Test Worsi - the definition of an angle of strabismus in Gyrshberg. Corner of the Ambassador by Gyrshberg Primary and Secondary Angle of Space

Space or Sturdy - Common visual pathology. It can meet both in children and adults, wearing an innate or acquired character. And if congenital anomalies Noticeable from the first months of life, it is not so easy to identify the acquired sturdy. To verify the patient for the presence and complexity of the disease, the doctor can resort to hospital tests and hardware research. They include techniques such as the definition of an angle of strabismus in Girshberg, research with synopoform, etc. Next, we will tell about them in more detail.

What to pay attention to the diagnosis

During the definition of the diagnosis, it is necessary to draw attention to anamnesis, namely:

• The time when the squint appeared, indicates etiology. The sooner it arose, the greater will be the probability surgical intervention. With a late appearance, the chances of the accommodation component increase.
• Corobality of angles is a significant criterion, since the periodic appearance of the squint makes it clear that the binocular vision is preserved.

In the case of alternating life, symmetric visual acuity is assumed on each of the eyeballs.

• It has great importance general stateor abnormality of development. For example, attention is drawn to the frequency of strabismus in a child suffering from cerebral paralysis.
• It is necessary to test the history of childbirth, to get acquainted with the indicators when pregnancy flow, weight gain at birth, pathologies with intrauterocal development, or in the process of childbirth.
• A strong effect also has a hereditary history, since in most cases this disease is congenital pathology.
• As part of the inspection sensory functions The level of binocular vision resistance is determined, its sharpness is detected, the presence or absence of a bifvectional fusion. Attention is drawn to the functional of the suppression, the nature of diplopia, the fusion reserves.

Doctor checking motor functions, analyzes the degree of mobility of each eyeball, gives the characteristic of deviation, determines the complexity of violations in the operation of the o'clock muscle of each eye separately.

Types of research - How to test yourself in strabismus, which norms and deviations exist

To establish an accurate diagnosis and measurement of the angle of straightening, experts can resort to various diagnostic methods. About the heteropory in adults and children will tell.

These include the following:

• determination of the corner of the area of \u200b\u200bHischberg;
• study with synopoform;
• color test Belostotsky-Friedman;
• test Worsi;
• raster haploscopy.

Consider each of the methods in more detail.

Determination of an angle of drafts of gyrshberg

As part of the diagnosis, an ophthalmoscope is applied. The scheme includes such steps.

1. Turning on the device.
2. Patient direction on a hole located in the central part of the apparatus.
3. Fixing an ophthalmologist location of light glare.
4. Blike on healthy eye Located strictly in the central part of the pupil.
5. The sick eye demonstrates the capture of the glare at some distance from the pupil.
6. Measurement of the angle of deviation.
7. Turning off the device.

About friendly squint and how it appears to tell.

Sturbize corners can be different, depending on the location of the glare. The norms are as follows:

• if the glare does not leave the limits of the pupil, the angle is at the level of 10 degrees;
• when the luminous point is located on the edge of the pupil, the angle of deviation will be 15 degrees;
• when you find the flare in the middle of the iris, the angle varies from 25 to 30 degrees.

After the diagnosis is completed, the specialist compares the primary and secondary angle of the squint. Primary is an angle affected by stubism, the secondary is the indicator of a fully working eye. Conclusions are made about the need for surgery. What is orthoptics and the diploptic find out.

If the indicator exceeds 15 degrees, operation is performed. In other cases, vision is adjusted hardware.

How to determine the angle of squinting with synopoform

Sintofofor is one of the most popular instruments for carrying a hapcopic diagnosis. In the instrument, the field of view is separated in a mechanical way. For this, two optical movable tubes are envisaged. With their help, a check is carried out by paired test objects.

The application of the device is also practiced to carry out an orthopedic exercise complex.

