Infantile esotropia

Introduction to infantile strabismus Infantileesotropia, also known as congenitalesotropia, is an esotropia that is diagnosed within 6 months after birth because it is rare to prove that the internal oblique occurs after birth, and it is only within 6 months after birth. It has been found that it is said that this type of internal oblique is regarded as infantile strabismus. It is also called congenitalorinfantileesotropia and infantileesotropiasyndrome. The disease is a common strabismus. Because the onset time is often combined with DVD, recessive nystagmus, superior oblique or inferior oblique muscle function and compensatory head position, it is listed as a special type of strabismus. . basic knowledge The proportion of illness: 0.02% Susceptible people: children Mode of infection: non-infectious Complications: nystagmus

Infant type esotropia etiology

Congenital fusion function defects (45%):

Stunting refers to the developmental developmental delay or congenital defect in the orthotopic position of the child after the birth of the cortex. Spiritus has synthesized several studies on 2,200 neonates indicating that the neonatal stage is still immature. Retinal parallax sensitivity is reduced at birth, retinal parallax is the basis of eyeball steering system and motor fusion, so the eye position of the child is unstable at birth, and the internal oblique is more common in the early postnatal period, and the external oblique is less, but this kind of Eye alignment is temporary and disappears within 3 months. Worth believes that congenital fusion function defects are the cause of strabismus in infants and young children. Therefore, it is impossible to obtain binocular monocular function in any age surgery. Chavasse et al. Peripheral factors interfere with binocular visual reflexes, causing strabismus in infants, and fusion is an acquired reflex. Most scholars have supported this view in recent years. They believe that early surgery can obtain a positive position and provide opportunities for binocular vision development.

Genetic factors (35%):

Infant-type esotropia often has a family history, but the genetic law remains to be explored. Wardenburg reports that the incidence of monozygotic strabismus is 81.2%, and that of twins is 8.9%. Helvenston found that 16% of infants with children with esotropia have stereopsis Only 2% of parents with non-strabismus have a low stereoscopic sharpness.

Infant-type strabismus prevention

1. Try not to keep your child away from objects in close proximity and in the same direction. If you find that your child has strabismus at 4 months, try the following simple method: if you are an internal oblique, parents can talk to the child at a remote location, or hang some colorful toys in a far-reaching range of sights, and Let the children see more things that will move.

2, children should watch TV as little as possible, do not do far-sighted gaze action. The gaze time for the near object should also be reduced, such as playing with blocks and watching comic strips.

Infant and child strabismus complications Complications, nystagmus

1. DVD or DHD: The incidence of DVD in children with infantile strabismus is reported in foreign countries as 46% to 90%, and domestic reports are 21.2%, which is lower than abroad.

2. Monocular or binocular oblique muscle function is too strong: Infant type strabismus side or bilateral inferior oblique muscle function is as high as 78%, domestic report is 63.6%, so often show V sign, combined with superior oblique muscle Those who are too functional are shown as A signs.

3. Recessive or manifest nystagmus: Hiles et al reported that 30% of children with pediatric strabismus had ocular nystagmus, and 50% of Lang observed occult nystagmus, domestic Shen Jie et al reported that 21.2% were accompanied by nystagmus.

4. Head position: Due to vertical strabismus and nystagmus, infantile children with strabismus often have head position abnormalities.

5. Optokinetic nystagmus (optokinetic nystagmus) and eyeball level follow the asymmetry of movement.

Infants and children with strabismus symptoms Common symptoms Eyeball tremors

Constant esotropia occurring within 1.6 months can occur intermittently.

2. Larger strabismus

Congenital strabismus is large, more than or equal to 40 , and stable, unchecked distance, gaze and adjustment factors. In foreign literature, Helvenston reported 133 cases with an average strabismus of 40 , and Costenbader with 48 cases of 50 cases. (96%), 17 of Foster's 34 cases (50%) had strabismus above 40; von Noorden et al reported an average of 50~60 strabismus, 55 cases were reported by the authors, and the average strabismus was 50.

