OPTIMIZATION OF DIAGNOSTICS, TREATMENT AND PREVENTION OF CONCOMITANT DIVERGENT STRABISMUS WITH A VERTICAL COMPONENT

Аннотация

Strabismus is a permanent or periodic deviation of the visual axis of the eye from the fixation point, which leads to impaired binocular vision. Strabismus is manifested by an external defect - deviation of the eye / eyes towards the nose or temple, up or down. In addition, a patient with strabismus may experience double vision, dizziness and headaches, decreased vision and amblyopia. Diagnosis of strabismus includes an ophthalmological examination (visual acuity test, biomicroscopy, perimetry, ophthalmoscopy, skiascopy, refractometry, biometric examination of the eye, etc.), neurological examination. Treatment of strabismus is carried out using glasses or contact correction, hardware procedures, pleoptic, orthoptic and diploptic methods, and surgical correction. Keywords: Classification, causes, symptoms, diagnosis, treatment, prognosis and prevention. Introduction: In pediatric ophthalmology, strabismus (heterotropia or strabismus) occurs in 1.5-3% of children, with equal frequency in girls and boys. As a rule, strabismus develops at the age of 2-3 years, when the coordinated work of both eyes is formed; At the same time, congenital strabismus can also occur. Strabismus is not only a cosmetic defect: this disease leads to a violation of the work of almost all parts of the visual analyzer and can be accompanied by a number of visual impairments. With strabismus, the deviation of the position of one or both eyes from the central axis leads to the fact that the visual axes do not intersect at a fixed object. In this case, the monocular images perceived separately by the left and right eyes in the visual centers of the cerebral cortex do not merge into a single visual image, but a double image of the object appears. To protect against double vision, the central nervous system suppresses signals from the squinted eye, which over time leads to amblyopia - a functional decrease in vision, in which the squinted eye is almost or completely absent from the visual process. If strabismus is not treated, about 50% of children develop amblyopia and vision loss. In addition, strabismus negatively affects the development of the psyche, contributes to the development of isolation, negativity, irritability, and also imposes restrictions on the choice of profession and the sphere of human activity. Research methods and materials Depending on the time of occurrence, strabismus is divided into congenital (infantile - present from birth or developing in the first 6 months) and acquired (usually developing before the age of 3). Based on the stability of the deviation of the eye, a distinction is made between periodic (transient) and permanent strabismus. 193 Noyabr, 2025-Yil Depending on which eyes are affected, strabismus can be unilateral (unilateral) and intermittent (alternating) - in the latter case, one eye, then the other, is squinted alternately. According to the severity, strabismus is classified as latent (heterophoria), compensated (detected only during an ophthalmological examination), subcompensated (appears when control is impaired), and decompensated (uncontrollable). Depending on the direction of deviation of the strabismus, horizontal, vertical and mixed strabismus are distinguished. Horizontal strabismus can be convergent (esotropia, converging strabismus) - in this case, the strabismus deviates towards the bridge of the nose; and divergent (exotropia, divergent strabismus) - the strabismus deviates towards the temple. In vertical strabismus, two forms are also distinguished, with the eye moving upwards (hypertropia, supravergence strabismus) and downwards (hypotropia, infravergence strabismus). In some cases, cyclotropia occurs - a twisting heterotropia, in which the vertical meridian is tilted towards the temple (excyclotropia) or towards the nose (incyclotropia). In terms of the causes of the occurrence, a distinction is made between combined and paralytic non-combined strabismus. In 70-80% of cases, combined strabismus is convergent, in 15-20% - divergent. Usually, torsion and vertical deviations are found in paralytic strabismus. With combined strabismus, the movements of the eyeballs in different directions are fully preserved, there is no diplopia, and there is a violation of binocular vision. Combined strabismus can be accommodative, partially accommodative, or ambiguous. Accommodative strabismus often develops at the age of 2.5-3 years due to the presence of high and moderate hyperopia, nearsightedness, and astigmatism. In this case, the use of corrective glasses or contact lenses, as well as hardware treatment, helps restore the symmetrical position of the eyes. In children aged 1 and 2 years of life, signs of partially accommodative and non- accommodative strabismus appear. In these forms of combined strabismus, refractive error is far from the only cause of heterotropia, therefore, surgical treatment is required to restore the position of the eyelids. Causes of strabismus The occurrence of congenit