appear, you should immediately consult an ophthalmologist.

With strabismus, work in almost all parts of the visual analyzer is disrupted, so treatment must be comprehensive.

In the squinting eye, visual acuity gradually decreases, that is, amblyopia develops. This, in turn, leads to even greater deviation from the norm. Thus, a vicious circle starts.

Prevention

The main way to combat strabismus is early diagnosis. Required:

mandatory early examinations of children, more frequent for children at risk(parents with visual impairments, birth trauma, etc.);
annual medical examination;
compliance with the norms and rules of visual hygiene.

If a child is prescribed glasses, they must be worn as recommended and visited an ophthalmologist every six months in order to promptly prevent the development of strabismus and amblyopia.

What causes blurred vision?

How to test for color blindness, read this article.

Treatment of iridocyclitis: Conclusions

So, strabismus in children and adults is not only a cosmetic defect; This is a pathology leading to further vision loss and the development of other eye diseases. If you notice that your child sometimes squints one eye (or both), be sure to rush to the doctor. Strabismus in adults is a condition that can be corrected.