Diagnosis and treatment of astigmatism in children

Update: October 2018 Astigmatism in children is not a sentence yet
for sight. In some cases, it may be associated with
uneven growth of eye structures that are involved in
light refraction. Sometimes its causes are
heredity, injury or surgery. In any case, the disease
It is well amenable to correction with the help of medicaments,
exercise and points. These measures are a necessity that will help the brain.
learn how to form (“see”) images correctly. Otherwise
operation, if it is needed after 18 years, will only change
the structure of the eye, but does not affect the vision.

What is astigmatism?

Astigmatism is a visual impairment in which
lost clarity of the objects in question. It happens because of
the fact that one of our main natural “lenses” eyes –
lens or cornea – lose their curvature uniformity. AT
the result on the retina – the back of the eye where it forms
image, every point of a real-life object gives
several points. However, only part of them can lie on the retina:
the center of several will be before it, while others will become
focus in the area behind the retina. So получается размытое,
distorted outline of the subject.

How does this work?

Our eye has a very complex structure, but it can be conditionally
divided into components – two systems:

  1. refractive, which with the help of light beams contributes
    image formation;
  2. perceiving system. This is the retina, on which there are special
    cells – “sticks” and “cones”. One of their end is able to perceive
    image, the second is associated with nerve cells, of which
    is the optic nerve. On this “cable” the image is transmitted to
    brain.

So that we can see something, both of these systems must
function correctly:

  • The environments through which the light passes must be transparent. If a
    there is no eyesore (corneal opacities), the lens is not cloudy
    (no cataracts) and the vitreous is not soaked with blood or
    inflammatory fluid, the first condition can be considered
    fulfilled.
  • The rods and cones should work normally (should not be
    retinitis, i.e. inflammation, in which the retina swells). Soже
    the connection between the cells of the retina and
    neurons of the optic nerve (that is, the retina is not detached).
  • The light should be refracted at the right angles, so as not to arise
    effect of “curved mirror”. In addition, each of the light refractive
    structures, and this cornea and lens, should not change their
    refractive index: 1.37 for the cornea, 1.38 for the sheath
    lens, 1,4 – at the lens nucleus.

Violation of the first two conditions does not lead to astigmatism, but
если не соблюдается третий пункт, развивается astigmatism.

Consider the schematic refracting system of the eye. At first
light enters the cornea of ​​the eye – a structure that has a hemispheric
form (like a dome). Then the light enters the lens –
biconvex lens that is “suspended” in the eye of Zinn
bundles. Bundles stretch, making the lens more flat, or
relax, increasing its bulge. So глаз подстраивается
under varying illumination, so that, independently of it, the beam
rays of light hit the retina, in its central
visual spot.

астигматизм у детейConditionally and the lens, and the cornea
проводят линии, аналогичные тем, которыми  расчерчивают карту
the globe – parallels and meridians. AT норме свет одинаково
It is refracted through different meridians and reaches the retina (with
normal vision), projected in front of her (with myopia) or
behind her (with hyperopia). If a кривизна преломляющих сред по
different (or only one at a time), horizontal or vertical,
meridians varies, focus changes. ATместо точки там
get a stain. At the same time myopia or hyperopia does not
are excluded.

The main meridians that suffer from astigmatism are 4. They
located at 3, 6, 9 and 12 hours (as on the dial). AND
an image is obtained, as if the person is looking through the water.

ATозникая у детей до года, астигматизм приводит к тому, что
the child becomes accustomed to seeing objects blurred, and if given
the violation will not be diagnosed, he will not complain about the bad
vision. The problem will become noticeable when learning to read and write, but
the child will not necessarily say that he does not see or letters
blurred. He most likely will not understand what is written, o
what it will say (so there may be suspicions of a lag in
development). And the sooner the diagnosis will be carried out, and earlier
will begin joint vision correction and exercises for
�The “learning” of the brain in a normal picture, the more successful will be crowned
efforts. To concentrate the light rays at one point will help
cylindrical lenses.

ATиды астигматизма

The disease has several classifications, based on –
various signs. So, по причине появления астигматизм может
to be innate and acquired (this is in the next
section).

AT зависимости от рефракции основных меридиан, он бывает:

  1. direct: maximum refractive power – vertical
    meridian;
  2. reverse: the main part of the ability to refract light
    horizontal meridian;
  3. with oblique axes.