Inside the device, the test objects can occur in a vertical, horizontal direction, against and clockwise. They differ among themselves by type of control elements for each eye. Combining pair drawings can be understood, there is no binocular merge. If it is not, it indicates the presence of functional cattle. Founding that the merger is still available, the fusion reserves are determined. To do this, test objects are reduced or diluted until the twist of test objects appear. The presence of positive or negative fusion reserves is determined. Is it possible to get the rights when protoropy find out.

The use of a syntopod makes it possible to establish an angle of the squint (objective or subjective), determine the ability to merge the picture of objects, set the fusion reserve, detect the functional cattle.

Four-point color Test Belostotsky-Friedman for the analysis of binocular vision

As part of the four-point color test of Belostotsky-Friedman, two blue or green mug are used, the rest have a red and white shade. The patient looks at them through the glasses of red and green. Near the right eye, a red filter appears, the left - green. White circle, located in the center, when viewing through green and red filters, will be perceived as red or green, based on how much the vision of the left or right eye prevails. If there is a monocular vision of the right eye, the survey will see two red mugs (when viewed through a red glass). In the case of the left eye - only three green. Simultaneous vision provides for the view of five circles - 3-green and 2 red. Simultaneous vision is characterized by viewing four circles - in a pair of green and red.

Using the polaroid or raster baguolini filters, as in the case of the use of the color instrument, provides for the presence of a common object for merging, as well as several objects that can be seen only with one eye.

It should be noted that color samples are used not only to determine stabysma, but also to detect Daltonism. To this end, a color partition table can be applied for drivers with answers.

The method of analysis of binocular vision differs with each other depending on the degree of "dissociating" action. In color equipment, it is characterized by greater severity, while in raster and polaroid tests, severity is smaller. The reason - in glasses conditions become the most natural as possible.

Worst test - Vision verification technique in adults and children

The Worst test is carried out using the projector of signs. It allows you to estimate the nature of the view when two eyes are open. The test allows you to determine which vision is y and adults -, simultaneous or binocular type. Also, the technique contributes to the detection of the vertical type.

The test includes two green figures perceived by a man through green glass. There is also one red figure for which the patient looks through the glass of red. Figure white color Summary at once in two eyes.

In the presence of binocular vision, a person sees four figures at once, simultaneous - five. Monocular vision provides recognition or three green or two red shapes.

Four-point test is one of the most popular. Before conducting the inspection, the patient must move by 1-5 meters. The doctor puts glasses with light filters. Them right part Equipped with a red lens, left - green.

Raster Gaploskopia (Test Bagolini)

The test of the Bagolini test provides for the use of a strip glass in several copies. They are located in a test rim in a mutually perpendicular direction. The patient in these glasses should look at the light source located point. Vision is regarded as a binocular, if a person clearly recognizes one light source within testing, and two beams intersect on it, reminding the shape of the cross. In the presence of simultaneous vision, the patient also sees a cruciform figure, but the number of sources is increased to two. Monocular, respectively, vision, provides for viewing only one beam or two alternating in the presence of alternating monocular vision. About paralytic squint in adults read by.

Ways to identify pathology and measurement of the angle of straightening at home

With congenital strapment, it is possible to have a problem from the first days. If the disease is acquired, it is unlikely to immediately notice a small deviation, given that people are rarely sent to the clinic for a planned medical examination. After that, the doctor may appoint.

To determine pathology, it is not always necessary to visit the clinic - the test can be passed at home. To do this, it is necessary to lean on the chair, fixing the head in a stationary position. Further, a person looks at a fixed object in the window - for example, on a signboard or antenna of a satellite. The focus of view on the selected object occurs for 1-2 seconds.

Next, closing the eye with the palm, the person considers the same object for 1-2 minutes. If the fixed object does not jump in different directions when opening each eye, it is possible not to worry about the presence of space - it is simply missing. This is a very simple test, but for more detailed information regarding the condition of the eyes, you should still seek help to an ophthalmologist. He will independently check using the appropriate diagnostic equipment and modern methods. And if after the opening of the eye, the object will start jumping from side to side, without the help of a specialist, it is not necessary to do without a specialist - you will have to carry out hardware or surgical correction vision. Perhaps you will also be interested to get acquainted with the technology of detecting daltonism. For this use.

