Alignment of the eye immediately after surgery. Strabismus after surgery surgery and strabismus vision correction Recovery period after strabismus surgery

Due to the fact that the eye does not work properly, over time it can lose its main function for good, because the brain excludes this eye from the process of vision, and after a while the visual skill disappears, after which it is almost impossible to restore it.

Most effective method treatment is surgery. This allows you to quickly and without consequences get rid of strabismus, operated patients often go home on the same day, and return to work or study on the third day after the operation.

However, the surgical treatment of strabismus provides for a subsequent long-term rehabilitation, during which it may be necessary to take strengthening drugs and perform daily exercises for the visual organs.

Etiology of the disease

Surgical treatment of strabismus Source: optimed.by

Strabismus is the absence of a parallel position of the eyeballs when looking at distant objects. With a parallel position of the eyes and coordinated movements of the eyeballs towards the objects under consideration, the images from the retina of each eye merge into visual center brain into a single volumetric image.

This type of vision is called binocular and is inherent in most people. If one of the eyes is in an “incorrect” position, when the axis of one eye is shifted to the temple or to the nose during distance vision, the images do not merge.

The brain perceives the "picture" of one eye, and the information from the second eye is "extinguished", this type of vision is called monocular. There is a gradual deterioration in the vision of the squinting eye - amblyopia (colloquially "lazy eye").

The cause of the disease is a violation of the synchronous work of the eye muscles and, as a result, the departure of one eye to the side. The occurrence of strabismus is affected by:

lack of glasses or contact lenses with a high degree of development of farsightedness, myopia or astigmatism
stress, trauma, diseases of the central nervous system
abnormal development of the eye muscles
sudden loss of vision in one eye
infectious diseases.

The two main types of strabismus are:

concomitant strabismus (characterized by the preservation of the full range of eye movements)
paralytic strabismus (limited movement of one or two eyes, in any direction)

Varieties of concomitant strabismus:

congenital (9-10% of patients) / acquired strabismus (90-91% of patients)
intermittent / permanent
unilateral / intermittent
divergent and convergent strabismus (with divergent strabismus, the eye is turned to the temple, with convergent - to the nose) / vertical strabismus (deviation down or up)

The earlier the correct diagnosis is made and the treatment of strabismus is started, the better the result will be, the probability of achieving evenly set eyes and maintaining high vision increases. Strabismus in children up to three or four months is considered physiological, tk. muscle balance has not yet been established.

If after this age the strabismus has not disappeared, then it is necessary to turn to pediatric ophthalmologist, which will check if there are any reasons for the development of strabismus (hyperopia, myopia, astigmatism).

Taking into account individual characteristics pediatric ophthalmologist selects a complex of hardware treatment aimed at eliminating amblyopia, increasing visual acuity, restoring the correct position of the eyes, binocular vision.

There are different treatments for strabismus. Treatment of childhood strabismus should begin immediately from the moment the disease is detected. Hardware treatment of strabismus includes two groups of methods:

Pleoptic treatment is a system of methods aimed at the treatment of amblyopia:
1. light-color stimulation (pattern stimulation) - based on the stimulation of eye functions with a light flux concentrated in a narrow spectral range
2. laser treatment (retinal laser stimulation)
3. magnetic stimulation (improvement of blood supply to the eyes)
4. electrical stimulation (improvement of hemodynamics, activation of metabolic processes, increase in the energy potential of tissues)
Orthoptic treatment:
1. liquid crystal glasses (alternate stimulation of both eyes, promotes the development of a motor-fixation reflex, increased visual acuity and the development of binocular function)
2. binarimeter is a new generation device that allows you to form binocular vision in vivo
3. computer methods for strengthening binocular function and improving visual acuity
4. weakened accommodative function training

In some cases, in addition to hardware treatment, surgical intervention can be performed to achieve the correct position of the eyes. If the angle of strabismus is large, then surgical treatment is carried out in two stages.

A favorable age for surgical treatment in children is 4-6 years (before entering school). Strabismus in adults is much more difficult to treat.

Treatment of concomitant strabismus begins with the appointment of the correct optical or laser correction. Glasses, contact lenses or surgery help improve visual acuity and, by restoring normal eye function, help reduce the angle of strabismus.

In some cases, with a decrease in the vision of the squinting eye, especially in children, a “shutdown” of the non-squinting healthy eye (direct occlusion - sticker) is prescribed so that the squinting eye is included in the act of vision.

Causes of the disease

According to the pathogenetic mechanism, concomitant and paralytic strabismus are distinguished. In concomitant strabismus, the angle of deviation of the affected eye from the point of fixation corresponds to the angle to which the healthy eye deviates if the patient is asked to “turn on” the squinting eye.

Characteristic features of vision with strabismus

The mobility of the eyes with such a pathology is preserved in full, doubling does not occur (the image from the squinting eye, as it were, is simply “discarded” by the brain at the processing stage). Most often occurs against the background of ametropia (refractive error), in particular in people with farsightedness.

Other reasons:

anisometropia (difference in the refractive power of the eyes) over 3 diopters);
a sharp decrease in the vision of one eye, including against the background of a decrease in the transparency of the natural “lenses” of the eye - the cornea, lens, vitreous body;
violation of the retina, diseases of the optic nerve;
neurological diseases;
congenital anomalies.

Paralytic strabismus is associated with dysfunction of any oculomotor muscle or nerve that innervates it. The main differences of this form of the disease:

limitation or absence of eye movement towards the affected muscle;
lack of binocular vision and diplopia (double vision);
the difference between the primary and secondary angle of strabismus - the squinting eye deviates from the fixation point less than the healthy one, when trying to give the correct position to the eye, which is moved by the affected muscle.

Causes of the disorder range from a birth defect to inflammation, neurological disease, injury, or poisoning. Sometimes, with paralytic strabismus debuts diabetes Therefore, the examination of patients with strabismus is always complex and exhaustive.

Hardware diagnostics of strabismus

Surgical treatment of strabismus is carried out in two ways, depending on the cause that provoked this deviation. If weakened muscles of the visual organs are detected, tenorrhaphy, anteposition, resection or the Faden procedure are indicated.

If axis deviations were provoked by overstrain of the muscles of the visual organs, a recession, plasty / removal of the oculomotor muscle, or partial myotomy is performed. Before the operation, the patient is prepared, which includes:

delivery of laboratory tests;
consultation of highly specialized specialists and other studies in the direction of the attending physician.

If the patient is shown surgery on two eyes, a phased intervention with a break of several months is recommended. To obtain successful results, experienced surgeons pre-calculate the size of muscle areas.

If a significant strabismus is detected, it is not recommended to carry out restorative correction on more than two muscles of the eye at the same time. The shortening or increase is carried out evenly on each side.

It is very important to maintain the natural connection of the eye with the correcting muscle, so as not to provoke unpleasant consequences that affect the level of visual activity. That is why operations of this kind are best carried out in clinics with good reviews, modern equipment and a staff of experienced specialists.

Why treat strabismus?

There is an opinion that strabismus can go away on its own - this is a serious misconception. If treatment is not started on time, serious complications may develop. If you notice the first signs of strabismus, you should immediately consult an ophthalmologist.

The danger of neglecting treatment

Refusal of treatment in childhood may lead to the inability to choose many professions in the future, for example: a surgeon, an artist, a professional driver and a number of other specialties associated with intense visual work.

If, nevertheless, strabismus was not corrected in childhood, then now it is possible to have an operation to correct strabismus at any age. It is necessary that the ophthalmologist surgeon conduct an examination, after which he will prescribe a surgical operation, based on the state of the oculomotor apparatus and the angle of deviation of the eye.

At present, it is customary to perform only such operations in which the muscles remain associated with the eyeball, since these operations can be dosed to a certain extent. The correct position of the eyes can be restored in the vast majority of cases.

In order to weaken the muscle, its recession (retraction), partial myotomy (incomplete dissection), tenomyoplasty (lengthening), etc., are performed, and for strengthening (shortening) - resection of the muscle-tendon part and prorraphy (moving forward).

There are two types of strabismus surgery: amplifying and attenuating. The principle of the weakening operation is to change the place of attachment of the muscle, which the ophthalmic surgeon transplants further from the cornea, after which the action of the strong muscle (the one towards which the eye is deviated) is weakened.

Treatment of this disease should not be postponed, because over time, the eye, deviated to the side, begins to see worse over time. With strabismus, in most cases, the ability to see normally retains only the eye that provides vision.

It is necessary to know that the purpose of strabismus correction surgery is to achieve an aesthetic effect, it is very difficult to restore binocular vision (when the brain combines two images obtained by the eyes into one) and it is necessary to approach such treatment comprehensively and thoroughly.

