Heterophoria in children and adults

The term "heterophory" derives from the confluence of Greek words "different" and "carrier." Denote this term is a violation of the normal location of the eyeballs, provided that both eyes work together. This pathology is also called a hidden strabismus, and it is caused by an incorrect function of the musculature of the eye.

[1], [2], [3], [4], [5]

Epidemiology

Heterophoria is most often diagnosed in childhood, namely, in children 5-9 years of age. At the same time, in girls, heterophory is encountered somewhat more often - by about 1.4%.

On average, almost 800 thousand people suffer from heterophoria in the world.

[6], [7]

Causes of the heterophoria

Speaking about the reasons for the appearance of heterophory, we have in mind the influence of certain risk factors, which are considered:

• Individual features of the anatomical location of the organs of vision (for example, the diameter of the eye sockets or the total volume of the skull is important).
• Weakness of individual muscle fibers responsible for the motor function of the eyeball. Often this is provoked by such refractive disorders as hyperopia or nearsightedness.
• Endocrine disorders - in particular, the abnormal thyroid function.
• Weakened immunity and nervous exhaustion caused by frequent infections, which inevitably affects the work of the organs of vision.
• Frequent stress, psycho-emotional stress.
• Various paralysis of the musculature.
• Injuries, tumor processes, localized inside the organ of vision and capable of damaging the eye muscles.

In adulthood, in the first place, consider such risk factors as various diseases and mechanical damage to the organs of vision. In children, heterophory is most often due to the transient weakness of the ocular musculature, or after the transmitted infectious pathologies.

Spasm of accommodation and heterophyry can also be interrelated, since with false short-sightedness the function of the ocular musculature is disturbed, which negatively affects the property of the organ of vision to clearly see objects removed at different distances. Speaking differently, the spasm of accommodation is a spastic reduction of the ocular musculature, which leads to an unclear perception of objects that are both close and far.

[8], [9], [10], [11]

Pathogenesis

Such a state, as heterophory, is explained by the different strength of the musculature responsible for the movement of the eye.

In normal conditions, because of the fusion function of the visual system, malfunctions in the muscular balance are imperceptible. If you divide the vision organs - for example, to cover one eye, or to place a prismatic polyhedron on top or bottom, then the partial weakening of any muscle fibers will already be detected. And the axis of fixation of one eye goes inside (with esophoria), to the outside (at exophory), upward (with hyperphoria) or down (with hypophoria). In some cases, the upper point of the vertical corneal meridian can be withdrawn inward (at incidence), or to the outer side (during excliphory).

[12], [13], [14], [15], [16], [17]

Symptoms of the heterophoria

Minor heterophory can occur without obvious symptoms for the patient. Experts associate this with the presence of fusional ability, responsible for a single three-dimensional visual image obtained by merging individual images from the left and right eyes.

If, however, the function of the eyes is broken significantly (strong heterophory), then with the tension of the muscles and nerves in the eyes, symptoms of discomfort can be observed:

• increased eye fatigue, increased fatigue;
• pain in the head associated with the strain of vision;
• bifurcation of the visual picture;
• nausea with visual tension;
• painful sensation when the eyelids are closed.

Such first signs of heterophory - this is the reason for going to the doctor and conducting additional diagnostic studies, because the exact diagnosis of the heterophore can only be put by the doctor after summarizing the diagnosis.

Heterophoria in children

Many infants can observe relative heterophory. However, in this case it is inappropriate to talk about pathology: the fact is that the oculomotor musculature of the babies is still underdeveloped, and control over the movements of the eyeballs is difficult. As the child develops muscle fibers strengthen, become elastic, there is a tone.

In the vast majority of children, such a violation as heterophoria, passes, about 4 months after birth. As a rule, no treatment is carried out. If the problem of heterophory remains, and with age, there has not been a correction, the children's ophthalmologist may decide to conduct an operative intervention.

[18], [19],

Complications and consequences

For heterophory the most common complication is fusion disorder. Fusion is a complex natural visual mechanism that ensures the connection of a pair of monocular images into one visual image. At heterophory this mechanism can be violated.