Video

This video will tell you how to determine the angle of the squint.

conclusions

1. Identifying squint - difficult process. For a full-fledged diagnosis, you need to pass a series of medical tests and assemble a patient's full history.
2. When identifying pathology, congenital and acquired factors are taken into account, because In most cases, lifebide is a hereditary disease.
3. To properly assign treatment, you need to determine the type and angle of the squint. For this purpose, the following techniques can be used: the detection of an angle of strabismus in Gyrshberg, a study with, color test of Belostotsky-Friedman, a test of the Worse, raster hapbloscopy.

Reliable and informative diagnosis implies not only the statement of pathology, but an assessment of the severity of existing disorders. With squinting, such a measure is the "Angle Corner". The deviation of the position of the eyeball from the norm is measured in degrees. The easiest way to measure this indicator is the Girshberg method.

Measurement of an angle of strabismus by Gyrshberg

When a patient is fixed on the opening of the Ophthalmoscope mirror, the light in the norm should be reflected in the middle of the pupil. In the presence of braveness, the bundle of the reflected light deviates from the center. The doctor records the degree of deviation. By hyrchberg, the 15-degree deflection is considered the location of the reflected light on the edge of the pupil. If the glare falls on the middle of the iris, the angle of the squint is 25-30 degrees.

The angle of deviation of the oblique eye is called the "primary", healthy - "secondary".

The results of such a survey significantly affect the choice of therapeutic scheme. Deviation more than 15 degrees is an indication to surgical operation. If the deviation does not exceed 10 degrees, hardware correction is possible.

The measurement method for Grishberg is most accessible, but only approximate results gives. If more accurate diagnosis is required, the angle of strabismia is made with the use of the synopophore.

Stroofing an angle of space on synopofofore

The hardware measurement of the angle of the groove is based on the combination of objects (for example, a circle and square). Optical sources, separate for each eye, rotate until the light bundles coincide with the patient's pupils. Then the objects in question are alternately turned off. The movements of the eyeballs for each new focusing correspond to the angle of deviations, which is displayed on the scale.

The use of the synopophor allows simultaneously with a measure of the angle of the area to carry out additional ophthalmic studies.

Effective means to restore vision without operations and doctors recommended by our readers!

The phenomenon of the squint represents the pathological process of visible nature, involving the violation of the movement function and the wrong position of the cornea. The disease is formed due to eye injuries and diseases, refraction anomalies, nerve paralysis, endocrine disorders, infectious and mental processes. The main sign of the Space is the direction of the eyes in different directions, and this can be seen by outdoor diagnostics. The disease may be congenital or acquired, with this phenomenon, an important role in the diagnosis is played by the definition of an angle of draft of Hischberg. Consider the features of the practical application of the technique to determine the angle.

Conducting settlement action

Restrictions in terms of mobility of apples eye and corner change can be observed during the identification of pathology in orbit. This method of determining the angle of stabysma is simple and based on the simplest principle: the study should look at the finger of the specialist and move the eyes behind its movement in all directions. If the apple has a maximum deflection indicator, dusted the edge of the cornea at an angle of the squint can reach the spike of the age, and in the inside it can reach the meat of the tear. When the patient looks up, the corneal shell can enter the edge of the century, located at the top, if the look is directed down - the shell crosses the edge part of the lower century half. Therefore, the definition of an angle of stabysma plays an important role.

If there is a clear alert, the sympalition signs are determined by testing. This can be done using a perimeter, as well as to use a proven method about Gyrshberg, although it is less accurate, it is considered the most simple in execution and effective. For the preparatory process, the patient sits near the lamps on both sides, then an ophthalmic mirror is used, the light beam is directed into the eye of the eye of the studied person, while it should look at a special device called an ophthalmoscope. Specialist is evaluated general symptoms Spaceship produces a general definition of angle and concludes.

