Intermittent squint

Introduction to intermittent strabismus Intermittent strabismus is a kind of strabismus between occult and common strabismus. It means that the visual axis is often separated, which occurs when looking far away. When looking far, the fusion spread exceeds the full set amplitude. , that is, the external oblique is generated, and the performance can be intermittent. Before intermittent strabismus occurs, there is a slant. basic knowledge The proportion of illness: 0.005%-0.008% Susceptible people: no specific population Mode of infection: non-infectious Complications: strabismus, strabismus, paralytic strabismus, intermittent exotropia

Causes of intermittent strabismus

Body factor

Its incidence is mainly caused by the imbalance of outreach and collection function. When the ability to gather is insufficient and the ability to integrate is low, it is impossible to resist excessive outreaching ability, and the eye position tends to be outwardly skewed.

Intermittent strabismus prevention

Prevention of children's strabismus focuses on eliminating the conditions that cause strabismus. Try not to keep children away from objects in close range and in the same direction. If you find that your child has strabismus at 2 months, try the following simple method: if it is internal oblique, parents can Talk to your child at a remote location, or hang some colorful toys in a distance that is far away, and let the children see more things that move.

Intermittent strabismus complications Complications , oblique oblique strabismus, paralytic strabismus, intermittent exotropia

The most common complication is strabismic amblyopia, which refers to the absence of organic lesions in the eyeball and the inability to correct visual function due to eye deflection.

After the eye position is skewed, the visual center actively suppresses the visual function of the oblique eye. The result of the inhibition causes the development of the macular function to be stagnant, forming amblyopia, and some do not produce inhibition, but form anoretical retinal correspondence (ARC). The macula has a new correspondence with the retinal components outside the macula. The visual function of the retinal components other than the macula is low. The corresponding results of retinal abnormalities also form amblyopia, especially in infants and young children, due to retinal vision. The central function is not fully developed, that is, the inhibition and abnormal retinal correspondence are generated, which is more likely to lead to the formation of amblyopia. Even if these children with strabismus have refractive errors, they cannot improve their vision through the glasses. The severity of amblyopia and the age of onset of strabismus , duration, treatment, morning and evening and other factors are closely related, congenital strabismus, monocular strabismus, long-lasting and untreated strabismus, easy to form severe amblyopia, clinically seen patients with severe amblyopia, mostly due to strabismus or squinting Due to the paradox, some parents think that strabismus does not affect The child's whole body development only affects the appearance. Some doctors even think that strabismus should be corrected after the adult. These views are all wrong. It ignores the consequences of strabismus which can cause amblyopia, and the patient misses the treatment of amblyopia. Good timing, even if the treatment of amblyopia after adult is effective, it is very difficult, especially for severe amblyopia in one eye. After covering the healthy eye, the patient can not work and learn normally. It is difficult to adhere to the treatment. Therefore, the early stage of strabismic amblyopia should be emphasized. The importance of treatment to prevent the occurrence of amblyopia, can cause recurrence, eye dizziness, affecting normal work and life.

Intermittent strabismus symptoms Common symptoms Intraocular oblique internal oblique V sign internal oblique A sign strabismic amblyopia

Intermittent exotropia often occurs in children's early stages. It occurs only when looking far. As the disease progresses, the number and duration of intermittent exotropia increases, and at the end of the day, exotropia can also occur. The slanting period of intermittent exotropia often occurs when fatigue, illness, drowsiness, or inattention. Intermittent exotropia may have temporary diplopia in visually immature children, which is soon suppressed and has abnormal retinal correspondence.

Common symptoms are photophobia. In outdoor sunlight, the eye is often closed. The reason is unknown. It is estimated that the patient looks at a distant target outdoors, no near-object stimulation, so that the two eyes gather, and the bright sunlight flashes the retina, which interferes with the fusion. The patient changes from the oblique to the obvious, but it is not necessarily certain that the patient closes one eye to avoid double vision. It is possible that the bright light affects the fusion set amplitude of the intermittent exotropia patient and closes the eye. Intermittent exotropia can be combined with AV signs, and can also be accompanied by other vertical strabismus, such as discrete upper strabismus.