Sometimes both eyes are operated on at once, with some types of strabismus, only one eye is operated on. The essence of operations to correct strabismus is to strengthen or weaken one of the muscles that move eyeball. This operation is carried out on an outpatient basis, under local drip anesthesia. The patient returns home the same day.

Transaction statistics

Surgical intervention in the treatment of concomitant strabismus is used in cases where conservative methods fail to achieve a symmetrical position of the eyes. All children with non-accommodative strabismus and 35-40% with partially accommodative strabismus are subject to surgical treatment.

Most ophthalmologists consider the most favorable age for surgery to be 4-6 years (before entering school), when the effect of glasses on the angle of strabismus has already been clearly defined and it is already possible to carry out orthooptic exercises in the pre- and postoperative periods.

The exception is children with congenital and early onset strabismus with a large deviation angle of 45° or more. Correction of such a large deviation with a single operation is impossible, therefore, surgical treatment is carried out in two, and sometimes in three stages.

The first stage - reducing the angle of strabismus - should be carried out, if possible, earlier, in the first or second year of life, as soon as the general condition of the child allows the use of anesthesia and surgery.
The second stage - correction of strabismus - can be carried out at 4 - 5 years.

The entire period between the first and second surgery, the child should receive the treatment indicated in each specific case: optical and therapeutic correction, direct or alternate occlusion, penalization, training of the oculomotor muscles, and, if possible, hardware pleoptic and orthooptic treatment.

Surgery often takes place in 2-3 stages, if necessary, pleoptic treatment is performed, after restoring the correct position of the eyes - orthopto-diploptic.

One should not hurry with the operation in children with partially accommodative strabismus and a small angle of deviation - up to 10 degrees - and a clear tendency to decrease it.

In these cases, it is necessary to extend the active conservative treatment using all the indicated and available methods, and the decision on surgical treatment postpone to a later date. In some of these children, the treatment of strabismus was successfully completed without surgical intervention.

The issue of the need for surgical treatment of children with convergent strabismus remains debatable in cases where glasses have a symmetrical position of the eyes and binocular vision, and without glasses there is a deviation to the nose and binocular vision is impaired.

Many ophthalmologists believe that in such cases it is necessary to operatively weaken the internal rectus muscles (their recession) and achieve the correct position of the eyes without glasses.

The experience of monitoring such children after operations does not confirm the correctness of this position, since some children with similar data had the appearance of secondary divergent strabismus. After analyzing the cases of this unpleasant complication, we identified the causes of its occurrence.

The binocular vision that was available before the operation was destroyed during surgery on the oculomotor muscles, and after the operation no vigorous measures were taken to restore it, to develop strong fusional reserves that could prevent secondary deviation of the eyeball.
In some children, the change in the configuration of the orbits, due to the growth of the bones of the facial skull, was important, which, in the case of instability or the absence of binocular vision, led to the appearance of divergent strabismus.
In some children, the optical positive spherical correction was not weakened in a timely manner, which could prevent the appearance of outward deviation.

We believe that if a child has established a symmetrical eye position and developed binocular vision with glasses, then there are chances to achieve this without glasses. This takes time and persistent treatment.

In such cases, we train the oculomotor muscles on a muscle trainer, strengthen the external rectus muscles with electrical stimulation, develop and train negative fusional reserves, perform exercises to disengage between accommodation and convergence, and strengthen binocular vision with orthopto-diploptic exercises.

And we are succeeding! The symmetrical position of the eyes and binocular vision are gradually established even without glasses. If the patient for some reason cannot receive such treatment, then all the more he cannot be operated on.

The risk of the operation

By destroying his binocular vision by the operation and not being able to restore it, we increase the risk of developing secondary divergent strabismus. Patients with asymmetric binocular vision should not be operated on.

If there is a deviation in the study on the color test and with the help of striped Bagolini glasses, they have binocular vision, and on the synoptophore in the zero position of the optical heads, the fusion of objects is determined.

After surgical restoration of the symmetrical position of the eyes, these patients develop persistent diplopia, which disappears only after the eyes return to their previous oblique position (recurrence of strabismus).

Children with such an anomaly are subject to long-term vigorous treatment to destroy and weaken the abnormal functional connections formed in the higher parts of the visual analyzer, and only after the treatment can be operated on.

Indications for surgery

In the therapeutic treatment of strabismus, different methods are used:

pleoptic course aimed at increasing the visual load on the problem eye;
orthopedic - provides for the restoration of the binocular function of each eye;
diplopic method - a set of therapeutic measures aimed at obtaining a comprehensive result, provided for by the pleoptic and orthopedic course;
active training of the oculomotor muscles.

After therapeutic treatment the patient is again examined by a specialist. If conservative methods did not allow to restore the symmetry of the eyes, the patient is recommended surgical treatment of strabismus. The best age for operating on small patients is 4-6 years.

During the rehabilitation recovery period, the operated person will have to perform certain exercises for the eyes.

The purpose of the operation is to eliminate the asymmetric arrangement of the visual organs. After surgery, positive visual changes are observed. If the patient also has vision problems, additional intervention will be required, since conventional surgery to correct strabismus does not improve vision.

Surgical treatment of strabismus gives effective results if the patient has a non-accommodative form of pathology or partially accommodative, within 35-40%.

If the deviation angle is 45% or more, one operation will not be enough to eliminate a visible defect. Typically, in such cases surgical procedure carried out in 2-3 stages, depending on the severity.

Types of surgery

Due to the fact that the surgical treatment of strabismus is a very important step in getting rid of this disease, it requires a responsible approach and careful preoperative preparation. It includes psychological preparation, a full examination and correction of detected deviations.

Of great importance is ophthalmic preparation, which will allow you to develop binocular vision instead of performing occlusion. Sometimes it may be necessary to weaken the nerve connections and train the oculomotor muscles.

In addition, a number of procedures may be required that will improve the results of treatment during the postoperative period. There are two types of operations:

Relaxing.
Reinforcing.

With weakening, there is a change in the place where the muscles are attached. It simply moves inward from the cornea. This results in a weakening of the muscle that caused the eye to deviate.

Correction of strabismus

With a reinforcing type of intervention, the muscle is shortened by removing one of its segments. In this case, the place of attachment of the muscle remains unchanged. After these manipulations, the eye muscles are balanced by strengthening the weak or weakening the strong muscle.

What type of operation should be performed is determined by the surgeon directly at the surgical table. This is due to the fact that this choice is influenced by many factors, for example, the following:

Patient's age;
The location of the oculomotor muscles;
Strabismus angle;
The state of the oculomotor apparatus.

Usually several muscles are operated on at once. If a patient has alternating strabismus (an alternating deviation of the eyes from the central axis occurs), then surgical intervention is performed simultaneously on the muscles of both eyes. There are cases when a combined intervention is provided (strengthening of one muscle and simultaneous weakening of the other).

Surgery takes place under local anesthesia, and the final recovery takes about seven days. Doctors strongly recommend that you also undergo a course of hardware treatment.

Hardware surgery

Source: moscoweyes.ru

The second type of operations is aimed at strengthening the action of a weakened oculomotor muscle. An example of operations of the second type is resection, tenorrhaphy (shortening of the muscle by forming a fold in the area of the muscle tendon), anteposition.

Often, a combination of the above types of surgery (recession + resection) is used during surgery to correct strabismus.

If there is residual strabismus after surgery that does not self-correct, a second operation may be required, which is usually performed after 6 to 8 months.

In order to achieve maximum efficiency during the operation to correct strabismus, it is necessary to adhere to several basic principles.

Excessive forcing of the process of surgical correction of strabismus often leads to unsatisfactory results. Therefore, all manipulations should be done in doses (if necessary, in several stages).
If it is necessary to weaken or strengthen individual muscles, dosed surgical intervention should be distributed evenly.
During the operation on a certain muscle, it is necessary to maintain its connection with the eyeball.

High-tech strabismus surgery: the specialists of children's eye clinics have developed a modern high-tech radio wave surgery with the principles of mathematical modeling. Advantages of high-tech eye surgery:

Operations are less traumatic, thanks to the use of radio waves, eye structures are preserved.
There are no terrible edema after the operations, the patient is discharged from the hospital the next day.
Operations are accurate.
Thanks to the principles of mathematical calculation, we can ensure the highest accuracy and show guaranteed result operation before it is carried out.
The rehabilitation period is reduced by 5-6 times.

