Strabismus is a condition in which a person's eyes are unable to look at the same point in space at the same time. According to statistics, about 4% of the world's population suffers from strabismus and is most often diagnosed before the age of 3 years. Healthy people have binocular vision, in which the images from both eyes are combined into one. But when one eye looks the other way, two different images enter the brain and the person experiences double vision. At a young age, children can stop analyzing the image from each eye, so they see normally. But adults who suffer from strabismus later become accustomed to combining two images into one and are unable to ignore the visual impairment. Double vision can cause frequent headaches and tension, so this condition must be treated. And to do this, you need to understand why exactly strabismus occurs.
In medical language, strabismus is called strabismus
Features of the development of strabismus
Strabismus is a pathological condition of the eyes, characterized by deviation of the pupils from the central axis. People with heterotropia cannot focus their gaze on the object in question, as a result of which the visible image is distorted and doubled. Strabismus refers to a pathology in which the patient lacks binocular vision, connecting the images of the retinas of both eyes into a single whole picture.
The brain excludes the information received by the squinting eye, and over time completely eliminates the participation of the affected organ of vision in the visual process. The reasons for the development of this condition can be very different - from fetal intoxication to head trauma. Under the influence of a number of factors, strabismus can develop at any age, but most often the disease is diagnosed in young children.
Is strabismus inherited? One of the common causes of childhood strabismus is hereditary predisposition.
Strabismus: what is dangerous, how to treat
Strabismus: what is dangerous, how to treat
Strabismus can develop in early childhood or in an adult. In any case, the sooner treatment is started, the higher the chance of regaining vision.
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Strabismus (strobism) is an incorrect position of the eyes. This is an ophthalmological disease characterized by impaired binocular vision. One or both eyes deviate to the side when trying to look ahead.
Normally, the brain finds a match in the images received by both eyes and forms a single three-dimensional picture. This function of the visual analyzer is called binocular vision. With strabismus, the images formed by the eyes are different from each other, making binocular vision impossible. A person loses the ability to adequately calculate the distance to an object, the size of objects, etc., and see a three-dimensional picture.
Forms of strabismus
Strabismus can occur in 2 forms:
- Friendly. Strabismus moves from one eye to the other, the deviation from the central axis in both organs of vision is almost the same. With concomitant strabismus, the movement of the pupils is preserved; when trying to focus the gaze, both eyes deviate. Most often it occurs in children and is inherited. Diplopia is not observed.
- Paralytic. Only one eye is squinting, the other is positioned correctly. The squinting eye is limited in movement towards the affected muscle. Paralytic strabismus is a consequence of paralysis of the extraocular muscles. A patient with this form complains of double vision, migraines, and dizziness.
An imaginary form of strabismus often occurs in infants. During the first year of life, the friendly functioning of the visual organs is just being formed, so it may seem that the baby’s eyes are squinting. This condition goes away on its own with age.
Consequences
The prognosis for strabismus largely depends on how timely treatment is started. Correction should be carried out in childhood, the optimal time to start therapy is 3-5 years. Almost all forms of strabismus require long-term complex treatment over several years. Late or incorrect correction of strabismus can lead to irreversible vision loss, even complete loss.
The most treatable type is concomitant accommodative strabismus. The prognosis worsens significantly when paralytic strabismus is detected late.
Features of the development of strabismus in children
Many people consider strabismus to be a childhood disease. Heterotropia actually occurs most often in children aged 2-3 years. The following main reasons for the development of strabismus in a child can be identified:
- genetic disorders;
- fetal intoxication;
- birth injuries;
- hereditary predisposition;
- pathologies of the central nervous system;
- infectious pathologies;
- eye diseases;
- mental trauma.
Violation of eye position in childhood can be congenital or acquired.
Violation of eye position in childhood can be congenital or acquired. The congenital form of the pathology manifests itself in the first six months of life. Acquired strabismus usually develops before the age of 4 years. Up to 6 months, the baby’s visual apparatus is still developing, so a slight deviation in the position of the eyes, not accompanied by oculomotor disturbances, is a normal condition (false strabismus), which goes away without medical help.
Read in a separate article: Surgery to correct strabismus: how it works, indications and types
The development of true strabismus in a small child will be indicated by the following symptoms:
- inability to concentrate both eyes on one point;
- noticeable deviation of the pupil to the side;
- non-synchronous eye movements;
- squinting of a squinting eye;
- constant bending and turning the head when trying to look at something.
Older children with strabismus may complain of eye fatigue, photophobia, double vision, and blurred images. If you have such symptoms, you should urgently contact a pediatric ophthalmologist.
Complications
The most common complication of strabismus is amblyopia or “lazy eye” - a significant decrease in visual acuity of the squinting eye. Amblyopia is reversible; by eliminating strabismus and performing a set of exercises, it is possible to partially or completely restore vision in the amblyopic eye.
Complications can also develop after eye surgery. The most common of these are overcorrection or undercorrection of strabismus. In rare cases, operations can lead to the development of intraocular infections, bleeding, and loss of vision.
Is strabismus inherited?
Many diseases can be inherited. Can strabismus be inherited? Experts' opinions on this issue vary. Many scientists are confident that if at least one of the parents or close relatives (grandparents, aunts, uncles) suffers from strabismus, then the child has a high probability of being born with such a pathology.
Most often, the disease is transmitted from the father or mother.
