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False strabismus. Strabismus in children: how to identify and correct (hardware, surgical and home treatment)

2-3% of newborns are born with strabismus. In the first years of life, as a complication of another eye pathology, strabismus appears in another 7-10% of children. And the existing myths about strabismus are so widespread that they prevent us from taking the necessary measures in a timely manner and completely rehabilitating the child. We asked Igor Aznauryan, Doctor of Medical Sciences, Academician of the Academy of Medical Sciences of the Russian Federation, pediatric eye surgeon, and head of the Yasny Vzor children's eye clinics, to debunk the myths about strabismus.

Myth one.

Up to 3-4 months, infants may have the impression of slanting due to structural features of the facial skull, for example, due to a skin fold at the corner of the eye or a wide bridge of the nose. If there are no oculomotor disturbances, this condition is called false strabismus, and you don't need to do anything. A pediatric ophthalmologist must carry out a differentiated diagnosis between false and true strabismus using special research methods.

INCLUDE: Strabismus can be congenital or early acquired and develops into a serious functional and cosmetic pathology if parents do not begin treatment for the child in a timely manner.

Myth two.

The squint will go away on its own.

REFERENCE: We distinguish more than 25 types of strabismus. For each type of strabismus, treatment must be individualized and comprehensive. This applies to both surgery and therapy. You cannot treat everyone with the same brush.
Here are some characteristics of the manifestations of disorders associated with various types of strabismus:

Divergent - to the temple.

A child with strabismus should be under our dynamic supervision. It must be conducted correctly, thereby ensuring the correct development of the visual system.

Myth three.

symmetrical gaze position;

timely initiation of treatment;

Myth four. Myths about operations for strabismus.

Mathematical modeling of the operation - individual calculation of correction of strabismus, MD. I.E.Aznauryan.

Myths about operations.

Surgeries to correct strabismus are traumatic and require a long recovery.

This is wrong. We perform operations while preserving the structures of the eye. We don't cut, we don't disconnect. We abandoned scalpels and scissors in favor of radio waves. Therefore, a long period of rehabilitation is not required; patients have the opportunity to be at home the very next day after the operation, and after three to four days return to their usual lifestyle - attending kindergarten or school. At the same time, there is no terrible swelling in the eyes and rapid healing is ensured. The rehabilitation period is greatly reduced in time - by 10 times! The child feels virtually no discomfort after such an operation.

There is no need to have surgery before school.

The myth about surgery for strabismus.

The operation will fix everything.

INTERRUPTION: Does strabismus have an age? No age. If strabismus is not cured in childhood, it can be eliminated in adult life, thereby significantly improving its quality.

Recommendations from a pediatric ophthalmologist, or “Note to Parents”:

2-3% of newborns are born with strabismus. In the first years of life, as a complication of another eye pathology, strabismus appears in another 7-10% of children. And the existing myths about strabismus are so widespread that they prevent us from taking the necessary measures in a timely manner and completely rehabilitating the child. We asked Igor Aznauryan, Doctor of Medical Sciences, Academician of the Academy of Medical Sciences of the Russian Federation, pediatric eye surgeon, head of the Yasny Vzor children's eye clinics, to debunk the myths about strabismus.

Myth one

All newborns mow. False or true strabismus.

Up to 3-4 months, infants may have the impression of slanting due to structural features of the facial skull, for example, due to a skin fold at the corner of the eye or a wide bridge of the nose. If there are no oculomotor abnormalities, this condition is called false strabismus, and nothing needs to be done. A pediatric ophthalmologist must carry out a differentiated diagnosis between false and true strabismus using special research methods.

INSTRUCTION: Strabismus can be congenital or early acquired and develops into a serious functional and cosmetic pathology if parents do not begin treatment for the child in a timely manner.

Myth two

The squint will go away on its own.

Strabismus will not go away on its own. To debunk the myth, we need to understand what strabismus is.
Firstly, these are serious functional disorders of the child’s entire visual system. A child with strabismus cannot merge images from both eyes into a single image - all objects appear double. With strabismus, a child may not perceive spatial volume, i.e. 3D format, he sees the world as flat. And secondly, this is a cosmetic defect in which the eyes look in different directions and cannot fix their gaze on an object, which, by the way, leads to decreased vision.
REFERENCE: We distinguish more than 25 types of strabismus. For each type of strabismus, treatment must be individualized and comprehensive. This applies to both surgery and therapy. You cannot treat everyone with the same brush.

