Strabismus: what is it, how to restore an attractive look

Strabismus, or strabismus in scientific terms, is a pathological condition in which one or both eyes deviate from the point of fixation. In the early stages it is not always noticeable; if the form is advanced, it can lead to loss of vision.

It occurs in children and adults, less often in newborns (in the latter group there is a passing “false or imaginary strabismus” due to underdevelopment of the eye muscles).

The causes are varied: congenital and acquired strabismus occurs due to severe visual impairment, underdevelopment or pathology of the visual muscles, mental disorders and severe psychological trauma, some childhood diseases and other factors. Conservative methods are initially used for treatment; if they are ineffective, surgical intervention is used.

Causes

As a result of strabismus, or strabismus, one or both eyes do not concentrate on an object, and there is no complete picture of what is seen. Due to lack of coordination in the functioning of the eye muscles, the brain receives scattered ideas. Normally, in a healthy person, the eyes are fixed at a single point, the brain receives and forms a three-dimensional picture of what it sees.

The occurrence of the disease can be influenced by pathologies of the organ of vision, central nervous system, endocrine system, and mental disorders.

Factors provoking strabismus:

• eye injuries, tumors of the organ of vision;
• pathology of the development of muscle tissue that interferes with eye movement occurs in newborns and children whose mothers suffered from measles, scarlet fever, ARVI, cytomegalovirus and other infectious diseases during pregnancy;
• cataract;
• glaucoma;
• refractive error due to myopia or farsightedness;
• transformation of the vitreous body;
• fear in young children, severe psychological trauma;
• neurosyphilis, multiple sclerosis, encephalitis, blood flow disorders leading to paralysis of the eye muscles;
• increased intracranial pressure;
• pathological conditions in the brain or spinal cord leading to weakening of the eye muscles;
• Disturbances in the functioning of the endocrine system in pregnant women can lead to strabismus in the child.

Strabismus is not a hereditary pathology. Due to complicated heredity, the child may have farsightedness, myopia, and other refractive errors and eye function, which are a risk factor.

Classification

Depending on its occurrence, strabismus is of two types - congenital and acquired. The first type develops in a child while he is in the womb due to provoking factors.

The eyes have 12 extraocular muscles, and the left and right eyes have 6 muscles each. Each of them is responsible for turning the eyeball to the right, left, up or down. When the work of the extraocular muscles is uncoordinated and there is a lack of synchronization between them, strabismus is detected. Depending on the dysfunction of any of these muscles, the following types of strabismus occur:

• exotropia, or divergent strabismus;
• convergent (internal) strabismus;
• vertical strabismus;
• mixed form.

With exotropia, the eyes look “outward” and focus in different directions. The convergent form is also called isotropy. It is characterized by focusing the eyes in the opposite direction, on the bridge of the nose. With the vertical variety, squinting eyes are observed in a vertical plane - up or down.

Acquired strabismus can occur in one of three forms:

• constant;
• temporary due to alcohol intoxication or the effects of narcotic and psychotic substances, severe relaxation or illness;
• sensory – a harbinger of decreased vision.

Another classification of strabismus divides the disease into imaginary, hidden and true types. If the development of the oculomotor muscles of the right and left eyes is unequal, latent strabismus is diagnosed, which is noticeable when covering the healthy eye with a hand.

Concomitant strabismus

It is characterized by identical strabismus angles, insufficient development of the extraocular muscles of both eyes and the absence of double vision.

According to the mechanism of development, strabismus is divided into 3 subtypes: accommodative, partially accommodative and non-accommodative. In the first subtype, the disease is preceded by farsightedness, myopia and other accommodation disorders. Glasses are required for treatment. In the second subtype, partial vision loss is diagnosed. The non-accommodative type of strabismus is not easily identified and eliminated, since it occurs in the child at birth due to sudden injuries and blows suffered by the mother and infectious diseases.

The opposite of concomitant strabismus is the paralytic type, accompanied by double vision. It occurs due to the inability to move the eyes, leading to headaches, fatigue and general malaise, and partial or complete paralysis of the eye muscle tissue.

Symptoms

The main symptom of strabismus is the asymmetry of the iris and pupil to the palpebral fissure.

With paralytic strabismus, the eye cannot move towards the paralyzed muscle, or this movement is difficult. Associated symptoms: dizziness, diplopia, difficulty determining the distance to an object. The angle of deviation of a squinting eye is less than that of a healthy eye.

• Strabismus in newborns: causes, treatment methods and prevention

To compensate for the squinting eye, a person with paralytic strabismus turns or tilts their head. He has to do this so that the image of the object falls on the retina, and then double vision is not observed.

If the oculomotor nerve is damaged during strabismus, then dilation of the pupil, ptosis of the upper eyelids is observed, the eye deviates, and paralysis of accommodation may occur.

With concomitant strabismus, there are no differences in the angles of the squinting and healthy eyes, the muscles work normally. Conjugate strabismus is divided into convergent and divergent, torsional, vertical, combined, monocular and alternating. Monocular strabismus leads to disruption of the functioning of the squinting eye, while vision decreases and amblyopia develops.

