The asthenopia is a disorder of sight of functional character which is followed by increased fatigue when performing visual work. It is clinically shown by burning sensation, gripes, pains, hyperaemia, emergence of fog before eyes, feeling of sand, and also decrease in visual acuity that develop after hard or long visual work. Diagnostics is based on visual acuity definition, carrying out refractometry, biomicroscopy, an accommodation research. Medical actions include correction of an ametropiya, conservative therapy, and also techniques of hardware treatment.
The asthenopia is the pathological state which is shown a complex of subjective symptoms of visual exhaustion. In ophthalmology this pathology is considered how borderline between functional violations of sight and the initial stage of formation of an organic disease of eyes. Visual fatigue is equally widespread among persons men's and female. Racial and age features are not noted. More than 75% of the population of the globe note at themselves complaints of astenopichesky character in time or after work with electronic devices. People whose professional activity is connected with long fixing of sight at small distance enter into risk group of development of an asthenopia.
The asthenopia is multifactorial pathology at which certain etiologichesky factors are starting in development of separate mechanisms of pathogenesis. Long work with electronic devices, reading at insufficient lighting, work with small objects, driving of the car in bad weather conditions and non-compliance with rules of hygiene of sight are the contributing factors to development of a spasm of accommodation. Also astenopichesky complaints develop at decrease in the akkomodatsionny ability caused by a gipermetropiya, an astigmatism, a hypotrophy or violation of an innervation of a tsiliarny muscle. The spastic condition of the muscular device of an eyeball during a long period is clinically shown by bystry visual fatigue.
As provocative factor of development of an asthenopia the incoordination between accommodation and convergence, and also increase in load of internal direct muscles of an eye acts that in turn acts as a miopiya predictor. Emergence of a number of astenopichesky complaints is connected with development of a syndrome of a dry eye since at long concentration of attention the number of blinkings in unit of time decreases. It leads to decrease in allocation of a secret meybomiyevy glands.
Violation of processing of visual signals in nervous impulses arises at neuroreceptor exhaustion of the visual analyzer that is shown by asthenopia symptomatology. A part in development of visual exhaustion is played by the low level of psychological adaptation to visual work. Thus, on the basis of an etiology and pathogenesis distinguish such forms of an asthenopia as akkomodatsionny, muscular, neuroreceptive and psychoemotional.
The clinical current of an asthenopia is characterized by staging of process. Allocate a stage of compensation, subcompensation and decompensation. At a stage of compensation the short-term violations of visual functions which are not going beyond side-altars of physiological borders are possible. Therefore the compensated asthenopia it is considered to be visual discomfort which develops after visual loading and is leveled after planned rest, without reducing at the same time working capacity. It is clinically shown by the burning sensation increased by dacryagogue, hyperaemia, emergence of fog before eyes.
At a stage of subcompensation long violation of sight which is potentially reversible develops. The symptomatology of this stage is characterized by accession of feeling of gripes, sand in eyes, distortion or doubling of the image. Functional violations of visual function can be observed 1-2 days later after rest or arise after insignificant loading with the short periods of remission.
The stage of a decompensation is shown by classical symptoms of visual overfatigue. In the anamnesis at patients frequent development of a blefarit, conjunctivitis are noted. The main difference is irreversibility of changes of a refraction and accommodation. Therefore at this stage emergence of early clinic of a presbiopiya, development and progressing of a miopiya is possible. At an asthenopia on each of stages development of such nonspecific symptoms as a headache, irritability, the general weakness is possible.
Diagnostics of an asthenopia
The complex of diagnostic actions includes carrying out a vizometriya, refractometry, biomicroscopy, an accommodation research. The method of a vizometriya possible to define extent of change of visual acuity. At patients with an asthenopia tendency to development of a miopiya is observed. It is very important to conduct a research in dynamics. Before the choice of tactics of treatment it is necessary to measure visual acuity after long rest from visual loadings that will give the chance to receive true values, but not caused by an accommodation spasm.
The research of accommodation is one of key methods of diagnostics of an asthenopia and includes carrying out a proksimetriya, measurement of width, scoping and tension of akkomodatsionny ability. At patients with the increased visual fatigue the shift of a point of clear vision towards a miopiya is observed. During a proksimetriya patients note at themselves early emergence of such symptoms as doubling, a text vagueness, low ability to fix a look, development of burning and pain. Required width, volume and tension of accommodation often allow to establish progressing of short-sightedness.
As the purpose of carrying out refractometry at patients with an asthenopia serves identification of a miopiya or astigmatism, and also early changes of a refraction. Advantage of use of this method at persons with the increased visual fatigue is that the device gives result of average values after carrying out several measurements in a row.
The method of biomicroscopy allows to investigate forward departments of an eyeball in details. Matters at patients with a dekompensirovanny asthenopia since allows to diagnose conjunctivitis, to estimate the nature of changes, and also efficiency of the carried-out treatment. With an asthenopia it is recommended to patients to have annual examination at the ophthalmologist with additional inspection of an eye bottom and measurement of intraocular pressure.
Treatment of an asthenopia
Treatment of an asthenopia is based on an integrated approach. At a stage of the compensated visual exhaustion in the absence of organic changes alternation of the mode of rest with visual loadings is recommended to patients. At a stage of compensation and subcompensation purpose of techniques of hardware treatment of sight is expedient. Their list includes an akkomodotrener, laser stimulation and Sidorenko's points.
The range of application of an akkomodotrener is rather wide. By means of this device it is possible to eliminate the residual phenomena of a spasm of accommodation at patients with the compensated asthenopia, and also to carry out optical correction of a miopiya and initial stages of development of a gipermetropiya. The technique of laser stimulation stabilizes operation of the receptor device of a retina and provides decrease in a tone of a tsiliarny muscle. Indications to this type of hardware treatment is the neuroreceptive asthenopia, and also the astigmatism, a miopiya, a gipermetropiya, a computer visual syndrome which are followed by astenopichesky complaints. Efficiency of treatment of an asthenopia by means of Sidorenko's points is reached thanks to vacuum massage of eyes and surrounding structures. The massing movements stimulate regional microcirculation and improve to a traffic.
Patients with visual fatigue at a stage have decompensations or it is necessary to carry out by an ametropiya in the anamnesis its correction by means of points or contact lenses. Conservative therapy consists in purpose of a course of midriatik of short action (a fenilefrin a hydrochloride, ). Duration of a course of application of drops depends on a stage and weight of a current of an asthenopia.
Forecast and prevention of an asthenopia
The forecast at an asthenopia depends on a disease stage. At normalization of visual loading at compensation stage perhaps complete recovery of function of sight. Adequate treatment at a stage of subcompensation can provide the return development of process therefore the forecast favorable. At a decompensation, as a rule, the absolute recovery does not manage to be reached.
Prevention of an asthenopia consists in alternation of visual loadings with the rest periods, and also the correct organization of a workplace. Reception of vitamins for eyes is shown to patients with an asthenopia (Bilberry Forte, Okyuvayt ). Before the predicted visual work it is recommended to dig in the moistening drops (Oftagel, Vidisik) in eyes. In house conditions for decrease in a spasm of accommodation it is necessary to use special glasses with small perforation and to do exercises for eyes.