If a baby is born much earlier than the expected due date, this increases the risk of various health problems. One of the quite serious and common pathologies in very premature babies is retinopathy.
What is this?
This is the name for a problem with the retina in babies born much earlier than their due date. Its code is 10 μb - N 35.1. The main danger of retinopathy is risk of permanent loss of visual function.
Retinopathy has been studied well enough to provide effective treatment.
Reasons
The disease is caused by many factors, the main one being immaturity of a baby born before 34 weeks of intrauterine development. However, a baby can be born on time, but still remain immature. Other factors that provoke retinopathy are:
- Low baby weight.
- Multiple births.
- Concomitant pathologies fetus, for example, the development of sepsis, anemia or acidosis.
- Chronic diseases mother's genitals.
- Preeclampsia.
- Bleeding during childbirth.
- Performing mechanical ventilation and using oxygen after birth.
For more information about the causes of retinopathy, watch the video:
Features of pathogenesis
The vessels inside the retina begin to develop from the 16th week of intrauterine development of the baby. Until this time, there are no vessels at all in this part of the eye. They begin to grow from the area where the optic nerve exits towards the periphery. The vessels actively grow until the very beginning of labor, therefore, The earlier a baby is born, the fewer vessels have time to form in its retina. In very premature infants, fairly large areas without blood vessels are detected (they are called avascular).
When a child is born, his retina begins to be affected by various external factors (primarily oxygen and light), which provokes the appearance of retinopathy. The normal process of blood vessel formation is disrupted. They begin to grow into the vitreous body, and the simultaneous growth connective tissue leads to stretching of the retina and its detachment.
Schematic representation of retinopathy
Retinopathy in premature newborns develops as follows:
- First passes active period(from birth to 6 months). During this period, the veins dilate, the arteries change, the vessels become tortuous, and clouding is possible vitreous, tractional detachment of fiber, less often its rupture or separation.
- Next comes phase of reverse development. This period begins at 6 months of age and lasts on average up to a year.
- Starts at 1 year scar period. During it, myopia may develop, clouding of the lens, detachment or rupture of the retina often appears, the eyeballs may become smaller, and intraocular pressure may also increase. Sometimes the iris and lens move forward, which causes clouding of the cornea and its dystrophy.
The scar period characterizes an increase in problems with the baby’s vision.
Stages of retinopathy
Stage I
A whitish line appears at the junction of normal vascular tissue and avascular areas. Identification of such a dividing line is the reason for weekly examinations of the baby.
Stage II
A shaft appears at the site of the line of separation of the avascular retina with the vascular areas. In 70-80% of newborns at this stage, spontaneous improvement occurs, while minor changes remain in the fundus.
Stage III
Fibrous tissue appears in the resulting shaft, and the vitreous body above it thickens, as a result of which the retinal vessels are drawn into the vitreous body. This causes tension on the retina and a high risk of detachment. This stage is also called the threshold stage, because as it progresses, retinopathy becomes almost irreversible.
IV stage
The retina is partially detached without involvement central department(transition to stage 4A) and with detachment in the central region (transition to stage 4B). This stage and subsequent changes are called terminal, since the prognosis for the child worsens, and vision is sharply impaired.
Stage V
The retina peels off completely, which leads to a sharp deterioration in the baby’s vision.
Separately allocate plus-disease, which has no clear stages. This form develops earlier and progresses much faster, which causes retinal detachment and rapid onset terminal stages retinopathy.
Diagnostics
All babies born before 35 weeks or with low birth weight (less than 2 kg) should be examined by an ophthalmologist using special equipment for this examination. If symptoms of retinopathy have been identified, the newborn continues to be examined once a week, and in the presence of plus disease even more often - every three days.
Examinations continue until the disease completely regresses or requires surgical therapy. As soon as the disease begins to regress, the baby is examined every two weeks.
During the examination of the baby in mandatory dilate the pupil and also use special eyelid dilators for the procedure (they will eliminate pressure on the eyes from the fingers). Additional method Examination for retinopathy is ultrasound of the eyes.
