Strabismus in children. Photos, what is strabismus, causes, treatment

Strabismus is a violation of the position of the eyes, accompanied by deviation of one or both eyes, alternately when looking straight. Taking into account the symmetry of the position of the eyes without pathology, images of objects fall on the central areas of each of the retinas of one and the other eye.

In the cortical centers of the visual analyzer, they are merged into a whole binocular image. The presence of strabismus makes such a merger impossible, therefore, in the central nervous system, to protect the body from double vision, images of a squinting eye are simply excluded. In this case, the squinting eye functions only when covering the healthy non-squinting eye. The long-term existence of such a condition causes a functional decrease in visual acuity of the squinting eye - amblyopia develops.

Symptoms of childhood strabismus

In ophthalmology, strabismus in a child is usually called strabismus. It may be insignificant and barely noticeable, but over time the disease develops and its symptoms become more pronounced.

Signs of strabismus in children manifest themselves in:

• Alternating squinting of the eyes;
• Closing one eye in bright light;
• Frequent headaches;
• Bumping into various objects while walking;
• Dizziness;
• Inability to direct your gaze to one point and keep it in one place;
• Stretching your head and tilting it forward at an unnatural angle to focus your gaze on objects.

If the baby is already three years old, then he can tell his parents that he sees forked objects, his eyes become very tired, and there is a sharp decrease in vision, which is also characteristic of strabismus.

Indications for surgery

Strabismus (strabismus) is an ophthalmological disease in which, as a result of an imbalance in the muscles that hold the eyeball, the focus of one or both organs of vision shifts. This leads to the fact that the position of the eyeballs in the orbit is different and 2 different pictures are received by the visual analyzer of the brain. And since the brain is not able to form a single three-dimensional picture from two different images, information from an incorrectly directed eye is ignored, resulting in another problem - amblyopia.

In addition to serious impairment of visual function, strabismus creates a pronounced cosmetic defect, due to which many people have problems adapting to social society. And if in childhood, in the early stages, unstable strabismus can be corrected with the help of special exercises and glasses, then in adulthood, the problem can only be eliminated through surgery.

Surgical treatment of strabismus is prescribed if the following indications exist:

• paralytic strabismus;
• asthenopia (an unpleasant condition in which, with prolonged visual strain, headaches, weakness and difficulties with reading are observed);
• impaired binocular vision;
• failure of conservative treatment;
• a pronounced cosmetic defect that causes inconvenience.

Squint surgery can be performed by any person who wants to get rid of a cosmetic defect and restore visual function. Surgery is not performed before the age of 6 years. But in extreme cases, a pediatric ophthalmologist may allow surgery at an earlier age. Strabismus cannot be treated in this way only in case of sudden strabismus, acute paralysis or paresis of the extraocular muscles, as well as inflammatory processes.

Exacerbation of chronic pathologies may also be a contraindication to strabismus correction.

Causes of childhood strabismus

Among the causes of the occurrence and development of strabismus in a child, a hereditary factor should be highlighted. If both or one of the parents had a similar problem in childhood, then strabismus may also be observed in the child. Depending on the age category, the causes of the disease may differ significantly.

Causes of strabismus in a child under three years of age

In children aged from one to three years, strabismus can develop against the background of:

• Various ophthalmological diseases;
• Diseases of a neurological nature;
• Too much stress on the visual system;
• Hereditary predisposition;
• Past diseases of infectious etiology;
• Past poisonings.

The above reasons can contribute to the development of strabismus in infants.

"Note! In addition, strabismus in a child can develop against the background of psychological trauma. Severe fear can lead to strabismus, the symptoms of which do not always disappear over time.”

Causes of congenital strabismus in a child

The exact causes of congenital strabismus are unknown, but ophthalmologists still identify several factors that can lead to its development:

• Ailments of infectious etiology suffered by a pregnant woman during gestation;
• Disorders that occur at the genetic level;
• cerebral palsy;
• Prematurity, which led to underdevelopment of the eyeball during gestation;
• Congenital diseases leading to defects in the visual system.

Congenital strabismus becomes noticeable immediately after birth and does not go away after the first six months of life.

