Update: October 2018
Strabismus (strabism or heterotropism) is called
pathological condition in which there is asymmetry of one
or both eyes in relation to the central axis. As a result
the child cannot focus on the point of fixation
accompanied by a violation of binocular vision – ability
perceive the world around with two eyes.
This vision disorder leads to amblyopia or “syndrome
lazy eyes “- suffers visual acuity of the organ, ghosting and
deep vision disorder (baby perceives all objects
flat). Strabismus in infants is not considered a pathology, but rather
a variant of the norm, occurs in 2 guys out of 100. This defect
prone to self-extinction.
When does strabismus occur in newborns?
- For newborns – eyes “float”
- At 6-8 weeks – the child begins to fix the object 2
- At 4 months – stable binocular fixation.
Normally, the disappearance of heterotropism occurs to 4, maximum to 6
months. If a six-month-old baby’s eyes continue to “float”
– should contact an optometrist to determine the cause
strabismus and the passage of the necessary treatment.
Why newborns mow
Just born and babies up to six months are not capable of
eye fixation due to congenital weakness of the eye muscles, and the child
can not control the movement of the eyeballs. Therefore organs
In the case of tension, they begin to move in different
directions, the pupils are rolling, being on opposite sides of
About 1 baby
out of 10, the eyes go to the temples, and the other 9 converge at the nose.
Also in the cause of transient or transient
strabismus in a child’s first weeks of life is a feature of the structure
In infants, the right and left half of the facial skeleton
form an angle with respect to each other, which creates a visual
strabismus, which will pass after aligning the bones through
Types of strabismus
Strabism depending on the cause, mechanism of development and
симптоматики может быть содружественным и паралитическим. Have
newborns and infants more often observed
friendly strabismus, which is classified as:
The involvement of the organs of vision:
- one-sided or monocular strabism – one “floats”
- intermittent or alternating strabism – in the process
both eyeballs are involved in turns.
The direction of deviation of the “floating” eyeball:
- vertical squint – the eye is shifted up or down;
- horizontal cross-eye – converging – eye or eyes
converge to the nose, divergent – eyeballs are rejected to
- mixed strabismus.
The severity of pathology:
- heterotrophy or latent squint;
- accommodating or compensated – wearing glasses
eliminates strabismus (additional treatment is not carried out);
- partially accommodating or subcompensated – wearing
points only reduces strabism;
- not accommodating or decompensated – not liquidated
wearing glasses and requires surgical correction.
The causes of strabismus in infants include:
- pregnancy and childbirth, which proceeded with complications (contribute to
the occurrence of microscopic hemorrhages in the brain, including
including in those departments where the visual analyzer is located);
- infections suffered by a baby before they reach 12 months
(flu, measles, ARVI, scarlet fever, diphtheria);
- stress (fright);
- weakened immunity;
- wrong baby care (close to the eye)
- pathology of the eye muscles (vascular or tumor);
- genetic predisposition;
- other ophthalmologic diseases (farsightedness, myopia,
conjunctivitis, cataract or barley);
- eye injury or brain injury during childbirth
- chromosomal pathology (Down syndrome);
- taking a number of drugs, including drugs, in gestational
- Cerebral palsy.
Squint in children under one year old parents may suspect
on their own. If there is an asymmetrical location
pupils and iris in relation to the palpebral fissure (after 6 months),
It is necessary to consult an oculist. To suspicious symptoms
- feature in holding the head – dear child tilts his head in
one side or the other when trying to see something;
- squinting – babe squints involved in pathological
the process of the organ of vision, considering the toy;
- frequent rubbing of the eyeballs – caused by rapid fatigue and
stress when looking at something;
- пелена перед eyes (можно выявить у ребят постарше);
- headache – caused by the tension of the organs of vision and their
- lack of deep vision – objects are perceived flat,
while attempting to walk, the child stumbles upon objects;
- the impossibility (pain) of the perception of light;
- doubling objects, their vagueness;
- lack of simultaneous movement of organs view;
- the impossibility of the direction of both eyeballs on the subject /
- different reflection – when you try to shine in the eyes of a child in
pupils have different reflections.
If the eye / eyes are deflected to the temples, then decreased visual acuity
occurs as myopia. In case of deviation of visual
bodies to the nose – there is a hyperopia.
Paralytic heterotropism is accompanied by stiffness or
limited mobility of the squinting eye. In addition, at this
In the form of pathology there is an expanded pupil, ptosis (omission
upper eyelid) and accommodation paralysis. These symptoms
evidence of damage to the optic nerve.