Children diagnosed with retinopathy are regularly observed by an ophthalmologist
Treatment
The treatment of retinopathy is influenced by the stage of the disease, but all treatment methods can be divided into:
- Conservative. The child is being given an instillation medicines, which were prescribed by the ophthalmologist. This treatment is considered ineffective.
- Surgical. The method of such treatment is chosen taking into account the course of retinopathy (usually it is carried out at stages 3-4 of the disease). Many children are prescribed cryosurgery or laser treatment. When detachment begins, in specialized clinics The child's vitreous body is removed.
Prognosis and prevention
The average duration of active retinopathy is 3-6 months. The development of the disease may result in spontaneous recovery.(often observed in the first and second stages), and scarring, in which residual changes have different severity. Based on them scar changes divided into degrees:
- At first degree the fundus of the eye is almost unchanged, so visual functions are not impaired.
- Second degree characterized by a displacement of the center of the retina, as well as changes in peripheral areas, which increases the risk of secondary detachment in the future.
- When develops third degree, in the retina there is a deformation of the area where the optic nerve enters it. The central part of the retina is greatly displaced.
- Fourth degree manifested by pronounced folds on the retina, causing severe violation vision.
- At the fifth degree total retinal detachment is noted.
Prevention of retinopathy involves preventing premature birth. In addition, it is aimed at proper nursing of a child born ahead of schedule.
Preterm birth is the most common reason occurrence of retinopathy in a child
When a child is diagnosed with stage 1 of the disease, a prophylactic prescription is required corticosteroid hormones, and during oxygen therapy, antioxidants are additionally prescribed. Having determined the baby has stage 2, the dosage of hormonal drugs is increased, and additional oxygen and drugs that dilate blood vessels, if possible, limit.
Quite effective in preventing retinopathy are methods of destroying avascular zones in the retina, such as cryocoagulation and laser coagulation. Their use reduces the incidence of adverse outcomes by 50-80%. The manipulations are carried out under general anesthesia, the result is assessed after 7-14 days and, if necessary, the procedure is repeated.
Cryocoagulation can stop the development of scar tissue in the baby’s retina
In severe stages of retinopathy, the child's vision is greatly affected. Even surgical treatment can only improve light perception and make it possible to navigate in a room and follow objects.
It is also worth noting that children with mild stages In the future, visual impairments such as amblyopia, glaucoma, myopia and late detachment are possible. For this reason they should be seen regularly by an ophthalmologist until age 18.
Retinopathy is a process in several stages, which can end with both the formation of a scar and complete regression, in which all manifestations disappear.
Formation visual analyzer begins as early as 3 weeks of intrauterine development and continues throughout pregnancy. By the time of birth, the eye is anatomically formed, but some structures have not yet fully matured.
The vision of a newborn child is caused by the following conditions:
- retinal immaturity;
- immaturity of neural connections optic nerve with the brain;
- immaturity of the visual centers of the cerebral cortex;
- weakness of the ciliary muscle;
- incomplete development of oculomotor nerves.
Given the immaturity of many structures responsible for vision, a newborn sees only light and shadow, that is, his vision is at the level of light perception. As the child grows and develops, the visual analyzer is formed, which leads to an improvement in visual functions.
Development of vision in newborns by month
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Visual acuity and visual functions |
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As the child grows and develops, visual functions improve. The visual acuity of a newborn will reach the level of an adult only by school age, by about 7 years.
Important! If, after the newborn's vision has formed, the eyes deviate in any direction, you should consult a doctor to determine the cause of strabismus.
There is an opinion that a newborn has inverted vision. But this is not so - the visual center of the cerebral cortex, processing information from the retina, turns the image to the desired position.
How is a newborn's vision checked?
A healthy child is first examined by an ophthalmologist at the age of 1 month, but if in the maternity hospital the neonatologist has any doubts about the condition of the eyes, he prescribes a consultation with a specialist.
There are various methods determination of visual functions in children, the possibility of their use depends on the age of the child.