Causes of divergent and convergent strabismus in a child

These two types of strabismus occur most often in children under five years of age, but they have different causes.
Convergent strabismus can occur in a child of any age. The reasons for its occurrence are presented:

• Early maternal toxicosis;
• Poisoning;
• Birth and postpartum traumatism.

Divergent strabismus in a child is rarely acquired. It develops against the background:

• Pathological deviations;
• Tumors in the visual system or brain;
• Diseases affecting the retina and optic nerve.

It can also be caused by a disorder in the central nervous system.

How is the operation performed?

Modern ophthalmologists say that the best operation is the one that is not performed. Surgery is resorted to only when all other methods have been exhausted.

Corrective surgery to correct strabismus in children is a simple surgical procedure performed in one day under general anesthesia. Operations are divided into weakening or strengthening, depending on what needs to be done to eliminate the problem in each specific case: weaken or, on the contrary, strengthen one of the muscles that move the eyeball.

After strabismus surgery in children, the rehabilitation period lasts a week and, as a rule, is easily tolerated by the child.

By the way, under the basic compulsory medical insurance program, minimally invasive surgical correction is available using vicryl (the thinnest self-absorbable suture thread) and mini-access, after which there is no visible scar.

Types of strabismus in children

In pediatric ophthalmology, there are various types of strabismus, characterized by the direction of squinting of the eyes, the time and stability of occurrence, as well as other factors.

Visual diagnosis of these types of strabismus can be carried out even by non-professionals, but the selection of the correct course of treatment will depend on how correctly the type of strabismus is determined, which will help get rid of the disease as soon as possible.

Vertical strabismus in a child

From the point of view of pediatric ophthalmology, vertical strabismus cannot be classified as a separate type, since the reasons for its occurrence are the same as for horizontal ones.

However, one should take into account the fact that vertical strabismus, unlike horizontal strabismus, often requires surgical intervention, since gentle, standard therapeutic methods do not bring results. Most often, such strabismus develops against the background of paralysis of the rectus, superior and oblique muscle structures of the eyeball. Less commonly, this disease develops as a result of surgical treatment of horizontal strabismus and is not independent.

Divergent strabismus in children

The causes of divergent strabismus are ailments associated with paralytic changes in the eye muscles, much less often it appears as a result of defects in intrauterine development.

The disease manifests itself as follows. One of the baby’s eyes is always in a standard position, and the second is constantly moving and it is on it that all the functions of the visual system are assigned.

A fixed eyeball is unable to move due to paralytic changes, as a result of which the baby sees split and blurred images, and when trying to concentrate and use binocular vision, which the brain has not yet cut off as unnecessary, severe headaches, irritability and increased fatigue appear.

Hidden strabismus in a child

If both eyes of the child are open, then visual problems will not be visible.

The child sees well until one eye leaves the binocular vision phase, that is, the child does not close his eyes while looking at the bright sun or while playing with peers. In this case, the squinting eye will move to the side either down or up.

Convergent strabismus in children

Convergent strabismus usually appears in children aged two to six years during the process of developing binocular vision in the child. However, ophthalmologists note the first symptoms of this disease in the first month after birth, when the visual apparatus begins to actively form.

If this type of disease is present, the baby does not have developed binocular vision, but since the child cannot yet tell his parents about his problems, it is possible to diagnose convergent strabismus in the absence of its signs only in the case of a clear deterioration in the vision of one of the eyes.

If the disease is detected at an early stage, then it is quite simple to cure it, using gentle therapeutic techniques, when choosing which the ophthalmologist takes into account the reasons that caused strabismus and its characteristic features.

Acquired strabismus in a child

Acquired strabismus can occur in a child at any age. It is often caused by herbs and illnesses of infectious etiology, leading to paralysis of the muscular system of the eyeball. It is not difficult for an ophthalmologist to diagnose this type of strabismus. When the baby looks straight, his eyes move in different directions and his gaze is fixed in each position; it is the defect in the movement of the eyeball that is noted by the doctor.

The complexity of diagnostic measures and treatment of this type of disease lies in the need for a detailed study, which allows us to identify which part of the muscular system is damaged or paralyzed. Treatment of acquired strabismus is usually complex and lengthy.

Imaginary strabismus in children

In some cases, a child may have a unique structure of the eyeballs, which is characterized by a displacement of a single visual line in relation to the standard position. As a result, it seems that both or one of the baby’s eyes are squinting, although the examination notes excellent visual acuity and a complete absence of complaints about the subjective symptoms of strabismus, which is represented by dizziness, fatigue and headaches.