3. General examination methods are difficult to find central nervous system abnormalities.

4. Mild hyperopia

After wearing corrective glasses, there was no change in oblique angle. Costenbader reported that in 500 cases of infantile strabismus, myopia accounted for 5.6%, mild hyperopia accounted for 46.2%, moderate hyperopia accounted for 41.8%, and high hyperopia accounted for 6.4%; strabismus size and flexion The type and degree of poor light are irrelevant. It is generally believed that the refractory of 0 to 3.OOD in infants aged 1 to 2 years is physiological, and with the increase of age, the degree of farsightedness is gradually reduced.

5. Children's internal strabismus is mostly crossed fixation

That is, the left eye is used when looking at the right side, and the right eye is used when looking at the left side, which is characterized by pseudoectal rectus paralysis, so amblyopia is rarely formed, such as monocular gaze, accompanied by amblyopia, Costenbader reports 500 cases, and amblyopia has 205 The case accounted for 41%. Therefore, early treatment should be given to such children. The method is alternately covered, and the atropine is alternately expanded to make it alternate.

6. Eye movement

Infants with children with esotropia may have a weak external rotation and a strong internal rotation. The lack of false external rotation and the absence of abduction examination should be excluded. The method is: when the external rotation is insufficient, the external rotation can be used for gaze. Eyes, try to guide the external rotation, if the external rotation is normal at this time, it is false; when the child does not cooperate with the examination, the "Doll Head Test" method can be used, that is, in the state where the child's eyes are directly in front of the child, Turn the head of the child to the left and right, and observe the function of the internal and external rectus muscles by turning the eye side.

Infant type strabismus examination

1. General examination: often have single or double oblique muscle function, recessive or dominant nystagmus, combined head abnormalities, visual nystagmus and other symptoms.

2. Vision and diopter examination: There may be fixed esotropia, and the degree of strabismus is large and fixed, and may be accompanied by amblyopia.

3. Eye movement examination: When it is found that the external rotation is insufficient, the external rotation eye can be used as the gaze eye, and the external rotation is tried to guide the external rotation. If the external rotation is normal at this time, it is false; when the child does not cooperate with the examination, the "baby head test" can be used. In the state where the child's eyes are directly in front of the child, the child's head is turned left and right by hand to observe the function of the internal and external rectus muscles.

Diagnosis and diagnosis of infantile strabismus

Diagnostic points

1. Detailed medical history: For patients with older age, the parents should be asked in detail when they have esotropia, whether they have other medical history and family history after birth, and whether there are photos when they are young, if available.

2. Carefully check the refractive status: Moderate or higher hyperopia should be worn with full-correction glasses for 3 months to see if there are regulatory factors involved.

3. Detailed strabismus examination: If the medical history is clear, the degree of strabismus is greater than 40, first consider the disease.

4. Check for combined DVD, DHD, recessive or dominant nystagmus.

5. Check for abnormal function of the oblique muscle, pseudoectal rectus paralysis, if necessary, do the doll head rotation test.

Differential diagnosis

Because many esotropia occurring within 1 year of age are similar to infantile strabismus, it is difficult to diagnose. Because these esotropia and infantile esotropia are different in treatment, they should be identified clinically.

False esotropia

2. Duane eyeball regression syndrome: Intrinsic is a congenital ocular dyskinesia disease characterized by limited external rotation of the eyeball, normal or mildly restricted internal rotation, and the eyeball retreats when the internal rotation is attempted, and the cleft palate is reduced. Mostly unilateral, the internal slope does not exceed 30, most children have compensated head position, the face turned to the side of the affected eye.

3. Ocular shock block syndrome.

4. Congenital sexual nerve paralysis: the original eye position is esotropia, if one side is involved, there is a compensatory head position, the face turns to the paralyzed eye side, in order to maintain the binocular single vision, can be identified by the cover method: infantile strabismus If the patient covers the gaze for hours or days, then the uncovered eye can be turned outwards, and the true external rectus paralysis can not be turned outwards. It can also be identified by the doll head rotation test. The external ocular paralysis is restricted by the extraocular rotation. .

5. Perceptual esotropia: Esotropia occurring in infants and young children is often accompanied by intraocular tumors, congenital cataracts, choroidal defects, monocular hyperopia, etc., one eyesight decline, severely hinder the development of binocular vision, can lead to esotropia.

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