Astigmatism In Children - What Is It? How To Treat?

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Astigmatism in children

Astigmatism in children cannot be considered a death sentence for a child. This disorder is often associated with uneven growth of the eyeball and other structures of the organs of vision, which are involved in the refraction of light. One should not panic after such a diagnosis. This disease responds well to drug therapy. You also do not need to give up doing specialized exercises and wearing corrective glasses. An integrated approach allows the brain to correctly form the picture that it receives from the organs of vision. If you ignore therapy, then after the age of 18, a person will need surgery. It will allow you to change the structure of the eye, but it will not affect vision.

Content:

• Astigmatism - what is it?
• Varieties of astigmatism
• Causes of astigmatism
• Astigmatism symptoms
• Diagnosis of astigmatism
• Treatment of astigmatism
• Forecast
• Prevention

Astigmatism - what is it?

Astigmatism is a visual impairment that is accompanied by a loss of clarity of objects that a person is looking at. This happens due to the fact that the lens or cornea changes its normal curvature. Light rays are not refracted correctly. As a result, on the back of the eye, where the image point is formed, several points are formed at once. Some of them are located on the retina, while others will focus outside of it. Therefore, a person sees the subject blurred.

The structure of the organ of vision is quite complex. To understand how a person with astigmatism sees objects, you need to understand the functioning of two eye systems: refractive and perceiving. The refractive system corrects and directs the beams of light in such a way as to form an image of the object on the retina. The perceiving system is represented by rods and cones. One end receives the picture, and the other transmits it to the optic nerve. The optic nerve, in turn, "translates" the image to the brain.

In order for a person to be able to normally see the image of an object, the perceiving and refractive systems must work correctly.

• All structures through which light beams pass must be transparent. Cataracts, corneal opacities, vitreous hemorrhage, or any inflammation of the organ of vision can cause a violation of their transparency.
• The rods and cones must perform their function correctly.
• Light that hits the eye structures must be refracted at the correct angle. This is provided by the refractive index, which differs in different structures of the eye: for the cornea it is 1.37, for the lens - 1.38, and for the lens nucleus - 1.4.

Astigmatism develops when light is refracted at the wrong angle. As a result of this violation, the so-called "crooked mirror effect" is created. Light rays pass through several structures in succession. They first hit the cornea, then the lens, and then the retina. The cornea of the eyeball has the shape of a hemisphere and resembles a dome. The lens is represented by a convex lens on both sides. The lens rests on ligaments that stretch when needed. Thus, the organ of vision reacts to changes in lighting and directs a beam of rays to the retina, to the central visual spot.

With normal vision, the rays of light are equally refracted and hit the retina. If a person has myopia, then the rays fall on the area in front of the retina, and if the person is farsighted, then they are focused behind the retina. When the curvature of the lens or cornea is disturbed, the focus changes. Instead of a dot, a spot is formed on the retina. This condition is called astigmatism. Moreover, it is impossible to exclude myopia or hyperopia.

With astigmatism, 4 main meridians are affected, which are located at points 3, 6, 9 and 12 (if we consider the structures of the eyeball as a clock face). In this case, the patient receives such an image as if he is looking through the water column.

If the disease develops in children under one year old, then they get used to seeing objects blurry and do not make any complaints to adults. The disease is often recognized when the child begins to learn to write and read. He does not see the letters, as they blur before him. While early diagnosis of the disease allows you to start treatment in a timely manner and cope with the existing problem.

Varieties of astigmatism

Depending on the cause of astigmatism, it can be congenital and acquired.

Depending on the refraction of the main meridians (perpendicular to the plane of the eye), astigmatism can be of the following types:

• Direct astigmatism, when vertical meridians refract light rays most of all.
• Reverse astigmatism, when the horizontal meridian has the maximum refractive power.
• Astigmatism with oblique axes, in which the main meridians are located away from the vertical and horizontal axis of the cornea.

Also distinguish between correct and incorrect astigmatism. With correct astigmatism, the major meridians run at 90 ° C to each other.

Correct astigmatism is most often a congenital pathology and is divided into simple, complex and mixed:

• With simple correct astigmatism, pathological refraction of rays occurs in 1 main meridian, while the other functions normally. Hyperopic astigmatism leads to the fact that a person sees an object as a patient with farsightedness, but also blurry. Myopic simple astigmatism results in a person seeing the image as a patient with myopia, but also blurry.
• Complex astigmatism is characterized by the fact that the two main meridians distort the light rays abnormally. At the same time, complex hyperopic and complex myopic astigmatism is also distinguished.
• With mixed astigmatism, one meridian forms farsightedness, and the other forms myopia.

Separately, irregular astigmatism is distinguished, in which the main meridians superimpose light rays on top of each other. This type of astigmatism is most often acquired. If the impairment is acquired, then vision will suffer more.