Here are some characteristics of the manifestations of disorders associated with various types of strabismus:

Concomitant strabismus, in which the synchronization of the work of the extraocular muscles is disrupted, is most often found in young children and is combined with optical disturbances.
Paralytic strabismus, in which the movement of the eyeball is limited, occurs due to neurological or muscular disorders.
Convergent strabismus is when the eyes converge toward the nose.
Divergent - to the temple.
There are also deviations vertically.

These disturbances in the oculomotor system are very serious and cannot go away on their own. Our task is to determine the type of strabismus and the characteristics of its manifestation in a child, and prescribe appropriate treatment taking into account these characteristics and taking into account the specific mechanism of development of this or that type of strabismus.

A child with strabismus should be under our dynamic supervision. It must be conducted correctly, thereby ensuring the correct development of the visual system.

Myth three

Strabismus needs to be treated when the child grows up.

This is a fundamentally wrong point of view, which can lead to irreversible consequences and serious psychological trauma in older age! A child’s visual system is formed before the age of 3-4 years. We begin treatment before this period ends. This is the only way to fully restore a child to school and ensure high functional results. Here are three main criteria for complete rehabilitation:

high visual acuity without glasses;
symmetrical gaze position;
stereoscopic nature of visual perception.

According to statistics, we achieve this result in 98% of cases under the following conditions:

timely initiation of treatment;
individually selected techniques depending on the type of strabismus;
when indicated, timely surgery;
correct choice of surgical technology depending on the type of strabismus;
an individual plan for the management of the child, depending on the characteristics of each specific case.

Treatment must be comprehensive; one cannot limit oneself to glasses or occlusions; it is impossible to fully cure strabismus using these methods. If indicated, therapeutic techniques are combined with surgical treatment. This depends on the type of strabismus and the preservation of visual functions.

Myth four

Surgeries are dangerous and scary. The operation will not help, the squint will return.

If surgery is indicated, then it is very important for us to choose the right surgical technology. Today we have achieved such surgery, very precise and low-traumatic.
With great success, we use in surgery methods of mathematical modeling of operations and radio wave technologies, which provide a symmetrical gaze position for various types of strabismus, including those with small and unstable angles, and restore the mobility of the eyeball in paralytic strabismus. This is a unique way to radically and effectively help the patient.
The use of such methods requires highly qualified medical personnel and modern technologies.

No need to have surgery before school

This is an outdated opinion. As we have already said, our tactics showed complete justification for early treatment. It must begin during the period of formation and development of the basic human systems, and the main stages of rehabilitation must be completed before three or four years. If you do not ensure an absolutely symmetrical position of the eyes in a timely manner, then there will be no correct picture before the eyes, and the brain subsequently, after 3-4 years, will no longer be able to restructure itself and begin to correctly perceive information from the eyes. It is important to ensure the correct supply of information to the brain at the time of the onset of the disease and not waste time. Otherwise, the entire architecture of visual perception will be built on a crooked foundation, which is extremely difficult to change at an older age. In this sense, the early surgery we perform ensures a symmetrical position of the eyes, thereby creating optimal conditions for the development of vision and complete rehabilitation.

The operation will fix everything

Surgery is one of the important stages of complex treatment, which allows us to position the eyes symmetrically and make the gaze even. But not the only one - surgery cannot provide high vision. To restore lost visual functions and complete rehabilitation, the child must be treated with therapeutic methods. The visual system is a complex mechanism. And if there is an eye pathology, its solution needs to be approached only in a comprehensive manner. Then success will be guaranteed.
INTERRUPTION: Does strabismus have an age? No age. If strabismus is not cured in childhood, it can be eliminated in adult life, thereby significantly improving its quality.

