In infants, the eyes are often squinted pretty cute. And there is nothing wrong with that - at first glance. Moreover, it touches the parents. However, several months pass, the child grows, and his eyes continue to mow, which cannot but alert adults. With suspicion of squint, parents turn to ophthalmologists most often. This is the most popular reason for an unscheduled visit to a pediatric optometrist. 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 rather complex names - strabismus or heterotropy. This is a pathology of the organs of vision, in which the visual axes cannot be directed towards the object in question. Eyes with differently positioned 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 after a few months on its own. Often, the disease is first detected at the age of 2.5-3 years., since at this time the work of visual analyzers is actively formed in children.
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 perceive the image from only one eye, the axis of which is not curved. If the child is not provided with timely medical care, the second eye will begin to lose visual acuity.
Often strabismus accompanies eye diseases. More often it occurs as a concomitant diagnosis with hyperopia or astigmatism. Less often - with myopia.
Strabismus is not only an external flaw, a cosmetic defect, the ailment affects the work of all components of the organs of vision and the visual center.
Causes of occurrence
In newborns (especially premature babies), strabismus is caused by the weakness of the eye muscles and the optic nerve. Sometimes such a defect is almost imperceptible, and sometimes it catches the eye right away. With the active growth of all parts of the visual analyzers, physiological strabismus disappears. This usually happens closer to six months or a little later.
This does not mean at all that the parents of a six-month-old baby who squints with eyes need to sound the alarm and run to the doctors. Of course, it is worth visiting a doctor, but only to make sure that the child has no other pathologies of vision. If the baby sees well, then strabismus continues to be considered physiological until they reach a year.
Strabismus, which persists to one degree or another after a year, is not considered the norm, and it is classified as a pathological disorder. The causes of pathological strabismus can be many:
- Genetic predisposition. If close relatives of the child or his parents have squint 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 trauma, including birth trauma. Typically, such strabismus occurs as a result of acquired problems from the central nervous system.
- Congenital factors. These include intrauterine malformations of the organs of vision, which could have formed as a result of infectious diseases of the mother or genetic "errors", as well as the consequences of fetal hypoxia.
- Negative external influence. These reasons include severe stress, fright, 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 explain the occurrence of pathology in a particular child. Usually it 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. The treatment of this ailment is also purely individual.
Symptoms and Signs
Signs of strabismus may be visible to the naked eye or may be hidden. One eye or both can squint. The eyes can converge to the nose or be "floating". In children with a wide bridge of the nose, parents may suspect strabismus, but in fact there may be no pathology, just the anatomical features of the structure of the child's face will create such an illusion. With growth (during the first year of life), this phenomenon disappears.
The symptoms of strabismus usually look like this:
- in bright light, the child begins to "mow" more;
- the baby is unable to focus on the subject so that the pupils move synchronously and are in the same position in relation to the corners of the eyes;
- in order to see an object with a squinting eye, the child has to turn his head at an unusual angle;
- while crawling and walking, the baby stumbles upon objects - especially if they are located from the side of the squinting eye.
Children over one year old may complain of headache, frequent fatigue. Eyesight with strabismus does not allow you to see the picture clearly, it can be blurry or double.
Children with strabismus often have a sensitivity to light.
Kinds
Strabismus can be congenital or acquired. Doctors talk about congenital pathology when clear signs of the disease are visible immediately after the birth of the baby (or appear during the first six months).
Usually the pathology develops horizontally. If you mentally draw a straight line between the pupils through the bridge of the nose, then the mechanism for the occurrence of such a violation of visual function becomes clear. If the eyes of the child seem to tend to each other along this straight line, this indicates a converging strabismus. If they strive in different directions in a straight line, then this is a divergent squint.
Less often, pathology develops vertically. In this case, one or both organs of vision can be deflected up or down. This vertical "withdrawal" 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 in most cases is reduced, 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 the second "turns off" as unnecessary.
Such a pathology is quite difficult to treat, and the function of the affected eye is not always possible to return. 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 when both eyes are squinted, but not simultaneously, 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 the 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 paralytic, as the name implies, paralysis of one or more muscles responsible for eye mobility occurs. Immobility can be the result of disturbances in the brain, nervous activity.
Friendly
Concomitant strabismus is the simplest and most common form of pathology, which is usually characteristic of childhood. With it, the eyeballs retain a full or almost full range of motion, there are no signs of paralysis and paresis, both eyes see and are actively involved, the child's image is not blurred and does not double. The squinting eye may see slightly worse.
