Runny nose

What causes strabismus in babies? Treatment methods for strabismus in children of different ages

U infants The eyes often squint quite 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 visual analyzers is actively developing 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” 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, 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 eye muscles, 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 that parents six month old baby who crosses his eyes, you 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 pathological disorders. 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, fright, psychological trauma, as well as poisoning 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 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 fact there may not be any pathology, just anatomical features 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 about headache, frequent fatigue. Vision with strabismus does not allow you to see the picture clearly; it may be blurry or double.

Children with strabismus often experience increased sensitivity to the light.

Kinds

Strabismus can be congenital or acquired. ABOUT congenital pathology doctors say when obvious signs illnesses 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 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 strive to different sides 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 the second “turns it off” as unnecessary.

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- up to a year or 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 in early age. However, myopia and farsightedness will not be the main and only reasons for the development of these types of strabismus. Often chosen for treatment surgical methods.

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. Constant divergence is almost always the cause congenital anomalies development of visual analyzers and requires serious treatment.

Hidden

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

Imaginary

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

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

Treatment

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

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

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

The treatment schedule is prescribed strictly individually, taking into account all the circumstances and reasons that led to the development of strabismus. ABOUT however, every treatment plan includes key points and the 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 they use special devices and devices, as well as corrective computer programs.
Third stage. It consists of restoring the normal muscular balance between the organs of vision. At this stage it may be prescribed surgical treatment, if the muscle damage is quite 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 to the fullest restore the child's stereoscopic vision. At this stage, as a rule, the eyes are already symmetrical and occupy 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 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, starting from the first, aimed at improving vision, and ending with the last - development 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 organs of vision. 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 development 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 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 for initial stage treatment of strabismus.
Apparatus "Rucheek". This device can help very well during the training phase oculomotor muscles and learning to control accommodation. The child will have to track approaching and receding figures with his eyes, as well as make various movements with his eyes, since the light points will flash in the most different directions fields.

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

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

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

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

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

Any gymnastics should be discussed with your doctor.

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

Surgical method

The help of surgeons has to be resorted to when conservative treatment was not successful when there is a need to restore the normal position of the eye, at least cosmetically, as well as 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 installations. 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.

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.

At 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.

Strabismus in newborns is caused physiologically and in most cases goes away by 3-4 months. If after this period there is no synchronization of eye movements, parents should consult a doctor.

Newborn children are born without knowing how to do many things. For example, coordinating eye movements. The child learns this over several months. Weakness of the eye muscles allows the baby to concentrate on an object for a few seconds, then the eyes begin to move apart. Such strabismus in infants is called functional, and it tends to go away on its own.

Features of vision in infants

When looking at a baby in the first weeks of life, you often get the impression that his eyes are a little squinted - instead of the usual synchronous movement, they converge or diverge.

This feature becomes a matter of concern for parents who are trying to show the child to everyone possible doctors and healers. Excessive anxiety often arises from a lack of knowledge about this feature of newborns, but even in the worst case, if the diagnosis is confirmed, modern techniques allow you to quickly recognize and effectively treat the defect.

In the first weeks of life, visual strabismus in newborns is caused by structural features of the facial bones - left and right parts facial skeleton babies are placed at an angle to each other, it takes some time for them to align. During this time, the baby's eyes may converge and diverge. After the baby reaches the age of 4-5 months, synchronous eye movement develops. Medical statistics assures that in 9 out of 10 babies, infantile strabismus will go away on its own.

A peculiarity of vision in infants is specific structure eyes. The eyeball of a newborn is special - not round, like in adults, but flattened. Because of this, children are born farsighted (up to +3 diopters).

Strabismus in infants is caused by congenital weakness of the eye muscles, which the baby has not yet learned to control, so the eyes move in different directions when stressed. In 1 out of ten babies they move towards the lateral edges (from the nose), in the remaining 9 they move towards the nose.