Recommendations from a pediatric ophthalmologist or “Note to parents”

Only a pediatric ophthalmologist should observe and treat children’s eye pathology and only in a specialized children’s institution;
contact between the patient and the doctor must be constant: only constant dynamic observation allows timely prescription of the treatment that is needed at the moment (be it correctly selected glasses or therapeutic procedures);
an integrated approach to treatment: the treatment of childhood eye pathology cannot be approached one-sidedly - treated only therapeutically or only surgically. In each specific case, it is necessary to accurately verify the methods used, and perform each operation (in particular, for strabismus, we use more than 15 protocols) depending on the specific type of disease. Do not use the common comb called “tighten muscles.” Only comprehensive and only staged treatment;
treatment in early childhood. All therapeutic methods used are more effective in early childhood, while the visual system is forming and developing
start treatment on time! Timely and correct treatment is the key to your child’s health and success!

Strabismus in adults is characterized by deviation of the axis of one or two eyes from the common point of fixation. Which subsequently leads to a lack of crossing of the visual axis on one object. This pathology is also commonly called. There is an opinion that this disease is purely childhood, but this is wrong, since it also occurs in adults, but much less frequently.

Characteristics of the disease

Cross-eyed people suffer not only from an external defect, but also from the loss of binocular vision, which eliminates the possibility of correctly determining the location of an object in space, and significantly affects the quality of life. What is strabismus or its other name, heterotropia, in adults needs to be understood.

With normal vision, the eyes are symmetrical, so the image of objects is fixed in the central part of each eye. After this, the image is transmitted to the human brain separately from each organ of vision, where it merges into a single binocular image. With the development of pathology, unification into a single whole does not occur, therefore, the nervous system, in order to protect the person from splitting, turns off the picture from the damaged eye, thereby giving impetus to the development of amblyopia (reduced functioning of the damaged eye). The mobility of the organs of vision is determined by the muscles that are located in them and is controlled by the brain, which allows you to focus your gaze in one direction. As a result of the lack of joint work of muscles, strabismus develops in adults. In order to find out how it is in an adult, you need to understand its types.

Classification of types of pathology

Strabismus is divided into several types according to the factors contributing to the appearance and development of the disease.

Varieties depending on the period of occurrence of the pathology:

congenital nature of strabismus;
acquired nature of the pathology.

Varieties depending on periods of manifestation:

temporary lack of symmetry of the organs of vision;
constant lack of symmetry of the eyes.

Varieties of eye involvement in the process:

unilateral (squints one eye);
alternating (the manifestation of pathology on both organs of vision alternately).

Important! There cannot be simultaneous strabismus of two eyes; one of them will always look in the right direction, but there is an imaginary form of pathology, in which, based on external signs, it seems that both eyes are damaged. This phenomenon is due to the personal characteristics of the structure of the human visual organ.

Varieties depending on the severity of the disease:

the secretive nature of the disease (this type can only be identified through a special examination);
compensated nature of the pathology (can be detected using tests);
subcompensated nature of strabismus (implies partial control over the squinting organ of vision);
decompensated nature of the pathology (the damaged eye cannot be controlled).

Varieties depending on the cause:

concomitant strabismus (includes convergent and varieties);
paralytic non-conjugate strabismus (observed when a pair of cranial nerves or one of them is damaged).

Varieties depending on the direction of eye displacement:

converging form of the disease (the damaged organ of vision squints towards the bridge of the nose);
divergent form of pathology (the damaged eye looks towards the temple).

The main causes of the disease

Factors contributing to the onset of the disease may differ depending on the etiology of the pathology. The concomitant form of the disease, in which strabismus appears alternately on both organs of vision, is caused by disturbances of accommodation. The causes of these deviations may be concomitant pathologies of the visual organs:

Paralytic non-conjugate strabismus occurs as a result of dysfunction of one or more muscles of the organ of vision. Paralysis of the superior oblique muscle of the eye is characterized by the superior direction of the defect, and paralysis of the inferior oblique muscle of the eye is characterized by the inferior direction. The reasons for the development of this type of pathology are:

acquired injuries to the muscles or orbit of the eye;
diseases of the human brain (stroke, meningitis, encephalitis, various types of tumors);
dysfunction of the optic nerves as a result of the progression of acute infectious diseases of the ENT organs, otitis media, sinusitis, etc.