It is impossible to determine visual acuity in a newborn in the maternity hospital and at 1 or 2 months due to age. To assess the condition of the visual analyzer, external inspection and ophthalmoscopic examination. During an ophthalmological examination, pay attention to the following features:
- shape and mobility of the eyelids;
- location of the eyeball in the orbital cavity;
- symmetry of eye placement;
- assessment of eyeball movement. Before the child learns to follow an object, eye movements are determined by changing the position of the child’s head (turn the head to the right, left);
- determine the presence of strabismus;
- assess the size of the pupils and their reaction to light;
- check the transparency of the eye media: cornea, anterior chamber moisture, lens, vitreous body;
- assess the condition of the retina, retinal vessels and optic nerve head.
After the child learns to hold his gaze on an object, the value of refraction can be determined. Refraction is determined in the following ways:
- skiascopic examination;
- using the PlusOptix pediatric autorefractometer.
It is very important to promptly detect the presence of eye pathology in children. Therefore, parents should know how to test their newborn's vision at home. To do this, you need to closely monitor the baby’s development:
- see whether the child reacts to light, whether he pays attention to his mother, what size the pupils are, whether there is squint;
- In children older than 1 month, you additionally need to pay attention to how the baby looks after the toys and whether he sees small details.
To check vision at home, you can do the following test: cover first one eye of the child with your palm, then the other, and show the toy. If the child looks and follows the toy and does not try to remove your hand, then his vision is normal.
Vision in premature newborns
The eye of a premature baby is distinguished not only by its functional immaturity, but also by its incomplete anatomical structure. It is the underdevelopment of retinal vessels that plays a role important role in the development of such a terrible disease as retinopathy of prematurity.
Children with retinopathy of prematurity are at risk for developing low vision and blindness among child population. Premature baby, born at less than 35 weeks of gestation and/or weighing less than 2000 g, should be examined by an ophthalmologist no later than 4 weeks of life. During the examination, attention is paid to the transparency of the eye media, the condition of the retina and retinal vessels.
The formation of the retina and vision in premature babies occurs as they grow and develop, but there may be some lag in the development of visual functions in relation to full-term babies.
Vision training for newborns
The main stimulus for the development of vision is the presence sunlight. Therefore, the children's room must have a window to let in sunlight.
For vision, it is important to have visual stimuli - bright toys that the child could pay attention to, and as he grows, reach them. From 2-3 months, you can show pictures to train vision for newborns - contrasting black and white drawings.
Yulia Chernova, ophthalmologist, especially for the site
Useful video
A newborn baby is no different good eyesight, and sometimes he completely shocks his parents because his eyes squint, cannot focus, they are clouded. Questions about whether the child is healthy and whether he can see are quite common reasons for visiting pediatricians. In this article we will tell you what the features of visual function are in babies of the first year of life and how to determine whether the baby can see.
Peculiarities
The baby sees the world around us not at all like adults. This is easy to explain first of all physiological reasons- a child’s eyes differ significantly in structure from the eyes of an adult. Children are not born with visual organs that are fully adapted to this world and sufficiently formed. All babies, without exception, have extremely low visual acuity in the 1st month of life. Everything that for us is a picture of the surrounding world, for a newborn is a set of spots of different illumination and intensity. His eyes are in a continuous process of formation.
The eyeballs of a newborn are much smaller in proportion than the eyeballs of an adult, and therefore the baby receives the image not on the retina, but in the space behind it.
This explains why all infants suffer from physiological farsightedness, which is completely normal for them. In the first days, the baby does not focus his gaze at all. Sees mostly black and white spots, only outlines and at an average distance - about 40 centimeters. But he perfectly distinguishes between light and darkness. In response to a bright source of light, the baby may begin to blink, close his eyes, try to cover himself with his hand, shudder with his whole body, and the baby may react to a too harsh and bright light with a dissatisfied, angry cry. These reflexes are called unconditioned visual. They must be checked in the maternity hospital.
There is a myth that a newborn's vision is upside down. This is not true. If there are no pathologies of the brain or gross congenital defects in its development, then the baby sees exactly the same as all other people. An inverted image is not typical for infants.