In the eye that does not mow, there is an obvious coincidence of the reflected beam with central part Pupil as regards the kosy eye organ, a displacement will be detected here. Depending on its indicator, the angle of the squint is determined. In the course of observation of the width of the pupil in 3 mm, when determining the angle of space, the reflex is located:

• at the edge of the pupil - this may indicate compliance of size 15;
• if around the edge in the field of iris - an angle of squint - 20;
• between the regional element and limb - it is up to 30;
• directly in the limb zone - 45;
• behind him - the size of the angle of strabismus is more than 60.

Complete disposal of the angle of the area is possible only under the condition of competent determination of the severity of the disease by determining the angle of the squint. A competent measurement with an ophthalmic study guarantees success in treating and improving subsequent well-being.

Detailed description of the methodology

In the normal condition, the eye is in motion in parallel to each other, if one of the pupils has a deviation from a straight axis, this indicates pathology. The degree of heterotropy is determined strictly in degrees. For example, if the visual body is in a healthy state, this indicator is 0 degrees. If the squint is diagnosed, the value becomes large, depending on the severity of the syndrome. In this technique, an ophthalmoscope is used, the procedure must be conducted strictly by a specialist.

Scheme on stages

So, how to determine the squint - consider the process of this event in the most detailed.

The specialist brings the device into a working condition by turning on and configuring.

The patient sends a look at the hole inside it.

The oculist should fix light glare by their location, they appear in the patient's eyeball area.

If the eye is healthy, the glare is strictly in the middle part of the pupil.

If the eye is mowing, there is a certain distance called the deviation. In this place there is a cluster of light.

Ophthalmologist at this stage grows the angle of deviation.

A specialized instrument is shutdown.

The fixation of the point of the world, located in the patient's area, can occur at different distances from the pupil, this is determined by stabism and its features. To competently determine heterotrophy, you need to conduct this species Testing exclusively in an equipped ophthalmologic office. The parameter value has a dependence on the degree of illumination, shadows and the correctness of the event.

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Friendly squint

Paralytic squint

Overallic apparatus provides eye turn, fixing the gaze (defined position of eyeballs) and convergence, so that it also creates conditions for binocular vision (see chapter 3 "Spectatical Functions").

The amplitude of the eye movements is assessed by the following way: the patient observes two eyes for moving the object in direct and oblique meridians. The movement of the eye towards the paralyzed muscle will be limited.

The ability to convergence is characterized by the possibility of the patient to record the eye on an object approaching to the nose (normally the nearest convergence point is located at a distance of 5 cm).

Tone overall muscle Balanced, when viewed by remote items, the visual axes of both eyes are parallel to each other.

Orthoforia is an absolutely balanced tone of all glazation muscles (noted in 20-30% of people).

Heteropory - imbalance of the sound muscles. There are insignificant heteropory (non-binocular vision, but causing hidden strabismus) and pronounced (disturbing binocular vision and leading to obvious squint).

The pathology of the oculomotor apparatus includes the wrong position of the eyes (squint), restriction or lack of eye movement in one direction or another (paresa or paralysis of the eye muscles), disruption of convergence and divergence, as well as violation of the fixation ability of the eyes (Nistagm).

STRABISMUS

Strabismine (Strabismus) - Deviation (deviation) of one eye from the total point of fixation.

Angle corner- The magnitude of the deviation of the axis of the oblique eye from the pair eye axis, expressed in degrees.

The angle of primary deviation is the angle of the squint of a kosy eye. For its measurement, the patient is asked to fix the eye on the cycle object, while one eye will mow.

The angle of the secondary deviation is the magnitude of the deviation of the axis of the unscrewing eye. When closing the previously ill-eyed eye, it deflects, and the patient looks at the object previously mowing eye (i.e., the angle of primary deviation "disappears", and the angle of the secondary deviation) appears.