But some doctors argue that it is not strabismus itself that is inherited, but only the anatomical features of the structure of the visual organs, which can provoke the development of heterotropia. In any case, we can definitely say that if a close relative has a similar problem, then the baby will have a tendency to strabismus. The risk of hereditary strabismus increases in the presence of the following factors:
- birth injuries;
- fetal intoxication;
- infectious pathologies;
- premature birth;
- underweight baby;
- congenital disorders of the central nervous system.
If a child has a hereditary predisposition to heterotropia, then it is necessary to regularly visit an ophthalmologist and prevent eye position disorders.
Causes
Congenital strabismus is formed under the influence of several factors. The leading role in the occurrence of strabismus in newborns is played by:
- heredity (the risk of developing pathology increases if close relatives have strabismus);
- genetic disorders such as Down syndrome;
- cerebral palsy (a disease of the central nervous system that affects one or more parts of the brain);
- taking certain medications, drugs or alcohol during pregnancy;
- premature birth;
- hydrocephalus (water on the brain);
- congenital eye pathologies, for example, cataracts (partial or complete clouding of the lens).
Acquired strabismus can develop acutely or gradually. Often the causes of pathology are astigmatism (a visual defect associated with a violation of the shape of the lens), farsightedness (a pathology in which a person clearly sees objects located at a distance), myopia (a visual impairment in which objects that are close are clearly recognized).
Other causes of acquired strabismus can be severe stress, high visual stress, childhood infections, for example, scarlet fever, diphtheria, measles. In adults, strabismus can develop against the background of cataracts, leukoma (cataract), optic nerve atrophy, and retinal detachment. Risk factors for paralytic strabismus also include:
- benign and malignant neoplasms of the visual organs;
- traumatic brain injuries;
- paralysis and paresis (complete or partial limitation of function) of the oculomotor, trochlear, abducens nerves;
- inflammation of the brain and meninges;
- strokes (bleeds in the brain);
- fractures of the wall and floor of the orbit;
- multiple sclerosis (severe chronic disease of the nervous system).
Note! In the absence of timely treatment, the disease in approximately 50% of cases leads to the development of amblyopia - decreased vision, in which the squinting eye partially or completely ceases to participate in the visual process.
Treatment methods
It is important to begin treatment for heterotropia as early as possible, since the lack of timely treatment can lead to serious consequences. The greatest effectiveness of therapeutic interventions will be achieved if therapy begins in early childhood. To eliminate the problem, the following treatment methods can be used:
- Optical correction. Special glasses or contact lenses are prescribed to improve the quality of vision and mask the external defect.
- Wearing glasses with the healthy eye sealed. This helps to increase the workload of the squinting eye, restoring its functioning.
- Hardware techniques, computer programs. They help improve visual acuity and restore binocular vision.
- Training on a convergence trainer, gymnastics for the eyes.
In advanced forms of strabismus, when conservative treatment is ineffective, doctors prescribe surgery. Surgical intervention eliminates the cosmetic defect and improves visual function.
It is best to have surgery before reaching 4 years of age.
Diagnostics
During the initial examination, the ophthalmologist determines the timing of the onset of the first symptoms, establishes the relationship with past diseases and injuries; in the case of paralytic strabismus, he pays attention to the forced position of the head, evaluates the symmetry of the face and the position of the eyeballs. To make an accurate diagnosis and establish the form of the disease, a comprehensive ophthalmological examination is performed, which includes:
- measurement of visual acuity;
- determination of the angle of strabismus;
- biomicroscopy - visual examination of optical media and eye tissues;
- ophthalmoscopy – examination of the fundus of the eye using special instruments;
- test with covering the eye to determine binocular vision.
In case of paralytic strabismus, a consultation with a neurologist, electroencephalography (testing the functionality of the brain), and electromyography (a study of the bioelectrical activity of muscles) are additionally prescribed.
Note! Early detection and timely comprehensive treatment of strabismus significantly improves the prognosis of the disease, therefore, at the first signs of strabismus, you should immediately contact an ophthalmologist for medical help.
Pleoptics
Pleoptics are methods aimed at correcting amblyopia (poor vision).
The main method of pleoptic therapy for children with amblyopia is occlusion - turning off the healthy eye from the act of vision. It allows you to switch the entire visual load to the squinting, worse-seeing eye, which leads to its activity. To carry out occlusion, you can use plastic occluders, or make your own bandage or curtain using a bandage and adhesive. The time a child spends with an eye closed varies and depends on the degree of visual impairment. For some this may be a few hours a day, for others all day.
It is possible that the visual acuity of a healthy eye that is under the bandage for a long time will decrease. To avoid this, it is necessary to change the glued eye with a schedule of 6/1 or 5/1. The main purpose of occlusion is to reduce the visual performance of the healthy eye so much that the amblyopic eye becomes the dominant eye.
Description of the Girshberg technique
During the examination, the patient must look directly into the opening of the ophthalmoscope, which is located directly in front of him. At the same time, the doctor notices how the light glare is distributed in each eye. In an apple standing straight, the highlight should be strictly in the middle of the pupil. In the case of strabismus, the highlight deviates from the center and is located:
- within the pupil, indicating a deviation of less than 15 degrees;
- along the edge of the pupil (in case of strabismus, exactly 15 degrees);
- in the middle of the iris, if strabismus reaches 25-30 degrees.
With the primary angle of deviation we are talking about a squinting eye. Secondary angle refers to the deviation of the healthy eyeball relative to the squinting eye.
