Ambliopiya – resistant one - or the bilateral decrease in sight which is not connected with organic pathology of the visual analyzer and not giving in to optical correction. The current of an ambliopiya can be asymptomatic or be followed by impossibility of steady fixing of a look, violation of color perception and orientation in space, decrease in visual acuity (from insignificant easing to a svetooshchushcheniye). Diagnostics includes visual acuity definition, perimetry, determination of color sensation and dark adaptation, survey of an eye bottom, a tonometriya, biomicroscopy, definition of a look and corner of squint, refractometry, a skiaskopiya, an elektroretinografiya, ultrasonography of an eye, neurologic inspection, etc. Treatment of an ambliopiya is directed to elimination of the reasons which caused its development: can be surgical (correction of squint, elimination of a ptoz, extraction of a cataract) or conservative (-point correction, a pleoptika, a penalization, physical therapy).
Ambliopiya (syndrome of a "stupid", "lazy" eye) is characterized by inaction, nonparticipation of one of eyes in the course of sight. In ophthalmology the ambliopiya is considered as one of the leading reasons of unilateral decrease in sight. Around the world about 2% of the population suffer from an ambliopiya. Ambliopiya is a disease of mainly children's age therefore so important aspect is gained by a problem of its early identification and correction.
On time of development of pathology distinguish primary (congenital) and secondary ambliopiya. Taking into account the reasons several forms secondary are allocated: strabizmatichesky (disbinokulyarny), obskuratsionny (deprivational), refraction, anizometropichesky, hysterical, mixed.
Despite a set of forms of an ambliopiya, the mechanism of development of a disease in all cases it is connected with a deprivation of uniform sight and/or pathological binocular communications that leads to functional decrease in the central sight.
The disorder of binocular sight caused by a long supressiya of one eye is the cornerstone of a strabizmichesky (disbinokulyarny) ambliopiya. The Strabizmichesky ambliopiya happens two types: with the central (correct) fixing when the central part of a retina acts as the fixing site, and noncentral (wrong) fixing – with any other fixing site of a retina. The Disbinokulyarny ambliopiya with the wrong fixing is diagnosed in 70-75% of cases. The type of a strabizmichesky ambliopiya is considered at the choice of a method of treatment.
The Obskuratsionny (deprivational) ambliopiya is caused congenital or early by the acquired turbidity of optical environments of an eye. It is diagnosed in case the lowered sight remains, despite elimination of the reason (for example, extraction of a cataract), and in the absence of structural changes in back departments of an eye.
At a refraction ambliopiya anomaly of a refraction which is not exposed to correction at present takes place. Long and continuous projection on a retina of the indistinct image of objects of the world around is the cornerstone of its emergence.
The Anizometropichesky ambliopiya develops at an unequal refraction of both eyes therefore there is a difference in the size of display of objects on a retina of the right and left eye. This feature interferes with formation of a uniform vision.
Rare form of the functional frustration arising because of any affect is the hysterical ambliopiya (a psychogenic blindness). At the same time extent of decrease in sight can be partial or full.
Depending on extent of decrease in visual acuity distinguish an ambliopiya weak (0,4-0,8), average (0,2-0,3), high (0,05-0,1) and very high degree (from 0,04 and below).
Ambliopiya can be diagnosed on one eye (unilateral) or on both eyes (bilateral).
Reasons and types
As immediate causes at different types of an ambliopiya multiple factors can act.
As the reason of a disbinokulyarny ambliopiya serves monolateral sodruzhestvenny squint when the rejected eye is excluded from participation in the visual act. At squint the ambliopiya arises in the mowing eye. In order to avoid a diplopiya, the brain suppresses the image arriving from the mowing eye that leads over time to the termination of carrying out impulses from a retina of the rejected eye to visual bark. In this case the vicious circle is formed: on the one hand, squint acts as the reason of a disbinokulyarny ambliopiya, with another – progressing of an ambliopiya aggravates squint.
Development of an obskuratsionny ambliopiya is, as a rule, connected with turbidity of a cornea (leykomy), congenital cataract, ptozy an upper eyelid, dystrophy and injuries of a cornea, rough changes in a vitreous body, gemoftalmy.
The nekorrigirovanny anizometropiya of high degree is the cornerstone of an anizometropichesky ambliopiya: in this case the ambliopiya develops on an eye with more expressed violations of a refraction. In turn, as the reasons of an anizometropiya high degrees of short-sightedness (> 8 bilateralno), far-sightedness (> 5 bilateralno), an astigmatism can act (> 2,5 in any meridian).
The refraction ambliopiya develops at a long absence of optical correction of far-sightedness (gipermetropiya), short-sightedness (miopiya) or an astigmatism. Ambliopiya develops at the following differences of a refraction of both eyes: gipermetropichesky> 0,5 , astigmatic> 1,5 , miopichesky> 2,0 .
Development of a hysterical ambliopiya is caused by the adverse psychogenic factors which are followed by hysteria, psychosis. At the same time can develop, both unilateral, and bilateral violation of sight, concentric narrowing of fields of vision, violation of color perception, a photophobia and other functional frustration.
In risk group on development of an ambliopiya there are children born from premature birth (especially with deep degree of prematurity), with the burdened perinatal anamnesis, delays of mental development, the ambliopiya having family history or squint. A number of the inherited diseases - Kauffman's syndrome, Benche's syndrome, an oftalmoplegiya with miozy and ptozy is followed by Ambliopiya.
