Strabismus In Children - What To Do? Causes And Treatment

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

Strabismus in children: causes and treatment

Strabismus is a pathology of the organs of vision, in which there is an asymmetry of 1 or 2 eyes with respect to the central axis. Strabismus is also called strabismus or heterotropism. Because of this disorder, the child loses the ability to focus his gaze on the fixation point, and binocular vision suffers. Binocular vision is understood as the ability to perceive the picture of the world with both eyes.

Strabismus causes amblyopia ("lazy eye syndrome"). Vision on a diseased organ worsens, deep vision suffers. The child perceives all objects poorly. In infancy, strabismus is not a pathology. It can even be regarded as a variant of the norm. It is observed in 2 children out of 100 newborns.

Strabismus in children resolves by the following age:

• The eyes of a newborn baby "float".
• Starting from 6-8 weeks, the baby will already fix his gaze.
• At 4 months, babies see normally with two eyes.

By 4-6 months of age, the strabismus should go away if it is not pathological. If by six months the child's eyes continue to float, you need to visit an ophthalmologist and find out the reasons for this violation.

Content:

• Why do newborn babies have squint?
• Types of strabismus
• Causes of strabismus in children
• Symptoms of strabismus in children
• Diagnosis of strabismus in children
• Recommendations for parents
• Treatment of strabismus in children

Why do newborn babies have squint?

The inability to fix a gaze on one object is an innate feature of all children. This is due to the weakness of the muscular apparatus of the organs of vision. The child himself is not yet able to control the movement of the eyeball. This causes them to move in different directions.

In 1 out of 10 children, the eyes diverge to the temples, and in the remaining 9 babies, they converge on the bridge of the nose. In this regard, the structural features of the bone structures of babies are important. The right and left sides of the face in children form an angle in relation to each other. Therefore, from the outside it seems that the child is squinting. After a few months, the bones of the face will align and everything will return to normal.

Types of strabismus

Strabismus in children can be paralytic and friendly. In infants, strabismus is most often friendly. It, in turn, is classified according to the following parameters:

1. By involvement of the organs of vision:
• Monocular strabismus, in which only one eyeball floats.
• Alternating strabismus, in which two eyeballs float. This type of strabismus is also called intermittent.
2. In the direction of deviation of the eyeball:
• Strabismus is vertical, with it the eye is displaced upward or downward.
• Horizontal strabismus (convergent). In this case, both eyes are reduced to the bridge of the nose. Diverging squint is characterized by the divergence of the eyeballs towards the temples.
• Mixed type of strabismus.
3. According to the severity of the violation:

• Latent strabismus (heterotrophy).
• Compensatory (accommodative) strabismus. At the same time, it is possible to cope with it through the use of lenses or glasses. No other therapy is required.

• Subcompensated strabismus (non-accommodating). It will not be possible to get rid of him with the help of glasses. The child needs surgery.

Causes of strabismus in children

The causes of strabismus in children are as follows:

• Complicated pregnancy or childbirth. This leads to the fact that the child has microbleeds in the brain. Often those departments in which the visual analyzer is located are affected.
• Infections that a child suffered before the age of one year. Measles, flu, scarlet fever, ARVI, diphtheria can provoke a violation.
• Postponed stress or severe fear.
• Weak mmun system.
• Positioning rattles and other toys too close to the baby's eyes.
• Hereditary predisposition to squint.
• Intoxication of the body.
• The resulting brain injury during the passage through the birth canal, or after childbirth.
• Diseases of the organs of vision: myopia, hyperopia, conjunctivitis, barley, cataracts.
• Diseases of the eye muscles, which can be vascular or neoplastic.
• Hydrocephalus.
• Down Syndrome.
• Taking medication or drugs by a pregnant woman.
• Cerebral palsy.

Symptoms of strabismus in children

In children under one year old, strabismus can be detected by parents. If, at the age of up to six months, the symptoms of the disorder persist, you need to consult a doctor.

Signs that should alert adults:

• When trying to consider any object, the child tilts his head all the time.
• Looking at the toy, the child squints one eye.
• The child often rubs his eyes with his hands. He does this due to the fact that they quickly get tired against the background of increased tension of the eye muscles.
• Older children have a veil before their eyes, which they can inform their parents about.
• The child may complain of headaches, which happens against the background of overexertion of the eyeballs.
• Children with strabismus lack deep vision. He sees objects not voluminous, but flat, therefore he bumps into them.
• When trying to look at the light, the child has painful sensations in the eyes.
• Older children indicate the vagueness of objects, their double vision.
• The child cannot bring both eyes in the direction of one object.
• If you shine into the eyes of a child, different reflections appear in the pupils.

When the eyes diverge to the temples, children develop myopia. If the organs of vision are reduced to the nose, the child develops hyperopia.