But many completely healthy babies who were born just a couple of months ago are characterized by a wide variety of eye movements, which parents sometimes mistake for strabismus, nystagmus, and other signs. poor eyesight. In fact, newborns and infants have very weak eye muscles, and therefore it is not surprising that one eye of the baby is looking at you, and the other is slightly to the side. This is a temporary phenomenon, which, with the normal development of visual analyzers, will disappear on its own in a fairly short time.
In the first three years of life, the baby’s visual organs undergo enormous dramatic changes. This process requires a reverent attitude on the part of adults, the elimination of all negative factors due to which vision problems may develop. To act correctly, mothers and fathers need to know what processes occur and at what stages of development; this will help maintain the child’s health and notice deviations in time if they occur.
Stages of development
The eyes of the embryo begin to form at 8-10 weeks of pregnancy. It is important that at this moment the mother is healthy, and no negative factors did not affect the correct formation of the organs of vision and the optic nerve. Pathologies that arise during the period of stay in the womb are quite difficult to correct, if they can be corrected at all.
In the mother’s belly, the baby distinguishes between light and darkness, demonstrates unconditioned visual reflexes, but he does not see bright light, getting used to a darkened and dim atmosphere. After birth, the toddler needs to adapt to its new living conditions. The baby begins to distinguish something other than light at about 3 weeks after birth. It is at this stage that object and color vision begins to form.
By the beginning of the second month independent life The baby can already hold his gaze for a very short time at large bright and large objects located at a distance of no more than 60 cm from him. By 3 months, the baby is able to follow a silent toy with his eyes for much longer. Moreover, the toy itself can now move left and right and up and down. The child repeats similar movements with his eyeballs, turns his head towards a bright object of interest to him.
By six months, children develop stereoscopic vision. The baby has no problems focusing on objects, following them with his eyes, and can reach out and take toys in his hands.
Color perception is formed gradually - first, babies begin to distinguish the color red and give preference to it. Then they see yellow. Green and blue are the last to be comprehended and realized.
After 6 months, toddlers learn to see distant spaces. Stereoscopic vision allows them to see the world as three-dimensional, full-fledged, and the improving capabilities of the body (he learns to sit, crawl, walk) gradually stimulate the development of the cortical part of the brain, which is also responsible for the accumulation of visual images. The baby learns to estimate the distance between objects and overcome it; the color scheme also becomes more saturated in the second half of life.
Congenital physiological farsightedness, characteristic of all infants, usually disappears by 3 years. During this time, children's eyeballs actively grow, the eye muscles and optic nerve develop and improve. A child’s visual organs become as similar as possible to adults only by the age of 6-7 years.
None age stage the child no longer experiences such dramatic changes and transformations in the organs of vision as in the first year of life.
Surveys
Children undergo their first examination by a neonatologist in the maternity hospital. It allows you to a large share accurately identify most congenital pathologies of the visual organs. These include neonatal retinopathy, congenital cataract and glaucoma, optic atrophy and other visual diseases. Serious congenital pathologies often accompanied by manifestations of such external signs, such as nystagmus (quivering and twitching of the pupils) and ptosis (drooping of the eyelid). However, an examination in a maternity hospital cannot be considered 100% reliable, since many diseases, including those inherited genetically, develop only over time.
That is why it is so important that infants, especially premature ones, are promptly examined by an ophthalmologist. The first examination always occurs at the age of 1 month. At this age, the doctor is limited to assessing visual reflexes, including a light test on the pupil, as well as a general examination of the eyes - the shape and size of the eyeballs, pupils, the purity (clearness) of the lens.
The next check for premature babies is planned to be at 3 months, and then at six months. For babies born on time, one check every 6 months is sufficient.
At six months, the doctor will be able to get a more detailed idea of the baby’s visual function. He will not only visually assess the condition of the eyes using instruments, but will also check their motor activity, focusing on objects, synchrony of reactions, accommodation and refraction. The doctor will tell the parents of a six-month-old child with a high degree of accuracy whether their child’s slight strabismus is functional and harmless or is it pathological change which needs correction.