Intermittent strabismus examination

1, eye general examination

Including the examination of far, near vision and corrected vision as well as extraocular, refractive interstitial and fundus examinations, in order to understand whether there is amblyopia, whether there is obvious refractive error, whether there are other eye diseases causing strabismus, with or without pseudo strabismus, etc. .

(1) Vision examination: should check far, near vision and corrective vision, children's visual examination is affected by many factors, such as children's age, intelligence, understanding, expression, mental state and environmental conditions, etc., especially infants and young children Can not cooperate well, vision examination is quite difficult, and there is no simple and accurate, accurate and reliable inspection method, so it should be patiently and meticulously repeated inspections, attitudes are amiable, methods are flexible, try to get children to cooperate, for Avoid infants and children crying and crying, the examination is not necessarily in the diagnosis room, the child can be placed in the waiting room, let him play with toys at random, read the book, observe whether the performance of the object is abnormal, or use toys and variable The brightness of the light is done to check the target to attract the child's interest and strive for the child's cooperation.

Inspection method: Usually children over the age of 3 can use the "E" shape chart or other letter eye chart check. The training should be carried out first, and the children should cooperate for the analysis. The results of several tests should be comprehensively analyzed. The following methods are commonly used for visual inspection of infants under 3 years of age.

(2) Examination of fundus and refractive interstitial: exclusion of fundus diseases and refractive interstitial opacity, such as retinoblastoma, post-crystal fibroproliferative disease, Coats disease, etc. Secondary strabismus caused by poor vision, clinically Many children have strabismus to the hospital for treatment. After detailed examination, it is found that there are obvious abnormal changes in the posterior segment of the eye. For patients with such strabismus, the diagnosis should be made first, and the primary disease should be treated. If the condition is stable, then consider whether to perform strabismus surgery. .

2, squint nature and squint direction inspection

The masking method is commonly used for inspection. The masking method is a simple and convenient method, and the result is accurate and reliable. The nature and direction of the eye position deflection can be quickly determined, the characteristics of the eyeball deflection when different eye positions are measured, and the squint eye is judged. In the fixation state, it is found that there is abnormality in the movement of the eyeball, and the type and characteristics of the double vision are determined. If the prism is added, the accuracy of the strabismus can be determined, and the cover inspection has double-eye alternate coverage and single-eye cover, except for the cover inspection.

(1) Alternate occlusion method: This method is a method for checking the presence or absence of occult and intermittent strabismus. When the patient is seated with the examiner during the examination, the two eyes are at the same height, and the patient is allowed to look at the light or small visual target at 33 cm or 5 m. Use an opaque hard plate with a width of 5cm and a length of 10~15cm as the eye-blocking plate, and cover the eyes alternately. Observe whether the eyeball rotates or rotates when the cover is removed. If the eyeball does not rotate, it means that both eyes are covered and uncovered. Can coordinate the gaze, the eye position is not skewed, if the eyeball rotates, it means that the occlusion eye deviates from the normal gaze position, no longer gaze at the target, and the fusion function is restored when the occlusion is removed, the eye returns to the gaze position, and the eyeball is inward. Rotate to the external oblique, outward to the inner oblique, downward to the upper oblique, upward to the lower oblique, if not covered, both eyes are looking at the eye position, when the eye is covered, the eye position is skewed, remove When the cover is closed, the positive position cannot be restored, so that the patient can look at the close target, the fusion function of both eyes is restored, and the oblique eye is turned into the positive position, which is explained as intermittent strabismus. The basic principle of the method is to eliminate the fusion function by covering the eyes and make the eyes Become a monovision, must be quickly converted blindfold plate check, do not let your eyes have the opportunity to expose the same time, the time should be covered in more than 2s, repeatedly, completely destroyed integration, fully exposed to the eye position deviation degree.

(2) Monocular covering and de-covering inspection method: This method covers one eye and observes the rotation of the uncovered eye. When the covering is removed, the movement of both eyes is observed to judge the nature and direction of the strabismus.