By sight, it happens:

What does it mean Subspecies Subspecies подвида

Right

The main meridians that refract light, pass at an angle of 90
degrees to each other. Its causes are almost always innate.
of character

Simple: abnormal refraction in one main meridian,
the second refracts light normally
Hypermetropic astigmatism of simple type: single refraction
meridian – as with farsightedness (a beam of rays converge
projection of the retina), the second meridian gives a normal focus
Myopic simple: one meridian refracts the light so that
the beam of its rays converge before the projection of the retina. Second meridian
forms a focus directly on the retina
Complicated astigmatism: the same degree of farsightedness or
myopia in the main meridians
Complex hypermetropic: both meridians determine
refraction, as with farsightedness, but in varying degrees
Difficult myopic: both main meridians form beams
light rays to the retina (as with myopia), but do so in
varying degrees
Mixed astigmatism: one meridian forms hyperopia,
the second is myopia
Has no division

Wrong

The main meridians obliquely overlap each other. It arises
due to acquired causes

Has no division

If astigmatism is innate, correct, and vision suffers on
0.5-1 diopters, this kind of pathology is called physiological and in
complex correction does not need.

Acquired pathology has a greater effect on vision, so here
allocate the degree of astigmatism. These dioptries are obtained by
subtracting the refractive power of the weakest meridian from the very
strong:

  1. low degree of astigmatism: visual acuity – up to 3
    diopter;
  2. средняя степень: 3-6 diopter;
  3. high degree: visual acuity – more than 6 diopters.

Soже есть классификация, учитывающая то, какая структура глаза
formed with the “wrong” meridians. By this division
astigmatism can be:

  • corneal – defects occurred only from the side of the cornea;
  • lenticular: astigmatism due to pathologies
    lens.

Why astigmatism occurs

Astigmatism, which does not impair vision, occurs in most
small children, and is associated with uneven growth of the light refractive
eye structures. In this case, it reduces visual acuity by less than
on 1 diopter, and gradually passes.

Astigmatism requiring correction is observed in 10% of children. More often
In total, it is predetermined by defective genes transmitted from parents,
one of which suffers from this disorder. As a result
irregular curvature of the lens or cornea is formed. Tall
the chance of occurrence of this disease is in those children who were born
with:

  • albinism;
  • fetal alcohol syndrome;
  • retinitis pigmentosa;
  • keratoconus – a condition where the cornea received no
    hemispherical and cone-shaped;
  • underdevelopment of the optic nerve;
  • congenital deformity of the dentofacial system, due to which
    deformed the wall of the orbit and malformed
    eye structures.

These cases are congenital and often cause astigmatism.
both eyes, while the degree of reduction of visual acuity in both
eyes different.

Pathology can be acquired and character. So она
appears after:

  • corneal injury resulting in the formation of her
    scarring;
  • eye surgery;
  • traumatic injury that caused the rupture of the zinn
    ligaments and subluxation of the lens;
  • keratitis, keratoconjunctivitis;
  • hypovitaminosis A;
  • some infectious diseases that may be complicated
    воспалением eye structures.

What symptoms should parents pay attention to?

In a child who is still unable to speak (up to 2-3 years) to suspect
any visual impairment is difficult, especially if the severity of his
is small. On medium to high astigmatism will
say these signs:

  • to watch a cartoon, a child comes to a computer or
    TV is pretty close;
  • if you need to consider something (a cartoon or a toy), he
    tilts or turns his head, squints, sometimes – stretches
    the corners of the eyes;
  • misses when putting the item (dishes or toys) on
    a place;
  • eyes get tired quickly, so baby rubs them with hands or
    covers for a few seconds through some kind of temporary
    intervals;
  • in games stumbles on items on furniture.

With the appearance of a constant visual load (in preparation for
school or in class) the child notes:

  • headaches: mainly in the neck and eyebrows
    arcs;
  • fatigue;
  • that he is not clearly visible on the board;
  • blurred vision, double vision;
  • feeling of “sand” in the eyes;
  • frequent redness of the eyes.

In the elementary school children with undiagnosed astigmatism
can be distinguished by poor performance, as it confuses and changes
in some places the letters written in his eyes. That is why,
and not because of harm, a preschooler or schoolboy can avoid reading
books.

How is the diagnosis made?