Formation of the eyes

A child’s eyes form throughout the first year of life, and go through several stages of development:

in the first days of life they are able to react only to a light source;
in the second month of life, due to the child’s congenital farsightedness, he can fix with his eyes only large objects that are located at a distance; he sees all other things as blurry and foggy;
After reaching three months, the baby can look at small toys and focus on their movement, but only a short time– this is explained by weakness of the eye muscles.

Ophthalmologists and pediatricians consider functional strabismus to be normal physiological phenomenon– as the child grows, he will learn to coordinate the eye muscles and look directly and meaningfully, like an adult.

Self-determination of strabismus

To determine a possible defect in eye coordination in a child, there are simple tests that parents can conduct on their own. To loving mothers it must be carried out from time to time, for this you need:

take a bright rattle;
move it from side to side, now moving away from the baby’s eyes, now bringing it closer;
Monitor the reaction of the child’s eyes and pupils.

Children under 4 months cannot coordinate their eyes; after this age, eye movements are synchronized. You need to be careful when conducting the test on a baby whose appearance is characterized by a wide bridge of the nose - in some cases the effect will persist false strabismus. If the phenomenon of strabismus (strabismus) does not go away by six months, the child should be shown to a doctor.

Signs of strabismus

The child undergoes periodic examinations every 2 months until six months, when strabismus in newborns physiologically resolves. For some children, this process can take up to a year.

Dad and mom need to pay attention to the following symptoms:

the baby cannot simultaneously focus his eyes on one object in space;
no synchrony in eye movements;
one eye “rolls” to the side or closes spontaneously in the sun;
to better examine the object, the child tilts his head;
If you shine a flashlight into a child's eyes, the reflection is different.

If there is a suspicion of strabismus in an infant, or there are cases of such a defect in the family, parents need to show the child to a specialist every two months. Already at six months, after examining the baby, the doctor will be able to determine whether a defect is present and determine its type.

Parents often begin to panic when the diagnosis is confirmed, mistakenly believing that it is impossible to correct the defect. This is not true - the disease can be treated, modern techniques make it possible to completely rid the child of the disease.

Causes of the violation

The occurrence of the defect is based on a number of reasons, many of them are physiological in nature. These include:

damage to the centers of the baby’s brain that are responsible for synchronizing the actions of the eyes during pathological pregnancy or difficult childbirth;
viral infectious diseases that disrupt the functioning of the baby’s body;
some diseases of the mother during pregnancy;
constant stress or illness that causes severe crying in the baby and increases desynchronization of the eyes;
hereditary pathology that is observed in the child’s parents or close relatives;
birth or postpartum trauma (damage) to the eye;
mistakes in baby care.

If the parents have pathology, the baby will inherit strabismus in 4/5 cases. A birth defect of this kind may be caused by a birth injury, or may be caused by microtraumas that form in the posterior system. longitudinal beam, due to oxygen starvation or damage. The consequence of such a lesion may be persistent divergent or convergent strabismus in an infant.

Gymnastics for the eyes

For proper development eye muscles, a mother can do some kind of gymnastics with her child:

after the baby learns to identify an object by sound, you need to sit (lay) him on your lap and show him a large bright toy, moving it from side to side;
in order for the baby to train eye movements, large educational toys need to be hung above the crib, which should be within the child’s reach;
All toys should be kept at a sufficient distance from the child’s face, taking into account the congenital farsightedness of infants.

Such simple exercises will help the baby quickly learn to synchronize the work of the eyes.

Treatment of the disorder

Dr. Komarovsky substantiates his point of view on the naturalness of asynchronous eye movements in infants physiological reasons, which allow the eyes to move only horizontally at first, and only a little later - vertically.

Komarovsky draws the attention of parents to the fact that after six months, if the defect remains, the child must be shown to an ophthalmologist and neurologist and treated.

Why should strabismus treatment be carried out as quickly as possible? A timely visit to a specialist will help not only correct the violation, but also prevent possible violations vision.

