Heterophoria in children and adults

The term "heterophoria" comes from the fusion of the Greek words "different" and "bearing". This term refers to a violation of the normal position of the eyeballs, provided that both eyes work together. This pathology is otherwise called latent strabismus, and it is caused by the incorrect function of the eye muscles.

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Epidemiology

Heterophoria is most often diagnosed in childhood, namely in children aged 5-9. In girls, heterophoria occurs somewhat more often - by about 1.4%.

On average, almost 800 thousand people worldwide suffer from heterophoria.

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Causes heterophorias

When talking about the causes of heterophoria, we mean the influence of certain risk factors, which are considered to be:

• Individual features of the anatomical location of the visual organs (for example, the diameter of the eye sockets or the total volume of the skull are important).
• Weakness of individual muscle fibers responsible for the motor function of the eyeball. This is often caused by refractive errors such as farsightedness or nearsightedness.
• Endocrine disorders – in particular, improper functioning of the thyroid gland.
• Weakened immunity and nervous exhaustion caused by frequent infections, which inevitably affects the functioning of the visual organs.
• Frequent stress, psycho-emotional stress.
• Various muscle paralysis.
• Trauma, tumor processes localized inside the organ of vision and capable of damaging the eye muscles.

In adulthood, risk factors such as various diseases and mechanical damage to the visual organs are primarily considered. In children, heterophoria most often occurs as a result of transient weakness of the eye muscles, or after infectious pathologies.

Accommodation spasm and heterophoria can also be interconnected, since false myopia disrupts the function of the eye muscles, which negatively affects the ability of the visual organ to clearly see objects at different distances. In other words, accommodation spasm is a spastic contraction of the eye muscles, which leads to blurred perception of objects located both close and far away.

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Pathogenesis

A condition such as heterophoria is explained by the different strength of the action of the muscles responsible for eye movement.

Under normal conditions, due to the fusion function of the visual system, disruptions in muscle balance are not noticeable. If the visual organs are separated - for example, by covering one eye or placing a prismatic polyhedron with its base up or down, then partial weakening of some muscle fibers will already be detected. And the axis of fixation of one eye moves inward (with esophoria), to the outer side (with exophoria), upward (with hyperphoria) or downward (with hypophoria). In some cases, it is possible for the upper point of the vertical corneal meridian to move inward (with incyclophoria) or to the outer side (with excyclophoria).

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Symptoms heterophorias

Minor heterophoria may occur without obvious symptoms for the patient. Experts attribute this to the presence of fusion ability, responsible for a single three-dimensional visual image obtained by merging separate images from the left and right eyes.

If the function of the visual organs is significantly impaired (severe heterophoria), then when the muscles and nerves are tense, symptoms of discomfort may be observed in the eyes:

• increased eye fatigue, increased tiredness;
• headaches associated with eye strain;
• duality of the visual image;
• nausea due to visual strain;
• painful sensation when closing the eyelids.

Such early signs of heterophoria are a reason to see a doctor and undergo additional diagnostic tests, since only a doctor can make an accurate diagnosis of heterophoria after summing up the diagnostic results.

Heterophoria in children

Many infants exhibit relative heterophoria. However, in this case it is inappropriate to talk about pathology: the fact is that the oculomotor muscles of infants are still underdeveloped, and control over the movements of the eyeballs is carried out with difficulty. As the child develops, the muscle fibers become stronger, become elastic, and tone appears.

In the vast majority of children, such a disorder as heterophoria disappears after about 4 months from birth. As a rule, no treatment is carried out. If the problem of heterophoria remains, and there is no correction with age, then the pediatric ophthalmologist may decide to perform surgical intervention.

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Complications and consequences

The most typical complication for heterophoria is fusion disorder. Fusion is a complex natural visual mechanism that ensures the combination of a pair of monocular images into one visual image. With heterophoria, this mechanism may be disrupted.

In addition, further progression of strabismus is typical for heterophoria. Moreover, it is mainly young people who suffer.

The greatest number of complications is found in patients diagnosed with farsightedness, nearsightedness, refractive errors, and astigmatism.

In almost all cases of heterophoria, strabismus occurs in patients whose refractions in both eyes differ. The eye that sees worse is most often affected.