The simplest is the way to determine the angle of strabismus in Gyrshberg. The doctor is located opposite the patient at a distance of 35-40 cm. The doctor through an ophthalmoscopic mirror is observed for the position of the light reflex on the cornea at first, and then another

eyes. When maintaining the normal position of the eyeball, the reflex almost coincides with the center of the cornea. If there is a squint, it is rejected in one direction or another (Fig. 18.1). It is possible to determine the angle of the squint with the help of a synapotor.

Imaginary squint it occurs if the angle between the visual (anal) and the optical axes of the eye exceeds 3-4?. Imaginary squint is due to the displacement of cornea centers in one direction or another under the influence of the characteristics of the structure of the facial skull. Binocular vision is not violated, so with imaginary alpoplation of treatment is not required.

Hidden squint it occurs with a slight imbalance of the sound of the october muscles while preserving the fusion reflex and binocular vision. The diagnosis is based on a sample with covering the eye, at which the conditions necessary for binocular vision are excluded. The patient is asked to fix the item with two eyes, then one eye doctor covers his hand. If there is a heteropory

Fig. 18.1.Determination of an angle of drafts of gyrshberg

deverted to the action of the prevailing muscle. When the doctor cleans his hand, the installation movement earlier makes the installation movement towards the original position (there are no installation motions during orthophory). The treatment of heteropory is usually not required. However, if the patient has binocular decompensation and asthenopia, then spherical or prismatic glasses are used.

Explicit squint developed with a pronounced heteropory and is resolved by a violation of binocular vision. Eliminate squint friendly(without changing the angle of strabismus when the eye moves) and paralytic(with a change in the angle of the squint when the eye moves).

Friendly squint

Friendly squint arises in 2-3% of young children.

Etiology

Friendly squint develops with the impossibility of forming binocular vision. The reasons:

Visual acuity of one or both eyes below 0.3;

Anisacyonium is a different amount of images on the retina two eyes due to anisometropy;

Inconsistency of convergence and accommodation;

Violation of the coordination of movements of the eyes and fixing the gaze;

Reducing the fusion reflex (brain ability to merge images from the corresponding sections of the retina).

Classification

The following varieties of friendly strabismus distinguish:

According to etiology and the formation mechanism, friendly squint is classified on accommodation, inaccodal and partial accommodation (mixed).

In the direction of deviations, it is allocated somewhat (the eye mows towards another eye, that is, medially), diverging (the eye deviates from the paired eye, that is, laterally) and vertical squint.

According to the deviation of one or both of the eyes, the alpasis is distilled (from the point of fixation the same eye is always deflected) and alternating (from the point of fixation alternately, then one, then another eye).

Pathogenesis

The impossibility of the formation of normal binocular vision leads to the allocation of the lead eye, which looks like a yellow spot, while in the jacukery eye, the function of the yellow stain is launched, and it looks another area of \u200b\u200bthe retina (eccentric fixation occurs). When closing the driving eye, the second eye begins to fix the objects with Makula, because at the same time a large acuity of vision is achieved. However, constant vision in two eyes leads to the formation of braking cattle and rack the function of the yellow spots of the roofing eye (dysbokuulant amblyopia). The acuity of vision of the dilated Makula becomes below the visibility of another retinal area, which drops an image of an object in a jamb. Gradually, this area of \u200b\u200bthe retina assumes the role of the functional center of the roofing eye (becomes a "false macula"), which leads to an abnormal corresting of the retina (corresponding areas for the macula of the lead eye are the noncomaqular areas of the mob of a roofing eye). The binocular vision arising from this is defable.

The monolateral squint is much faster than alternating, leads to the formation of dysbokuulant amblyopia, as the macula of the same eye is always launched.