Unfortunately, all effective modern methods for eliminating strabismus are designed for older children. Indicated for babies acupressure which is performed by a professional are possible medicinal methods treatment.

It is much easier to correct a still small defect in a baby than to treat additional visual impairment later.

At older ages, it is possible to surgically restore eye synchronization or stimulate the eye muscle by taping the eye.

Quite often, strabismus can be observed in children under one year of age. The basis of strabismus, especially in newborns, is: weak eye muscles and poor innervation. As a result, uncoordinated movement of the eyeballs occurs. Until 3-4 months, this condition is physiological and is not a cause for concern. However, if a child older than 6 months has strabismus, it is necessary to consult an ophthalmologist.

Causes of strabismus in children under 1 year of age:

hypoxia during pregnancy
hypoxia or asphyxia during childbirth
disruption of the innervation of the eye muscles, which may occur due to intrauterine infection or trauma during childbirth
hereditary diseases

There are two types of strabismus:

convergent
divergent

Convergent strabismus

We can talk about convergent strabismus when the ocular axes are shifted towards the bridge of the nose. In children under one year of age, convergent strabismus can occur separately, as independent disease, so be a symptom of Children's Cerebral Palsy, Down syndrome, microcephaly, birth trauma or abnormalities of brain development.

Exotropia

We speak of divergent strabismus when the ocular axes shift towards the temples. In children under one year of age, congenital divergent strabismus is observed. Manifestations of this disease can be observed directly from birth.

Treatment of strabismus in children under one year of age

Many famous doctors believe that visual impairment is physiological until 4 months of age. If a child has had strabismus for six months or has a family history, the child should be immediately shown to a specialist. Indeed, due to long-term strabismus, visual acuity can be dramatically impaired.

The following methods are used to treat strabismus:

set of exercises
surgical intervention

IN infancy use special dressings, which are put on the dominant eye and thus stimulate the work of the second eye. Along with the headbands, catchy and bright toys are used. Parents should limit sudden movements of the child or sudden movements in the immediate vicinity of the child. In addition, you should not bring toys or other objects close to the child.

If the complex is ineffective and strabismus is long-term, surgical treatment methods are used.

Observation by an ophthalmologist

For timely assistance to your child, he must be shown to an ophthalmologist at least 3 times per year of life. The first visit to an ophthalmologist occurs at age 1st month life. At this age, developmental anomalies are detected.

IN six months of age the child is re-showed to the ophthalmologist. At this time, the doctor can already find out how light is refracted, refraction and the reaction of the pupil to light are determined. The doctor offers a complex for treatment.

IN one year old the doctor evaluates how the main indicators have changed and determines the indications for surgical intervention or makes a selection of points.

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

Strabismus is a position of the eyes in which the visual axes do not converge on the object in question. Outwardly, this is manifested by the fact that the eye deviates in one direction or another (to the right or left, less often up or down, and various combined options are also found). If the eye is brought to the nose, the strabismus is called convergent (more common), and if it is brought to the temple - divergent. One eye or both may squint. Most often, parents turn to a pediatric ophthalmologist after noticing that the child’s eyes are looking “wrong.” Strabismus is not only a problem appearance. The effect of strabismus is a consequence of disturbances in perception and conduction visual information throughout the child's visual system.

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

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

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

When did strabismus occur?

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

What do you attribute its occurrence to?

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

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

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

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

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

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

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

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

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

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

Causes of strabismus in children under one year of age

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

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

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

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

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

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

But what about infectious disease, fear, falling and other unfavorable factors that many parents associate with the occurrence of strabismus? It's just " Last straw”, an impetus that set in motion something that was long overdue.

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

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

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

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

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

The doctor advises the child to exercise more small toys, subjects:

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

How long will it take to go to the clinic?

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

This is bad?