In addition, there are a number of common reasons that contribute to the development of pathology:

severe stress or fear;
psychological trauma;
acute inflammatory processes in the body;
diseases of the central nervous system;
traumatic brain injury;
acute infectious eye diseases.

Symptoms of the disease

In most cases, identifying the presence of pathology is not difficult based on external signs. However, with different symptoms, the symptoms can also be different; with the friendly nature of the pathology, the eye tilts to the side, and there is also no fixation of the organ of vision on a specific object.

Signs of concomitant strabismus:

Displacement of one of the eyes in any direction.
Alternating displacement of the right or left organ of vision.
The same angle of displacement of both eyes.
Excessive eye movement in any direction.
Lack of three-dimensional and comparative images.
Decrease in the quality of vision of a squinting eye.
Various types and values of refraction of the organ of vision.

The paralytic nature of the disease is caused by a deviation in one eye, since the oblique muscles of the eye cannot perform their function.

Signs of paralytic strabismus:

Limited eye mobility.
Different deflection angles.
Lack of three-dimensional vision.
Duality of the image.
Dizziness.
Involuntary turning of the head towards the damaged muscle.
Squinting.

Important! Double vision with this pathology occurs specifically in an adult, since the child’s body is able to compensate for this symptom.

Diagnosis of pathology

To study the structure of the eyes and their pathologies, there is a branch of medicine - ophthalmology. Strabismus is one of the areas of focus in this section. To prescribe the necessary course of treatment, the ophthalmologist conducts the necessary examinations of the patient to establish a diagnosis and type of disease.

First of all, a person is interviewed to identify the timing of the onset of the pathology and its possible relationship with previous injuries or concomitant diseases. Then a visual examination of the patient is carried out, during which the symmetry of the face and eyeballs is assessed, as well as the location of the palpebral fissures and the tilt of the head.

To determine the degree of visual acuity, the doctor performs a test with closing the eye, in which the organ of vision deviates to the side with strabismus. In addition, additional diagnostic methods are carried out.

Methods for diagnosing strabismus:

Synoptophore survey. This method allows you to determine the ability of the eyes to merge an image into a single whole.
Computer refractometry. With the help of which clinical refraction is determined.
Biomicroscopy and ophthalmoscopy. These methods allow you to assess the condition of the anterior layer of the retina, as well as examine the fundus.
Passing the test system. With its help, the presence or absence of three-dimensional vision is confirmed.

If the paralytic nature of the disease is established, an additional consultation with a neurologist is prescribed, and neurological examinations of the patient are carried out using electromyography, electroneurography, and EEG.

After carrying out all the necessary diagnostic methods, the doctor announces the diagnosis and prescribes the necessary treatment.

Important! Strabismus cannot go away on its own; it is subject to mandatory therapy, so the sooner it is started, the faster you can achieve the desired result.

Complex treatment of pathology

Correction of strabismus in adults includes complex therapy methods that are aimed at achieving positive treatment results. Only an experienced doctor can determine how to correct strabismus after an established diagnosis.

Main goals of treatment:

align the visual axes of the eyes;
normalize the synchronicity of their work;
restore visual acuity.

Therapeutic treatment methods

Vision correction using special glasses or contact lenses. With this treatment, the doctor selects the optimal prismatic glasses or lenses that help relieve muscle tension and restore the quality of vision of the damaged organ of vision.
Orthoptic treatment method. This method involves applying a special bandage to the healthy eye to stimulate the squinting eye. Basically, the course of such treatment is about 3 weeks.
Hardware method. Its action is aimed, first of all, at suppressing the active work of the healthy eye and stimulating the squinting organ of vision. With this method, various corrective devices are used: massage glasses, complex computer programs, ultrasound therapy, infrared laser exposure, electric current stimulation, magnetic therapy.

Surgical treatment of strabismus

Often, severe strabismus can only be corrected through surgery, however, it is worth remembering that this method of treatment eliminates, first of all, a cosmetic defect in a person, but to restore visual acuity it is necessary to use complex therapy methods. This procedure is performed using anesthesia and lasts 1 hour.