If parents have doubts that the child sees well, the doctor may try to examine the baby’s vision using a special tablet. One half of the sheet is covered with black and white stripes, the second is white. The mother closes one of the baby’s eyes, and the doctor brings this piece of paper to his face. If the baby automatically begins to look at the striped part of the table, then he sees, and there is no reason to worry.
An ophthalmologist can conduct the same study at the next scheduled inspection which must be completed in 1 year. After one and a half years, Orlova’s diagnostic table is used to assess visual acuity; if any disorders are detected, the degree and severity of the problem is checked using special techniques and devices. After one and a half years, it is recommended to check your child’s vision twice a year.
How to check it yourself?
Check your newborn's vision independently at home and infant quite difficult. However, there are symptoms that parents must pay attention to and consult a doctor as early as possible, who will help conduct a full and detailed examination at the clinic:
- The child was born into a family where close relatives have vision problems. With a high degree of probability, the baby will inherit the pathology; he should be observed by an ophthalmologist as often as possible.
- The child was born premature.
- At 1 month the baby does not react by constricting the pupil, if you shine a flashlight in his face.
- After 3 months the baby does not focus on bright big toys, reacts only to “sounding” rattles and squeakers, not noticing toys and objects that do not make any sounds.
- At the age of 4 months does not follow the toy, which is moving.
- At the age of 5-7 months, the baby does not recognize the faces of his family and does not distinguish them from the faces of strangers, does not reach for toys, does not try to grab them with his hands.
- If purulent or other discharge appears from the organs of vision.
- If the child's eyeballs are different sizes.
- If the pupils move up and down involuntarily or from side to side, shaking slightly.
- If the baby noticeably “squints” with one eye.
- By the age of one year, the child does not pay attention to birds on the street, to other fairly distant objects.
All these signs cannot independently speak about possible pathology visual analyzers, but are a very convincing reason to visit an ophthalmologist unscheduled.
Development
The anatomical and physiological features of vision development in children of the first year of life (AFO) will tell parents what and how to do in order to promote the development of the baby’s visual function. If the baby was brought from the maternity hospital and placed in a darkened room with little sunlight, then all stages of vision formation may occur with a significant delay. For newborns, it is very important that the room is bright, so that there are no bright sources of light or mirrors near the crib. Access to the crib should be from all sides so that the baby gets used to looking at people and objects on both the right and left sides.
In the first days and even weeks, the child does not need any toys, since he will not really see them anyway. But by the 3-4th week of life, you can attach a mobile to the crib or hang rattles. The main requirement that will help maintain the health of your baby’s eyes is the distance from the face to the toy. It should not be less than 40 centimeters.
For the development of visual function, it will even be useful if the toy or mobile is raised from the baby’s face at a distance of 50-60 centimeters.
From one and a half months, the child can be shown black and white pictures, consisting of simple geometric elements. They can be found on the Internet and printed on sheets of A4 format. Such simple activities contribute to the development of the optic nerve, eye muscles, the child learns to perceive contrasting images.
From 40 to 90% of information about the world around us enters the brain through the eyes. Children with visual impairments require special attention to develop brain function.
According to WHO, every minute one child goes blind around the world. Moreover, in 75% of cases this could have been prevented, since a child’s visual apparatus develops before the age of 14. At early diagnosis Many eye diseases in children are curable.
The diseases that pediatric ophthalmologists encounter are most often acquired rather than congenital.
Common pathologies in childhood, their photos
Dry eye syndrome
Dry eye syndrome is a lack of moisture in the cornea and conjunctiva.. 50 years ago, the syndrome was considered a problem for adults, but now children also complain.
Appears due to dry air, constant eye strain, allergies, infections, and abnormalities in the structure of the eye.
Symptoms intensify in the evening or after being exposed to the wind or cold for a long time:
- pain and burning;
- photophobia;
- feeling of eye fatigue;
- the child often rubs his eyes;
- complaints of blurry vision;
- a network of red capillaries is visible on the protein.