The result of the operation: highly effective technologies of strabismus surgery allow to provide a symmetrical gaze position with various types strabismus, including those with small and unstable angles, to restore the mobility of the eyeball in paralytic strabismus in 98% of cases. This is a unique way to effectively help the patient.

Surgical treatment of strabismus in children

Conservative treatment strabismus involves a long and active implementation of a set of pleopto-orthoptic exercises. In cases where this does not eliminate strabismus, proceed to surgical treatment.

The duration of the operational process

Strabismus surgery in adult patients can be performed at any time, depending on the wishes of the patient. Before venturing into surgery for strabismus, you need to understand that this surgical intervention will help get rid of the external manifestations of strabismus.

The return of lost vision is not possible in all cases. The choice of surgical intervention is largely influenced by the angle of deviation of the eye and the general condition of the oculomotor apparatus.

At present, it is customary to perform only those operations in which the muscles do not separate from the eyeballs, because these operations can be dosed to a certain extent. To weaken the muscle, they use its recession (retraction), partial myotomy (incomplete dissection), tenomyoplasty (lengthening), etc.

For strengthening, resection (removal) of the tendon-muscle part and prorraphy (moving forward) are carried out. The physiological position of the eyes during these operations can be restored in most cases (up to 90%). After the operation, a slight deviation (deviation) may remain.

In the future, this deviation can be eliminated with conservative orthopto-diploptic treatment. Reoperations are rarely needed. Surgical treatment of strabismus in children and adults can be carried out in two ways: they perform reinforcing and weakening interventions.

With weakening surgical interventions, the place of attachment of the oculomotor muscle is changed. It is transplanted further from the cornea. Thus, a weakening of the tension of a strong muscle is achieved (in the direction where the eye is deviated).

Reinforcing surgery consists in shortening the muscle by removing (resection) a certain part of it. The place of attachment to the eyeball does not change. Thus, the action of the weakened opposite muscle is enhanced.

Such surgical intervention makes it possible to restore even muscle balance by strengthening or weakening one of the oculomotor muscles. The surgeon prefers one or another type of surgical intervention directly on the operating table.

This is due to many features that need to be taken into account: the angle of strabismus, the location of the muscles in a particular patient, the state of his oculomotor apparatus, age and other individual characteristics. Often, several muscles of the oculomotor apparatus are operated on.

Simultaneous operations, which are performed on the muscles of the same name in both eyes, are preferred for alternating strabismus. If there are indications, combined ophthalmic operations are also performed. During which, the oculomotor muscle of one eye is simultaneously weakened and the muscle of the other eye is strengthened (resected).

It is important that a good cosmetic effect is achieved as a result of surgical treatment. After all, most patients, both children, adolescents and adults, are constantly in a state of stress because of their appearance. The operation fixes this problem.

Surgical treatment for the correction of strabismus is carried out under local (drip) anesthesia. The final recovery after such surgery takes about one week, but ophthalmologists strongly recommend that you undergo an additional course of hardware treatment.

Experts have proven that a person with normal vision sees a slightly different image with the right and left eyes. You can check this by closing first one, and then the second eye. Normal vision is binocular.

And in order for the operated patient to see one image, and not two, only the operation is not enough. This is due to the fact that the brain is not yet accustomed to such work. It is in order to restore physiological binocular vision that constant exercises are required for a long time.

The essence of surgical treatment

Strabismus is the result of an imbalance between the 6 extraocular muscles. During strabismus surgery, these muscles are weakened or strengthened in such a way as to restore the lost balance and thus return the eyes to the correct position.

Muscle relaxation is performed by moving the end of the muscle closer to the equator of the eye, so that its tone decreases. Strengthening of the muscle is performed by removing part of the muscle and suturing the remainder to the place of fixation, which leads to shortening of the muscle and an increase in its tone.

Adjustable suture surgery is modern method correction of strabismus, which significantly increases the success of the operation. The essence of the method lies in the imposition of muscle sutures so that it remains possible to adjust them when the patient regains consciousness after the operation.

If after awakening the correction is insufficient, the knot of the muscle suture is opened and the threads are tightened until the desired effect is achieved. It is important to note that the current technique of general anesthesia is safe and low risk, and the risk of serious complications is about the same as that of a traffic accident on the way to the hospital.

Using this method gives an additional 10% success rate. Surgery to correct strabismus in children is performed only under general anesthesia, while in adults the choice of anesthesia depends on the patient and the doctor's preferences.

Most patients return to school or work within three days after surgery. You need to follow the instructions of the doctor and bury the prescribed eye drops within two weeks after the operation. After about three weeks after the operation, its signs are leveled.

Modern technology operational correction strabismus is very effective, although it does not reach one hundred percent. In 10-15% of surgeries, there remains a slight residual strabismus, which, according to the majority of operating strabologs, does not interfere with normal life and performance of duties.

If the residual strabismus is of a high degree, it is possible to perform a second correction operation, since the operation is performed on the extraocular muscles and practically does not pose a threat to vision. In very rare cases an infection of the surgical field appears, which, fortunately, is effectively treated with drops of antibiotics.

Sometimes in the early postoperative period, double vision appears, which disappears within a few days. In very rare cases, diplopia does not go away and then there is a need for additional types of correction.

Conditions for the operation

Since the recovery after strabismus surgery is quite quick and easy, many patients from abroad combine a pleasant trip with medical tourism and undergo surgery in the Holy Land. You must arrive two to three days before the operation for a check-up.

After a couple of weeks after the operation, you can return home. It is important to bring all medical certificates and documents from previous checks with you to the checks. The correct position of the eyes can be restored in the vast majority of cases (up to 90%). Reoperations are rarely required.

Surgical treatment of strabismus consists either in weakening the action of a strong muscle (the one towards which the eye is deviated), or, conversely, in strengthening the action of a weak, i.e., opposite muscle. The volume and nature of the intervention is chosen depending on the state of the oculomotor apparatus, the angle of strabismus and the age of the patient.

In many cases, it is necessary to resort to combined operations, both on strong and weak muscles, interventions on both eyes, and surgical treatment of strabismus in several stages.
Strabismus surgery can be performed under general or local anesthesia.

After the operation, without fail, conservative therapy is carried out, which is aimed at complete rehabilitation. visual functions, and hardware treatment aimed at restoring and strengthening binocular vision, otherwise strabismus may recur.

Rehabilitation

Surgical treatment of strabismus allows you to correct a cosmetic defect, which is a strong traumatic factor for patients of any age. A one-stage operation to correct strabismus in adults can be performed on an outpatient basis; in the treatment of children, hospitalization is required in most cases.

However, to restore visual functions (i.e., binocular vision) after surgery, an integrated approach is required, which includes pleoptic therapy (it is aimed at treating amblyopia associated with strabismus) and orthoptodiploptic therapy (restoration of deep vision and binocular functions).

The approximate recovery time after the operation is 1 week, but to recreate a full-fledged binocular vision, i.e. the ability to see a three-dimensional picture with two eyes at the same time, this is not enough.

During the time that a person had strabismus, the brain, figuratively speaking, “forgot how” to combine images from both eyes into a single image, and it will take quite a long time and considerable effort to “teach” the brain this again.

Hypercorrection may occur immediately after surgery, or may develop after some time. For example, if the operation was performed in childhood, then in adolescence as the eye grows, the child may squint again.

This complication is not irreparable and is easily corrected with the help of surgical intervention. This surgical intervention is performed in most ophthalmological centers in Moscow and Russia (both commercial and public).

When choosing a clinic for an operation to correct strabismus, it is important to study the possibilities of the clinic, the conditions of stay, the equipment of the clinic with modern equipment, and others. important points. It is equally important to choose the right doctor to perform the operation. after all, the prognosis of the cure will fully depend on his professionalism.

If you or your relatives have already undergone surgery to correct strabismus, we will be grateful if you leave feedback about the intervention and the clinic where the procedure was performed, as well as the results obtained.

Operation results

When deciding on an operation for strabismus, you need to know that such a surgical intervention allows you to get rid of the external manifestations of strabismus, but does not always return the ability to see well.

Operations for strabismus are of two types: amplifying and weakening. During the loosening operation, the place of attachment of the muscle is changed, it is transplanted further from the cornea. That is, there is a weakening of the action of a strong muscle (the one towards which the eye is deviated).

During augmentation surgery, the muscle is shortened by removing part of it, the place of attachment of the muscle to the eyeball remains the same. That is, the action of a weak, opposite muscle is enhanced.

As a result, such surgical intervention allows you to restore the correct muscle balance, strengthen or weaken one of the muscles that move the eyeball.