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

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

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

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

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

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

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

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

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

Treatment for strabismus in children

With congenital strabismus, it is important to complete surgical stage no later than 3 years, if acquired - depending on the timing of achievement of conservative stage treatment of good visual acuity and restoration of the potential ability to merge images from both eyes into a single visual image. Tactics surgical treatment is 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, used general anesthesia with a specific anesthesia that 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.

Strabismus in children it is a disease that will not go away on its own with time. Timely diagnosis and treatment will increase the chances of full vision restoration. Below we will look at the causes of this disease, its types, as well as methods and methods of therapy.

Strabismus or strabismus (heterotropy) is a disorder of eye function when the movements of the eyeballs deviate when looking straight.

With normal vision, a person receives 2 images, and in visual analyzer everything is combined into one picture. With strabismus, the image is not connected.

In order to get rid of bifurcation, the central nervous system removes the distorted image, i.e. what the squinting eye sees.

Why are children born with strabismus?

Strabismus It is very common in children under one year of age. Weakness of the eye muscles and lack of control over them cause different movements eyeballs.

There may be several reasons for this. First of all, it affects the correct formation of the fetus inside the womb. If during this period there were factors that contributed to the development of the disease, then in the future this can lead to serious consequences.

Fact: After birth and up to one year, visual function develops. If during this period not enough light reaches the retina, there is a risk of impaired vision development.

At the age of 2-3 months, heterotropia may be suspected. During this period, bevelling may occur due to the structure of the facial skull.

Parents don't need to worry. This imaginary strabismus . To reassure you, it is recommended to conduct special tests to distinguish between imaginary and true strabismus.

Fact: In premature babies, this disease and other diseases are more common.

The main causes of childhood strabismus

There are several main causes of strabismus in children:

injuries;
stress;
infectious diseases;
heredity;
prematurity;
presence or ;
neurological diseases.

Types of strabismus

This disease can be divided into several classifications:

by time of occurrence;
by stability of deviation;
by eye involvement;
by type of deviation.

Fact: There are about 25 types of strabismus.

Classification by type of violation

By type of deviation: childish strabismus divided by:

convergent;
divergent;
vertical;
mixed.

Most often, convergent strabismus occurs, when the ocular axes are shifted towards the bridge of the nose.

Convergent strabismus In children under one year of age, it often occurs along with farsightedness.

Divergent - when the ocular axes are directed towards the temples. The causes of divergent strabismus in children can be injuries, fear, infections, and neurology.

The photo below shows the types of deviation.

Classification by time of occurrence of the violation

By time of occurrence strabismus can be divided into:

congenital;
acquired.

The causes of congenital strabismus may be intrauterine infections or illnesses that a woman suffered during pregnancy.

As a rule, signs of the disease appear from infancy. The child does not look at one point. The eyes diverge. One of visual organs moves towards the nose or deviates towards the temple.

Traditional treatment for strabismus

Treatment should begin immediately after diagnosis. Moreover, this disease manifests itself before the age of 3 years.

If you do not start solving the problem in time, it will only get worse in the future.

Regular visits to the ophthalmologist are important

There are several methods that are used to eradicate this disease:

surgical;
therapeutic.

Therapeutic treatments

The disease can be treated not only with surgery, but also with less scary methods.

Therapeutic methods consist of:

diagnostics;
treatment with glasses, lenses;
hardware procedures;
orthoptic and diploptic treatment;
strengthening monocular and binocular functions.

Important: It is imperative to undergo treatment from a specialist - an ophthalmologist. He will conduct a vision test, determine the type of heterotropia and prescribe special treatment.

It is worth considering that recovery does not happen quickly. Fighting the disease can take up to 2 years.

Very often, glasses are prescribed that need to be worn constantly. After 3 weeks of wearing glasses, you can begin the next stage of treatment.

It is necessary to equalize the visual acuity of both eyes. For this purpose, the vision of a good-seeing eye is specifically impaired. With this method, the other eye, which sees poorly, will start working faster.