1 In the case of binocular gaze, the eyeball does not rotate when covering any eye and removing the cover, indicating that after the fusion is destroyed, the macula gaze can be maintained, and the visual axes of both eyes are kept parallel and there is no strabismus.

2 No matter whether one eye is covered or not, the eyeball rotates in the uncovered eye, indicating that the naked eye has an eye position skew, and the eye is not able to look at the target. After the eye is covered, the naked eye is forced to change from the oblique position to the gaze position.

3 When the cover is removed, the eyes do not rotate. There may be two kinds of situations. One is the right eye and the other is the alternating strabismus. Both eyes have good vision and have gaze function. In patients with alternating strabismus, the eyes cannot At the same time, when gazing, when the eye is covered, the naked eye is gazing. When the cover is removed, the naked eye is still watching the eye position, and the original covered eye is still in the oblique position.

4 When the cover is removed, if both eyes rotate, it means that the naked eye is a constant squint eye, and the covered eye is a gaze eye, because when the eye is covered, the naked eye, that is, the constant squint eye, is forced to turn into a positive position and gaze. The target is that when the eye is covered, the eye is rotated and becomes a squint. However, when the eye is covered, since the eye is the eye, it immediately turns back to the positive position, and the other eye rotates accordingly. The original oblique position, so when the single eye is constantly deflected, both eyes appear to rotate when the eye is covered and uncovered.

5 When covering the cover, if the original naked eye does not move, and the cover eye rotates, it means that it is hidden, the covered eye is covered, the fusion is broken and the deflection occurs. When the cover is covered, the fusion is restored, and the covered eye turns into the eye position. .

6 Cover any eye, when the eye is covered, the eyeball rotates from top to bottom, accompanied by the rotation of the eyeball, indicating that the eyes are alternately inclined, so-called vertical eye position separation.

In addition, the clinical use of the occlusion test can also distinguish the strabismus with cross-gaze as common strabismus or paralytic strabismus, determine the nature of gaze, diagnose intermittent strabismus, etc., cover the gaze for several hours, if the abduction function is restored, then cross Common slanting or pseudo-external palsy of gaze. If the gaze is gaze and the strabismus is gazing, the strabismus cannot be turned to the right position. The corneal gliding point is not in the center of the cornea, or nystagmus occurs, indicating that the squint is the side center. Gaze, if the eye position is right when the close-up examination, after cloaking, the occultation of the covered eye appears, and the squint after occlusion, indicating intermittent strabismus.

3, eye movement check

Through the examination of eye movements, to understand the strength of muscle strength, whether there is obvious muscle paralysis or excessive muscle strength, whether the movement of both eyes is consistent, when examining eye movements, the examination of monocular movement and binocular movement should be performed separately.

(1) Monocular exercise:

1 When the internal rotation of the pupil reaches the upper and lower puncture points, the inner rotation is stronger than the limit, and the inability to reach is insufficient.

2 The outer edge of the cornea reaches the external ankle angle when the external rotation is exceeded. If the limit exceeds this limit, the external rotation is too strong, and those who cannot reach the outside are insufficient. It is necessary to pay attention to the difference between true abduction paralysis or pseudo abduction paralysis. In addition to the method of checking the abduction function after a few hours of covering, the "doll head test" can also be used, that is, the head of the child is hand-held, and the head is forced to suddenly turn to the opposite side while observing Whether the eyeball can be turned outwards, if it can be transferred to the external ankle angle, it is a false abduction paralysis. If it cannot be rotated, it is a true abduction paralysis.

3 When the car is turned up, the lower edge of the cornea reaches the inside and the outer iliac crest is connected.

When the 4 turns down, the upper edge of the cornea reaches the inside and the outer rim is connected.