Concomitant strabismus can be accommodative and non-accommodative, as well as partial. Accommodation pathology usually appears in early childhood - up to a year or at 2-3 years. It is usually associated with high or significant myopia, hyperopia, and astigmatism. Such a “childish” eye disorder is usually treated quite simply - by wearing glasses prescribed by a doctor and by sessions of apparatus therapy.
Partial or non-accommodating visual impairment also appears at an early age. However, myopia, hyperopia will not be the main and only reasons for the development of strabismus of these types. Surgical methods are often chosen for treatment.
Strabismus in children is constant and fickle. The inconsistent divergent is often found, for example, in infants, and it does not cause great concern among specialists. Constant divergence is almost always the cause of congenital malformations of the visual analyzers and requires serious treatment.
Hidden
Latent squint is difficult to recognize. With him, the child sees normally, with two eyes, which are positioned completely correctly and do not deviate anywhere. But it is worth “turning off” one eye from the perception of visual images (for example, closing it with a hand), as it immediately begins to “float” horizontally (to the right or left of the bridge of the nose) or vertically (up and down). To determine this pathology, special ophthalmic techniques and devices are required.
Imaginary
Imaginary strabismus occurs due to the completely normal features of the development of the eye in this or that child. If the optical axis and the line of sight do not coincide, and this mismatch 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.
The imaginary strabismus does not need correction and treatment at all. False strabismus includes cases when the 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 cut of the eyes or the wide bridge of the nose.
Treatment
It is possible to correct such a visual defect in almost all cases, the main thing is that the parents turn to the ophthalmologist in a timely manner, without delaying the visit to the doctor. If, after six months or a year, the baby's strabismus has not passed, 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 ineffective.
Modern medicine offers many ways to correct strabismus. This includes hardware treatment, physiotherapy, and special gymnastics to strengthen the ophthalmic 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. ABOUThowever, each therapy plan includes key moments and stages that will need to be passed in order to correct the visual defect most successfully:
- First step. Includes treatment for amblyopia. The goal at this stage is to improve vision, increase its acuity, and bring the values of acuity to normal. This is usually done by wearing glasses with a sealed lens. In order not to frighten the child with such a medical device, you can use special children's seals (occlusions). At the same time, several courses of hardware treatment are prescribed.
Strabismus itself does not go away at this stage, but vision usually improves significantly.
- Second phase. It includes procedures that are aimed at restoring synchronicity, the connection between two eyes. For this, special instruments and apparatus are used, as well as corrective computer programs.
- Stage three. It consists in restoring normal muscle balance between the organs of vision. At this stage, surgical treatment can be prescribed if the muscle damage is sufficiently pronounced. However, in children's practice, it is often possible to get by with methods that parents can practice at home - gymnastics, exercises for the eyes and procedures that can be offered by physiotherapy rooms of polyclinics.
- 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, 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 scheme, the doctor will be able to conclude whether the baby has been cured - or whether he is indicated for a surgical operation.
You can read more about some of the modern techniques for treating strabismus below.
Hardware
Apparatus 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 large enough a list of devices that a child can use in a clinic or at home - if parents have the opportunity to buy such equipment:
- "Ambliokor" apparatus. Used to improve vision. It is a monitor and a system of sensors that record nerve impulses during the operation of the organs of vision. The child is just watching a movie or cartoon, and the sensors make up a complete picture of what is happening inside his visual analyzers. Special video programs allow you to send “correct” impulses to the brain and restore visual function at the subtlest (nervous) level.
- Apparatus "Synoptophore". This is an ophthalmic apparatus 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. Exercises on such a device train the eye muscles well. The child receives only parts of the image for each eye; attempts to combine them will be an effective correction for strabismus at one of the final stages of treatment.
- Ambliopanorama. This is a simulator with which you can begin to treat strabismus even in infants, because no effort on the part of the child is required. It is enough for him to look at the disc with blinding fields, wearing glasses with corrective lenses prescribed by the doctor, and try to examine objects. From time to time, the so-called retinal flare will occur. The trainer is very useful in the initial stage of strabismus treatment.
- The device "Trickle". This apparatus can very well help in the stage of training the oculomotor muscles and learning control over accommodation.The child will have to track with his eyes the approaching and receding figures, as well as make various movements with his eyes, since the points of light will flash in different directions of the field.
Apparatus treatment can be carried out both in a polyclinic and at home.
Usually a child is prescribed 3-4 courses at the initial stage, each of which includes at least 10 lessons. At the subsequent stages of treatment of strabismus, the duration and expediency of courses of apparatus treatment are determined exclusively by the doctor.
