Short-sightedness at children – the visual impairment caused by discrepancy of optical power of a cornea of a perednezadny axis of an eyeball that leads to focusing of the image before a retina, but not on her. At short-sightedness children well see close objects, and remote – it is bad; complain of visual exhaustion, headaches. Inspection of children with short-sightedness includes visual acuity assessment, an oftalmoskopiya, a skiaskopiya, autorefractometry, ultrasonography of an eye. Treatment of short-sightedness at children is carried out in a complex by means of-point or contact correction, optical exercises, medicamentous therapy, FTL, IRT; if necessary – scleroplasticity.
Short-sightedness at children
Short-sightedness at children (miopiya) – one of the most widespread diseases of visual system in children's ophthalmology. By 15-16 years short-sightedness is found in 25-30% of children. Short-sightedness at the child comes to light at the age of 9-12 years more often, and in the teenage period there is its strengthening. At short-sightedness the parallel rays of light going from far objects are focused not on a retina, and before it that leads to an illegibility, a smazannost, an image vagueness.
About 80-90% of the full-term babies are born gipermetropa with "a far-sightedness stock" +3,0+3,5 D. It is explained by the short perednezadny size of an eyeball at the newborn (17–18 mm). In process of growth of the child there is a growth, and together with it is change of the refracting eye force. Gradually the gipermetropiya becomes less, approaching a normal (emmetropichesky) refraction, and in many cases (at an insufficient "stock of far-sightedness" +2,5 and less than D) it passes into a miopiya – short-sightedness at children.
The short-sightedness reasons at children
Children can have a hereditary short-sightedness, congenital and acquired. Predisposition to short-sightedness is higher at those children whose parents (one or both) also have a miopiya. In this case speak about hereditary short-sightedness at children.
As prerequisite of congenital short-sightedness at children serves weakness skler and its raised tensile properties that leads to steady progressing of a miopiya. Besides, this form of short-sightedness often occurs at premature children, and also children having congenital pathology of a cornea or crystalline lens, congenital glaucoma, a Down syndrome, Marfan's syndrome, etc. Congenital short-sightedness usually comes to light at children of the first year of life.
The acquired short-sightedness at children arises and progresses in school days in connection with the increased visual loading, early training in the letter and reading, non-compliance with hygiene of sight, uncontrolled use of the computer or viewing of the TV, a lack of minerals and vitamins B to food, rapid growth of the child. Patrimonial spine injuries, rickets, infections (tonsillitis, antritis, tuberculosis, measles, diphtheria, scarlet fever, infectious hepatitis) and associated diseases (adenoides, diabetes, etc.), violations of musculoskeletal system (scoliosis, flat-footedness) can promote development of short-sightedness in children.
Classification of short-sightedness at children
Taking into account the nature of development of a miopiya distinguish physiological, lentikulyarny (lenticular) and pathological short-sightedness at children.
Physiological short-sightedness is caused by the strengthened growth of an eye which is observed at children. Degree of a physiological miopiya increases to the moment of the end of growth of an eyeball and further does not progress. Such type of short-sightedness at children is carried to stationary: it does not lead to considerable deterioration in sight and disability.
At lentikulyarny short-sightedness at children excessive increase in the refracting crystalline lens force at changes of its kernel takes place. Lenticular short-sightedness often occurs at children with a congenital central cataract and diabetes, and also at defeat of a crystalline lens owing to reception of some medicines.
Pathological short-sightedness at children (a miopichesky disease) develops with an excessive growth of an eyeball in length and is characterized by the progressing decrease in visual acuity to several dioptries in a year. Such form of short-sightedness at children proceeds most zlokachestvenno and often results in disability on sight.
On direct mechanisms of emergence children can have an axial short-sightedness (in case of increase in the perednezadny size of an eye> 25 mm and a normal refraction), refraction (at increase in the refracting force and normal perednezadny length of an eye) and mixed (at a combination of both mechanisms).
On force of expressiveness distinguish short-sightedness at children weak (to-3,0 D), average (to-6,0 D) and high degree (over-6,0 of D).