In addition, heterosis is typically characterized by further progression of strabismus. And mostly people of young age are affected.

The greatest number of complications is found in patients with diagnosed long-sightedness, nearsightedness, violation of refraction, and astigmatism.

In almost all cases, heterosis is accompanied by strabismus in patients with refractive errors of both eyes. Most often the eye is affected, which sees worse.

[20], [21], [22], [23], [24]

Diagnostics of the heterophoria

Diagnosis with suspicion of heterophory is based on the exclusion of one organ of vision from the binocular visual principle.

Analyzes in the laboratory with heterophory, as a rule, are not carried out.

Instrumental diagnostics of heterophoria includes special ophthalmological testing:

• Carpet test for heterophory.

The doctor suggests that the patient look at some highly remote subject. Then the patient covers one at first, and then the other eye, simultaneously noticing which eye the installation movement was tracked, and which one does not. After that, the test can be repeated, but already using a closer subject.

• The Maddox test for heterophory.

This technique involves the use of a special table with a scale of degrees and a stick (a cylindrical row made of red glass). The test is to provide a condition for detuning normal binocular vision. The patient through the wand looks at the lighted table: if there is a heterophory, then the line from the backlight will move from the center of fixation to the left or to the right. The scale makes it possible to know the exact angle of displacement.

[25]

Differential diagnosis

Differential diagnosis in heterophory does not present any difficulties and is carried out with a thorough examination of motor eye function. As a rule, different types of strabismus are differentiated, including imaginary and hidden strabismus.

Treatment of the heterophoria

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

With the disturbed refractive power of the eyes, correction is carried out by setting special decentered lenses, and also using eye gymnastics, which restores normal fusion (synoptophor or prism can be used).

If the motor eye musculature has a pronounced power imbalance, and the patient himself complains of a number of expressed symptoms of heterophory, then it is recommended that he wear glasses with special prismatic lenses. The base of the prisms is applied to the side opposite to the direction of the displacement of the eye.

If the above methods were unsuccessful, then the heterophore is treated by an operative route.

Medicines for heterophrenia are prescribed only for individual indications. The following preparations have the general strengthening effect on the ocular musculature:

• Optix is a carotene based product containing a number of useful vitamins and minerals.
• Mertilen Forte - a complex preparation with zinc and riboflavin, belongs to hypoallergenic agents.
• Vizualon is especially suitable for patients with myopia. For children, a safe preparation of Vizualon with blueberry is provided.
• Glazorol - eye drops to improve the nutrition of the eye and facilitate the functioning of the eye nerves.
• Blueberry Forte - is suitable as a strengthening agent for patients with heterophoria on the background of hyperopia, myopia and other visual deviations.

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

Vitamins

In order to get rid of heterophory as soon as possible, we 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 from the food all the necessary vitamins, you need to include in the menu such products:

• sea fish, turkey, chicken and quail eggs, sour-milk products;
• root vegetables, vegetables, beans (carrots, pumpkins, sweet peppers, beans, tomatoes, cabbage);
• berries, fruits (persimmon, grapes, apricot, peach, watermelon, blueberries, sea-buckthorn);
• oatmeal and buckwheat porridge;
• greens, sorrel, celery;
• unrefined vegetable oil;
• bitter chocolate (the content of cocoa - from 60%, and better - 85%).

The listed products contain vitamin A, ascorbic acid, B-group vitamins, and also a lot of useful microelements. These substances help in strengthening the ocular musculature and improving visual function in heterophory.

Physiotherapeutic treatment

To treat heterophory, physiotherapy is used to restore weak eye muscles. The choice procedure often involves muscular electrical stimulation. It is prescribed to enhance the functionality of weak muscle fibers.

In addition to electrostimulation, darsonvalization of the eye region along the orbit circle is a positive effect. This procedure has the greatest effect in the treatment of patients belonging to the young and middle age category. However, the proposed treatment should be long: do not expect a positive result after 10-15 sessions. Therefore, physiotherapy is always applied against the background of general therapy of heterophory. Also exercises for vision are effective .