Some ophthalmologists argue that this feature may cause the development of strabismus in the future, so they advise taking measures that are in fact completely unnecessary, since imaginary strabismus does not require therapy.

Diagnostics

If strabismus is immediately visible in a newborn, it is only on this basis that it is early to make a diagnosis and prescribe treatment. Diagnosis of strabismus is carried out by an ophthalmologist.

To do this, the doctor determines visual acuity using a special apparatus and tests. Watches how the eyes react to movements in different directions. Performs perimetry, fundus examination, and determines refraction. Conducts a 4-point color test, which helps determine the type of vision - binocular or monocular.

As additional studies, ultrasound, MRI, CT may be prescribed to identify tumors, neoplasms, and developmental defects.

Diagnostic measures

Unlike other ophthalmological diseases, strabismus in a child is easily diagnosed. Diagnosis of strabismus consists of several stages, presented:

• Visual ophthalmological examination;
• Using hardware diagnostic methods to determine the necessary parameters for selecting therapy;
• Electrophysical studies aimed at determining the presence of physical or functional damage to the eyes or the visual system as a whole.

Such a diagnosis is absolutely safe and painless for the child, but sometimes parents are afraid to subject their baby to such procedures, not thinking that such fears lead to a deterioration in the toddler’s condition and minimize the chances of his quick recovery.

Prevention of disease occurrence

Strabismus can be corrected with glasses

You can reduce the risk of converging concomitant strabismus in a child by following simple recommendations.

1. In early childhood, try to protect your baby from injuries and bruises.
2. Make sure that the location of toys and books corresponds to a safe distance from the organs of vision. This will help protect your eye from strain.
3. Avoid self-medication of infectious diseases in a child, as improper treatment can trigger the onset of the disease.
4. Prohibit your child from deliberately squinting his eyes.

If the child is greatly frightened at this moment, the strabismus may persist.

• Protect your child from severe stress.
• Closely monitor the baby's health and periodically visit an ophthalmologist.

If you discover converging concomitant strabismus in a child, do not despair. With proper and timely treatment, the defect can be overcome. Therefore, it is necessary to constantly be observed by an ophthalmologist and strictly follow all the recommendations of the attending physician.

Strabismus therapy

It is often possible to eliminate strabismus using conservative treatment without the use of surgery, but for this, parents must consult a specialist in time and undergo a detailed examination. If the baby’s strabismus has not disappeared by six months, it needs to be treated.

You should not worry about treatment; often the child is cured without surgery. Surgery is recommended only when alternative therapeutic methods fail.

Modern ophthalmology offers young patients many methods for treating strabismus. These include hardware therapy, physiotherapy, and specialized exercises to strengthen the ocular muscular system and optic nerve.

The therapeutic schedule is built individually. To compile it, the doctor takes into account all the reasons and circumstances that caused the child to have strabismus. But despite this, each of the treatment plans consists of stages and points that are mandatory and make the treatment much more effective and faster.

Strabismus in a child: Stages of therapy

• In the first stage, the ophthalmologist treats amblyopia. At this stage, the doctor tries to improve the visual acuity of the small patient, bringing it to the established standards. For this purpose, the baby is prescribed to wear glasses with one lens sealed. To make it less awkward for a child to wear such a medical device, the lens can be covered with special children's stickers with funny colored scenes. In addition to wearing glasses, the child will be prescribed several courses of hardware therapy. At this stage, it will not be possible to get rid of strabismus, but visual acuity can be normalized.
• At the second stage, the specialist adds procedures to the treatment that can restore the synchronicity of communication between the two eyes. For this purpose, special equipment and corrective computer programs are used.
• At the third stage, therapy is carried out, which allows you to adjust the normal balance of the muscular system between the organs of vision. At this stage, the child may be referred for surgery if the muscle defect cannot be corrected and it is pronounced. But most often it is possible to do without surgery. Special gymnastics, eye exercises and physiotherapeutic procedures allow you to achieve the desired result.
• At the fourth stage, the ophthalmologist tries to do everything to completely restore stereoscopic vision in the baby. At this stage, the child’s eyes are already symmetrical, their position is correct, the baby’s vision is good and he can do without glasses.