The type of operation is determined by the surgeon directly on the operating table, since with such a surgical intervention it is necessary to take into account many features: the angle of strabismus, the location of the muscles in a particular person, the condition of the oculomotor apparatus, the age of the patient, and others.

As a rule, several muscles are operated on. Sometimes both eyes are operated on at once, with some types of strabismus, only one eye is operated on. There are cases when an ophthalmic surgeon performs a combined operation on both eyes on both strong and weak muscles. This operation is performed in several stages.

It is important that the result of surgical intervention is, first of all, a good cosmetic effect. Most people, both adults and children, teenagers constantly experience psychological trauma because of their appearance. The operation solves this problem.

Surgical treatment to correct strabismus is performed in the "one day" mode, under local drip anesthesia. On the same day, the patient returns home. The final recovery takes about a week, however, after such a surgical operation, doctors strongly recommend a course of hardware treatment.

Experts quite often mention that in a person with normal vision, each eye receives slightly different images (this can be seen by closing first one eye and then the other). Normal vision should be binocular.

Binocular vision is vision with two eyes with a combination in the visual analyzer (cerebral cortex) of the images received by each eye into a single image. In order for a person to see one picture, and not two, the operation is not enough. The brain is not used to such work.

One of the main results of surgical intervention is an excellent cosmetic effect. After all, strabismus greatly complicates people's lives, especially for children and adolescents who feel some discomfort, and sometimes are ridiculed by their peers.

After the operation, these problems become irrelevant. The difficulty lies in the fact that with normal vision, each of the eyes receives a slightly different picture, which the brain processes and combines into one.

In a person with strabismus after surgical treatment, the brain is not able to immediately acquire the ability to combine these pictures. Therefore, for the normal functioning of binocular vision, it is necessary to perform exercises for a long time to restore this function.

Strabismus can be congenital in nature, and also occur as a result of various factors. And although some consider strabismus only an aesthetic problem, in fact, this pathology can provoke the formation of many unpleasant consequences. It is very important for the patient not only to diagnose the disease in a timely manner, but also to start solving this problem as early as possible. Strabismus surgery is a radical and effective method.

Strabismus and its consequences

Strabismus is diagnosed in the presence of existing deviations in the parallelism of the visual axis of the eyes. More often, the patient mows only one eye. In some cases, the deviation is symmetrical. There are several types of strabismus and there are also several ways to solve the problem: wearing special glasses, turning off one eye organ, surgery.

Important: Most specialists are inclined to ensure that surgical intervention is performed in extreme cases. To begin with, it is recommended to try conservative methods for correcting strabismus.

What threatens strabismus? Complete loss of vision of the eye organ, which has deviations. In this case, the brain stops receiving three-dimensional images, and the images do not correspond to each other. Nervous system gradually blocks the data received from the defective eye organ. His muscle tone begins to be lost. The functioning of the eye deteriorates over time, and amblyopia develops in 50% of cases.

Reasons for the formation of strabismus

Strabismus can be acquired or congenital. The formation of each of them has its own causes of occurrence. For example.

Acquired strabismus

Most often, this type of strabismus develops in children before they reach six months. A significant role in this case is played by the existing diseases that provoked such a side effect. But episodes of the development of strabismus are also frequent in the older secular category. The most common causes of acquired strabismus are:

strabismus as a result of sharply impaired vision with astigmatism, farsightedness, and myopia;
refractive errors in the eye can be provoked by developing cataracts or glaucoma, and as a result, strabismus is formed;
paralysis of the eye muscles can cause psychological disorders, as well as somatic diseases (for example: neurosyphilis, encephalitis);
a mild degree of strabismus can be provoked by circulatory disorders and sudden pressure surges, and if the pathology is ignored, disability;
Experts also consider such childhood diseases as scarlet fever and measles to be provoking factors in the development of strabismus.

Important: In the case when the child had a predisposition to strabismus, the pathology can manifest itself as a complication after suffering diphtheria or influenza.

Strabismus can develop in children up to school age after a strong fright, and also as a result of a psychological trauma. These reasons for the development of pathology were also recorded in older patients. Although in rarer cases.

congenital type of strabismus

In practice, congenital strabismus is very rare. It is even rarer to find it in pure form i.e. immediately after the baby is born. The manifestation of pathology in the first six months of a baby's life is established as infantile. More often in a newborn, imaginary strabismus is observed. Toddlers of this age are unable to accurately focus their eyes, and at the same time it seems that the child is developing a pathology.

Interesting: Imaginary strabismus can also be observed in adults when a person is in a state of extreme intoxication.

Infantile strabismus is often formed with genetic disorders and during the period when the fetus is still in the womb. This can be caused by such diseases: cerebral palsy, Crouzon or Down syndrome, as well as hereditary predisposition. In cases with heredity, one of the baby's relatives also has similar deviations.

At risk are babies whose mothers suffered infectious diseases during pregnancy, used drugs, and medications without the appointment of specialists.

Is strabismus surgery the only solution to the problem?

Strabismus surgery refers to radical methods problem solving. Immediately after the diagnosis, the specialist will offer conservative methods of treatment, which are more gentle methods. It can be special glasses. Their task is to force both eye organs to focus on one point. Over time, the muscles of the damaged eye are developed. The pathology is gradually corrected.

If the patient mows one organ, the procedure of "turning off the eye organ" may be offered. For these purposes, a special bandage is placed on a healthy eye. Thus, the brain begins to receive an image only from a diseased organ. Muscles gradually develop and the pathology is corrected.

Surgery is recommended in more advanced cases. It cannot guarantee the complete restoration of lost vision, but it allows to achieve a more symmetrical relationship between the eye organs. More often, young people agree to the operation, for whom it is very important to have no external defects.

Indications for the operation

The patient used all conservative methods of treatment, but no improvements were achieved (or they were not achieved to the maximum extent).
The patient wants to eliminate cosmetic defects in as soon as possible. Conservative treatment can last several months or even years.
The patient is severely handicapped. The doctor considered it more expedient to first restore vision with the help of surgical intervention, and only then apply conservative methods to fix or improve the previously obtained result.

Important: The operation may be contraindicated only in cases where the patient has individual characteristics that are previously discussed with his specialist.

There are also some age restrictions. For example, the optimal age for surgery is considered to be 4-5 years old for a child. Younger patients may be denied. An exception is the congenital form of strabismus, which is corrected in 2-3 years. It is explained simply. After the operation, the patient must adhere to a special regimen and perform special exercises. Children under 4 years old will not be able to do this consciously and independently. The chances that the pathology will return are significantly increased.

Principles and types of surgical intervention to eliminate strabismus

Surgical intervention to correct strabismus is carried out by several types of operations. Sometimes a specialist selects one optimal option for a given situation, but more often during the operation several types are combined with each other. More about each type.

Muscle recession involves the cutting off of tissues from the place of its physiological attachment. After clipping, the muscle is sutured. The specialist selects the optimal place for its future fastening. It can be a tendon, as well as a sclera. As a result, the fiber shifts back and its action weakens. If the fiber is displaced forward, the action of the muscles, on the contrary, is enhanced.
The operation of myectomy involves similar manipulations with cutting off the muscle. The difference from the previous type is the absence of a suturing procedure.
Less trauma to the eye organ can be achieved with the Faden operation. In this case, manipulations with cutting off the muscle are not performed. The fabric is immediately sutured to the sclera. This procedure uses non-absorbable sutures.
If the muscle is weakened and its action needs to be strengthened, a shortening operation is used. During surgery, part of the muscle is removed.
A different type of operation will help to get a similar effect. It involves creating a fold between the tendon and the muscle. It is possible that this fold is formed inside the body of the muscle itself.

Any of the selected operations to correct strabismus is carried out in compliance with the main principles. Correction must be gradual. The operation is performed on only one eye organ. On the second, the procedure is repeated after a few months (approximately 3-6). Although with a small mowing angle, the surgeon may decide to correct both eyes simultaneously, but this is often the exception.

Features of the operation

If the patient has severe strabismus, surgery is performed in several stages. The fact is that it is undesirable to carry out the operation on more than two muscles at a time.

Lengthening or shortening of the muscle must be carried out evenly from all sides. For example, if the muscle on the right is reduced in size, then on the left it must necessarily increase. In this case, the dimensions of excision and increase are necessarily identical.

Observing all the main principles of surgical intervention, the specialist tries to preserve the connection between the eyeball and the operated muscle as much as possible.

For adult patients, the correction is performed under local anesthesia. At the end of the procedure, a bandage is applied to the patient. You can go home after a few hours. For children (of any age), general anesthesia is always used. Without fail, the child is hospitalized for a day, but cases with a longer stay in the hospital are not excluded.

