Strabismus in children causes, treatment, types

Causes of childhood strabismus

Hereditary factors play a major role in the development of strabismus in children. But this is not the only reason for the formation of the disease. Predisposing factors are divided into groups:

congenital;
acquired from children from 0 to 7 years.

Congenital

The congenital form of strabismus in children is observed quite rarely. The following situations can trigger the development of congenital heterotropia:

inherited influencing factor;
the birth of a child with various syndromes (Down syndrome);
if one of the parents or both suffered from the disease in childhood;
incorrect behavior of the expectant mother during pregnancy;
abuse of alcohol and drugs during pregnancy;
premature birth caused by placental abruption;
development of cerebral palsy in a child.

How to treat true strabismus?

If the Hirschberg test reveals an asymmetry in the corneal light reflex, the doctor finds oculomotor disturbances or a binocular vision disorder in the child, this may indicate true strabismus. The sooner you start treating it, the more effective the result will be. Typically, in the treatment of childhood strabismus, spectacle correction, gluing of the healthy eye, and techniques that develop visual acuity and binocularity are used. In some cases, surgical treatment is justified.

Thus, tests for the light reflex of the cornea and assessment of oculomotor disorders help to distinguish true from false strabismus. An ophthalmologist should conduct such testing and make a diagnosis. If the examination results show the presence of true strabismus, the doctor will prescribe adequate treatment taking into account the child’s individual characteristics.

MagazinLinz.ru team

Classification

Strabismus in children is divided into different types:

Monocular strabismus

In a situation where only one eye deviates from the center, this indicates a monocular type of strabismus. Almost always, with this form, the affected eye has low visual acuity or completely ceases to clearly focus on a certain point, which makes it difficult for a person to recognize an object.

In this case, the child’s brain “turns off” the affected organ of vision, as it reads information from the healthy eye.

Alternating

This type of heterotropia involves impaired visual acuity in both eyes, that is, the child has two eyeballs squinting. In this case, the deviation is observed in turn on each eye - either the left or the right organ is capable of uncontrollably changing its position. Both in the horizontal and vertical directions, but the angle of deflection is always the same. Alternating strabismus is much easier to treat, because the pupils of the eyes, when directed correctly, can participate in receiving information from the outside world, which means that the visual functions of both eyes are not lost.

Concomitant strabismus

This mild form of the disease occurs in children under 3 years of age. The organs of the visual system are able to function fully without any obvious signs of eye pathology. When focusing on the picture, the child sees everything clearly without double vision or blurriness. Only in some situations can the affected eye see slightly worse than the healthy side.

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Hidden strabismus

The latent form of the disease is difficult to determine even during diagnosis. With the development of pathology, the eyes do not show strabismus, and the child does not squint when looking at the image, since his visual acuity does not differ from that of his peers. But if you close one of the eyes with your hand or a sheet of paper, then the other begins to deviate from the axis vertically and horizontally.

Imaginary strabismus in children

Imaginary strabismus in children is an acquired or sudden form of strabismus, since it is formed with normal features of the eyeballs. In a situation where the axis and the optical line do not coincide and are measured at a large angle, the formation of false heterotropy is likely.

At the same time, the baby’s vision does not suffer changes, and outwardly the eyes look natural.

Symptoms

The main sign of strabismus is the deviation of the pupil of the eye from the axis. But there are a number of other absolute signs of the disease:

significant decrease or complete absence of movement of the affected eye;
dizziness occurs if you close your eyes;
the baby may complain of double vision;
blurred vision and difficulty describing the image;
involuntary tilt of the head when focusing your gaze;
in a situation where the optic nerve is damaged, accommodation paralysis, pupil dilation or ptosis develops.

In children under 3 years of age, the main reason for a visit to an ophthalmologist may be regular squinting when focusing on an object.

Clinical manifestations of vertical strabismus

Hypertropia and hypotropia are clearly distinguishable because they are manifested by asymmetry, which is clearly visible to the naked eye. Clinical manifestations are as follows:

diplopia or double vision, in which the image appears in two;
frequent headaches and dizziness;
cyclotorsional deviation of the eyes (from rotation around the visual axis);
turns the head depending on the direction of gaze.

If we are talking about a child, parents need to pay attention to how he holds his head. Very often, with vertical strabismus, the baby involuntarily tilts it to the side. The easiest way to notice this is when he is looking at toys or watching TV. Other signs may include increased sensitivity to bright light and an inability to correctly judge the distance of objects.

Treatment

Non-surgical treatment

Optical therapy is prescribed upon reaching 6 months of age, since before this time, strabismus in a child may be temporary due to the active development of the visual system. The selection of glasses for near is made in cases of difficulty working at close range with existing glasses.