After several years of treatment according to this regimen, the specialist will be able to conclude whether he was able to rid the child of strabismus or whether the baby still needs surgical intervention.

Treatment methods

In most cases, strabismus can be successfully treated. Usually, an integrated approach is sufficient - using special equipment, physiotherapy, wearing glasses, and sometimes performing special gymnastics.

If a child was diagnosed with strabismus at 6 months, and it has not gone away by one year, then treatment should be started. Surgeries are prescribed only in extreme cases when other treatment methods do not help.

Correction with glasses can be performed from one year of age. Until then, vision is restored on its own and no treatment is required. Starting from the age of two, special eye patches are used. When one is closed, the second becomes the leader. As a result, his visual acuity improves. Starting from 3 years, hardware treatment methods are used.

There is no single therapeutic regimen. Treatment depends on the type of disease, its form, degree, and tendency to further development.

Therapy occurs in stages:

1. At the first, the goal is to improve the child’s vision, perceptual acuity, and ideally to bring the values ​​back to normal. To do this, they prescribe glasses with one lens closed. You can select special occlusions. Plus, hardware treatment is prescribed. Strabismus does not go away, but vision improves.
2. At the second stage, therapy is supplemented with procedures to restore the synchrony of eye movements and establish communication between them. This is achieved with the help of corrective computer programs and equipment.
3. In the third stage, the goal is to restore the muscular balance of the visual system. Sometimes this requires surgery if the problems cannot be corrected by other methods. However, more often special techniques for home use, therapeutic exercises, and physiotherapy are sufficient.
4. At the fourth and final stage, stereoscopic vision is restored. By this period, strabismus has already been eliminated, the eyes are symmetrical and in the correct position. The child sees well without glasses.

In each case, the program is selected individually. Treatment lasts at least 2 years, after which the doctor can make a conclusion about the effectiveness of therapy and the need for surgery.

Medicines are prescribed depending on the cause of the disease and to relieve symptoms. For example, to fight infection, inflammation. At the same time, supporting complexes containing vitamins B, C, A, E, and omega-3 are prescribed.

Gymnastics for the eyes, therapeutic exercises

For minor strabismus or the initial stage of the disease, therapeutic exercises are prescribed. The exercises are aimed at strengthening the eye muscles. The complex is performed 2-4 times a day, daily. Each lesson lasts 15-20 minutes. With children who cannot yet perform the exercises on their own, the course is conducted in a playful way - moving bright cubes, balls, closing their eyes one by one.

Gymnastics for the eyes is necessary when developing stereoscopic vision. To do this, use the programs of Shvedov and Norbekov. However, only an ophthalmologist should choose the exercises. Otherwise, it may lead to deterioration and loss of vision.

Occlusions or dressings from two years of age are indicated only for monocular strabismus. Starting from the age of three, children are asked to look for differences in pictures. For this, there are manuals in printed form and special programs on the Internet.

Start with simple pictures, gradually increasing the complexity of the task. Children over three years old are offered maze tasks. For example, guide a dog along it to a bone, and a bunny to a carrot.

Hardware treatment methods

Strabismus in children (photos of devices are in the article) are treated using special devices. They are used throughout the course of therapy. Some devices can be used at home, which increases the effectiveness of correction.

For the treatment of strabismus the following is used:

1. "Amblyocor" to improve vision. The device consists of a monitor with sensors that record nerve impulses while the child watches a cartoon. At this time, the device evaluates the state of the visual analyzers. Special programs help restore vision. Can be used for children from three years of age.
2. “Synoptophore” is intended for training the eye muscles and binocular vision. The child examines two-dimensional and three-dimensional pictures and combines them. Each eye receives only part of the image. The correction consists precisely in trying to make the pictures compatible. Used for children from three years old.
3. “Rucheek” trains the eye muscles and teaches them to control accommodation. The child must watch for objects that are approaching and moving away. Additionally, the eyes will make rotational movements, following the points that flash in different places on the field. Use for children from two years old.
4. Amblypanorama. This device can be used from the age of one year, as no effort is required from the child. He is wearing glasses with corrective lenses. The baby will look at the blinding disk, examining objects there. The device is most effective at the beginning of the development of strabismus.

