Strabismus ( heterotopia , strabismus ) - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Eye Disease

squint (strabismus, strabismus) - a visible manifestation of the pathology of the oculomotor system, characterized by the wrong non-parallel position of the cornea.


Causes Strabismus

Causes Strabismus:

- eye (congenital hypoplasia of the eye muscles, tumors and trauma eye refractive errors, especially anisometropia, amblyopia),
- nerve (paralysis and paresis of muscles,multiple sclerosis),
- endocrine (hyperthyroidism),
- infectious (influenza, measles),
- mental (neuroses, fear)

Strabismus can be congenital (shown with a newborn age) and purchased.

Symptoms of strabismus

apparent strabismus

Newborn babies up to 6 months of age are not able to fix things, so the eye "float".You may feel that there is strabismus with a certain structure of the skull with a broad bridge of the nose.This is normal (so-called alleged or apparent strabismus).

Latent strabismus Latent squint

appears due to the difference in muscle strength on both sides.When viewed with both eyes included c

ompensatory muscle mechanisms and strabismus are not noticeable.However, at shutdown of one eye visual act, for example, closing his hand, the second side deviates.Depending on the hand isolated esophoria (medially), exophoria (outwards), gipoforiyu (down), giperforiyu (up).

Treatment of latent squint is only required in cases of asthenopia (eye fatigue).Assign the correction of refractive errors.

True strabismus

True strabismus can be friendly and paralytic.Wherein one or both eyes are deflected to the side.

concomitant strabismus happens mostly in children, accompanied by a violation of binocular vision.Depending on where the deflected eye, distinguish:

- esotropia (converging)
- exotropia (divergent)
- vertical (up-Hypertropia, down-hydrotropes)
- combined strabismus

There monolateral (squints one eye)and alternating (rejected both eyes alternately) strabismus.

Depending on the involvement in the process of accommodation is strabismus:

- accommodative.With adequate correction of refractive error eye position becomes normal.
- neakkomodatsionnoe.The correction is only effective after surgery.
- partially accommodative.Wearing glasses or contact lenses does not completely eliminate the deviation of one or both eyes.

Depending on the magnitude of the deviation (deviation) is strabismus:

- very small (up to 5 degrees)
- small (6-10 degrees)
- average (11-20 degrees)
- pronounced (21-35 degrees)
- vyrazhennnoe dramatically (over 36 degrees)

Paralytic strabismus occurs due to paresis or paralysis of the eye muscles, due to injuries, tumors, infectious or neurological diseases.Symptoms: the restriction or total immobility of the eyes, double vision, compensatory head turn.The main method of treatment and surgery (muscle plastic)

Paralytic strabismus

patient strabismus may impose the following complaints: the deviation of one or both eyes to the side, double vision, decreased visual acuity, asthenopia (eye fatigue), as well as relatedmajor diseases caused by strabismus.

Diagnostics in strabismus

For diagnosis will need the following research methods:

- visual acuity with correction and without.
- perimetry.
- the amount of movement of the eyeballs can be reduced, and absent in paralysis of muscles.For this purpose, please watch out for any object (eg, pen, leather ophthalmoscope) when moving up, down and sideways.
- definition of refraction in mydriasis state by skiascopy or refractometer.
- four-point tsvetotest - exploring nature view (binocular, monocular or simultaneous).To do this, put on special glasses and asked to look at the screen with colored dots.Depending on the how many circles and what the patient sees the color, set the type of

Quattro tsvetotest

- squint angle for Hirschberg.With indirect ophthalmoscope watching the situation reflex on the cornea.

squint angle for Hirschberg

- sinoptofore to determine the presence and degree of strabismus (in degrees).In this fragment the images from each eye, and normally get a picture.
- biomicroscopy
- ophthalmoscopy and fundus examination with Goldman lens (pathology of the vitreous and retina)
- US eyes, including the determination of PZO
- Computed tomography of the orbit to exclude organic pathology of muscle or
nerves - consultation neurologist, pediatrician and endocrinologistif necessary, treatment of strabismus

Treatment should be initiated as early as possible to prevent the development of complications such as amblyopia.

First eliminate the causes of the strabismus, if any.Then, the main goal - to reach the central locking, eliminate squint or make it alternating (alternating).

first pick up an adequate vision correction, depending on the type and degree of refractive error.It is possible to the normal position of the eyes, if accommodative strabismus.

then used pleoptiki methods for the treatment of amblyopia - "shut down" of the visual process is not squinting eyes.To do this, set an opaque screen (gluing), closing the better seeing eye on the time period set individually.At night, the screen is removed.Thus, squinting eye becomes fixed.

glasses and contact correction is assigned to 6-9 months of age (before the child is not an object and captures the eye can "float").

uses special devices to improve visual acuity and secure central locking (akkomotrener, ambliopanorama, makulostimulyator).

also used in amblyopia penalization method, when in the best order atropine eye, creating artificially anisometropia.In this case, the squinting eyes as it becomes fixed.

After reaching the desired visual acuity (0.4-0.5) begin orthoptic treatment.With this method, the ability to develop the eye to merge, for example, sinoptofore, binarimeter.The fields of view are separated and in front of each eye has its own image is visible, together they form a single object (a mouse with a tail and no ears + mouse ears and no tail = whole mouse).

diploptiki methods with a large angle strabismus (over 10 degrees) is applied only after surgery.Their goal - to establish and secure a normal binocular vision.With the help of prisms first create an artificial diplopia, and then encouraged to bifixation.This puts your eyes alternately Sphero-prismatic lenses of different strengths.Also used vehicles (Diploptik-P) and software ( "Circuit», «EYE»).

Physiotherapy affects the weakened muscles.Apply electromyostimulation and darsonvalization the eye.

The angle of strabismus determines treatment.If initially squint angle greater than 15 degrees, it is likely that surgery is inevitable.If you squint angle of 20 degrees or more, the operation is recommended immediately after the adaptation points and gluing.At small angles of strabismus - less than 10 degrees, often limited to hardware treatment.In any case, keeping the patient assumes a logical sequence of treatment in order to restore binocular vision.

Conservative treatment hardware and in any case need to go at least 2 times a year.

Surgical treatment of strabismus

If the eye position still remains unbalanced, use the surgical method.Principles of surgical treatment:

- operate in the absence of the effect of extended wear glasses or lenses (1-2 years)
- optimal age for operation of 4-5 years.In congenital or a large angle strabismus - 2-3 years
- at an angle of more than 30 degrees of squint, operate in 2 stages
- if both eyes need to operate, observe the phasing, ie,period of about six months.

for surgery, reinforcing the action of the muscles, muscle resection refers (shortening), the formation of tendon or muscle folds and moving the insertion anterior muscle.

operations, reduces the effect of muscles: elongation using incisions posterior to the insertion of the transfer and plastic muscles or tendons.

Strabismus - a disease whose treatment should be started as early as possible.Otherwise it will lead to the development of amblyopia in older age will trouble as a cosmetic defect.For some professions need to binocular vision.Strabismus can be cured, but you need patience and a desire to get well.

Ophthalmologist Letyuk TZ