(2) Binocular movement examination: Both eyes include two-eye movement and two-way movement, and the two-eye movement is coordinated under normal conditions. If there is eye muscle paralysis or sputum, the two-eye movement can show different degrees. An abnormality, which can be judged by comparing the amplitude of the eye movement of the terminal eye position with the degree of eyeball deflection when gazing in different directions. When the eyes move in the same direction in one direction, the eye does not reach the proper position or The tremor-like movement (which should exclude the physiological nystagmus that occurs when the eye turns to the extreme side under normal conditions) indicates that the muscles rotating in this direction are insufficiently functional. If the movement exceeds the normal range, it indicates the muscle function of the movement in that direction. Too strong, if moving in all directions, the eyeball skewness is equal, it is common strabismus, otherwise it is non-common strabismus.

4, the same machine inspection

Synoptophore, also known as large amplyoscope, is a large-scale multi-functional optoelectronic instrument widely used in clinical practice. It is not only used to check the strabismus of different gaze directions of strabismus patients, binocular visual function status and main , objective bevel angle, Kappa angle, etc., can also be used for training of binocular vision function, treatment of amblyopia and correction of abnormal retina, etc. The same vision machine consists of 4 parts: left and right lens barrels, middle connection part And the base.

When checking with the same machine, first adjust the position of the lower jaw and the forehead, adjust all the dial hands to 0, adjust the interpupillary distance, so that the patient's eyes are close to the eyepiece of the lens barrel, and the head position is kept straight, especially For patients with compensated head position, it is more important to pay attention to whether the head position is correct. If there is refractive error, wear corrective glasses or a lens with corresponding diopter in front of the eyepiece. Be patient, serious and repeated for young children. Check for accuracy.

(1) Determination of conscious bevel: Apply simultaneous sensation pictures, which are two pictures with completely different patterns, such as lions and cages, cars and houses. The size of the pictures is divided into 10° pictures of the yellow spots at the same time. The 3° picture of the macular part and the 1° picture of the fovea at the same time can be selected according to different uses, age, vision and intelligence of the patient, so that the patient can push the handle of the squint side tube by hand. The two pictures are overlapped. At this time, the scale indicated by the lens arm is the patient's conscious angle. If the patient repeatedly pushes the lens barrel and cannot simultaneously hold the two pictures together, it means that there is no conscious angle. Retinal correspondence is absent. If the two pictures gradually approach, they suddenly jump to the opposite side, indicating that there are inhibitory dark spots nearby.

(2) Determination of the oblique angle of the squint: When checking, the ocular side lens barrel is moved to 0, the squint eye side lens arm is moved to coincide with the squint eye line of sight, and the double barrel light source is alternately turned off to observe the binocular movement. In this case, adjust the position of the lens arm until the eyeball is no longer rotated when the lamp is turned off alternately. At this time, the degree indicated on the arm of the lens tube is his oblique angle of view.

Intermittent strabismus diagnosis

Differential diagnosis

Mainly distinguished from pseudo-strabismus, the position of the eyeball is related to many factors, sometimes it seems that there is strabismus in appearance, in fact, the eye position is positive, the head, the width of the eyelid, the face, the position of the eyelid, the shape, the shape of the cleft And the length and length of the gap, etc., can cause the appearance of a false oblique, if not carefully checked, often caused misdiagnosis.

Pseudostrabismus (pseudostrabismus) is internal oblique, exotropia is more common, and false upper oblique is relatively rare.

False internal oblique is common in the internal epidermis, the nasal root is wide, the distance between the eyelids is narrow, the negative Kappa angle, the pupil distance is small, the eyeball is sunken, the highest point of the upper jaw is moved outward, etc. The inner suede is half a month on both sides of the nasal root. The skin folds, the concave surface faces the inner corner, and the heavy one can completely cover the inner corner and the half moon fold. The cornea is inwardly clustered and misdiagnosed as an internal oblique. If the skin of the bridge is lifted with a finger, the appearance of the inner oblique is Disappeared, under normal circumstances, when we look at the target in front, the position of the highest point of the upper jaw should correspond to the center of the pupil. If the highest point moves outward, the appearance of the internal oblique can be revealed, but the cornea is used to check the eyes. The corneal reflection point is symmetrical, and when the eyes are alternately covered, the eyeball has no outward movement.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.