To prescribe the correct treatment of astigmatism in children, you need
establish this diagnosis and determine the degree of visual impairment.
For this you need to contact an ophthalmologist who can
determine astigmatism still in infants, using the method
skiascopy. This is the so-called “sample in a dark room”, based
on the appearance and movements on the retina of the shadow from the mirror, which the doctor
holds in his hand. After establishing the type of refraction, the doctor takes
appropriate skiascopic ruler with cylindrical lenses and
sets the degree of refraction for the lens that neutralizes
shadow on the pupil.

Visual acuity, that is, the degree of astigmatism, is usually checked
when the child is 3 years old – when he can cooperate with
ophthalmologist and answer his questions. At the same time
Apply such studies as:

  1. computer refractometry. Here with a special device,
    refractometer, determines the type and degree of astigmatism. Does he do it
    more accurately than skiascopy or determination of visual acuity by
    tables;
  2. Visometry (checking on tables) without correction and after
    fitting cylindrical lenses in the test frame;
  3. inspection in the slit lamp – study of the structures of the eye under
    magnification to see possible causes
    astigmatism;
  4. ophthalmoscopy – fundus examination with a special
    a magnifying device that the doctor holds in his hand;
  5. keratometry – measurement of corneal curvature using a special
    apparatus and computer program that analyzes the refraction
    light on the main meridians. The study reveals
    keratoconus and keratoglobus as possible causes of astigmatism.

If ophthalmoscopy is impossible to carry out, difficult
appointed by ultrasound of the eye – a study that allows you to exclude
retinal detachment, scars and hemorrhages.

Is astigmatism treated

It is your child’s astigmatism that is being treated or not,
ophthalmologist on the basis of inspection. The fact is that physiological
Forms of astigmatism in children under one year can pass by themselves – as far as
eye growth slight curvature deviations may even out.
If the degree of astigmatism is mild and higher, then before the eyes
structures will be fully formed (by the age of 18–20);
conservative treatment. It aims to prevent dangerous
complications – amblyopia and asthenopia.

The main treatment that can completely eliminate
astigmatism is operational.

Astigmatism treatment

We will tell how to treat astigmatism in a child. Up to 18 years old
Conservative tactics are always used. She is in
following:

  • vision correction;
  • treatment of amblyopia and asthenopia;
  • ensuring normal nutrition of eye tissue.

Vision correction

In order for the child to see the items on which he
looks applied vision correction. Mainly for children
points are used. The latter must have cylindrical lenses,
which focus the light rays directly on the retina.

Initially, the glasses are not comfortable for a child, they may even hurt their heads,
as the load on the visual cortex increases. Need to give eyes
time a week, persuading the child to suffer. If after 2 weeks
these symptoms persist, you must reapply to
ophthalmologist to review the correctness of the selection of glasses.

Of course, glasses are not the most convenient kind of correction, because they
accelerate eye fatigue, limit lateral vision, do not allow
engage in active sports and limit views
modern films and cartoons in cinemas. However,
contact lenses for correction are used in rare cases and the fact that
children over 10 years old.

When corneal astigmatism is resorted to a special type of treatment –
prescribe orthokeratology lenses. It is tough and uncomfortable
lenses that are worn only for the night and should lead
curvature of the lens to normal. Orthokeratotherapy does not apply if
visual acuity is more than 1.5 diopters.

Improving the nutrition of eye tissue

This is facilitated by 2 methods:

  1. instillation of special medication into the eyes;
  2. performing gymnastics for sight.

Some ophthalmologists refer here and training with glasses
�”Laser-vision” (“points in the hole”), but the proven benefits of them
not.

Eye drops

For instillation in the conjunctival sac, such
drops:

  • �Quinax. The effect of these drops is to
    suppress chemical reaction between dissolved in eye fluid
    proteins and lens, because of what it can dim;
  • �”Emoxipin”. It is an antioxidant that stabilizes cellular
    membrane, reduces the permeability of the walls of blood vessels, inhibits
    deposition of neutrophils and platelets on their walls;
  • �”Ujala” – Ayurvedic eye drops that contribute to
    improving the transparency of the lens.

Drops are prescribed by a doctor. They are used according to the instructions. In year
You need to undergo 2-3 courses of treatment.

Exercises for vision

They should be performed in a good mood, imagining that with their
using you can see everything around. You need to do them with good
illumination; twilight should not be.