Those who have the opportunity to correct the pathology in foreign clinics should pay attention to German and Israeli specialists. Their approach to such a correction is more radical. Almost all types of pathologies are corrected in one go. Another plus is the possibility of carrying out the operation for babies up to a year old.

Recovery period

Although the operation to correct strabismus is performed on the same day and the patient is immediately released home, this does not mean that there is no rehabilitation period. For quick recovery it will take some time to adhere to certain recommendations of the doctor and perform special exercises for the eyes.

The first day after the operation, the eye organ will hurt, slightly redden and inflamed. This is the natural state. Also possible short-term visual impairment. During this period, each of your movements must be controlled, since any attempts to touch the eye can only result in an increasing pain syndrome.

Important: Restoration of the tissues of the eye organ and binocular vision occurs after a month. Most patients see a double picture all the time. If after this period the vision is not restored, you need to contact an ophthalmologist.

In children, the adaptation period is significantly reduced. The main thing is to perform the exercises prescribed by a specialist and visit an ophthalmologist.

For active recovery, a specialist may recommend using special corrective glasses, as well as from time to time to cover a healthy eye. This will help create a load on the operated organ. Muscles will develop faster and gain the desired rate.

What complications should be expected after surgery

The most common complication that occurs in medical practice after strabismus surgery is hypercorrection. It is formed with excessive lengthening or sewing in of the muscles of the eye organ. The main reasons for this undesirable effect:

surgeon's mistake;
wrong preliminary calculations;
the natural growth of the patient, which affects the increase in the size of the eye organ.

Recently, experts have found best way minimize the risk of such complications. Increasingly, operations are performed with not cutting, but sewing in muscle folds. At the same time, the superimposed suture is regulated and the undesirable effect can be corrected in a minimally invasive way.

The formation of a rough scar at the site of muscle cut-off and its subsequent sewing. This method of surgical intervention deprives muscle tissue of mobility and elasticity, which are partially replaced by fibrous tissue. The only alternative to this moment is a reduction in the size of the excised area.

Strabismus returns (recurs) after a while. This complication most often occurs through the fault of the patient himself, who neglects to comply with all the rules in the postoperative period. In children, a relapse can occur due to a sharp increase in the load on the eye organ. For example, surgery to correct strabismus was performed at the age of five or six years, and after a couple of months the child began to attend school.

The most serious, but very rare complication is damage during the operation of the vagus nerve, which is responsible for the functioning of the lungs, organs of the gastrointestinal tract and heart muscles.

Patient reviews

Basically, a lot of negative feedback can be heard from parents who decided to have their child operated on in domestic clinics. They justify their dissatisfaction with the following comments.

In most clinics, there is no individual approach to each patient and the existing problem.
The refusal of specialists to carry out surgery at an early age, and the delay for a small patient turns into a progression of the disease and deterioration of vision.
Basically, all clinics use outdated methods and equipment during surgery and diagnostics. This does not make it possible to get a 100% result from the first operation. Correction of strabismus is performed with insufficient results and after a while it is necessary to carry out repeated surgical interventions.
There are few specialists in this profile, which greatly limits patients' choice.

Most parents note only a temporary positive result. As soon as it starts academic year and the child goes to school, the vision begins to fall again, and the strabismus returns. This is explained by the increased load on the eyes. Many children refuse to wear special corrective glasses at school. So that classmates do not laugh, they secretly take them off and hide them from adults. Less time is devoted to special exercises. All these negative factors lead to the fact that young people decide on a second operation only after finishing school.

Important: The older the patient, the less successful the strabismus surgery is.

How much does a strabismus surgery cost?

The cost of strabismus surgery varies from clinic to clinic. For example, if this is a state institution and the child is a minor, the operation can be performed free of charge. Treatment will also be free for adults, but only for those who have a compulsory medical insurance policy. It is worth noting that some private clinics also work with compulsory health insurance. The operation itself will be free, but additional services may be required that will need to be paid.

In the case of other private clinics, here the price can vary within 20,000 thousand rubles. The price fluctuates depending on the availability of modern equipment in the institution, the professionalism of the doctor, the complexity of the operation itself, etc.

Patients who are thinking of going to a German or Israeli clinic will have to count on an amount of about 7 thousand euros. But there is also one caveat. Contacting a foreign clinic through an intermediary will increase in price (about 2 times).

The ultimate goal in strabismus surgery is to restore a symmetrical (or as close to symmetrical) eye position as possible. Such operations, depending on the situation, can be performed both in adulthood and in children.

Types of operations to correct strabismus

In general, surgeries for strabismus are of two types. The first type of surgery is aimed at loosening an overly strained oculomotor muscle. An example of such operations is recession (crossing the muscle at the place of its attachment and moving it in such a way as to weaken its action), partial myotomy (partial excision of part of the muscle fibers), muscle plastic (for the purpose of lengthening). The second type of operations is aimed at strengthening the action of a weakened oculomotor muscle. An example of operations of the second type is resection (excision of a section of a weakened muscle near the site of attachment, followed by fixation of the shortened muscle), tenorrhaphy (shortening of the muscle by forming a fold in the area of the muscle tendon), anteposition (moving the place of fixation of the muscle in order to enhance its action).

Often, a combination of the above types of surgery (recession + resection) is used during surgery to correct strabismus. If there is residual strabismus after surgery that does not self-correct, a second operation may be required, which is usually performed after 6 to 8 months.

In order to achieve maximum efficiency during the operation to correct strabismus, it is necessary to adhere to several basic principles.

1. Excessive forcing of the process of surgical correction of strabismus often leads to unsatisfactory results. Therefore, all manipulations should be done in doses (if necessary, in several stages).

2. If it is necessary to weaken or strengthen individual muscles, dosed surgical intervention should be distributed evenly.

3. During the operation on a certain muscle, it is necessary to maintain its connection with the eyeball.

High-tech strabismus surgery:

Specialists of children's eye clinics have developed modern high-tech radio wave surgery with the principles of mathematical modeling.

Advantages of high-tech eye surgery:

Operations are less traumatic, thanks to the use of radio waves, eye structures are preserved.
There are no terrible edema after the operations, the patient is discharged from the hospital the next day.
Operations are accurate.
Thanks to the principles of mathematical calculation, we can ensure the highest accuracy and show a guaranteed result of the operation even before it is carried out.
The rehabilitation period is reduced by 5-6 times.

The result of the operation: highly effective technologies of strabismus surgery make it possible to provide a symmetrical gaze position in various types of strabismus, including those with small and unstable angles, to restore the mobility of the eyeball in paralytic strabismus in 98% of cases. This is a unique way to effectively help the patient.

Results of surgery for strabismus

Surgical treatment of strabismus allows you to correct a cosmetic defect, which is a strong traumatic factor for patients of any age. However, to restore visual functions (i.e., binocular vision) after surgery, an integrated approach is required, which includes pleoptic therapy (it is aimed at treating amblyopia associated with strabismus) and orthoptodiploptic therapy (restoration of deep vision and binocular functions).

A one-stage operation to correct strabismus in adults can be performed on an outpatient basis; in the treatment of children, hospitalization is required in most cases. The approximate recovery time after the operation is 1 week, but to recreate a full-fledged binocular vision, i.e. the ability to see a three-dimensional picture with two eyes at the same time, this is not enough. During the time that a person had strabismus, the brain, figuratively speaking, “forgot how” to combine images from both eyes into a single image, and it will take quite a long time and considerable effort to “teach” the brain this again.

It should be mentioned that, like any operation, the surgical correction of strabismus may be accompanied by the development of certain complications. One of the most common complications of surgery for strabismus is overcorrection (the so-called hypercorrection), due to an error in the calculations. Hypercorrection may occur immediately after surgery, or may develop after some time. For example, if the operation was performed in childhood, then in adolescence, when the eye grows, the child may again develop strabismus. This complication is not irreparable and is easily corrected with the help of surgical intervention.

This surgical intervention is performed in most ophthalmological centers in Moscow and Russia (both commercial and public). When choosing a clinic for an operation to correct strabismus, it is important to study the possibilities of the clinic, the conditions of stay, the equipment of the clinic with modern equipment and other important points. It is equally important to choose the right doctor to perform the operation. after all, the prognosis of the cure will fully depend on his professionalism.