Alternative treatment

The eye muscle strengthens carrots, so this root should be eaten raw as often as possible, or drink freshly prepared carrot juice. You can prepare a salad or juice from carrots, cucumbers and beets - this combination of vegetables is most suitable for strengthening the musculature of the organs of vision. Doctors recommend drinking about 500 ml of carrot juice combined with beetroot juice and cucumber daily.

To correct the heterophory it is often useful to drink infusion from the leaves of black currant. Take 200 ml of boiling water and brew in it 5 g of dry raw materials. Insist and drink instead of regular tea daily.

Another recipe: wash the fresh leaves of cabbage, dip them into boiling water and boil until the leaves fall apart. The drug is cooled and consumed 4 times a day, along with a decoction, like soup.

Interesting and popular way to treat heterophory dark chocolate. For treatment, only dark chocolate without fillings and pores is suitable, with a content of cocoa of not less than 60%, and sugar - no more than 40%. This method is suitable only for those patients who are not allergic to chocolate, as well as diabetes and obesity. Experts also indicate that the chocolate method is more effective in the early stages of the disease, and especially in children 3-4 years old. A patient with heterophory should eat 4 normal slices of treats, 60 minutes after breakfast and lunch. The course of chocolate therapy - 4 weeks. Specialists point out that bitter chocolate can strengthen and tone the eye muscles.

[26], [27]

Herbal Treatment

To strengthen the ocular musculature is useful rhizome aira. Prepare infusion of 10 grams of crushed roots and 200 ml of boiling water, and then take this medicine for ¼ cup in the morning, before dinner and before dinner.

If the heterophory is at the initial stage of development, then ordinary tea from the dog rose will help - it is brewed at the rate of 100 g of berries per 1 liter of boiling water, insisted in a thermos for 3 hours. In the finished tea, you can add a little honey, and drink 200-250 ml before meals, 4-5 times a day.

You can brew pine needles - for this you need 100 g of needles and 500 ml of boiling water. Infusion is taken after it has cooled down 1 tbsp. L. After eating, 4-5 times a day, for a long time.

In addition, you can affect the disease externally, for this you only need to prepare special plant drops. Ground dill in the amount of 10 g is poured 200 ml of boiling water. The resulting product is carefully filtered and used as eye drops, 2-3 drops a day, several drops in the affected eye. The broth is stored in the refrigerator for no more than a day. Before digestion, the droplets are heated to body temperature.

Homeopathy

Homeopathic treatment for heterophory use is not so common: in many children this condition does not require any medical correction, and with a pronounced problem, doctors often resort to prompt intervention.

Doctors-homeopaths in heterophoria recommend as a supportive and corrective means to pay attention to the following drugs:

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

Some patients may be treated with other drugs:

• Agaricus muscarius 12c;
• Gelziumium 3c;
• Euphrasia 3c;
• Ruta Graveolens 3c;
• Physostigma 6c.

Treatment with homeopathic medicines requires an individual approach, therefore, no general recommendations on the dosage of these drugs are provided. Side effects are usually absent.

Surgery

The method of surgical intervention is appropriate only at significant angular intergrowth values, or when other therapeutic techniques do not lead to the desired result.

If a heterophory is found in a child, then surgery is performed only after a preliminary conversation between the doctor and his parents.

The essence of the surgical treatment under heterophory is the correction of the length of the musculature of the eye for stabilization and balancing during the operation of both vision organs.

Prevention

Preventive measures can be identified with observance of such rules:

• Regularly monitor and diagnose any pathology of the eyes;
• promptly consult a doctor and follow all of his prescriptions;
• to observe the measure in the load for the organs of vision, especially in childhood;
• protect eyes from all kinds of irritations - for example, from bright light.

If there is already a heterophore, it can reduce its manifestation by regularly conducting special eye gymnastics, with which the eye muscles are strengthened and its tone is stabilized.

[28], [29], [30], [31], [32],

Forecast

Heterophy is a phenomenon that does not necessarily require medical intervention. But, if there are significant visual impairments, it is better to apply to competent qualified specialists who have experience and skills in the treatment of such pathologies. Only under such circumstances can we speak of a favorable prognosis of this state.

[33], [34], [35]