Lazy eye syndrome in adults and children

Among the large number of different functional vision problems, lazy eye syndrome (or amblyopia) is the most common.

This pathology is characterized by a visual defect that occurs as a result of a coordination failure in the function of the visual centers in the brain.

Epidemiology

According to the latest statistical data from surveys conducted by vision preservation and restoration specialists, at least 2% of adults worldwide suffer from lazy eye syndrome. Among children, this percentage is:

• about 1% without clinical symptoms of visual impairment;
• about 4-5% with diagnosed pathology of the visual organs.

At the same time, about half a percent of preschool-age children develop lazy eye syndrome every year.

In 91% of diagnosed cases, the syndrome is represented by a dysbinocular and refractive variant of the disease.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]

Causes lazy eye syndrome

Lazy eye syndrome can develop in a child even before birth. In addition, some changes in the visual organs can interfere with the rays hitting the retina - this can cause the development of amblyopia.

Other reasons may include:

• Hereditary predisposition.
• Drooping of the upper eyelid.
• Refractive imbalance – anisometry.
• Congenital visual impairments.
• Astigmatism.
• Clouding of the cornea of the eye.

[ 5 ], [ 6 ]

Risk factors

According to WHO, the following factors have been identified to contribute to the development of lazy eye syndrome:

• premature birth of a baby;
• prematurity (underweight);
• retinopathy;
• Cerebral palsy;
• disorders of intellectual and/or physical development;
• existing cases of similar syndrome in the family, as well as strabismus, hereditary cataracts, etc.

In addition to the listed factors, the risk of developing lazy eye syndrome is increased by:

• consumption of alcoholic beverages by a pregnant woman;
• smoking during pregnancy;
• use of medications prohibited during pregnancy.

[ 7 ]

Pathogenesis

Normal visual function requires a good visual field in front of the left and right eyes. Any obstruction that prevents the transmission of an accurate image to the retina during the first ten years of a child's life can trigger the development of lazy eye syndrome.

Most often, the syndrome occurs when there is asymmetry in visual perception. In this case, unilateral amblyopia develops.

Bilateral lazy eye syndrome may occur in the presence of severe bilateral visual impairments, such as bilateral cataracts or ametropia.

In lazy eye syndrome, vision may decline gradually or rapidly, leading to complete loss of visual function, but with preservation of peripheral vision.

[ 8 ], [ 9 ]

Symptoms lazy eye syndrome

Among the main signs of lazy eye syndrome, the following should be especially highlighted:

• visible difference when looking in one direction;
• one-sided visual acuity;
• decreased visual depth perception;
• decreased vision in the affected eye;
• the appearance of a dark spot (or spots) that interferes with vision;
• limitation of the field of vision of one eye;
• decreased visual concentration of one eye.

The first signs of the disease may differ depending on the type of syndrome.

• Anisometropic lazy eye syndrome is manifested by myopia, hyperopia and astigmatism, almost never occurs against the background of strabismus and is found in children under 7 years of age.
• Refractive lazy eye syndrome is essentially a latent disorder, without any obvious symptoms.
• Obscuration syndrome of lazy eye manifests itself with cataracts, clouding of the lens and cornea, small hemorrhages in the eye. The patient feels as if he sees surrounding objects as if through a veil.

All types of lazy eye syndrome progress with progressive deterioration of vision.

Stages

According to the degree of deterioration of visual function, lazy eye syndrome can be:

• weak (from 0.4 to 0.8 diopters);
• average (from 0.2 to 0.3 diopters);
• high (from 0.05 to 0.1 diopters);
• very high (less than 0.04 diopters).

Mild to moderate stages of the syndrome are very difficult to diagnose, unlike other stages of the disease.

Forms

Depending on the underlying cause, experts have identified the following types of secondary lazy eye syndrome:

• Refractive syndrome – characterized by refractive disorder, unclear focusing of the image by the eye (or eyes). Refractive disorder may occur with improper or insufficient treatment of myopia, hyperopia or astigmatism.
• Obscuration syndrome is a disorder associated with corneal opacity, drooping eyelids, and congenital cataracts. This disorder leads to a significant decrease in vision with no hope of recovery.
• Anisometropic syndrome develops with refractive imbalance of the visual organs, which leads to incorrect formation of a clear visual image in the visual center. As a result of such a discrepancy, the brain center "switches off" one eye.
• Disbinocular syndrome occurs against the background of monolateral concomitant strabismus. In the absence of high-quality focusing, a person's ability to see is reduced to zero (due to the development of lazy eye syndrome as a result of anopsia).
• Hysterical syndrome appears after a strong psycho-emotional traumatic situation, when visual perception is blocked by the brain. This variant of the syndrome develops especially often in very impressionable and easily excitable people.