With paralytic heterotropism, the squinting eye will not be as mobile as a healthy organ of vision. Also, the child develops ptosis, accompanied by drooping of the eyelid and accommodation paralysis. When such signs of impairment occur, there is always damage to the optic nerve.

Diagnosis of strabismus in children

To clarify the diagnosis, you need to visit an ophthalmologist. The doctor must study the peculiarities of the course of pregnancy and childbirth, collect a family history.

Inspection involves the implementation of the following steps:

• Assessment of the symmetry of the skull and palpebral fissures.
• Assessment of head position.
• Measuring the angle of deviation of the pupil.
• Alternate covering of the eyeballs. If at this time, when one eye of the child is closed, and the other deviates to the side, this indicates a latent squint.
• Biomicroscopy with the study of the anterior parts of the organs of vision and the fundus.
• Study of the fundus.
• Examination using a synoptophore. It allows you to measure the angle of deflection of the pupil.
• Carrying out computer refractometry and skiascopy.
• Measuring the length of the organs of vision (echobiometry).

In the event that the doctor suspects the child has paralytic strabismus, he will refer him to a neurologist. To make a diagnosis, you will need electromyography, electroneurography, and electroencephalography.

Recommendations for parents

Strabismus should go away by 6 months. This is the norm. Immediately after giving birth, the baby should be examined by a neonatologist. This specialist determines if the child sees or is blind.

Parents with a child should get an appointment with an ophthalmologist at 2 months, at 4 months, at 6 months and at 12 months. If by six months the strabismus has not gone away on its own, you need to visit the doctor more often. If necessary, the doctor will prescribe therapy.

To strengthen the eye muscles of the crumbs, you need to regularly work with the child. It is necessary to hang large and eye-catching toys over his crib. He should be at some distance from the baby's face, at a distance of 20 cm. This will allow him to focus on them, but not touch them with his hands.

It is recommended to perform simple eye exercises. The child is seated on his knees and led in front of him with a toy in different directions. Parental movements should be slow. The object is lowered and raised, taken to the right and left.

Treatment of strabismus in children

To get rid of strabismus, you need to take timely measures. Treatment is prescribed after the child is six months old. Therapy may differ, depending on the cause of the disorder and its severity.

Diploptics. With the child, you will need to do certain exercises every day. They are carried out with glasses. Classes per day should be 2 hours long (this is the total class time, which should be broken down into 20 minutes). Exercises require colored cubes, balls and lotto.

Examples of exercises:

• A lamp is installed on the table, and a bright object is placed at a distance of 5 cm from the light source.
• The child is seated at a distance of 40-50 cm from the lamp. They close his healthy eye.
• For about 30 seconds, the baby should look at the object without taking his eyes off.
• Then the parents show him bright pictures.
• The exercise is repeated 3 times using different objects. The duration of treatment is one month.

To make the muscles of the organs of vision stronger, you need to practice another activity. A bright object is attached to a stick and led in different directions in front of the child. At the same time, one or the other of his eyes is closed in turn. When the object is brought close to the child's face, his eyes should converge at the bridge of the nose.

Optical correction. Strabismus in this case is eliminated with the use of glasses. This allows you to cope with myopia, astigmatism, hyperopia. The child should wear glasses from 8 months. Their use allows you to put stress on the sore eye and will not lead to loss of vision on it.

Pleoptics. This method of treatment helps to cope with amblyopia. In this case, the healthy eye is simply turned off from the vision process. It is covered with a bandage or glass. In this case, the entire load falls on the sore eye. This leads to the fact that the vision on it is aligned. If the strabismus is bilateral, then the bandage is alternately worn on one eye, then on the other. The eye that sees worse is closed for 1 day, and the one that sees better for 2 days.

Hardware treatment. One course consists of 10 sessions. This therapy allows you to quickly get rid of strabismus at an early age. For treatment, a synoptophore, amblyocor, etc. can be used.

Operation. If a child develops paralytic strabismus and cannot cope with it with conservative methods, surgery is required. It will be possible to eliminate the aesthetic defect, but it is not always possible to cope with visual impairment. For the operation, hospitalization is not required, it is carried out on an outpatient basis. In time, it takes about 15 minutes.

The operation is performed after the child turns 3 years old. It can be of 2 types:

• Reinforcing operation. In this case, the eye muscle is shortened by lengthening its part.
• Laxative surgery. The eye muscle is fixed further from the cornea.

After surgery. When the operation is completed, the child will need to instill antibacterial drops in the eyes. The treatment lasts 14 days. For a month, the eye must be protected from dirt. Also, the child should not overexert his vision.

The author of the article: Sokolova Praskovya Fedorovna | Pediatrician

Education: Diploma in the specialty "General Medicine" received at the Volgograd State Medical University. A specialist certificate was immediately received in 2014.