The goal of extraocular muscle surgery for strabismus is to achieve correct eye position and, if possible, restore binocular vision. However, the first step in the treatment of childhood strabismus is the correction of any significant refractive errors and/or amblyopia. Once the maximum possible visual function has been achieved in both eyes, any residual deviation must be corrected surgically.

muscle weakening surgery

This is the weakening of the muscle by moving the place of its attachment posteriorly towards the beginning of the muscle. Recession can be performed on any muscle except the superior oblique.

a) the exposure of the muscle belly is achieved through the lower temporal arcuate incision;

b) one or two absorbable sutures are placed on the muscle near the place of its attachment;

Back fixation seams

The principle of this intervention (operation Faden) is to reduce the strength of the muscles in the direction of their action without changing the place of attachment. The Faden operation can be used for ADHD and also for weakening the horizontal rectus muscles. When correcting the VIA, the recession of the superior rectus muscle is usually performed first. The belly of the muscle is then sutured to the sclera with a non-absorbable suture 12 mm posterior to its insertion.

a) after exposure of the muscle, two absorbable sutures are passed through the muscle at the marked points posterior to the place of its attachment;

b) a part of the muscle anterior to the sutures is excised, and the stump is sutured to the original attachment site

3. Education muscle or tendon folds are usually used to enhance the action of the superior oblique muscle in congenital IV cranial nerve palsy.

2. Move(suturing the muscle closer to the limbus) may provide increased action after a previous recession of the rectus muscle.

a) recession of the internal rectus muscle;

b) the lateral halves of the upper and lower rectus muscles are cut off and sutured to the upper and lower edges of the paretic lateral rectus muscles

2 Operation Jensen improves abduction and is combined with recession or CI toxin injection. bolulinum into the external rectus muscle.

Paralysis of the superior oblique muscle

1. congenital hypertropia with a large angle in the primary position. In this case, the fold of the superior oblique muscle is performed.

2. Acquired

a) small hypertropia is corrected by ipsilateral weakening of the inferior oblique muscle;

b) acquired medium to high angle hypertropia is corrected by ipsilateral inferior oblique weakness combined with ipsilateral superior rectus and/or contralateral superior rectus weakness. It must be taken into account that weakening of the inferior oblique and superior rectus muscles of the same eye can lead to hyperelevation;

2. The two ends of the thread are passed close to each other together through the stump at the attachment site.

3. The second suture is tied and tightly tightened around the muscular suture in front to secure it from the stump.

5. The conjunctiva remains open.

3. If a large recession is required, the knot is pulled anteriorly along the muscle suture, providing additional relaxation of the recessed muscle, and pushed back.

4. If less recession is required, the muscle suture is pulled anteriorly and the knot is pulled in the opposite direction of the muscle stump.

5. The conjunctiva is sutured.

A similar technique is used for resection of the rectus muscle.

Chemodenervation with botulinum toxin for strabismus

Main indications for chemodenervation:

To determine the function of the external rectus muscle in paralysis of the VI CN, in which the contracture of the internal rectus muscle interferes with abduction. A small dose of CI toxin. bolulinum is injected into the abdomen of the hyperactive antagonist (internal rectus muscle) under electromyographic control. Temporary paralysis of the muscle causes it to relax, and the action of the horizontal muscles of the eye is balanced, allowing you to evaluate the function of the external rectus muscle.

To determine the risk of postoperative diplopia and assess the potential of BZ. For example, in an adult patient with left exotropia and high visual acuity in both eyes, injection of CI toxin. bolulinum into the rectus externus of the left eye will either straighten the position of the eyes or converge.

However, placing a corrective prism in front of the deviated eye is often a simpler and more accurate method for assessing the risk of postoperative diplopia. If one of the ways indicates the possibility of diplopia, the patient can be informed about it. However, such dilopia. usually disappears spontaneously.

Eye surgery to correct strabismus

Often, surgery for strabismus does not immediately restore normal vision. Many will agree that it is a pity to look at a young pretty girl or child squinting. Without this cosmetic defect, everything would be fine. In addition, ophthalmologists recommend trying conservative treatments for strabismus before going under the knife.

What is strabismus or strabismus

Strabismus is a pathology in which one, both, or alternately the right and left eyes deviate from the normal position when looking directly. When a person looks at an object, the information received by each eye is slightly different, but the visual analyzer in the cortical brain unites everything. With strabismus, the pictures are very different, so the brain ignores the frame from the squinting eye. The prolonged existence of strabismus leads to amblyopia - a reversible functional decrease in vision, when one eye is practically (or completely) not involved in the visual process.

Strabismus can be congenital or acquired. Newborns often have a floating or squinting gaze, especially after a difficult birth. Treatment by a neurologist can remove or alleviate the manifestations of birth trauma. Another cause may be a developmental anomaly or improper attachment of the oculomotor muscles (see Fig. 1).

Acquired strabismus occurs as a result of:

infectious disease: influenza, measles, scarlet fever, diphtheria, etc.;
somatic diseases;
injuries;
a sharp drop in vision in one eye;
myopia, hyperopia, astigmatism of high and medium degree;
stress or severe fear;
paresis or paralysis;
diseases of the central nervous system.

How to get rid of strabismus

Strabismus corrects:

wearing special glasses;
a series of exercises for the eyes;
wearing a bandage covering one eye;
surgery to correct strabismus.

Inconsistent strabismus, when sometimes the right or left eye mows, they try to correct by wearing a bandage. Quite often, long-term use of specially designed glasses helps. Focusing exercises are recommended for almost all patients with strabismus. If all of the above methods did not correct vision, an operation is performed to correct strabismus. This type of surgery is performed both in infancy and in adulthood.

Types of operations to correct strabismus

The following types of strabismus occur in children and adults:

horizontal - converging and diverging relative to the bridge of the nose;
vertical;
combination of two types.

Doctors encounter convergent strabismus more often than divergent strabismus. Together with converging strabismus, the patient may have farsightedness. People who are nearsighted usually have divergent strabismus.

During the operation can be carried out:

amplifying type operation;
debilitating operation.

In loosening surgery, the eye muscles are transplanted slightly further away from the cornea, which deflects the eyeball in the opposite direction.

During augmentation surgery, a small piece of the eye muscle is removed, which leads to its shortening. Then this muscle is sewn to the same place. Surgery to correct strabismus involves shortening and weakening of the necessary muscles, which restores the balance of the eyeball. The operation is performed on one or both eyes. The microsurgeon determines the type of surgical intervention when the patient is in a completely relaxed state on the operating table.

In some clinics, the operation is performed under local anesthesia only for adults. and in others, all patients are given general anesthesia. Depending on age, health status and other factors, mask (laryngeal), endotracheal anesthesia is performed using muscle relaxants or an alternative type of anesthesia.

It is important that during surgery the eyeball is motionless and there is no tone in the muscles, because the surgeon conducts a special test: he assesses the degree of restriction of eye movements by moving it in different directions.

An adult can go home after the operation on the same day. The child also needs preliminary hospitalization. Most often, mothers are in the hospital with children, and discharge occurs the next day after the operation. The recovery period takes about 14 days. After discharge, the patient extends the sick leave or certificate in his clinic.

It should be noted that in 10-15% of cases, strabismus is not completely eliminated and a second operation may be necessary. Surgery with adjustable sutures helps to reduce the failure rate. After waking up the patient, the doctor after a while checks the condition of the eyes under local anesthesia. If there are deviations, he slightly tightens the knots of the seams and only then finally fixes them. All types of operations are performed with fully absorbable suture material.

In adults who have lived a significant time with strabismus, sometimes double vision after surgery, because the brain has lost the habit of perceiving the binocular image. If before the operation the doctor determined a high probability of developing double vision, the correction of strabismus is done in two stages so that the brain can gradually adapt.

Operation

A few days before surgery, you need to take blood tests, do an ECG and consult with some specialists. Do not eat for 8 hours before the operation. If it is scheduled for the morning, you can have dinner, and if in the afternoon, then a light breakfast is allowed. The child and mother are admitted to the hospital a couple of days before the operation. The procedure is carried out under general anesthesia. The operation itself lasts 30-40 minutes, then the patient is taken out of anesthesia and transferred to the ward. All this time there is a bandage on the eye. After the operated patient has completely recovered from anesthesia, the surgeon examines him in the afternoon. He opens the bandage, checks the eye, instills special drops and closes it again. After that, adults are allowed to go home with detailed recommendations: what drugs to take, how to bury the eye, and when to come for a second examination. The bandage on the eye is left until the next morning. A week later, you need to come for an examination, where the doctor will assess the healing rate and the condition of the eye. The final assessment of the position of the eyes is carried out after 2-3 months.