Clinical picture

Signs of friendly strabismus are as follows:

Preserving the total volume of movement of the eyeball;

Equality of angles of primary and secondary deviation;

Lack of doubles in violation of binocular vision. Accommodation squint due to various accommodation

two eyes or inconsistencies between accommodation and convergence. Accompanition arises, as a rule, at the age of 2-3 years. This is the most frequent variety of friendly strabismus. Accommodation is violated with inappropriate refraction: high hypermetropia leads to excessive, and myopia is to insufficient accommodation. Difficulties occur when fixing objects with two eyes, and the launching of the worse eyes occurs. The position of this eye depends only on the tone of its glasses, so it begins to mow toward the prevailing muscle. In children with hypermetropia, there is a tendency to convergence, so the eye deviates

ri (there is a converging squint). In myopia, the convergence is weakened, and the eye is deflected by the diver (formed diverging squint). With the optimal correction of the aetropy in the early stages, accommodation stabilizes disappears.

Neacocodal squint due to rails of glacial muscles due to intrauterine injury or child disease during the first year of life. Refraction anomalies with non-surgodational seproinations are usually expressed weakly, therefore, drug paralysis of accommodation and wearing points do not lead to its correction.

Partial accommodation squint associated both with disorders of accommodation, and with the passage of the eye muscles. It can develop after surgical treatment of inaccodative strabismus.

Treatment

Treatment of a friendly squint is aimed at restoring normal binocular vision. For this, the following activities are carried out:

Refix ne. proper position eye;

Elimination of amblyopia;

Restoration of normal fusion ability. Treatment should be timely (as early as possible),

complex, individual and phased. Achieve sustainable binocular vision is possible in 70% of patients with children.

Throughout the treatment, the rational correction of the aetropi is needed (prescribed glasses for constant wearing). In the early stages of accommodation straightening, this is sufficient to restore the normal position of the eyeball and creating conditions for the formation of binocular vision.

Stages of treatment

First stage- Treatment of amblyopia (Pleoptika).The main methods of pleoptics: direct and reverse occlusion, penalization, local light stimulation and the use of a consistent phenomenon.

Direct occlusion - shutdown better than a visionary eye from an act of view for 2-6 months. The method is quite effective, the acuity of vision of the amblyopic eye in the first 3-4 weeks after the start of occlusion is rapidly rising. Regular control is required

visual acuity, and in the case of a decrease in visual acuity of the closed eye, an alternate occlusion is used (they are turned off from the act of view, then another eye). Direct occlusion is prescribed during amablopia with proper fixation, when "false macula" has not yet been formed.

Reverse occlusion - shutdown from an act of view of an amabyl eye to 3-4 weeks. The method is used if the formation of "false macula" has already occurred in order to master it and activate the yellow stain.

Penalization is the creation of unprofitable conditions (the imposition of a "fine") for the leading eye by creating in it with the glasses of artificial aetropy. At the same time, the vision is better than the visionary eye worsen, and the accumulating eye becomes fixing. Braking scotoma in this case is liquidated. Penalization differs from occlusion in that no eye turns off completely from the act of view.

Local light stimulation of Makula serves to disjoint true macula with eccentric fixation.

The phenomenon of the sequential image occurs if the pump is shielded during the hilt of the entire retina. The image of the object used for shielding is saved in a macule for some time after stopping the backing of the retina. It also creates conditions for activating the yellow stain with eccentric fixation.

Second phase- Development of normal binocular vision (orthopic).Orthtics is possible only when all the conditions achieved that are necessary for the development of binocular vision (including with a corrected severity of vision of at least 0.3). Developed orthoptic exercises on synotic apparatus (synapotor), exercises with stereoscopic pictures, etc. Orthoptics are used for 6-12 months before the establishment of persistent binocular vision. With partly accommodative and non-vocational seducing, orthoptic treatment is used until the operation.

Third stage- Training Fusion Reflex (Diploppy).The Diplopica is aimed at the development of the ability to overcome the diplopy by recovering the visual fixation with Makulas of both eyes. Artificial diplopia is created by appointing prismatic glasses after reaching the right position of the eyes.