In connection with the emergence of a large number of private clinics and ophthalmological offices that offer paid hardware treatment - however, at the same time, the child is practically not examined, there are many negative reviews about such treatment. Parents argue that the procedures and training did not help the child.
This proves once again that any therapy should be prescribed by the attending physician. If he sees that the degree and nature of the lesion of the eye are such that hardware treatment is not enough here, he will definitely choose other methods for the child.
Eye gymnastics and classes
In some cases, with a slight 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 during the daytime, in daylight. Exercise is best done with glasses. Gymnastics should become daily, it is advisable to repeat the set of exercises with the child 2-4 times a day. The duration of each lesson is 15 to 20 minutes.
It is impossible to explain the essence of gymnastics to the smallest patients, and therefore it is recommended to just play with them - moving balls, bright cubes and other objects in front of them, tying one or the other eye.
For older children, it is advisable to use occlusion or an eye patch only if the strabismus is monocular. Children over 3 years old are encouraged to look for differences in pictures every day. Today, there are many such tasks on the Internet that parents can print on a color printer and offer to their child. For a start, it is recommended to take simple pictures with a few differences, but gradually the complexity of the puzzle should increase.
It is useful for kindergarten children with strabismus to decide every day maze puzzles... These are drawings. The kid is invited to take a pencil and lead the bunny to the carrot, the dog to the booth or the pirate to the ship. Such pictures can also be downloaded from the Internet and printed.
Exercising the eyes in the treatment of strabismus is very useful at the stage of stereoscopic vision formation. To do this, you can use ready-made programs compiled by Professor Shvedov or a doctor of psychology, an unconventional healer Norbekov. However, in no case should you choose a technique yourself. Improperly selected and used exercises can lead to vision loss.
Any gymnastics should be discussed with your doctor.
Many exercises that are suitable for a particular child, the ophthalmologist will show and teach them to do.
Surgical method
It is necessary to resort to the help of surgeons when conservative treatment has not been successful, when there is a need to restore the normal position of the eye, at least cosmetically, as well as at the stage of treatment, when there is a need to strengthen the muscles responsible for eye movements.
There are not so many options for intervention for strabismus: by operation, 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 systems. This is a bloodless and gentle method that allows you to leave the hospital room the next day and go home, in a familiar and understandable environment for the child.
For small children, surgery is performed under general anesthesia.
For older boys and girls - under local anesthesia. The most effective surgical intervention is considered 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). For almost the same time, the ban on practicing other sports applies. After the operation, you should not rub your eyes with your hands for several weeks, wash your face with water, the quality and purity of which is in great doubt.
After such an operation, the child can only return to the children's team (to kindergarten or school) 2-3 weeks after discharge. During the crescent, you will have to carefully follow all the prescriptions and prescriptions of the doctor, including the daily instillation of drops with antibiotics or other anti-inflammatory eye agents into the eyes.
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 is to live is well lit, that there is enough artificial lighting in it for the evening.
- Do not hang toys too close to your baby's face in a crib or stroller. The distance to the eyes should be at least 40-50 cm. Another big parental mistake, which often leads to the development of strabismus, is a single bright toy suspended in front of the child in the center. 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 eye muscles.
- Small toys are not suitable for babies, not only because they can choke on them. He will definitely try to consider them, and for this he will have to keep his eyes on the bridge of his nose, bend low over the toy or bring it too close to his face. For the eyes, such children's experiments are in no way useful.
- Learning, writing and reading too early (up to 4 years of age) can also lead to the development of strabismus, since the unformed visual apparatus gets very tired during activities that require maximum concentration and concentration.
- If a child is sick with the flu, scarlet fever or other infection, do not keep him busy with reading, drawing or cross stitching. During such diseases, the risk of complications from various organs and systems of the human body increases.
- A child's diet must contain foods and vitamins necessary for the formation of normal vision. To do this, you should choose foods and vitamin complexes that contain a large amount of vitamins A, B1 and B2, as well as PP, C, and E.
- You should pay close attention to the fears and experiences of the little man, since the psychological factor is far from the last 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 scary factors. Avoid too sudden movements near a small child.
- Children should strictly limit the time they spend in front of the computer and TV, and also make sure that they do not use gadgets uncontrollably - especially when traveling by bus or in a car.
- If there is a genetic predisposition to strabismus, the child should be shown more often to the ophthalmologist, visiting the doctor's office not only during routine 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 on strabismus, see the next issue of Dr. Komarovsky's program.