The operation can be aimed at strengthening the muscle function of the eye (for this it is shortened) or weakening the function of the muscle. The purpose of the operation is determined by an experienced specialist based on the reasons contributing to the development of the disease. If necessary, it is possible to perform the procedure under local anesthesia.

The person can go home the same day after the operation. The recovery period generally lasts for 1 week, then hardware therapy is prescribed to restore visual acuity. After this, a person needs to begin to get used to living with new sensations and perceptions of the image.

Often strabismus is accompanied by severe psychological trauma, especially a cross-eyed girl can develop a huge inferiority complex, so it would be worth visiting a psychologist who will help you gain confidence in your new quality. And also a favorable mood of the patient helps to get rid of the pathology as quickly as possible.

Preventive measures

In order to prevent the development of strabismus, it is necessary to regularly see an ophthalmologist. In addition, prevention of strabismus consists of following simple rules that do not require any special effort.

Basic rules:

Be attentive and careful about the health of your eyes and if you have any doubts or assumptions, promptly contact a specialist.
Agree with your doctor on the optimal mode of working at the computer, based on your personal capabilities and characteristics.
Wear sunglasses to avoid excessive exposure to sunlight and to prevent injury.
Avoid reading while driving.
Balance your diet, giving preference to healthy foods.
Carry out regular eye exercises after consultation with your doctor.
Arrange for proper lighting while working.

Important! Treatment of the pathology can last for several years, and prevention will need to be carried out throughout life; only these measures can completely eliminate relapses of the disease.

If you live with strabismus, you should not aggravate this problem; it will not be solved without an experienced doctor. Further connivance can lead to irreversible consequences and lead to complete loss of vision.

Strabismus or strabismus is a violation of the strict parallelism of the visual axes. With this disease, the joint work of the eyes is disrupted and coordinated fixation of the gaze on a visual object is significantly difficult. The main symptom is the asymmetrical nature of the location of the corneas of the eye in relation to the corners and, accordingly, the edges of the eyelids. Acquired in adulthood, strabismus most often causes characteristic double vision - the brain receives two images, but cannot combine them into one. This is much less common in children: their brain adapts faster, suppressing the image from the squinting eye. The long-term result of this is that the eye eventually becomes amblyopic. Over time, he will see much worse than the healthy eye. It must be said that treatment of strabismus is effective in childhood. During this period, the visual system had not yet fully developed. At the same time, it has colossal reserves.

We look at surrounding objects simultaneously with both eyes, and our brain then combines these two images into a single image. It should be noted that such vision is volumetric or binocular. It is the coordinated and joint work of the eye muscles that is one of the main conditions for ensuring three-dimensional vision.

In humans, there are six muscles in each eye. Working together, they provide control over the collective movement of apples. In a healthy person, they should make unidirectional movements, respectively, when the direction of gaze changes.

Strabismus is a condition in which there is a lack of coordination in the movement of the eyes. It is disrupted as a result of improper functioning of the above muscles. In simple terms, there is a complete or partial deviation of a particular eye from a single point of visual fixation. That is why slanted eyes “look” in opposite directions: one at a right angle, the second in the other direction. Strabismus is also a cause of three-dimensional vision abnormalities.

Medicine distinguishes two categories of strabismus: the first is friendly, the second is paralytic.

Concomitant strabismus is most often born in early childhood. It can be caused by illnesses and characteristic injuries of the human brain. It may appear after a strong fright. It often occurs after suffering complex illnesses as a result of infections and some other injuries. Often the cause of strabismus can be farsightedness or nearsightedness. In the latter case, the eye muscles receive a strong stimulus for precise focusing on a certain point in question.

In simple terms, we can say for sure that if a small child has farsightedness, then a converging type of strabismus develops; If the baby is myopic, divergent strabismus most likely develops.

Monolateral strabismus is considered to be an ailment in which one eye goes to the side, alternating - when both eyes go to the side alternately. Strabismus is also distinguished by the direction of deviation of the abnormal eye.

There are deviations towards the nose, temple and more complex displacements.

With concomitant strabismus, the mobility of the apples is completely present. This means that when the patient looks at an object with the abnormal eye, his other apple will move as much as the abnormal eye moves.

