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Strabismus in children
Last reviewed: 23.04.2024
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Strabismus - different in nature lesions of the oculomotor and visual systems, in which there is a deviation of one eye from a common point of fixation, leading to a violation of monocular and binocular visual functions. In addition, strabismus is a psychologically painful cosmetic defect. People suffering from strabismus are limited in professional choice.
Strabismus is polyethiologic in nature:
- refractive disorders (hypermetropia, myopia, astigmatism); o congenital defects of binocular vision:
- diseases leading to vision loss or blindness to one eye;
- congenital or acquired paresis and paralysis of the oculomotor muscles;
- atypical oculomotor syndromes (syndromes of Dwayne, Brown, Moebius, etc.).
Often, strabismus is hereditary (up to 35-40% of cases).
There are two main types of strabismus: friendly and unfriendly. They differ both in the clinical picture and in the pathogenesis.
Friendly strabismus is a pathology of mostly childhood. According to generalized literature data, it occurs in 1.5-2.5% of children.
With friendly strabismus, the functions of the oculomotor muscles are not violated, but the apparatus of binocular guidance suffers, which is manifested in the violation of the vertex mechanism - convergence and divergence and a more subtle mechanism of bifixation. The mechanism of the appearance of binocular disorders in a friendly strabismus is explained by the phenomenon of retina correspondence and the phenomenon of diplopia due to the displacement of the visual axis (with deviation) and the projection of the image of the fixation object onto the disparate site. Due to adaptive mechanisms, which is especially easy to manifest in childhood, the visual and nervous systems adapt to the asymmetric position of the eyes, and doubling is eliminated by functional inhibition in one of the monocular visual systems. This is the reason for the decrease in vision (amblyopia) on the constantly mowing eye.
In the direction of the deflection of the squinting eye, the converging strabismus (esotropia) is distinguished - the deflection of the squinting eye to the nose, the diverging (exotrophy) - the deflection of the squinting eye to the temple; vertical strabismus - when one eye is tilted up or down (hyper- and hypotrophy). When torsional shifts of the eye (the slope of its vertical meridian toward the temple or nose), one speaks of cyclotropy (ex- and incisotropy).
With friendly strabismus, convergent (70-80%) and divergent (15-20%) are more common . Vertical and torsional abnormalities occur, as a rule, with paretic and paralytic strabismus.
To non-friendly forms of strabismus include paralytic, paretic strabismus, atypical oculomotor syndromes, limitations of eye mobility caused by abnormalities of muscle attachment, neurogenic, traumatic factors, etc.
By the nature of the deviation of the eye, the strabismus can be one-sided, that is, monolateral, when one eye constantly moults (about 70% of patients), and alternating, when one or the other eye alternately mows.
Monospecific strabismus accompanies amblyopia, i.e. Decrease in visual acuity of a constantly mowing eye.
The degree of visual acuity reduction distinguishes amblyopia:
- low degree - with visual acuity of the mowing eye 0.4-0.8;
- average degree - with visual acuity of 0.2-0.3;
- high degree - with visual acuity 0,05-0,1;
- very high degree - with visual acuity 0.04 and lower (Avetisov ES, 1968).
With alternating strabismus, the visual acuity of both eyes is, as a rule, quite high and practically identical in connection with alternate fixation.
The development mechanism distinguishes amblyopia of the dysbinocular, arising from the violation of binocular vision, refractive, in the presence of refraction anomalies (ametropia), a former consequence of untimely or inconsistent wearing of glasses; in the presence of uncorrected anisometropia (the difference in refraction between the right and left eyes), there is an akizametropige amblyopia. Refraction amblyopia is successfully overcome with rational and constant optical correction (glasses, contact lenses).
Blurred vision (congenital cataract, throat) can cause obscure amblyopia difficult to treat and requires timely surgical intervention (for example, extraction of congenital cataracts).
On the side of defeat amblyopia can be right-sided, left-sided, bilateral.
By the degree of participation of accommodation in the appearance of strabismus distinguish accommodative, partially-accommodative and non -accustomed strabismus.
For accommodative strabismus (15-25%), it is characteristic to eliminate deviation (eye deflection) with optical correction of ametropia, i.e. With constant wearing of glasses. It is quite often that binocular vision is restored. Patients do not need surgical treatment. With nonaccumulative strabismus, wearing glasses does not eliminate deviation, and treatment necessarily includes a surgical stage. With partially-accommodative strabismus, wearing glasses reduces, but does not completely eliminate deviation.
Strabismus can also be permanent or periodic, when the presence of deviation alternates with the symmetrical position of the eyes.
The system of preventive measures includes examination of the ophthalmologist for decrepit ages, annual targeted prophylactic medical examination, protection of the mother's health during pregnancy. This provides an opportunity for timely treatment. Which is especially important during the formation of visual functions.
Paralytic strabismus is caused by paralysis or paresis of one or several oculomotor muscles caused by various causes: trauma, infections, neoplasms, etc. It is characterized first of all by the limitation or lack of mobility of the mowing eye towards the action of the paralyzed muscle. When looking at this side, doubling or diplopia occurs .
In domestic and foreign practice, the system of complex treatment of friendly strabismus is used. Treatment should begin with the appointment of optical correction of refractive disorders and the constant wearing of glasses. This ensures the restoration of visual acuity and helps to eliminate or reduce the angle of strabismus.
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