At the initial stage of strabismus, 3-4 courses are prescribed, consisting of 10 sessions. If it is necessary to continue treatment, the number of procedures and their duration are determined depending on the achieved result.

Home treatments

For classes, choose a period when the child is in a good mood.

From 1 to 3 years of age you can do:

• put the child on a chair, sit opposite and show the toy at a distance of 25-30 cm from the face;

  

• repeat the exercise with another object;
• offer a toy with lacing or a cone with “steering wheels”;
• move a bright object in front of the child’s eyes in different directions so that he follows it with his eyes.

Such exercises should be performed three times a day, for 10-15 minutes.

Gymnastics for children over 3 years old is somewhat more complicated:

• ask the child to close and open his eyes (perform the exercise 5-6 times);
• take a ball with a rope and swing it in different directions (the baby should follow it with his eyes);
• take a bright-colored cube, slowly bring it closer to the eyes and move it back;
• Offer your child drawn puzzle labyrinths, games with searching for objects, and differences.

Strabismus in children (the photo, if it is bright, can also be used in the process) is treated with a simple exercise. You need to draw a red or yellow mark (1-2 cm in diameter) from colored paper on the glass. Then ask the child to look first at it, then at the distant tree outside the window, and again at the mark. The exercise is performed for 5-10 minutes.

Physiotherapy methods

In the field of physiotherapy, special equipment is often used. The procedures are painless, well tolerated by children, and enhance the effectiveness of treatment.

Physiotherapy methods used:

• ultrasound;
• electrophoresis;
• quantum therapy;
• magnetic therapy;
• diadynamophoresis;
• laser stimulation;
• massage;
• electrical stimulation.

Physiotherapy is carried out in hospitals, clinics, and private clinics. The required technique is selected individually.

Surgery

Surgery is prescribed when vision deviation exceeds 10 degrees. Additionally, other correction methods are selected. When the deviation angle is more than 30 degrees, the operation is performed on each eye separately, in 2 stages. Between them there is a break of six months.

The operation does not cancel conservative therapy, but is part of it. Indications for surgical intervention are progressive diseases, if after a year of wearing glasses vision does not improve or with a large angle of strabismus.

Surgery is performed when other treatments have failed or is recommended as a cosmetic procedure. With the help of surgical intervention, weak eye muscles are strengthened or relaxed, and the eyeballs are returned to their normal position. More often this is done using laser devices.

Then the operations are painless and gentle, and the child can return to normal life the very next day. However, for very young children, correction can be performed under anesthesia. Surgical treatment is most effective at the age of 4-6 years. After the operation there is a rehabilitation period of 6 months. During this time, physical activity is excluded, it is necessary to protect your eyes.

Prevention of strabismus in a child

Prevention of strabismus should begin immediately after the baby is born; it should not be postponed until later, otherwise it may result in serious problems in the future and the need for surgical treatment.

Preventive measures for strabismus are as follows:

• Parents should equip the nursery in such a way that it is well lit during the day and there is enough artificial light in it at night.
• Toys that are usually hung on a baby’s crib and stroller should not be placed too close to the baby’s face. The distance between them and the eyes should be at least 50 centimeters. The most common parental mistake that leads to the development of strabismus is a bright single toy hung in the center of the crib above the baby. Toys should be hung to the right and left of the baby so that he can move his gaze from one side to the other, thereby training the oculo-rotatory muscular system.
• Small toys should not be given to an infant; he may not only choke on them, but also try to look at them, for which he will have to strain his eyes, bringing them to the bridge of his nose or bringing the toy too close to his face. Such experiments are dangerous for a toddler's eyes.

Early child education

• Early teaching of a child to read and write can also cause the development of strabismus, since due to the immaturity of the visual apparatus, the child will strain it greatly in order to concentrate as much as possible. It is tension at an early age that can provoke strabismus.
• If your baby has had the flu, scarlet fever or other illnesses of infectious etiology, you should not read or draw with him for some time, so as not to strain the visual system. During these diseases, the risks of complications in various systems of the child’s body increase sharply.
• The child's diet should be balanced and rich in foods containing vitamins necessary for the formation of a healthy visual system. At an older age, toddlers can be given vitamin-mineral complexes containing vitamins E, A, B1, C, B2, PP.
• Parents should take into account all the experiences and fears of their child, since disturbances in his psycho-emotional background can cause the development of strabismus. For this reason, everything must be done so that the baby is not afraid, does not worry, and grows up in a friendly atmosphere. As for infants, too loud sounds and too sudden movements should be avoided around them.
• Older children need to limit the time spent in front of the TV or computer. You should also limit the uncontrolled use of gadgets, especially while traveling in public transport.
• If the baby has a hereditary predisposition to strabismus, he should be shown to an ophthalmologist more often to make sure that strabismus does not develop. The doctor, in turn, will talk about preventive measures that will prevent the disease from developing.