To do this, glue an eye patch or glasses. Depending on the type and degree of strabismus, such a bandage may be prescribed for several hours or for the whole day.

Hardware therapy

Often, pediatric ophthalmologists insist on the use of hardware procedures.

May be involved:

Computer techologies;
lasers;
flash lamps.

The goal of this method is to get a complete picture from both eyes.

Important: To eliminate double vision in gases, the diploptic stage of treatment is used. It is carried out only at a certain angle of strabismus, which should be no more than 7 degrees.

Surgical method of treatment

Surgery is used when other methods of combating the disease have not helped. This decision is made only by the attending physician, depending on the type of strabismus and the location of the muscles in the person.

Modern technologies allow mathematical modeling of the operation and the use of radio wave technologies. When planning, the result of the operation can be seen even before it is performed.

Radio wave technologies allow the operation to be performed without a single incision. The child may be discharged from the hospital the next day.

The operation only improves cosmetic effect, but does not restore binocular functions of the eyes.

For full recovery Surgery alone will not help your vision. It is necessary to undergo an additional therapeutic course of treatment.

Treatment of strabismus at home with gymnastics

It is not possible to completely cure the disease at home, but you can do special exercises for the eyes.

To perform the exercises, the baby must not be tired.

Each lesson should take no more than 20-25 minutes. You should spend up to 2 hours a day on practice.

Of course, it all depends on the degree of heterotropia in the child.

With small children you need to do simple and exciting gymnastics.

For the first exercise you will need a plastic plate with holes made in it. various shapes(square, triangle, circle). Your child needs to thread a string through these holes.

You can also use paper. You need to draw cells and place figures in them, for example, a flag, a Christmas tree, a house. There should be a number of drawings in pairs. The child is asked to find and cross out identical images.

Important: Such exercises can be a prevention of the disease, and not the main stage of treatment.

Treatment with unconventional methods

TO unconventional methods Treatment includes the use of chocolate, herbal infusions, phyto-drops, etc.

Dark chocolate will help strengthen the muscles that support eyeballs. It is worth giving your baby sweets within an hour after breakfast and lunch, 4 slices each. This approach should only be tried with those who are not allergic to this type sweets.

Rosehip decoction is useful at the initial stage of the disease. Several berries, poured with boiling water and infused for 5-6 hours, must be taken before meals.

Very famous recipe preparing a decoction from cabbage leaves. It is necessary to boil several leaves until soft, crush them, thereby turning them into a paste, and drink 3-4 times throughout the day.

At home, you can prepare special phyto-drops or lotions. To do this you will need 10 g of dill and boiling water. The greens must be poured, cooled and strained. This decoction can be dropped into the eyes and also used as a lotion.

If parents believe in higher power, then it would be useful to read prayers. This is not a deposit good vision, but this type of self-hypnosis helps to tune in to the best and recharge with faith in the success of therapy.

Important: All of the above methods should be used only after consultation with an ophthalmologist and pediatrician. Some foods may cause an allergic reaction.

Unconventional methods and treatment at home do not replace official treatment.

What does Komarovsky say about strabismus?

Dr. E. Komarovsky says that children under 4 months have poorly developed visual functions, they see everything “in the fog.”

At first, the child's eyes begin to move in a horizontal position. Over time, they begin to master vertical movement. After 4-8 weeks, the eyes move along a normal trajectory.

If after six months the child’s vision does not normalize, then you should consult a doctor. Especially if there has been a history of this disease in the family.

Don't hesitate. The sooner you see a doctor and start treatment, the faster your visual acuity will be restored.

If such a disease is started, it will lead to further complications vision.

The famous doctor emphasizes that parents should closely monitor the child’s health and stop the development of the disease in the bud.

If a diagnosis is made strabismus, then Evgeny Komarovsky recommends sending children to specialized preschool institutions.

In the video below, Komarovsky talks in more detail about strabismus in children under one year of age: