strabismus in children
Introduction
Introduction to pediatric strabismus Strabismus refers to the fact that both eyes cannot simultaneously focus on the target, which is an extraocular muscle disease. Can be divided into two types of common strabismus and paralytic strabismus. The former has an eye position biased to the temporal side, the eyeball has no movement disorder, and no recurrence is regarded as the main clinical feature; paralytic strabismus has limited eye movement, diplopia, and accompanied by systemic symptoms such as dizziness, nausea, and gait instability. The etiology of strabismus is complicated. Modern western medicine has no ideal method for the cause and surgical treatment. A considerable part of infants and young children are pseudo-intralateral, and the surface looks like a cross-eyed eye or a pair of eyes. This is because the nose of the infant is wide and flat, covering part of the inner ankle (commonly known as the big eye). The two black eyes seem to be concentrated in the center. The white eye on the outside of the cornea is more than the inner side, giving an illusion of esotropia. . A convenient way to identify the false internal oblique is to pinch the skin of the bridge of the nose, revealing the white eyeballs in the inner ankle. The appearance of the inner oblique disappears. It can also be covered. When the cover is covered, the eye of the pseudo-esoteric strabismus is not. Will move. False esotropia will gradually improve with age. basic knowledge The proportion of illness: 0.005% Susceptible people: children Mode of infection: non-infectious Complications: Amblyopia
Cause
Pediatric strabismus cause
According to the survey, maternal dystocia can also cause strabismus in children. Pediatric strabismus is a common eye disease, mostly in childhood. There are many reasons for children's strabismus, mainly the following:
First, visual function hypoplasia
In general, the visual center of the brain in children is not perfect, so it is not well coordinated and controls the contraction and extension of the extraocular muscles. Therefore, the monocular function of the eyes of children is not stable, and any external factors such as fright, Stimulations such as fever and trauma may lead to unstable or even loss of unstable single vision function in the eye.
Second, children's eyeball factors
In general, children's eyeballs are relatively short, and most of them have physiological hyperopia. In general, after two years of age, the demand for near-objects is slowly increasing, and the adjustment of children's eyes is very strong. The contraction of the extraocular muscles is very good. If children have a habit of seeing things from a young age, they will lead to two long-term. The long-term state of the eye is highly regulated, which in turn causes the eyeballs to turn inward, which in the long run leads to esotropia.
Third, congenital and birth injury factors
In general, congenital extraocular muscle development in children is not too complete; the congenital paralysis of the nerves that control the movement of the extraocular muscles; the dystocia of the mother causes damage to the extraocular muscles and extraocular muscles, and the deflection of the eyeball position may occur.
Prevention
Pediatric strabismus prevention
1, prevention of strabismus should be taken from the infant period, parents should pay attention to carefully observe the child's eye development and changes.
2, infants and young children in fever, rash, weaning, parents should strengthen nursing, and often pay attention to the coordination function of the eyes, to observe whether there is abnormality in the eye position.
3. For children with a family history of strabismus, although there is no strabismus in appearance, please check with an ophthalmologist at 2 years of age to see if there is hyperopia or astigmatism.
4. When children watch TV, besides paying attention to a certain distance, children should not be allowed to sit in the same position every time, especially the position of the TV. Should always exchange seats in the left, center, right, otherwise the child in order to watch TV, the eyeballs look in one direction, the head will habitually squat to one side, for a long time, the development and tension of the six eye muscles are different, lost In the original adjustment of the balance, one side of the muscle is always in a state of tension, the other side is slack, it will cause strabismus.
Complication
Pediatric strabismus complications Complications amblyopia
Strabismus affects binocular vision and, in severe cases, does not have good stereoscopic vision. Stereoscopic vision is an advanced visual function that only humans and higher animals have. It is one of the prerequisites for people to do fine work. Without good stereo vision, there will be a lot of restrictions on learning and employment. Most patients with strabismus have amblyopia at the same time. Because the strabismus patient has long-term one eye gaze, the other eye will cause disuse of vision loss or stop development, and even after wearing appropriate glasses, vision will not reach normal. Pediatric strabismus also affects the development of the whole body's bones, such as the compensatory head position of congenital paralysis strabismus, which causes neck muscle contracture and pathological curvature of the spine, and facial asymmetry.
Symptom
Pediatric strabismus symptoms common symptoms strabismic amblyopia
1. Most of the strabismus that occurs in childhood has no obvious symptoms. A small number of school-age children will have visual fatigue, and parents will mistake the child for learning.
2, most exotropia is initially intermittent, often appear in fatigue, sorrow or fever and other physical discomfort, careful parents often find, and some are often neighbors or school teachers feel that the child's eyes are not normal to be discovered, Because the family is together with the children every day, they see "weird" and not "weird".