Complications and consequences

Lazy eye syndrome can lead to various adverse effects, the most severe of which is considered to be absolute loss of vision. In this case, the vision of not only the affected eye, but also the healthy eye, can suffer, since it suffers from visual overload for many years.

The risk of vision loss with lazy eye syndrome is very high.

The general range of consequences can be summarized as follows:

1. Absolute or partial loss of visual function, with preservation of the ability to see sides.
2. Professional unsuitability in many areas of activity.
3. Some social isolation.
4. Inability to operate vehicles and other machinery that require visual coordination.

[ 10 ], [ 11 ]

Diagnostics lazy eye syndrome

Early diagnosis is very important in order to influence the further development of lazy eye syndrome in time and prevent vision loss.

Deprivation syndrome can be diagnosed already in a newborn, so it is recommended to examine the child no later than 4-6 weeks after birth. When the baby turns 1 year old, a repeated refractive power check should be performed. If the child has a high risk of developing lazy eye syndrome (for example, with a burdened anamnesis), an ophthalmologist's examination is carried out every year.

Laboratory tests cannot indicate specific problems with the visual organs. Blood tests can help identify inflammatory diseases, blood disorders, hormonal disorders, etc.

Instrumental diagnostics may include the use of the following procedures:

• visometry (checking the degree of visual acuity using special Orlova or Sivtsev schemes);
• perimetry (studies of the boundaries of the visual fields, with projection onto a spherical surface);
• automatic refractometry and keratometry – methods of refractive examination;
• control of eye motor function;
• eye fixation control;
• electrophysiological diagnostic procedures, which include electroculography, electroretinography, testing the electrical sensitivity of the optic nerve and electroencephalography with subsequent recording of the potentials that are evoked in the visual cortex of the brain.

Differential diagnosis

Often, the diagnosis of lazy eye syndrome is established using the exclusion method. Thus, differential diagnostics are carried out taking into account the following diseases:

• Astigmatism, hyperopia, myopia.
• Congenital variant of optic nerve hypoplasia.
• Optic nerve atrophy.
• Compression, intoxication or hereditary factor with the development of optic neuropathy.
• Retinopathy.
• Damage to the occipital lobes of the brain - cortical blindness.
• Glaucoma.
• Deterioration of vision associated with psychogenic pathologies.

Treatment lazy eye syndrome

There are several known techniques that are used by practicing ophthalmologists to treat lazy eye syndrome.

Lazy eye syndrome in adults is most often cured by using occlusion - artificial covering of a healthy eye with good vision. For this purpose, a special device is used, which is sold in pharmacies and opticians. Due to the fact that the unaffected eye is covered, the cerebral cortex of the diseased eye is stimulated, which over time leads to the restoration of visual function.

Occlusion can be used to treat lazy eye syndrome in both adult patients and older children. The standard frequency of wearing the device is 1 hour per day, with increasing duration.

Lazy eye syndrome in children can be treated with computer correction - this method is used in most ophthalmological centers.

The total duration of therapy is determined by the doctor individually, which may depend not only on the patient’s age, but also on the degree of eye damage.

During the entire treatment period, the patient is under the supervision of the attending ophthalmologist, who evaluates the dynamics of the process.

In addition to the listed methods, it is possible to use hardware procedures such as laser correction, electrical and magnetic stimulation.

Medicines are prescribed as a supplement to hardware procedures. In the vast majority of cases, we are talking about multivitamin preparations, the action of which is aimed at improving visual function, strengthening the optic nerves and improving metabolic processes.

To speed up the restoration of vision and if indicated, the patient may be recommended to wear contact lenses. Lenses will be especially relevant if one eye suffers from myopia and the other from hyperopia.

Less commonly used is a therapeutic method called penalization, which is a targeted temporary reduction in the quality of vision of the healthy eye. This method leads to activation of the visual function of the affected side. Penalization is performed using atropine and is used to treat lazy eye syndrome in children under 4 years of age.