Congenital astigmatism of the correct type, which does not impair vision by more than 0.5-1 dpt, does not require the initiation of complex therapy, since it is considered a physiological phenomenon.

There are several degrees of astigmatism:

1. Less than 3 dpt is a weak degree.
2. From 3 to 6 dpt - medium.
3. More than 6 dpt is a high degree.

If corneal defects occur during the disease, then they speak of corneal astigmatism. When the disease develops due to pathologies of the lens, then they indicate lens astigmatism.

Causes of astigmatism

In childhood, astigmatism, which does not impair vision, is a normal variant. It develops due to the fact that the cornea and lens develop unevenly. In this case, you need to ensure that visual acuity does not decrease by less than 1 diopter.

No more than 10% of children need treatment. In this case, the disease most often has a congenital nature and one of the parents suffers from astigmatism.

The likelihood of developing pathology increases in the following cases:

• The person is albino.
• A person has retinitis pigmentosa.
• The child was born with alcohol syndrome.
• The human cornea is cone-shaped, not hemispherical.
• In humans, the optic nerve is underdeveloped.
• The patient has a congenital deformation of the jaws and teeth, which affects the wall of the orbit and the eyeball.

All of these pathologies are congenital. In this case, the child will suffer from both eyes with varying degrees of intensity.

Acquired astigmatism can develop in the following cases:

• The resulting corneal injuries due to which scars formed on its surface.
• Surgical interventions on the organs of vision.
• Lens subluxation due to rupture of the zinn ligament.
• Vitamin A deficiency.
• Keratitis and conjunctivitis
• Diseases of an infectious nature that can lead to eye inflammation.

Astigmatism symptoms

If a child is younger than 2-3 years old, then it is quite problematic to understand that he is developing astigmatism. This is especially true for those babies in whom the disorder is not too developed.

The following symptoms can indicate moderate and severe astigmatism:

• The child comes very close to the TV screen while watching the cartoon.
• To examine the toy, the child tilts his head, squints his eyes, or stretches the corners of his eyes with his fingers.
• When trying to place an object on a surface, it will miss.
• The child's eyes get tired quickly, he rubs them with his hands or often closes his eyes to relieve tension.
• During the game, the child bumps into foreign objects.

When a child experiences visual stress, for example, when doing homework, the following complaints are presented:

• For a headache that will be concentrated in the back of the head and in the eyebrows.
• Fatigue that comes quickly.
• The inability to see objects that are in the distance.
• Double vision.
• On the sand in my eyes.
• Redness and burning sensation in the eyes.

In elementary school, the child will lag behind in learning from his peers, since the written double in his eyes. This affects reading, counting, etc.

Diagnosis of astigmatism

Astigmatism is diagnosed by an ophthalmologist. The doctor is able to identify pathology even in an infant, which is possible using the skiascopy method (test in a dark room). Thanks to the study, it is possible to determine not only the presence of astigmatism in a child, but also to establish the type and degree of refraction.

Visual acuity is determined after the child reaches the age of three and can verbally interact with the doctor.

If you suspect a visual impairment, the child may be shown such studies as:

• Computer refractometry, which allows you to find out the type of disease and the degree of its development. This technique is more accurate than skiascopy.
• Visometry, which is carried out without the use of lenses and with their use.
• Slit lamp inspection. Eye structures are examined under multiple magnification. This technique is aimed at clarifying the etiological factor that led to the development of astigmatism.
• Keratometry. This study allows you to measure the curvature of the cornea using a special device and computer technology. Thanks to this technique, it is possible to diagnose keratoconus and keratoglobus.

• Ophthalmoscopy. This procedure allows you to examine the patient's fundus and visualize certain pathological changes on it.

  Less commonly, an ultrasound examination of the eyeball is performed. This method provides information about the state of the retina (it allows visualizing cicatricial changes, hemorrhages or detachment thereof).

Treatment of astigmatism

Until a child diagnosed with astigmatism is 18 years old, conservative therapy may be prescribed. The operation is not performed before this age. Treatment directions:

Vision correction is carried out using glasses. Cylindrical lenses must be inserted into them. They allow you to correctly focus beams of light on the retina. In the initial stages of using glasses, the child will experience some discomfort. They can prevent him from watching 3D films, as well as from active sports. However, lenses under the age of 10 are not recommended for use.

If a child is diagnosed with a corneal form of the disease, then he is shown wearing orthokeratological lenses. They are uncomfortable and tough, so they only wear them for a night's rest. Lenses allow you to normalize the curvature of the lens. If a child's visual acuity exceeds 1.5 dpt, then such lenses are not worn.