The following complex is effective for application:

  • Slowly describe the circles clockwise, and then – against
    hour hand.
  • Pupil eight pupils – then one, then another
    side, then horizontally, then vertically.
  • Look up for 10 seconds, then down for 10 seconds.
    10 seconds to the left, 10 seconds to the right.
  • Put your index finger to the nose, look at it.
    Hold your finger forward and keep track of him.
  • Place your index finger 30-40 cm from your eyes.
    Look alternately, for 5 seconds, then at him, then at the objects
    outside the window.
  • Close your eyes. Assistant names colors, your task is theirs
    present and hold before your eyes for 2-3 seconds.

Elimination of astigmatism complications

The main complication of astigmatism is amblyopia – so
called the “lazy eye.” In this case, the brain “turns off” blurred
a picture that he gets from a sick eye, and does not “learn”
see. Amblyopia does not necessarily manifest itself – it can
be asymptomatic. It may also be a violation
color perception, orientation in space, significant
decrease in visual acuity (irrelevant degree
astigmatism).

Treatment of amblyopia should begin before 6-7 years, since after
11-12 years, it is almost impossible to adjust (even if you spend
operation and completely remove astigmatism). It consists in
pleopic treatment: sticking better than seeing eyes, training
on a special device “Amblicor”, stimulation of the retina with a laser,
light, color, electromagnetic waves. Effective for treatment
amblyopia and physiotherapy methods: vibratory massage,
reflexology, medicinal electrophoresis.

The second complication is asthenopia – visual fatigue,
reduced visual acuity, blurred objects,
feeling of “sand” in the eyes. These symptoms are exacerbated by visual
work, weaken at rest. This complication is treated by removal.
spasm of accommodation with drugs like “Atropine”, but having less
duration of action. After that classes are held on
special simulators – accessory, synaptophore.

Surgical treatment

The main methods that can cure (glasses and lenses are
only correction) astigmatism, can only be applied if
when the development of the eye apparatus is completed, that is, after 16
years old. The following main types of surgical interventions are used:

  1. Keratotomy. This is the name of the method by which
    cuts on the cornea. In this case, the cornea is a bit
    �“Spreading”, and the refraction along a certain axis decreases. So
    myopic or mixed astigmatism is treated.
  2. Thermokeratocoagulation. It is based on touching the cornea in
    certain places with a heated needle, as a result
    �”Rises”, and the refractive power in these places increases.
    So корректируется гиперметропический (дальнозоркий)
    astigmatism.
  3. Laser thermokeratoplasty. Very thin laser beam
    burns to the cornea, causing its shape to change,
    becoming more convex.
  4. Conductive keratoplasty. Its principle is the same as that of
    previous method, only thermal defects are not
    laser and radio frequency radiation.
  5. Photorefractive certoectomy is the exact method by which
    necessary areas of even a thin cornea are evaporated by a laser;
    the result is that it must change shape.
  6. LASIK method. Here the laser beam cuts off the thinnest layer of the cornea.
    in the right place, as a result of which the shape is adjusted
    last. The operation lasts only 15 minutes. Held under local
    anesthesia in persons whose vision is better than 4 diopters.
  7. Implantation of phakic (lens) lenses. This method
    used for the correction of high astigmatism when there is
    contraindications to laser treatment.
  8. Keratoplasty: instead of own cornea is established
    donor or artificial.

Postoperative period

After any of the operations, vision is restored in 2 hours. But in
for half a year, there may be photophobia, a foreign sensation
body in the eye, tearing. At this time it takes to complete
healing tissue, you need to protect yourself from physical exertion, not
stand over the fire, avoid rubbing the eyes and staying in the bath or
the sauna. 2 of 10 operated after surgery regress
refraction: myopia or farsightedness may return,
existed before the intervention.

Forecast

Congenital astigmatism by the year usually either disappears, or
going down. By age 7, the degree of visual impairment stabilizes at
time, but may decrease or increase with time. If
baby astigmatism single eye high degree and he didn’t get
correction, developing amblyopia, strabismus.

Prevention

As much as possible reduce the risk of astigmatism,
if a:

  • undergoing routine examinations by an ophthalmologist from the age of 6
    months;
  • teach a child to do gymnastics for the eyes
  • create sufficient and proper illumination at work
    place;
  • useful massage the neck area, swimming, contrast
    shower;
  • food must be complete.

Автор: Кривега Мария Салаватовна врач-реаниматолог

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