A few weeks after the operation, special anti-inflammatory drops are used and (if necessary) antihistamines. The eye will be red and swollen. Sometimes the next morning the eye will stick together due to accumulated pus. No need to be scared: it is washed with warm boiled water or sterile saline. For a couple of days, the eyes will be very watery and sore, it will also seem that there are motes in the eye. The stitches dissolve on their own after 6 weeks.

Within a month after surgery, you need to carefully protect the eye. You can not swim, be in dusty rooms and play sports. Children at school are exempted from physical education for six months.

A month after the operation, you need to undergo a course of treatment. To return the binocular ability to see and recognize the correct picture, you need to undergo special hardware treatment at the medical center. Some clinics have the Amblicor complex, developed by specialists from the Institute of the Brain. Treatment on this device is a computer video training. It helps to overcome the skill of suppressing the vision of one eye. While watching a cartoon or movie, the patient is continuously taking EEG of the visual cortex of the brain and readings about the work of the eyes. If a person sees with two eyes, the film continues, and if only with one, it stops. Thus, the brain is trained to perceive the image from both eyes.

Strabismus in children

Detected strabismus in children under one year old will not heal on its own, the child will not outgrow, the pathology will not disappear anywhere. If the disease is present and symptoms can be identified, treatment should not be delayed. Otherwise an unused squinting eye loses the ability to see, farsightedness or amblyopia develops- lazy eye syndrome

With the coordinated work of the visual apparatus, the muscles of both eyes work together, focusing the gaze on one point in space. In the case of strabismus, the work of the eye muscles is mismatched and the joint movement of the eyes becomes impossible.

Each eye is directed in its own direction (convergent or divergent strabismus), as a result of which the brain is not able to determine the amount of incoming information, to combine two images into one.

Causes

Converging strabismus in a child can be caused by the following reasons:

congenital (non-permanent) strabismus - may be present from birth or occur in the first months of life. The reasons are in fetal processes; infectious diseases of the mother or the consequences of microscopic hemorrhage;
visual acuity disorders (ametropia), causes - farsightedness, myopia, astigmatism;
a consequence of violations of the central nervous system of the child, the causes are cerebral palsy, hydrocephalus;
acquired (amblyopia) - past illnesses: diphtheria. measles, influenza, rubella;
consequences of fright or severe stress;
injuries, fractures, bruises.

Strabismus, depending on the timing of appearance, causes, complexity and degree of manifestation, can be: inconsistent, descending, hidden, friendly, imaginary.

Sometimes parents are terribly afraid of diagnoses of amblyopia. descending or imaginary strabismus in children under one year old, although such phenomena are temporary and are due to the immaturity of the visual apparatus, conducting channels and nerve endings.

Symptoms

Descending strabismus in children of any age is determined by the following signs:

the child is not able to direct both eyes at the same time to one arbitrarily chosen point (convergent, divergent or alternating strabismus);
unfriendly eye movement;
one eye visibly squints or closes in bright light (amblyopia);
the child has an involuntary desire to tilt his head at a certain angle to look at an object (hidden strabismus);
violation of the perception of the depth of space (the child may fall or stumble on objects).

In children preschool age and older may attend complaints of a fuzzy image, eye strain, increased photophobia, or bifurcation of objects. Symptoms may recur and worsen during periods of increased fatigue or illness.

In newborns and infants, farsightedness, as well as slight intermittent strabismus, is quite common. But since the disease is descending, after 4 - 5 months the eyes are aligned.

Treatment

It will be much easier to treat non-permanent convergent and divergent strabismus if the process is started in a timely manner. The types of treatment are as follows: conservative (therapy) and surgical (surgery). The therapeutic method includes special exercises and implies a complex prolonged treatment. Without surgery, strabismus, amblyopia and farsightedness are successfully treated.

The main steps in the treatment of strabismus are:

examination to determine the cause of strabismus;
preliminary correction of visual acuity (glasses or contact lenses);
diploptic and orthooptic apparatus treatment (restoration of binocularity);
elimination of amblyopia (amblyopia - lazy eye syndrome);
consolidation of the achieved effect.

Operation

The operation will be appropriate only in case of complete ineffectiveness therapeutic method. The most favorable period for such operations is the age of 4-5 years. A preschool child is able to follow all the recommendations and perform the necessary orthooptic exercises.

Congenital paralytic strabismus in children with a large angle of deviation, especially vertical diverging-alternating, therefore, surgical treatment of childhood strabismus is carried out at an earlier age.

Surgery to correct strabismus (surgical correction) involves two types of surgical solutions:

weakening of the overstressed oculomotor muscle after its intersection or partial excision of the muscle;
strengthening of weakened muscles by excision with their further fixation.

Both methods in their pure form are implemented infrequently, since in most cases it is necessary to treat the symptoms of the disease in a combined way.

Depending on the complexity of the picture, the desired effect may not be achieved the first time. In this case, a second operation is prescribed, which is carried out no earlier than in 6-8 months.

At the first stage of surgical treatment, the goal is to remove a cosmetic defect, that is, to cure converging, divergent, less often alternating concomitant strabismus, traumatizing the psyche of a child of any age, after which amblyopia, farsightedness and visual function are treated.

Sometimes, after surgical treatment of strabismus in children, an acquired specific complication is observed - hypercorrection. resulting from errors in calculations. Side effect develops not only immediately after the operation, but also a little later. In this case, the operation is repeated.

Gymnastics

To strengthen the eye motor muscles, experts recommend performing certain exercises:

raising a hand with an outstretched index finger and, performing vertical movement down, lower it, bringing the finger closer to the nose, and then repeat the same, but horizontally, moving the hand to the side;
“write” a figure eight with your eyes, make circular movements, then look up and down, left, right.

Very useful will be games with a ball or a shuttlecock. Table and tennis, football, volleyball contribute to the fact that the child follows the moving ball with his eyes, which constantly changes direction, approaches and moves away.

For children of preschool and school age working at the computer will be useful periodically look out the window, look at distant objects. focusing then look at something close.

Similar exercises are performed daily for 10-15 repetitions, afternoon or after dinner. If you are not lazy and take the issue seriously, the proposed gymnastics will help cure the disease.

The result of the treatment of strabismus is not only a successful operation, but also perseverance, a desire to recover and, of course, regular daily exercises.

Prevention

There are a number of rules, the observance of which will help correct concomitant strabismus in children, as well as preschool children and schoolchildren:

to avoid looking at one point, it is not recommended to hang a child of any age near the crib items that attract attention. It is optimal if there is access to the crib from all or at least several sides;
to prevent farsightedness and imaginary strabismus, rattles in the stroller should hang at arm's length baby;
necessary ensure an even load on the eyes the child, after which the brain will be able to evenly process the signals coming from outside;
acquaintance of the baby with the TV should take place at the age of not earlier than 3 years with the obligatory screen time limit ;
it is not allowed to watch TV lying down. to do this, you can put a pillow and take a half-sitting position;
need to carefully maintain correct posture. especially at your desk. Children with poor posture have a habit of leaning low over a table, which can result in amblyopia and farsightedness;
check and exclude literature with small print from the student's library;
small pictures and fonts in the monitor unnecessarily overload the eye muscles, therefore start communicating with a computer no earlier than 8 years ;
in the presence of a hereditary factor, regular check-ups with an ophthalmologist- necessarily;
if possible protect the child from stress and mental trauma .

If this is not an imaginary strabismus, it is impossible to let the course of the disease take its course. The sooner you start treating its symptoms and doing special exercises, the better.

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Strabismus, heterotropia, or strabismus is called a failure in binocular vision, when there is an incorrect coordination of the work of the eyes on the object in question. One or two eyes deviate from the center of the visual axis in the direction of the nose or temple, as a result of which the fixation of the eyes on the object is disturbed. If no correction methods help, surgery eliminates strabismus.

Definition of strabismus and methods of correction

Strabismus is considered to be a childhood disease, since it manifests itself precisely in childhood. The occurrence of strabismus in adults is much less common, the cause of which is often a disruption in the functioning of nerve connections. There are many reasons that contribute to the occurrence of strabismus:

Traumatic brain injury;
genetic predisposition;
Psychological herbs;
Poor circulation of the brain;
Infectious diseases of the brain;
Incorrect treatment of myopia and hyperopia;
Excessive strain on the eyes;
Violation of the extraocular muscles.

The strabismus test covers a holistic analysis of the organs of vision - the work and location of the muscles, the fundus and visual acuity, the angle of strabismus and the age of the patient are assessed. In the presence of strabismus, the operation is not immediately prescribed, it is first tried to be eliminated without surgical intervention. Treatment has three subsequent stages:

Optical correction;
Pleoptic treatment;
Orthoptic treatment.