With the friendly type of strabismus, there is no doubling or other similar distortions at all. Simply because the image from the diseased eye is ignored by the brain. In concomitant strabismus, the squinting eye is not used by the brain. This is the most dangerous, because gradually the clarity of vision decreases, then partial or complete amblyopia develops.

The opposite situation also occurs - with poor vision in one eye, there is no potential to unite the visual axes, and the poorly seeing eye simply “moves out”. In the latter case, strabismus does not seem to be the cause of amblyopia, but its direct consequence - it is necessary to correct it too.

Multiple features can indicate strabismus:

- atypical facial tilt;
- atypical face turn;
- strong squinting;
- double vision.

The latter feature is characteristic when strabismus develops in adulthood.

Strabismus treatment can be carried out only after a complete ophthalmological analysis. It includes identifying the refraction of vision, carrying out correction, accurately determining the angle of the specified strabismus, and passing a test to determine the ability of three-dimensional vision. The list of procedures is always individual.

Typically, surgery to correct strabismus lasts 30 to 40 minutes.

The choice of treatment is directly dependent on several factors. Among them:

— person’s age;
- the root cause that caused strabismus;
— degree of displacement;
- presence or absence of amblyopia.

Treatment of strabismus simply needs to begin as quickly as possible. Otherwise, irreversible changes in the eye may develop. The main objectives of strabismus treatment are to restore three-dimensional vision, also among the goals are to increase the visual acuity of the abnormal eye, and visually achieve the correct location of the eyeballs.

Treatment of strabismus often begins with a refractive correction procedure - hypermetropia, myopia, and astigmatism are eliminated.

At an early stage, optical correction seems to be the main method of correcting the disease. Strabismus can be treated in several ways. The ultimate goal of pleoptic treatment is to restore the refraction of a squinting eye. The following methods are used:

— stimulation of the central and other areas of the retina with electricity, light, laser;
- using computer programs to develop the ability to merge images;
— the healthier eye is isolated from the visual process, thereby the amblyopic eye begins to work more.

It takes about two years to treat strabismus using the methods listed above. If after treatment the strabismus is not eliminated, surgery is performed.

It should be noted that correcting strabismus surgically is most effective in preschool age.

The purpose of surgery is to weaken the function of a strong muscle. It is in this direction that the eye has the strongest deviation. Strabismus is corrected by moving the muscle attachment points. Recession refers to just such manipulations.

It is important to treat strabismus already in the postoperative period. After the operation, a so-called orthoptodiplopic correction is performed. It restores three-dimensional vision and strengthens it in the future. If children's strabismus is operated on in adulthood, then only a cosmetic effect can be obtained. It is impossible to restore three-dimensional vision in this case due to the irreversible transformations that have occurred in the retina.

It should be noted that only early and timely diagnosis can most effectively combat amblyopia and strabismus.

Paralytic strabismus may appear after injury. Most often it appears after paralysis of one of the muscles. There are also congenital and acquired paralytic strabismus.

Among its reasons:

- depression and further damage to nerve endings;
- damage to one or all extraocular muscles;
- damage to the patient’s brain due to infections or injuries.

Paralytic strabismus has a characteristic feature. It consists in the full or partial ability to move the oblique eye in the direction of the affected muscle. When looking in the indicated direction, strong double vision is created.

Stimulation of the affected muscles occurs using electrophoresis, reflexology, electrical stimulation and other non-drug treatments.

Restoration of symmetry is also carried out using surgical operations on the extraocular muscles. Strabismus is corrected in the postoperative period with the help of muscle exercises. In case of uncompensated diplopia, the patient is prescribed special glasses - prismatic ones. They allow you to shift the visual axis in the required direction.

It is believed that strabismus is only an aesthetic complication, but in reality everything is somewhat more complicated. What are the dangers of this disease? Firstly, a person with strabismus falsely assesses the position of things in space, which can be dangerous for obvious reasons. Secondly, the biggest danger is the complete loss of vision of the squinting eye.

After all, over time, the brain stops perceiving images received by a squinting eye. In this case, amblyopia appears.