In case of insufficient effectiveness of pleopto-orthoptically diploptic treatment, which is usually carried out for 1.5-2 years, resort to surgical treatment. It is necessary to operate the child in preschool age, otherwise there will be mental trauma of personality. Operational treatment about the squint is to weaken the action of the strong muscle (the one in the direction of which is rejected by the eyes) and the increase in the action of weak muscle (the opposite). The weakening of muscle action is achieved by elongating or moving the place of attachment to the stop. The enhancement of muscle action is achieved by its shortening (resection) or moving the place of attachment of the kepened. After the operation, the Pleopto-orthopty-diploptical treatment, which is aimed at further increase in visual acuity and the formation of binocular vision.

Prevention

The prevention of the development of a friendly strabismus is the early detection of an aetropy. In children who have a high risk of developing an ametropi (severe course of pregnancy and childbirth in the mother, the presence of an ametropi among parents, etc.), to investigate the refraction during the first 3-4 months of life. The rest of the children have a refraction assessment for 6-12 months of life. It is very important to pay attention to the presence of a coordinated movement of eyeballs in a child (normal with 2-3 months of life movement becomes combined). In addition, the hygienic requirements necessary for the normal development of the organ of vision should be observed (it is impossible to hang toys at close range from the eyes, etc.).

Paralytic squint

Paralytic squint may occur at any age. Among the diseases of the organ of vision, paralytic squint is rarely found.

The reasons for the appearance of paralytic strabismus - the paresis and paralysis of the ice muscle muscles. The violation of the function of the weatherless muscles arises due to various lesions: central (toxic lesions, tumors, inflammation, ischemia, brain injuries) or peripheral (tumors, inflammation, orbit injuries with damage to innervating nerves or directly the muscles themselves).

Signs of paralytic squint are as follows:

Restriction or lack of movement of the eyeball in the direction of the affected muscle;

The angle of the secondary deviation is larger than the angle of primary deviation;

A pronounced painful diplopia (forced turn of the head towards the affected muscle reduces the bone).

Paralytic squint should be differentiated from a friendly strabismus (Table 18.1).

Table 18.1.Differential diagnostic signs of friendly

and paralytic strabismus

Sign	Type of squint
	Friendly	Paralytic
Age of the debut of the disease	Usually up to 3 years	Any
Movements of eyeballs	Saved in full	Restriction towards the affected muscle
Convergence	Saved	Broken
Symmetry lesion	Monolateral or alternating	Monoili bilateral
The ratio of primary and secondary corners of deviation	The angle of primary deviation is equal to the corner of the secondary deviation.	The angle of the secondary deviation is larger than the angle of primary deviation
Diplopia	Absent	Pronounced
Dizziness	Absent	Pronounced
Head position	Not changed	Changed

Treatmentparalytic squint consists primarily in the elimination of the underlying disease. Timing operational treatment Paralytic squint is determined individually. Post-traumatic paralytic squint is quickly eliminated after at least 6 months after injury. Prior to operation for restoring muscle function, physiotherapy treatment is used (thermal procedures, electrophoresis, electrostimulation), and prismatic glasses are prescribed to eliminate diplopia.

Deviation of the eyeball (deviation) from the total point

fixation is a sign of a squint.

Friendly squint, as a rule, occurs in children and is associated with a number of factors, among which non-corrected refraction anomalies, genetic factors, a one-sided violation of vision as a result of the corneal pathology, lens, eyeboard; high degree anisometropy.

Paralytic squint arises due to violation of eye mobility:

Under the damage to the motor nerves, innervating glasses (extraocular) muscles, their nuclei or inter-identical disorders;

With the pathology of the glasses of the muscles (myopathy, myasthenia, outdoor ophthalplegia);

For diseases of orbit (fractures, volumetric processes).

Primary deflection angle - Deviation angle when fixing with a healthy eye.

Secondary angle of deviation - angle of deviation when fixing the eye with a violation of the muscle function.