The manifestations have various forms of an ambliopiya. At weak degree of expressiveness the asymptomatic option is possible.
Children, in view of a lack of touch experience, cannot adequately estimate, how well they see and whether both eyes are equally involved in sight process. At the small child it is possible to think of a possibility of an ambliopiya in the presence of squint, a nistagm, impossibility to accurately record a look on a bright subject. At children of more advanced age decrease in visual acuity and lack of improvements from its correction, violation of orientation in the unfamiliar place can indicate an ambliopiya, a deviation of one eye aside, a habit to close one eye at a look regarding or reading, an inclination or turn of the head at a view of the interesting subject, violation of color perception and dark adaptation.
The hysterical ambliopiya at adults develops against the background of strong emotional shocks and is characterized by sudden deterioration in sight which remains from several hours to several months.
Violations of sight at an ambliopiya can vary from easy decrease in visual acuity to almost its total loss (svetooshchushcheniye) and impossibility of visual fixing.
Identification of an ambliopiya requires carrying out comprehensive ophthalmologic examination. At primary survey of eyes the ophthalmologist pays attention to eyelids, an eye crack, position of an eyeball, defines reaction of a pupil to light.
The general information on a condition of sight is obtained by ophthalmologic tests: checks of visual acuity without correction and on its background, color testing, perimetry, the test for refraction. Depending on decrease in visual acuity degree of expressiveness of an ambliopiya is defined.
For survey of structures of an eye the oftalmoskopiya, biomicroscopy, inspection of eye day with Goldman's lens is carried out. For definition of transparency of the refracting environments (a crystalline lens and a vitreous body) survey of an eye in the passing light is used. At opacity of environments their state is investigated by means of ultrasonography of an eye.
From biometric researches an important role is played by definition of a corner of squint across Girshberg and measurement of a corner of squint on a sinaptofor. For the purpose of an exception of a refraction and anizometropichesky ambliopiya it is shown refraction researches: carrying out refractometry and skiaskopiya.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Only the early, individually picked up and persistent treatment of an ambliopiya yields positive results. It is preferable to make correction aged up to 6-7 years; at children 11-12 years are more senior the ambliopiya will practically not respond to treatment.
Success of ophthalmologic correction is directly connected with elimination of its reason. So, at an obskuratsionny ambliopiya removal of a cataract, surgical correction of a ptoz, performing rassasyvayushchy therapy or a vitrektomiya at a gemoftalma is necessary. In case of a disbinokulyarny ambliopiya surgical correction of squint is carried out.
Treatment of a refraction or anizometropichesky ambliopiya is carried out by conservative methods. At the first stage optimum correction of sight is appointed: selection of points, night or contact lenses is made, at an anizometropiya laser correction is carried out.
Approximately in three weeks begin the pleoptichesky treatment aiming at elimination of the dominating role it is better seeing and activation of function of an ambliopichny eye. For treatment of an ambliopiya the active and passive pleoptika is used.
The passive pleoptika consists in sticking up (occlusion) of the leading eye; the active pleoptika combines occlusion of the leading eye with carrying out stimulation of a retina of a defective eye by means of light, electric impulses, special computer programs. Among hardware methods the greatest distribution at an abliopiya was gained by trainings on Ambliokor, the lazerstimulyation, a svetotsvetostimulyation, electrostimulation, electromagnetic stimulation, vibrostimulation, a refleksostimulyation, computer methods of stimulation, etc. repeat Pleoptichesky courses at an ambliopiya 3-4 times a year.
At children of younger age (1-4 years) treatment of an ambliopiya is carried out by means of a penalization – purposeful deterioration in sight of the dominating eye by purpose of hyper correction or an instillation of atropine solution to it. In this case visual acuity of the leading eye decreases that involves activization of work of an ambliopichny eye. At an ambliopiya physical therapy methods – reflexotherapy, vibromassage, a medicinal electrophoresis are effective.
After a pleoptichesky stage of treatment of an ambliopiya pass to restoration of binocular sight – to ortoptichesky treatment. Carrying out this stage is possible at achievement of visual acuity in both eyes not less than 0,4 and age of the child is not younger than 4 years. Usually the device-sinoptofor is for this purpose used, looking in eyepieces of which the patient sees separate parts of the whole image which need to be united in one picture visually.
Treatment of an ambliopiya is carried out to achievement of approximately identical visual acuity of both eyes. At a hysterical ambliopiya sedatives are appointed, the psychotherapy is carried out.
Forecast and prevention
The forecast at an ambliopiya depends on the reasons and time of detection of a disease. The earlier it is begun corrections of an ambliopiya, the result will be more successful. The greatest effect is reached when performing treatment before achievement of 7 years by the child, the formation of an eye is not completed yet. In case of timely and full treatment of an ambliopiya in most cases it is possible to normalize sight almost completely. At adults with an ambliopiya permanent irreversible decrease in visual acuity develops.
Prevention of an ambliopiya is reached by carrying out regular dispensary inspection of children, since 1 month of life. At identification of turbidity of optical environments of an eye, a ptoz, nistagm, squint early elimination of defects is necessary. The lasting effect at treatment of an ambliopiya manages to be reached when passing a full course of treatment, accurate observance of instructions of the ophthalmologist (glasses wearing, okklyuder, regular inspection).