A child's squinting eyes are a very good reason to immediately go to an ophthalmologist. Although some parents are still convinced that a child’s strabismus is normal: as he grows up, it will go away. Of course, the eyes of young children can squint in the first months of life - due to the nervous, muscular and visual systems not being fully formed. But it is better to go overboard with medical examinations in childhood than to eliminate the consequences of this disease in adolescence or adulthood. This is why routine inspections must be strictly observed and not postponed. The latter is especially relevant for all children at risk - with poor heredity, prematurity, pathologies of the nervous and muscular systems, eye injuries, congenital refractive errors.

Another common misconception is that children squint because of nerves. Of course, the causes of the disease may be disorders of the nervous system, but a direct connection between them and the appearance of strabismus has not yet been proven. Strabismus occurs much more often in children with eye refractive error.

The earlier strabismus appears, the greater the chance of complications. Almost any type of strabismus can be treated today. Young children can completely lose their vision within a few months of life. That is why it is important to identify strabismus as soon as possible and begin comprehensive treatment.

Some are convinced that squinting with one eye is definitely much better than squinting with both. This is a big misconception. After all, functional vision loss occurs precisely when one eye does not function.

In the case when the eyes squint with alternating indicators, we can say for sure that they are both, to one degree or another, used in the visual process.

It is impossible to cope with strabismus, which is born due to pathology of the eye muscles, without surgical intervention. It should be noted that there is no laser correction for strabismus. As noted above, to eliminate this disease, all manipulations are performed only on the extraocular muscles.

Imaginary strabismus may arise due to the individual structural features of the apple itself. It appears when there is a pronounced angle between the optical axis and the visual line itself. If it is relatively small, then the position of the eyes will be parallel. But with a significant divergence of the axes, the center of the cornea can be removed in a certain direction. This is why it may seem like there is strabismus. However, in this case, three-dimensional vision is completely preserved.

False strabismus is often noticeable with asymmetrical facial features. Imaginary strabismus does not need correction.

There are four incorrect points of view on childhood strabismus that can interfere with the child’s healing: “it will go away on its own”; “we still won’t cure”; “squint is better than surgery”; and also “glasses for squint are forever.”

What is false strabismus?

As a rule, Only “false” infantile strabismus goes away on its own, associated with the immaturity of the nervous system, which lasts for the first six months. Periodic deviation of the eye in children under 6 months of age is normal. After the 7th month, you can no longer expect it to “go away on its own.” And this early form should be monitored by a doctor: it may turn out to be true and not false.
There is also the optical illusion of squinting. If the baby has a wide bridge of the nose and slanted eyelids, at first it seems that he is squinting a lot. By the age of 3, the nose enlarges, the palpebral fissure becomes larger, and this optical illusion passes. Usually such cases are repeated in the family with a successful outcome. But seeing a doctor still won't hurt.

What is true childhood strabismus?

There are more than 20 types of strabismus. Each has its own option and duration of treatment.
True strabismus usually occurs between 3 and 5 years of age; convergent occurs more often than divergent. The most common cause of the disease is farsightedness and astigmatism, less often - congenital or early myopia.
We already know that farsightedness of +3 diopters is normal until the age of six. But when it is higher than three diopters, the child strains his eyes so that the contours of objects do not blur. This tension is the main prerequisite for childhood convergent strabismus (one eye squints towards the nose).
Generally speaking, binocular connections, like other visual functions, mature slowly and are therefore easily impaired in childhood. Under certain conditions, strabismus in a child can be triggered by high temperature, physical or mental trauma.

What complications threaten strabismus in a child?

Unfortunately, strabismus creates problems not only in aesthetic and psychological terms. It is fraught with decreased vision.
To avoid chaos, the visual system blocks the transmission of images to the brain that are perceived by the squinting eye. This, in turn, leads to an even greater deviation of the eye (the brain seems to take it out of the game). In the squinting eye, visual acuity gradually decreases, that is, amblyopia develops, the so-called blindness from disuse. This is a condition in which a completely healthy anatomically eye is not able to perceive an image, since a connection has not been formed between it and the cerebral cortex.
In addition, with strabismus, stereoscopic, that is, three-dimensional vision is impossible, which impairs orientation in space. So, it is necessary to treat strabismus, and in the most decisive way.

How is childhood strabismus treated?