Imaginary strabismus

This type occurs in newborns and can persist for up to 4 months due to the underdevelopment of the optic nerve and the inability to focus the gaze. It does not require observation or correction.

To develop the eye muscles, it is necessary to show the child objects of predominantly black and white colors, from a month - green and yellow colors at a distance of 15-20 cm. After focusing the gaze on the object, it should be slowly moved to the sides, up or down.

If the condition persists after 4 months, a visit to an ophthalmologist is required.

Surgery to correct strabismus

In most cases, the only effective treatment for persistent strabismus is strabismus surgery.

If your child's eye doctor finds that your child has a squint, he or she may refer you to an ophthalmologist who specializes in surgery to correct strabismus.

The success of surgery to correct strabismus depends on many factors, including the direction and degree of misalignment of the eye. In some cases, multiple surgeries may be required. The surgeon performing strabismus surgery will provide you with more information about this during your preoperative consultation.

This type of strabismus surgery can also be effective for adults with long-standing strabismus. However, in many cases of adult strabismus, a significant degree of amblyopia may persist even after proper alignment of the misaligned eye. This is why early treatment of strabismus is so important.

The earlier surgery is performed, the more likely it is that the affected eye will develop normal visual acuity and both eyes will function smoothly.

Diagnostics

To diagnose strabismus, it is necessary to collect an anamnesis, the timing of the onset of the disease, and establish a connection between strabismus and previous or existing diseases. Biometric studies, a test ophthalmological examination, a refractive examination are carried out and the ophthalmologist examines the structures of the eye.

When making a diagnosis, the angle of strabismus is measured and the volume of accommodation is determined. If a paralytic type of pathology is diagnosed, additional consultation with a neurologist and a computer examination is required.

Treatment

Strabismus therapy is aimed at restoring normal, binocular vision. It includes several methods. With successful treatment, stable binocular vision, high visual acuity, and symmetry of eye position are restored.

Correction with glasses and lenses

Necessary for any type of strabismus. Especially with accommodation, when the provoking factor for the disease was myopia, farsightedness or other accommodation disorders.

The purpose of optical correction with the help of selected contact lenses or glasses is to restore visual acuity, eye similarity and accommodation.

Hardware treatment

Using special devices, the visually impaired or amblyopic eye is stimulated. Computer programs, Synoptophore, photo, laser and magnetic stimulation, Amblyocor, vacuum ophthalmic massage are common.

Wearing an occlusive dressing

A special bandage is fixed on the healthy eye, the person sees objects with a squinting eye. This is done with the aim of increasing the load on the pathological eye, excluding the fixing, healthy eye from the vision process. Hardware treatment and the use of special computer programs are based on this principle.

Surgery

A treatment option if conservative treatment for a year and a half has not produced positive results and improvement in the patient’s condition. The most optimal age for surgical intervention is 3-5 years. First, the tendon is cut or a muscle is transplanted to weaken muscle regulation, then in the second stage the action of the extraocular muscle is strengthened by shortening it.

The disadvantage of surgical treatment is the possibility of complications (poor vision and blindness, bleeding, infection, insufficient or excessive correction of strabismus).

Expert opinion

Kiryukhina Svetlana Lvovna
Ophthalmologist of the highest category in the children's department, ophthalmic surgeon, Candidate of Medical Sciences

Treatment of strabismus is a long process, and surgical treatment alone is not enough. It is not enough to return the eye to the correct position, you need to teach the body how to use it correctly. This is achieved by regular training: visual gymnastics, development and consolidation of binocular vision, correction of amblyopia.

And while it is still possible to explain to an adult the need for regular exercise, children quickly get bored with it. In this case, the success of treatment depends on the parents, who must monitor the implementation of all prescriptions of the attending physician.

Cost of basic services

Full price list The cost of microsurgical operations is indicated for one eye

Full price list

Prevention

To prevent the development of strabismus in an adult or child, before planning a pregnancy, it is important to be examined, identify the presence of ophthalmological diseases and correct the condition. Do not be in areas of epidemics during the season of colds, flu, or other infectious diseases.

One of the preventive measures is regular visits to the doctor for examination.

If strabismus is detected, it is important not to be shy, adhere to the prescribed treatment, and perform gymnastics to strengthen and move the extraocular muscles. For example, look into the distance, then examine objects in the distance, draw a bow, a Christmas tree, or other objects with your gaze.

To hide squint, women can learn makeup techniques that don't focus on the eyes.

How it manifests itself

One of the main signs of strabismus is the appearance of the eyes, but it is not always reliable, since in children in the first year of life the strabismus is imaginary. Strabismus in children of the first year of life can be considered true only if one eye is constantly deviated to the side; this may indicate paralytic strabismus.

When this sign appears, you need to pay attention to the position of the child’s head, it will be forced. The child will constantly keep his head on his side or turn it to the side, this will compensate for the split image, decreased vision, headache, and the child may squint.

Useful video

The video tells who is more likely to experience strabismus, what visual features are observed, and how others treat them.

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