Clinical meaning.

The corner of the squint is determined by diagnosis different species squint.

Study algorithm.

Method.

1. Place the light source opposite the patient at the level of his eye

2. Ask patient to see the distance right in front of him

3. Rate the location of light reflexes on the cornea of \u200b\u200bboth patient's eyes.

Method.

1. Place the light source on the left and rear from the patient's head at the level of his eye.

2. Ask patient to look directly in front of yourself.

3. Install a mirror ophthalmoscope in front of the doctor's right eye.

4. Rate the location of light reflexes on the cornea of \u200b\u200bboth patient's eyes.

Criteria for evaluation.

1. The light reflex on the cornea is localized in the center of the pupil - the position of the eyeballs is correct, the angle of the squint is 0 (there is no squint).

2. When shifting the light reflex aside from the center of the pupil on one eye - there is a squint:

· When shifting the duck from the center of the pupil, there is a converging squint,

· When shifting Knuts from the center of the pupil - diverging squint.

3. When the light reflex is location:

· At the level of the edge of the pupil, the corner of the squint is 15 degrees,

· In the middle of the distance between the pupil and the Limb - 30 degrees,

· At the limb level - 45 degrees.

6. Inspection of the front segment of the eyeball using lateral lighting.

Clinical meaning.

Inspection of the front segment of the eyeball using lateral lighting, it is necessary to assess the condition of such structures of the eyeball, like a conjunctive, scler, cornea, anterior camera, iris.

Study algorithm.

2. Place the light source from the temporal side of the patient's eye under study.

3. To inspect the front cut structures when necessary, changing the direction of the patient's look.

Criteria for evaluation.

The condition of the front cutting structures of the eyeball must match the norm.

· Condition of conjunctiva (color, transparency, surface, shine, absence of discharge, films, foreign languages, neoplasms);

· Corneal condition (shape, transparency, gloss, surface, mirror);

· Schedule state (color, move and caliber of the front cylinder vessels);

· The state of the front chamber (depth, moisture transparency);

· The state of the iris (color, drawing);

· Pupil condition (localization, form, diameter, reaction to light and accommodation).

7. Inspection of optical media in the transmitted light

The transparent environment of the eyeball is explored by the passing light: a cornea, anterior chamber moisture, a crystal, a glassy body. However, most often passing lights are used to diagnose pathological changes in lens (congenital and acquired cataracts) and vitreous body (partial or total hemophthalm). This method is approximate.

A beam of light, passing transparent eye media, will reflect from the eye bottom. In this case, part of the rays, passing through the opening of the ophthalmoscope, enter the eye of the doctor and the pupil of the patient begins to glow in red, which is due to the reflection of the rays from vascular shell and retinal pigment layer (reflex from the eye bottom). If on the path of the light beam reflected from the patient's eye, turbidity will meet, they will detain a part of the rays and on a red background of the pupil will appear fixed or bias dark spots. Lounge in the lens is fixed, with the moves of the eyeball, they are shifted with it. The clouding of the vitreous body is not fixed, with the movements of the eyeball, they "float" against the background of the red reflex from the eye bottom.

Clinical meaning.

Inspection of the optical media of the eyeball in the passing light makes it possible to estimate the transparency of the refractive media of the eyes (cornea, lens and the vitreous body).

Study algorithm.

1. To put a patient opposite the doctor at a distance of 50 - 70 cm.

2. Install the lamp on the left and behind the patient.

3. Place an ophthalmoscope in front of the doctor's right eye, to direct the light on the pupil area of \u200b\u200bthe patient's eye under study.

Criteria for evaluation.

Normally pink reflex from the eye bottom is visible in the area of \u200b\u200bthe pupil. In the presence of clouds in the cornea, lens and vitreous body, a local or diffuse weakening of the reflex from the eye bottom is possible.

8. Inspection of the conjunctiva of the age (with the twists of the upper eyelid)