By carrying out timely prevention and contacting a specialist when the first symptoms of strabismus appear in a child, the disease can be stopped in time, avoiding serious and long-term treatment, including surgery.

Treating strabismus at home

There are many recipes that will be useful and will help you quickly cope with this disease. They should be used exclusively in combination with basic techniques, only after consulting a doctor.

Many kids will be pleasantly surprised to learn that chocolate can be used to restore vision and strengthen the eye muscles. It should be black and bitter. In order to get the desired effect, you should take it as a remedy immediately after breakfast or lunch, about 4 slices.

When treating, you can use healing infusions that have already proven their effectiveness and have been used for a long time. It is useful to take a decoction of rose hips, which is brewed for 6 hours in a thermos. Take 0.5 liters of boiling water per tablespoon of berries. Strain, drink 100 ml 2-3 times a day, half an hour before meals.

Cabbage leaf helps treat illness. It is recommended to boil it until mushy and eat one tablespoon several times a day, washing it down with the same decoction.

It is useful to drink juices from vegetables that can be mixed together. Cucumbers, carrots, and beets are best suited for obtaining juice.

Drops made from plants are also a means of preventing and treating illness at home. Here are some of them: pour 10 g of dill powder with a glass of boiling water, let it brew a little. Apply eye drops 2-3 times daily.

Mix juice from fresh apples, May honey, onion juice in a ratio of 3:3:1. Place the resulting mixture in your eyes before going to bed for 10 days. After a break, repeat the course.

Before treating hyterotropia with traditional methods, it is important to consult a doctor. Using herbs or other natural ingredients may be harmful if your baby has an allergic reaction.

Eye gymnastics can be a good addition to treatment. For example, you can take a piece of paper in a box, draw some shapes in each of the boxes with the condition that some of them are repeated. Give the sheet to the child and ask him to carefully look at the drawn shapes and cross out similar ones.

Take a plastic plate, make several holes of different sizes and shapes in it, and be sure to grind off the sharp edges so that the child does not cut himself. Give the plate to your baby and also give him a cord. Explain that he must thread a string through each hole. This activity does not bore children for a long time, and it gives excellent results.

Take two pictures with the same image, and one of them should be missing some details. The child must carefully compare both images and answer which parts of the picture are missing.

You can come up with dozens of similar exercises. The main thing is that they make the child’s eyes work. Before home therapy, be sure to consult with an ophthalmologist: perhaps he will tell you what exercises are best to do to speed up the treatment of the disease.

A prerequisite is the child’s good mood and well-being. It is recommended to perform eye exercises for at least two hours daily, in several approaches lasting 20 minutes. If your child has glasses, they should be used when performing special movements.

Why does divergent strabismus develop?

The exact causes of this disease have not yet been identified. All movements of the eyeballs are controlled by only 6 muscles. Four of them are responsible for up and down movements, and only 2 muscles regulate left and right movements. When the movements of all muscles are coordinated, the visual organs function normally. If individual eye muscles are affected, strabismus occurs. Sometimes the cause of such ailment is neurological diseases.

Common causes of this pathology in people of different ages are:

• significant difference between eyes in visual acuity;
• exposure to toxic substances on a pregnant woman, especially during the development of major organs. In this case, a baby is born with vision problems;
• tumors of various etiologies, not only of the eye sockets, but also of the ears, nose and head;
• congenital anomaly of the structure of the visual organs;
• cerebral palsy;
• dropsy of the brain;
• Down syndrome;
• injuries of various etiologies. The cause of unstable divergent strabismus can be psychological trauma.

Severely suffered infectious diseases in childhood can also cause visual impairment of this kind. This could be measles, rubella, mumps or the flu.