It is possible to cure strabismus. Sometimes this takes about 6 months, and in other cases up to 3-4 years or more.
The earlier treatment is started, the greater the effect, since the visual system of babies is in constant development and is very mobile. By school age, maximum rehabilitation must be achieved. And vice versa: the older the child, the more difficult it is to achieve results even with surgical intervention, and complete recovery becomes problematic.
Strabismus can be successfully treated non-surgically. 97% of children get rid of it forever and without a trace. Treatment is usually complex. If there is farsightedness or nearsightedness, the child is prescribed glasses. Sometimes glasses completely correct children's strabismus and are no longer needed. Please note that in addition to glasses, hardware methods are always used. They are aimed at curing amblyopia (if present) and restoring stereoscopic vision: the child is taught to combine information from the right and left eyes into a single visual image.
If there are indications for surgery, it is better not to postpone it. Moreover, modern methods of eye surgery are gentle: the scalpel has been replaced by radio waves and lasers. If earlier the eye muscle was cut off from its attachment point and reattached to another place, often requiring several operations, now everything is different. After surgery, the same hardware treatment is required that complements wearing glasses.

What complications are possible after strabismus surgery?

Most often, this is hypercorrection of a strabismus defect - when the eye deviates in the opposite direction. Typically, this complication occurs in adolescence if the operation was performed on a child older than 4-5 years. Here is another proof that it is better to solve the problem as early as possible.

The ultimate goal in the treatment of childhood strabismus is high vision without glasses with symmetrical eye position and three-dimensional stereoscopic vision. And it is achievable.

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At the first meeting with a patient who complains of temporary or permanent deviation of the eyeball, the doctor must conduct a differential diagnosis of the following types of strabismus: true, hidden, imaginary.

Imaginary strabismus- these are anatomical and physiological features of the organ of vision observed in healthy individuals.

As is known, the optical axis passes through the center of the cornea and does not coincide with the visual axis, which connects the central fovea of the retina with the object. An angle γ (gamma) is formed between them - positive or negative. Normally it is 1-4°. At a larger angle, one gets the impression of strabismus. This type of strabismus can be observed with a wide epicanthus, facial asymmetry, etc.

A study of binocular vision helps to make a correct diagnosis: with true strabismus it is absent, with imaginary strabismus it is detected.

Hidden strabismus. The position of the eyes at which binocular vision occurs depends on the normal tone of all 12 extrinsic muscles of both eyes. Ideal muscle balance is called orthophoria. It creates optimal conditions for binocular image fusion.

If, during orthophoria, one eye is closed or a prism is placed, then the eyeballs maintain a symmetrical position.

Most common heterophoria , in which there is a different force of action of the oculomotor muscles. The doctor's palm closure test is used to detect hidden strabismus. The patient fixates with one eye an object, for example, the end of a pen. At this time, the doctor closes and opens the patient’s second eye. With strabismus, you can see how the closed eye changes its position as a result of a violation of muscle balance, which indicates heterophoria, or hidden strabismus. It is called hidden because under normal conditions of binocular vision the eyeballs are positioned correctly relative to each other. This is achieved only with the help of correct fusional (from the French fusuon - merging) movements. When binocular vision is impaired, one eye begins to deviate.

In order to distinguish heterophoria from concomitant strabismus, it is necessary to check the nature of vision: with heterophoria it is binocular.

The most accurate way to determine heterophoria is by Graefe’s method or using a Maddox stick (Fig. 1). The patient is corrected for ametropia and asked to look from a distance of 30-35 cm at a stick, in the center of which there is a dark spot. A prism with a power of 10-12 diopters is placed in front of one eye with the base down or up. The prism creates two images of the black spot: one above, the other below. When muscle balance is normal, the spots will be placed one above the other on the same vertical line. With exophoria or esophoria, the spots will lie relative to each other on the right or left.

Visual work, especially at close range, requires increased neuromuscular tension, which can cause headaches and nausea. This condition is called decompensated heteriphoria. In the fight against asthenopia in this case, visual hygiene, daily routine, and general strengthening measures are important. In severe cases, glasses with prisms are prescribed or surgery is performed on the extraocular muscles.