Short-sightedness symptoms at children
Congenital short-sightedness at the child of early age can be revealed only at planned survey of the children's ophthalmologist.
At more senior children the habit to shchurit eyes, to wrinkle a forehead, to often blink, bring toys closely to eyes, to low incline the head when drawing or reading allows to think of existence of short-sightedness. At the same time the child sees close located objects well, and removed - it is worse. Complaints of children to discomfort and gripes in eyes, bystry visual exhaustion, a headache are typical.
At in due time not skorrigirovanny short-sightedness at children binocular sight is broken, the dispersing squint and an ambliopiya develops. As the most serious complications of the progressing miopiya serve an otsloyka of a vitreous body, the changes of a retina leading to hemorrhages and its otsloyka.
At children it is necessary to distinguish the false short-sightedness (or an accommodation spasm) caused by violation of functioning of eye muscles and which is followed by loss of a possibility of maintenance of accurate vision of objects from a true miopiya. Such state is potentially reversible, however if in due time not to take appropriate measures, the accommodation spasm at children will develop into true short-sightedness.
Diagnosis of short-sightedness at children
At identification of signs of deterioration in sight afar, parents, teachers or the pediatrician have to take measures to inspection of a condition of visual function of the child.
In the course of external examination of eyes of the child the children's ophthalmologist pays attention to a form, size and position of eyeballs, fixing of a look on bright toys. In the course of biomicroscopy and an oftalmoskopiya the condition of a cornea, the forward camera of an eye, a crystalline lens, an eye bottom is estimated.
Presence of short-sightedness at children from 3-year age is specified by visual acuity check close and afar, without corrective glasses and with them. Improvement of sight with minus and deterioration with a plus lens testifies to a miopiya. At the following stage the clinical refraction by means of a skiaskopiya and refractometry after a preliminary atropinization is investigated.
By means of ultrasonography of an eye the type of short-sightedness at children is defined (refraction or axial), measurement of the perednezadny size of an eye is performed.
For an exception of false short-sightedness at children the volume and a stock of accommodation is defined. At identification of a spasm of accommodation consultation of the children's neurologist as this state often occurs at children with vegeto-vascular dystonia, the adynamy raised by nervous excitability is necessary for the child.
Treatment of short-sightedness at children
Tactics of treatment of short-sightedness at children is defined by its degree, progressing and existence of complications. At increase in short-sightedness no more than on 0,5 D in a year, waiting tactics is possible. In other cases the complex of methods is applied to treatment of short-sightedness at children (physiotherapeutic, optical, hardware, medicamentous).
First of all to the child selection of points or contact lenses (children of advanced age) is made. At short-sightedness of weak or average degree points are used only for a distance, there is no need for their constant carrying. In case of a miopiya of high degree or its progressing character, it is required to wear glasses constantly.
Non-drug methods of treatment of short-sightedness at children include the all-strengthening mode, the balanced food, visual gymnastics, hardware treatment (vacuum massage, laser therapy, electrostimulation, a training of accommodation and convergence, etc.), massage cervical zones, an electrophoresis, acupuncture.
As drug treatment of short-sightedness at children purpose of vitamin and mineral complexes, vasodilating medicines (nicotinic acid, a pentoksifillin), instillations of the eye drops improving eye food is carried out.
When progressing or high degree of short-sightedness at children surgical treatment – the scleroplasticity interfering further stretching skler is shown. Laser correction of sight at a miopiya is carried out on reaching the patient of 18 years.
The forecast and prevention of short-sightedness at children
If short-sightedness at children does not progress and proceeds without complications, the forecast concerning sight favorable – such miopiya well gives in to-point correction. At a miopiya of high degree even in the conditions of correction visual acuity often remains lowered. For visual function the progressing short-sightedness at children leading to degenerate changes in a retina has the worst forecast.
An important role in the prevention of short-sightedness at children is played by respect for hygiene of sight: dosage of visual loadings, correct organization of a workplace of the school student, prevention of pathological visual habits. The sufficient dream, good nutrition, stay in the fresh air, sports activities is useful to the correct development of sight. Children with short-sightedness have to be examined by the oculist each half a year.