Selection of contact vision correction in children is carried out in cases of intolerance to glasses.

To achieve the desired result, taped therapy is used - this is when the healthy eye is covered with a cloth or cotton pad for the required time. Thanks to this, the damaged organ of vision becomes the main one and the level of vision increases. Ophthalmic devices are used to improve visual acuity and fix the pupil axis exactly in the center of the eyeball.

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Hardware therapy

To eliminate the existing vision problem in a child, many devices have been created, due to which the child can undergo treatment at home.

Amblyocor ophthalmological device

Used to increase visual acuity. It consists of a monitor and numerous sensors that monitor the work of nerve endings while receiving information from the outside world through the eyes. At the same time, the baby does what he loves, and the sensors do all the work themselves. The programs embedded in the device help send the necessary nerve impulses to the child’s brain and normalize the visual organs.

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Ophthalmic apparatus Synoptophore

This device allows your baby to view parts of both 3D and flat images and combine them together. The procedure is necessary for the child to develop binocular vision. Regular exercise with this device trains the eye muscles and makes them stronger over time. The mechanism allows the child to view only part of the picture for each eye and then combine them together, helping to correct vision and restore the pupils of the eyes to the desired level.

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Ophthalmic apparatus Rucheek

Daily exercises on the device will help restore control over accommodation and train the eye muscles. The baby will have to carefully monitor the images, which are moving away and approaching in a chaotic manner, and also make eye movements. Due to the fact that the dots will flicker in the most unexpected fields, heterotropy is corrected.

For strabismus in children at the first stage of development, 3 courses of hardware therapy are prescribed, each of which consists of 10 procedures. At subsequent stages, the duration and nature of hardware therapy is determined only by an ophthalmologist.

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Surgery

In the case of a large angle of deviation of the pupil of the eye, preliminary surgical intervention is used, and then hardware treatment is prescribed. The surgical method of vision correction does not replace the use of eye exercises or ophthalmological devices, since surgery is one stage of treatment for large deviations.

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Indications for surgery for strabismus are:

progressiveness of the pathology even with treatment;
ineffectiveness of optical therapy for one year;
squint angle 10% or higher.

Gymnastics to correct vision

Eye gymnastics is only suitable for children over 2 years old. It is important to understand that it will only help with a slight deviation from the norm. This treatment of heterotropia does not require any financial costs, but all exercises are prescribed by an ophthalmologist; you do not need to prescribe therapeutic exercises to the child yourself from Internet sources.

Forecast

The prognosis is positive only if treatment for strabismus in children is started on time. Therefore, the sooner parents pay attention to such shortcomings, the greater the chance of recovery. It is necessary to begin therapy for a child before he goes to school, since it is until the age of 7 that children actively develop their visual organs and have a chance to bring their eyes back to normal.

Prevention

Prevention of strabismus should begin from the first month of a baby’s life:

a newborn's playpen should be placed so that the child can be approached from all sides;
secure the mobile and other toys at a distance of 60 centimeters from the baby;
shift the baby from side to side, so the load is distributed evenly;
at an older age, it is necessary, if possible, to limit the child from playing computer games, let him play more on the street;
bring your routine back to normal, create a clear daily routine, set aside time for rest, activities and games;
Let's take children's multivitamin complexes only after prior consultation with a doctor.

Treatment of strabismus in children

There are more than 20 different types of strabismus. Outwardly, all of them are manifested by deviation of the visual axis from the point of fixation, but in their causative factors and development mechanism, as well as in the depth of the disturbances, they differ greatly from each other. Each type of strabismus requires an individual approach. Unfortunately, even among doctors there is an opinion that until the age of 6, a child with strabismus does not need to do anything and everything will go away on its own. This is the greatest misconception. Any deviation of the eye at any age should be considered the beginning of the disease. If no measures are taken, loss of visual acuity may occur , and then treatment will require much more effort and time, and in some cases the changes become irreversible.

Sometimes a child’s strabismus is imaginary: due to the wide bridge of the newborn’s nose, parents suspect the presence of this vision defect, but in fact it does not exist - it is just an illusion. In newborns, the eyes are set very close, and the bridge of the nose, due to the peculiarity of their facial skeleton, is wide. As the facial skeleton develops, the distance between the eyes increases and the width of the bridge of the nose decreases. It is precisely in this case that everything really goes away with age and nothing needs to be corrected, but only a pediatric ophthalmologist can determine whether it is an imaginary strabismus or a real one. Any suspicion of a deviation from the norm should alert parents and prompt them to visit a pediatric ophthalmologist as soon as possible.