Treatment of amblyopia and asthenopia. To cope with amblyopia, that is, a drop in vision against the background of a lazy eye (a diseased organ of vision is simply turned off by the brain, since it is inconvenient for him to see a blurred image), you need to start treatment as early as possible. It is desirable that therapy is started until the child reaches 6 years of age. At age 11 or older, treatment will be ineffective. Even an operation will not help to cope with the problem.

Amblyopia does not always present with any obvious symptoms. Sometimes the baby's color perception is impaired, or the visual acuity in one eye may decrease. However, amblyopia is a complication of astigmatism and therefore requires treatment. For this purpose, pleopic therapy is performed. A healthy eye is glued and the child is seated in a special device "Ambliokor". With its help, the patient's eye is stimulated with a laser beam, color, light, electromagnetic waves. Also, patients are shown physiotherapy, for example, drug electrophoresis.

Asthenopia is another complication of astigmatism and is expressed in the rapid fatigue of the visual apparatus, in low visual acuity and blurred perception of objects. To cope with the violation, the use of drugs such as Atropine is indicated. They do not last long, but they allow you to relieve the spasm of accommodation. Also, the child should practice on special devices using a synaptophore and an accommodation trainer.

Creation of conditions for normal nutrition of the organ of vision. To improve the nutrition of the eye structures, drugs and gymnastics are used.

Drops used to improve eye nutrition:

• Quinax. They prevent lens clouding.
• Emoxipin. These drops are antioxidants, help to reduce the permeability of the vessels of the eyeball, prevent microscopic blood clots from forming in them, and improve the state of the cell membrane.
• Ujala. These drops improve the clarity of the lens of the eye.

Drugs for instillation into the eyes should be prescribed by a doctor. Treatment is carried out in courses 2-3 times a year.

Gymnastics for the eyes is carried out with high-quality lighting. Exercises to improve eye nutrition:

• Rotation of the eyeballs clockwise and counterclockwise.
• Rotation of the eyes along a trajectory resembling the number 8.
• Eye movement up, down, left and right. In each position, you need to linger for 10 seconds.
• Bringing the finger to the tip of the nose. In this case, you need to closely monitor him.
• Consideration of objects that are nearby, and then transferring your gaze to the horizon line. You need to hold your gaze for 30 seconds.
• Squinting eyes. In this case, the other person must name the colors, and the patient himself must imagine them before his eyes.

Operation

Most often, astigmatism is treated with lenses. The operation can be performed after the structures of the eye stop growing (not earlier than 16 years).

Types of surgical intervention:

• Keratomy. In this case, incisions are made on the cornea, which leads to its divergence and a change in the angle of refraction. This procedure helps to deal with mixed astigmatism and myopic astigmatism.
• Thermokeratocoagulation. The cornea is lifted using a special hot needle. This method allows you to cope with farsighted astigmatism.
• Thermakeratoplasty using a laser. During the procedure, burn areas are created on the cornea, which makes it more convex.
• Conductive keratoplasty. In this case, the cornea is affected not by a laser, but by radio frequency radiation.
• Photorefractive keratectomy. The cornea is subjected to high-precision action, which allows it to change its shape.
• LASIK method. Corneal shape correction is carried out by cutting off its thinnest layer in the affected area. The procedure takes no more than a quarter of an hour. It is performed for people whose vision exceeds 4 dpt. The operation does not require general anesthesia.
• Phakic lens implantation. This procedure is carried out only when astigmatism is severe and it is not possible to carry out the procedure using a laser.
• Keratoplasty. During the procedure, the own cornea is removed, replacing it with a donor or artificially created one.

After any operation, vision should be restored within 2 hours. However, for another 6 months, a person may suffer from photophobia and lacrimation, he may experience a sensation of a foreign body in the eye. Until the tissues are completely restored, it is necessary not to be near the fire, not to visit the sauna and bathhouse, not to perform heavy physical exertion. About 2 out of 10 patients are faced with the fact that the myopia or hyperopia, which was present before the procedure, returns.

Can astigmatism be cured?

To say for sure whether it is possible to cure astigmatism of a particular child can only be a doctor, after a diagnosis. Some forms of the disorder do not need treatment and go away on their own. Curvature can return to normal as the child grows older. Until the age of 18, some patients require conservative therapy. It will help prevent vision loss and asthenopia. In other cases, surgery is required.

Forecast

If a child has congenital astigmatism, then by the year it either disappears completely or becomes less intense. By the age of 7 years, the degree of visual impairment has stabilized, but may gradually continue to decline. A high degree of astigmatism without treatment leads to strabismus and amblyopia.

Prevention

Measures to prevent astigmatism:

• After the child reaches six months, you need to regularly take him for examination to an ophthalmologist.
• The child must be able to do eye exercises.
• It is important that the workplace is well lit.
• It is necessary to massage the neck area, swim, take a contrast shower.
• The child must eat right.

Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist

Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".