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Diagnostics heterophorias

Diagnosis of suspected heterophoria is based on the exclusion of one visual organ from the binocular visual principle.

Laboratory tests for heterophoria are generally not performed.

Instrumental diagnostics of heterophoria includes special ophthalmological tests:

• Carpet test for heterophoria.

The doctor asks the patient to look at some very distant object. Then he covers first one and then the other eye of the patient, simultaneously noting which eye showed the setting movement and which did not. After this, the test can be repeated, but using an object that is closer in distance.

• Maddox test for heterophoria.

This method involves the use of a special table with a degree scale and a rod (a cylindrical row made of red glass). The test consists of providing a condition for disrupting normal binocular vision. The patient looks through the rod at the illuminated table: if there is heterophoria, the line from the backlight will shift from the center of fixation to the left or right. The scale makes it possible to find out the exact angle of displacement.

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Differential diagnosis

Differential diagnostics for heterophoria does not present any difficulties and is carried out with a thorough examination of the motor function of the eye. As a rule, different types of strabismus are differentiated, including apparent and latent strabismus.

Treatment heterophorias

The tactics of correcting heterophoria are selected taking into account the degree of pathology. If the displacement does not exceed 3-4 pr. diopters, the quality of vision does not deteriorate, then there is no need for correction. It is only necessary to take measures to ensure adequate visual load with observance of the work and rest regime.

In case of impaired refractive power of the visual organs, correction is carried out by installing special decentered lenses, as well as with the help of eye exercises that restore normal fusion (a synoptophore or prisms can be used).

If the motor eye muscles have a pronounced power imbalance, and the patient complains of a number of pronounced symptoms of heterophoria, then he is recommended to wear glasses with special prismatic lenses. The base of the prisms is applied to the side opposite to the direction of the eye displacement.

If the above methods are ineffective, then heterophoria is treated surgically.

Medicines for heterophoria are prescribed only according to individual indications. The following drugs have a general strengthening effect on the eye muscles:

• Optix is a carotene-based product containing a range of beneficial vitamins and minerals.
• Mertilen Forte is a complex preparation with zinc and riboflavin, and is a hypoallergenic product.
• Visualon is especially suitable for patients with myopia. For children, there is a safe preparation Visualon with blueberries.
• Glazorol - eye drops to improve eye nutrition and facilitate the functioning of the optic nerves.
• Blueberry Forte is suitable as a strengthening agent for patients with heterophoria due to farsightedness, nearsightedness and other visual deviations.

All listed drugs have a restorative and strengthening effect in heterophoria. Dosages are determined individually, depending on the degree of pathology.

Vitamins

To get rid of heterophoria as quickly as possible, you need to establish proper nutrition, which will include all the useful substances that strengthen the oculomotor muscles and improve the quality of vision. To get all the necessary vitamins from food, you need to include the following products in your menu:

• sea fish, turkey, chicken and quail eggs, fermented milk products;
• root vegetables, vegetables, beans (carrots, pumpkin, sweet peppers, beans, tomatoes, cabbage);
• berries, fruits (persimmon, grapes, apricot, peach, watermelon, blueberry, sea buckthorn);
• oatmeal and buckwheat porridge;
• greens, sorrel, celery;
• unrefined vegetable oil;
• dark chocolate (cocoa content – from 60%, and preferably – 85%).

The listed products contain vitamin A, ascorbic acid, B vitamins, and a host of useful microelements. These substances help strengthen the eye muscles and improve visual function in heterophoria.

Physiotherapy treatment

Physiotherapy is used to treat heterophoria, to restore weak eye muscles. Muscle electrical stimulation is often the procedure of choice. It is prescribed to enhance the functionality of weak muscle fibers.

In addition to electrical stimulation, darsonvalization of the eye area around the orbit has a positive effect. This procedure has the greatest effect in treating patients belonging to the young and middle age category. However, the proposed treatment should be long-term: you should not expect a positive result after 10-15 sessions. Therefore, physiotherapy is always used against the background of general therapy for heterophoria. Vision exercises are also effective.