Pathology is established by an ophthalmologist, who
the inspection carefully collects anamnesis and complaints (asks
mothers). In the history of the doctor will be interested in the course of this pregnancy,
childbirth, illness, heredity of the child.
Further inspection includes:
- assessment of the position of the head, symmetry of the palpebral fissure and facial
- assessment of the degree of visual impairment (test lenses);
- measuring the angle of deviation of the image in the pupil;
- test with cover alternately one and the other eyeball
– if when closing one eye deviation to the side occurs
another, talk about hidden strabismus;
- bimicroscopy (anterior examination of the organs of vision and
the fundus of the eye);
- офтальмоскопия (изучение the fundus of the eye);
- Synoptic survey – allows you to measure the angle
deviations of the pupil from the normal position;
- skiascopy and computer refractometry allow
examine eye refraction
- echobiometry – measurement of the length of the organ of vision.
If the ophthalmologist suspects paralytic strabismus, then he
recommends consultation with a neurologist with a further neurological
examination. The examination includes: electroencephalography,
What should parents do
Physiological strabismus should disappear to execution
half a year to a child. At birth, the baby in the maternity hospital examines
only a neonatologist, who establishes whether he sees. First inspection
The ophthalmologist should occur at 2 months, then at 4, in half a year and in
year. If the squinting eyes have not ceased to “swim”, it is recommended
further observation, and if necessary – treatment.
To stimulate the eye muscles, increase their tone and strengthen
It is recommended to entertain a child with toys. Rattles should be
bright and large, hung not over the very face, but somewhat higher
(20 cm). In this case, the baby does not reach them with his hands,
focusing on distracting objects. It is also useful to perform
simple exercise for the eyes. Putting the child on his knees facing
yourself, slowly drive the toy from side to side, picking it up and
Is it possible to correct strabismus? A similar question interests many
parents. In addition, concerned about the timing of the start of treatment of pathology.
Treatment патологии должно проводиться как можно раньше, то есть
after establishing the cause and final diagnosis in 6 months
age Various methods of strabismus treatment in children are used.
up to 12 months. The duration of therapy and the choice of a method
depends on the form and severity of pathology:
The method is to perform special exercises.
Gymnastics for the eyes must be in glasses. Classes should
spend every day for 2 hours, dividing them into several
intervals of 20 minutes. For exercises used color
cubes, balls or lotto.
Visual acuity is increased as follows:
- turning on the table lamp, you need to fix bright
subject not far from him (5 cm).
- The child should close the healthy eye and set it at 40 – 50
cm from the lighting device.
- For 30 seconds, the baby must concentrate on
- After you need to show him bright pictures that
will form a consistent image.
- In one lesson, the exercise is repeated three times with different
items. The duration of therapy is 1 month.
Development of binocular vision and strengthening of the eye muscles
stimulated by another exercise. Hanging on a stick bright
the object is led in different directions in the face of the child. At that time
it is necessary to close one and the other eye alternately. Moving up
subject to face, mark the reaction of the eyeballs, which should
come together at the nose.
This technique involves wearing glasses that
correct myopia, astigmatism or farsightedness. Glasses
written out from 8 – 12 months of age. In addition, this view
therapy prevents the appearance of amblyopia, that is, squinting eye
loses sight in the absence of a load on it.
The method is aimed at the treatment of amblyopia. The technique is
off a healthy organ of vision from the visual process. With this
the goal is occlusion of the healthy eye with a bandage on
him either closing one glass with glasses. In this case, mowing
the eye begins to work hard and evens out. If strabism
two-sided, one by one, then the other ocular
an Apple. That organ of vision that sees worse stuck on one
day, and healthier at 2.
Performed by courses. Each course includes up to 10 procedures.
Ideal for the treatment of strabismus in young children. Method
It is selected by the doctor individually. Use ambliokor, synoptophor
and other techniques.
As a rule, it is used in the paralytic form of pathology or
in the absence of the effect of conservative therapy. Operational
intervention eliminates aesthetic defect, but not always
normalizes visual acuity. The operation is performed on an outpatient basis.
takes no more than 15 minutes. Surgical intervention
strabismus is indicated when the child reaches 3 years of age.
2 types of operations are performed:
- reinforcing – aimed at shortening the eye muscles due to
removal of its part;
- weakening – changes the place of attachment of the eye muscles, for
transplant it further away from the cornea.
After performing a surgical correction on a small patient
anti-inflammatory drops drip into the eye three times a day for
2 weeks. During the month, the operated organ of vision
must be protected: to prevent pollution, to limit the physical