Medications and vitamins that may be prescribed by your doctor for lazy eye syndrome include:

• Biofit-blueberry is a biologically active food supplement, the purpose of which is to improve vision and relieve the patient from visual problems. The drug is taken, depending on the symptoms, from 1 to 3 tablets per day. Do not take the product if you have an individual intolerance to the components.
• Duovit is a complex multivitamin preparation that is successfully used to support the body and replenish reserves of essential vitamins and microelements. Duovit for lazy eye syndrome is taken 2 pills per day. Rarely, the drug can cause allergies.
• Lutein complex is a widely used biologically active supplement that contains carotenoids, flavonoids, vitamins and microelements necessary to restore the functionality of the visual organs. Lutein complex is used 1-3 tablets per day with food. The only contraindication to taking the drug is individual intolerance to the vitamins and other components included in the composition.
• Vitrum is a supportive and restorative complex drug that is recommended to be taken 1 tablet daily, both as a treatment for lazy eye syndrome and for its prevention. Vitrum is approved for use from the age of 12.
• Strix is a herbal preparation approved for use from the age of 7. Strix improves retinal function and has long been successfully used in ophthalmological practice, including for lazy eye syndrome. The drug is recommended to be taken 1-2 tablets per day. Allergic reactions during treatment occur relatively rarely, but the possibility of their development should not be excluded.

A comprehensive approach often includes physiotherapy treatment. Medicinal electrophoresis procedures, acupuncture (reflexotherapy), and vibration massage sessions are prescribed.

Folk remedies

The following folk medicine recipes can slow down the development of lazy eye syndrome and speed up the restoration of vision:

• include young nettle leaves in your diet every day, both fresh and dried - you can use them to prepare first courses, salads, and also add them to side dishes and casseroles;
• drink a glass of currant or carrot juice every morning (preferably freshly squeezed);
• prepare and periodically consume wine from red or black currants (approximately 50 g of dry wine daily);
• drink blueberry juice, compote or fruit drink on an empty stomach.

Traditional medicine also includes treatment with medicinal herbs.

[ 12 ], [ 13 ]

Herbal treatment

• Take a handful of rosemary leaves or sprigs, pour 1 liter of dry white wine, leave for two days and filter. Take 1 tbsp. daily before meals.
• Take 3 tablespoons of the hernia plant and 1 tablespoon of eyebright, pour 600 ml of boiling water and leave under the lid for 2 hours. Take 1 glass before meals.
• Take 1 tbsp. finely chopped parsley, pour a glass of water and boil for 2-3 minutes. Take 1-2 glasses a day, every day, for a long time.
• Grind the dried plants in a coffee grinder: ginseng rhizome (4 g), horsetail grass (5 g) and carrot seed (10 g). Take a small amount of the resulting powder on the tip of a knife three times a day before meals.

Homeopathy

The issue of using homeopathic medicines for lazy eye syndrome should be covered separately - especially if the pathology is caused by accommodation disorder. Homeopathy can help eliminate accommodation spasm and relax the visual muscles. The following medicines may be suitable for this purpose:

• Yaborandi, Physostigma - used for pain in the eyes, for accommodation disorder in patients with myopia;
• Cocculus, Gelsemium, Pulsatilla - will help with farsightedness;
• Selenium, Lycopidum - used for weak mobility of the visual muscles.

Before using homeopathic medicines, it is necessary to remember that their effectiveness is possible only against the background of traditional treatment of lazy eye syndrome. The dosage of the medicines is determined individually, after an appointment with a qualified homeopathic doctor.

Is there any surgical treatment for lazy eye syndrome?

Surgical treatment is possible if the lazy eye syndrome is associated with strabismus or cataracts - in such situations, it is really possible to help the patient. In all other cases, surgery does not allow for complete elimination of the disease, so the only optimal option is considered to be a comprehensive therapeutic approach without surgical intervention.

Prevention

In order to prevent the development of lazy eye syndrome, it is necessary to observe some simple conditions:

• get a good night's sleep, have quality rest;
• avoid eye strain, nervous shocks and injuries;
• periodically visit an ophthalmologist or optometrist for a preventive examination.

In some cases, when the risk of developing lazy eye syndrome is especially high, the doctor may recommend wearing special glasses that have the ability to relieve eye strain and facilitate the function of the optic nerves.

There are even special computer programs in the form of games developed for children that improve the quality of visual focusing.

[ 14 ]

Forecast

The prognosis for lazy eye syndrome can depend on many factors:

• from correctly prescribed treatment;
• depending on the type of syndrome;
• from the quality of eye fixation;
• from the initial quality of vision;
• from the duration of lazy eye syndrome at the time of treatment initiation;
• from the patient's age at the start of treatment;
• from the completeness of the therapeutic effect.

Unfortunately, there is no guarantee that lazy eye syndrome will not recur after the end of therapy. Given this, patients should undergo regular examinations by an ophthalmologist at two and four months, and then at six months and a year after treatment.