Folk remedies

Carrots strengthen the eye muscle, so this root vegetable should be eaten raw as often as possible, or freshly prepared carrot juice should be drunk. You can make a salad or juice from carrots, cucumbers and beets - this combination of vegetables is best suited for strengthening the muscles of the visual organs. Doctors recommend drinking about 500 ml of carrot juice in combination with beet and cucumber juice daily.

To correct heterophoria, it is useful to frequently drink an infusion of blackcurrant leaves. Take 200 ml of boiling water and brew 5 g of dry raw material in it. Infuse and drink instead of regular tea every day.

Another recipe: wash fresh white cabbage leaves, put them in boiling water and cook until the leaves begin to fall apart. Cool the potion and take it internally 4 times a day with the decoction, like a soup.

An interesting and popular method of treating heterophoria is dark chocolate. Only dark chocolate without fillings and pores, with a cocoa content of at least 60% and sugar content of no more than 40% is suitable for treatment. This method is suitable only for those patients who are not allergic to chocolate, as well as diabetes and obesity. Experts also point out that the chocolate method is more effective in the early stages of the disease, and especially in children aged 3-4 years. A patient suffering from heterophoria should eat 4 regular slices of the treat, 60 minutes after breakfast and lunch. The course of chocolate therapy is 4 weeks. Experts point out that dark chocolate can strengthen and tone the eye muscles.

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Herbal treatment

Calamus rhizome is useful for strengthening the eye muscles. Prepare an infusion of 10 g of crushed roots and 200 ml of boiling water, then take this medicine ¼ cup in the morning, before lunch and before dinner.

If heterophoria is at the initial stage of development, then regular rosehip tea will help - it is brewed at the rate of 100 g of berries per 1 liter of boiling water, infused in a thermos for 3 hours. You can add a little honey to the finished tea, and drink 200-250 ml before meals, 4-5 times a day.

You can brew pine needles - for this you will need 100 g of needles and 500 ml of boiling water. Take the infusion after it has cooled, 1 tbsp. after meals, 4-5 times a day, for a long time.

In addition, you can act on the disease externally, for this you just need to prepare special herbal drops. Ground dill in the amount of 10 g is poured with 200 ml of boiling water. The resulting product is carefully filtered and used as eye drops, 2-3 times a day, a few drops in the affected eye. The decoction is stored in the refrigerator for no more than a day. Before instillation, the drops are heated to body temperature.

Homeopathy

Homeopathic treatment for heterophoria is not used very often: in many children this condition does not require any medical correction, and when the problem is severe, doctors often resort to surgical intervention.

Homeopathic doctors recommend paying attention to the following medications as a supportive and corrective remedy for heterophoria:

• Cyclamen 6c – 3 granules on an empty stomach in the morning, every day;
• Cicuta 12c – one granule once every three days, preferably in the evenings.

Other medications may be appropriate for some patients:

• Agaricus muscarius 12c;
• Gelsemium 3c;
• Euphrasia 3c;
• Ruta graveolens 3c;
• Physostigma 6s.

Treatment with homeopathic medicines requires an individual approach, so general recommendations on the dosage of these drugs are not provided. Side effects are usually absent.

Surgical treatment

The surgical intervention method is appropriate only for significant interocular angular values, or when other treatment methods do not lead to the desired result.

If heterophoria is detected in a child, then surgical intervention is performed only after a preliminary conversation between the doctor and the parents.

The essence of the surgical treatment for heterophoria is to correct the length of the eye muscles to stabilize and balance both visual organs during operation.

Prevention

Preventive measures can be identified with compliance with the following rules:

• undergo regular examinations and diagnose any pathologies of the visual organs;
• consult a doctor in a timely manner and follow all his instructions;
• observe moderation in the load on the organs of vision, especially in childhood;
• protect your eyes from all kinds of irritations, such as bright light.

If heterophoria already exists, its manifestation can be reduced by regularly performing special eye exercises, which strengthen the eye muscles and stabilize their tone.

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Forecast

Heterophoria is a phenomenon that does not always require medical intervention. However, if there are significant visual impairments, it is better to contact competent qualified specialists who have experience and skills in treating such pathologies. Only under such circumstances can we talk about a favorable prognosis for this condition.

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