3. Most of the esotropia will become constant soon after it appears, or the state of strabismus is often present, so it is easier to find and see early than exotropia. However, because many children have the characteristics of inner suede and nasal bridge width, sometimes it seems that "opposite eye" (espeoscosis) has been "probably internal oblique" after examination by a professional doctor. This situation is more common in our oriental people.
4, gimmicks are sometimes eye problems rather than neck problems, which is often not understood by people, why do you want to see an ophthalmologist, this is because when the child suffers from strabismus (vertical strabismus) The special position adopted by the body for compensation is medically referred to as the compensatory head position.
5, close one eye outdoors or in the sun, is one of the common manifestations of some intermittent strabismus, such patients only show the abnormal situation of closing one eye in the outdoors or in the sun, and other situations No abnormalities.
Examine
Pediatric strabismus examination
There are many methods for examination and measurement of strabismus in children. It can be measured by the perimeter or by the same machine, but there are also more convenient and simple methods:
1. Corneal retroreflection position measurement method: This method can roughly estimate the strabismus of strabismus in children. Usually, the doctor inspected and the examinee sit face to face. The doctor holds a flashlight with the lampshade removed 33cm in front of the patient. The light shines on the surface of the patient's cornea. Generally, people with normal eye positions will have light reflection points at the center of the cornea of both eyes, with a squint of 0°. If one side reflects the light spot in the center of the cornea and the other side reflects the light spot toward the nasal side of the cornea, this patient belongs to an exotropia patient. If the reflected light spot is biased toward the temporal side of the cornea, the patient belongs to esotropia. Generally, the line from the center of the pupil to the edge of the cornea is divided into three equal parts, each 15 °, the general doctor will estimate the strabismus of the patient according to the position of the reflection point.
2. Use a meter ruler to check the strabismus of the child. Don't turn to the front, record the position of the corneal edge of the oblique eye on the meter ruler, then cover the eye of the eye and gaze forward, and observe the degree of displacement of the squint. The millimeter is equivalent to a squint of 5oC.
3. Tri-prism with eye-shaping method: This method is a more accurate method for detecting squint degree. When covering the eye of the patient's gaze, the squint eye will move in the direction of the gaze target, if placed in front of the squint With the prism with increasing degrees, the resetting movement of the strabismus eye will not occur, so the degree of the prism used to eliminate the movement of the squint eye represents the degree of strabismus.
4. Same-view machine inspection method: This method is to check with an instrument that specifically checks strabismus. The same vision machine needs to fix the forehead of the patient. After adjusting the height and the position of the pupil, add the sensory piece in front of both eyes, and place the eye tube in the 0 position, then turn the deflection eye tube to make the two eyes overlap. The index of the lens barrel is the main oblique angle of view. Alternately switch the light source of the two barrels, and move the barrel to the center of the cornea when its reflection point is not moving. When the eyes do not move, the degree at this time is the squint point.
Diagnosis
Pediatric strabismus diagnosis
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1. Children's side view
Children with strabismus may have a facial and eye-to-side deflection when viewing the object, and some children usually have normal head positions. There are no abnormalities in eye position, eye movement and refraction. Only when watching TV, the face and eyes are deflected to one side, and the eyes are staring forward. This phenomenon is "sidesight". . Children with side-effects only appear in the special environment of watching TV. The eye position examination is no problem, not caused by strabismus.
2. False esotropia
A considerable part of infants and young children are pseudo-intralateral, and the surface looks like a cross-eyed eye or a pair of eyes. This is because the nose of the infant is wide and flat, covering part of the inner ankle (commonly known as the big eye). The two black eyes seem to be concentrated in the center. The white eye on the outside of the cornea is more than the inner side, giving an illusion of esotropia. . A convenient way to identify the false internal oblique is to pinch the skin of the bridge of the nose, revealing the white eyeballs in the inner ankle. The appearance of the inner oblique disappears. It can also be covered. When the cover is covered, the eye of the pseudo-esoteric strabismus is not. Will move. False esotropia will gradually improve with age.
3, surgical torticollis
Surgical torticollis can be divided into congenital muscular torticollis and congenital pelvic torticollis. The former is congenital neck deformity caused by head and neck slant caused by one side of sternocleidomastoid contracture, which is quite common; the latter is due to Cervical vertebrae developmental deformity caused by the torticollis, less common, there is a type of torticollis is the ocular torticollis, the surgical torticollis and ocular torticollis identification also has a simple method is to cover one eye and see the torticollis There are improvements, and those with improvement are mostly ocular torticollis, otherwise they are mostly surgical torticollis.