Optical correction is a treatment through properly selected glasses, lenses, in order to create optimal conditions for the functioning of the eyes. If there are concomitant diseases (nearsightedness, farsightedness, astigmatism, infections), then their treatment is carried out at this stage of therapy.

Pleoptic treatment is aimed at increasing and equalizing the sharpness of both eyes to age norms.

Orthoptic treatment is essentially a preoperative step. It is advisable to carry it out only after a relative equality of visual acuity between the eyes is created. Its goal is to develop the patient's ability to turn on binocular vision (the ability to clearly see an object with both eyes) when looking away in different directions. In the absence of binocular vision, the question of a ban on the operation may arise. The symmetry of the eyes is possible only with the same spatial perception of objects, objects by both eyes.

It is prescribed only when the maximum possibility of visual functions in both eyes is achieved.

Surgery for strabismus

All operations whose purpose is to correct strabismus are to correct the work of the oculomotor muscles - strengthening and weakening. Manipulations are carried out only within the framework of traditional surgery, laser correction of strabismus is not practiced. Surgical treatment of strabismus consists in dissecting the muscle, and this cannot be done with a laser.

The goal of strabismus surgery is to restore muscle balance and binocular vision. But often it is possible to improve only cosmetic defects, the restoration of visual functions after surgery requires an integrated approach and active conservative therapy. In ophthalmology, there are three areas of surgical correction of strabismus:

Weakening traction of muscles;
Strengthening traction;
Changing the direction of muscle action.

Muscles that reduce cravings include:

Recession, which implies surgical intervention, as a result of which a laxative effect of muscle traction is formed, achieved by shifting the place of attachment of the muscle to the beginning of the muscle.
A myectomy is a procedure to remove a specific muscle from its insertion site. Basically, the indication for such an operation is muscle hypercontraction.
Posterior fixation sutures - a procedure consisting in recession with successive suturing of the abdomen of the transferred muscle to the sclera, slightly behind the place of its attachment.

Aimed at restoring weakened oculomotor muscles:

Resection is the process of excision of a certain area of a weakened muscle at the site of its attachment, followed by its fixation. In fact, the remaining sections are stitched together.
Tenorrhaphy is the process of shortening a muscle by creating a fold in the area of the muscle tendon. As a result, the shortened muscle is significantly enhanced in terms of contractile function.
Anteposition is the process of changing (transporting) the place of attachment of the muscle.

Advantages of surgical ophthalmology:

Low trauma;
The structure of the eye is preserved;
The accuracy of the operation;
Small % of consequences;
High guarantee of a good result;
A short recovery period.

Surgical intervention to eliminate strabismus does not give a 100% guarantee for a complete correction, but the chances are high - up to 80%. If strabismus persists after the manipulation, the operation can be repeated after six months. You should not expect that immediately after the operation you will see “correctly”. During the time that a person suffered from strabismus, the brain lost the habit, forgot how to compare visions from both eyes into one image, and it will take him a long time to learn this. As with any operation, there may be complications. First of all, these are calculation errors that lead to repeated strabismus.

Strabismus surgery is performed under full or local anesthesia (according to indications) on an outpatient basis, a hospital is not required - a few hours after the operation, the patient is allowed to go home. Ophthalmic operations, like all others, are performed on an empty stomach. All necessary tests are taken in advance. During the procedure, the patient must be absolutely healthy (no SARS, temperature, infections). The procedure on average does not exceed 30 minutes. After the operation, a special bandage is applied to the patient, which is left for 12-24 hours. The applied sutures give the sensation of a foreign object in the eye, they do not need to be removed, they dissolve within 6 weeks after application. After the operation, the patient needs the use of anti-inflammatory drops. With suppuration, washing will be indicated.

You need to do the following:

Carefully protect the eye from contamination;
Do not engage in physical labor for the first three weeks after surgery;
Do not swim in public places;
Do not disturb the eye, do not rub it.

After surgery, careful monitoring of the eye is required. Regular visits to the ophthalmologist, the use of the necessary drugs and rest of the eyes are necessary. To restore muscles, a special system of exercises is being developed that must be performed. Eye position assessment is checked no earlier than two months after surgery.

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Surgery for strabismus is recommended by a doctor if conservative methods of treatment do not give a positive effect. The tactics of surgical intervention is determined individually, based on the degree of deviation of the eyeball, the state of the muscular apparatus. The effectiveness of surgical intervention reaches 90%.

Eye surgery to eliminate their deviation is not the primary method of treatment. If it was prescribed by a doctor, you should not postpone it, since it is impossible to fix the problem in other ways. Due to untreated strabismus, vision is gradually lost.

The purpose of the operation to correct strabismus in children and adults is to eliminate a cosmetic defect, to restore binocular vision. Depending on whether there is a deviation of one or both eyes, a unilateral or bilateral operation is performed.

Surgery for strabismus is more often performed in children aged 4-6 years. For children with congenital strabismus, a large angle of deviation, bilateral lesions, surgical intervention is indicated regardless of age.

The surgical method is corrected taking into account the same indications, as well as at the request of the patient himself.

Operation types

There are two types of strabismus surgery:

reinforcing - aimed at strengthening the muscle that cannot hold the eyeball in the correct position;
weakening - suppression of the action of a stronger muscle that deflects the eyeball.

Relaxing surgery for strabismus is performed by moving or cutting the muscle. To strengthen the muscle, it is shortened.

Preparatory stage

Before choosing an operative method for the treatment of strabismus, the doctor conducts a comprehensive examination of the patient:

general clinical tests;
assessment of the functional state of the organ of vision;
if necessary, appoint consultations of narrow specialists.

Special preparation is not required. If the operation is performed on a child, the last meal should be no later than 12 hours before the intervention. This condition is necessary for general anesthesia.

If a pronounced spasm of the oculomotor muscles is detected, it is recommended to do special exercises for a month. They allow the muscles to relax and take the most natural position.

How is strabismus surgery done?

The surgical method of treating strabismus is selected taking into account the characteristics of the disease. Operations to eliminate strabismus are called according to the technique.

Recession. The oculomotor muscle is dissected at the site of its attachment, sutured to the sclera. The tension force decreases, the eyeball takes the correct position.
Myectomy. Dissection of the muscle without subsequent suturing.
Muscle resection. Due to shortening, the muscle fiber shifts the eyeball in its direction.

The surgeon uses a laser or radioknife. These devices are the least traumatic, provide an instant stop of bleeding.

In an adult, surgery is usually performed with local anesthesia. General anesthesia recommended for strabismus surgery in a child. An adult is allowed to go home a few hours after surgery. In children, the operation takes place in a hospital, then they are left under observation for 1-2 days.

The operation to correct severe strabismus in children takes place in two stages.

Reducing the angle of strabismus should be carried out as early as possible. This is done at 12-14 months, when the child is able to endure anesthesia.
The final correction of strabismus is carried out at 4-5 years of age.

In the interval between the stages of surgical correction, conservative treatment is carried out.

The operation will be free if you do it under the MHI policy at a state clinic. If you go to a private hospital, surgery will cost 15,000-30,000 rubles.

Video: Surgical correction of strabismus

Rehabilitation stage

Immediately after the procedure, there is swelling and redness of the eye, and pain is possible. This condition lasts 3-5 days, then the symptoms disappear. Full recovery of vision functions lasts about 4 weeks.

After surgery for strabismus, you need to perform rehabilitation measures:

visual gymnastics;
instillation of vitamin eye drops;
the use of antihistamines, anti-inflammatory drugs, if necessary, analgesics;
use of tinted glasses or a bandage.

Once a week you need to see an ophthalmologist. Postoperative recovery implies limitation physical activity. For a month, patients are advised not to play sports, not to visit a bath or sauna. The child is exempt from physical education at school.

It is recommended to do daily throughout the year. They help strengthen muscles, prevent the recurrence of the disease. If there is a decrease in vision, the baby is selected corrective glasses or lenses.

Possible Complications

Surgical intervention in most patients passes without adverse consequences. Possible complications:

injury to the vagus nerve, which leads to disruption of the heart, lungs, esophagus;
hypercorrection - excessive change in muscle length;
scarring on muscle tissue;
damage to the eyeball.

Recurrence of the disease during surgical treatment is rare. Strabismus may return if the patient does not perform rehabilitation measures, ignores visits to the ophthalmologist. Repeated operation can not be done within six months after the first.

A rare form of strabismus is. In this disease, there is a congenital dysfunction of the oculomotor nerves. The eye is not able to turn towards the temple. Even surgery does not give a positive effect. It is used only to reduce the severity of symptoms.