Treatment is good hydration with drops and gels and mandatory elimination of the causes: getting rid of the infection, changing lenses to glasses, humidified warm air. If dryness is due to allergies, help antihistamines.
Uveitis
Inflammation of the iris and choroid eyes is called uveitis. It is caused by bacteria. Uveitis in children is a symptom of rheumatism, rheumatoid arthritis, glomerulonephritis, viral infection, . Since the choroid of the eye nourishes the retina and is responsible for its accommodation, disorders can cause partial or complete blindness.
Rheumatic uveitis is diagnosed in children over 3 years of age. It occurs more often in girls than in boys. The chronic form worsens in spring and autumn.
Symptoms of uveitis are not noticeable at first, especially in children who cannot talk about their feelings:
- tearfulness;
- fear of bright light;
- redness of the eye;
- vision is blurred;
- the eyelid swells;
- at acute form- sharp pain.
The main symptoms of ueviitis in children are presented in the photo below:
Uveitis is treated with initial stage anti-inflammatory drugs in the form of drops. In severe cases, injections are given in the lower eyelid, sometimes surgery is required.
Macular degeneration
Macular degeneration is a degenerative change in the retina due to insufficient nutrition. It is rare in children and can develop for hereditary reasons. Macular degeneration can be dry or wet.
Dry eyes form drusen - yellow age spots; then they merge and begin to darken.
Blackening means the death of light-sensitive cells and the development of blindness. At an early stage, it can be cured without consequences for vision.
The wet form is more dangerous. With it, new vessels appear, which burst and cause hemorrhage in the eye, light-sensitive cells die and are not restored.
With macular degeneration, the baby complains of:
- a blurred spot without pronounced contours;
- disorientation in the dark;
- straight lines appear curved.
Treatment of the dry form is carried out with antioxidant agents, preparations containing zinc, vitamins A and E. The wet form is treated with laser, intraocular injections, and photodynamic therapy.
Episcleritis
Episcleritis is an inflammation of the tissue that is located between the sclera and the conjunctiva of the eye.. It is rare in children. The most important symptom is severe redness white of the eye. The remaining signs are common to any inflammation of the eye: swelling, photophobia, lacrimation, headache. A rash may appear on the face.
Episcleritis goes away on its own without treatment in 5-60 days, but can become chronic. Then the disease will return. Treatment is usually symptomatic: artificial tears, chamomile rinsing, resting the eyes.
Anisocoria
Anisocoria is not considered a disease, it is a symptom, in which the difference in pupil diameter in children is greater than 1 mm (as in the photo below). This is explained by the fact that one of the pupils reacts incorrectly to irritants: light, illness, medications.
Anisocoria in a child, including infants, may indicate:
For diagnosis, diseases are excluded from the list one by one. When the cause is eliminated, the diameter of the pupils will return to normal.
Names of common ophthalmic diseases
At birth, the eyes are the least developed organ., therefore, various problems and dysfunctions can occur throughout the development of the visual system, up to 14 years.
In addition to the diseases listed above, ophthalmologists also encounter other problems in children:
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, or "lazy eye"– a symptom in which one eye sees worse than the other. IN baby brain a different image arrives and is processed incorrectly.
When the underlying disease is corrected, one eye still “habitually” sees worse. Amblyopia can be treated without consequences for up to 3-4 years, while the visual areas in the brain are being formed. In older children, vision will no longer be 100% the same in both eyes.
- – clouding of the lens, due to which the eye loses light sensitivity. This disease occurs in approximately 3 children out of 10,000. If it is congenital, it is diagnosed in the maternity hospital, if it develops later, it is diagnosed by an ophthalmologist at an appointment. If cataracts are not treated, complete blindness is possible. Surgery can completely restore vision.
- - a contagious disease. It can be viral, bacterial or allergic in nature. It is characterized by the appearance of purulent contents that stick together the eyelashes, redness of the eyes, a feeling of pain and “sand.” Treat with antiviral or antibacterial drops depending on what caused the disease.
- – bacterial inflammation of the hair follicle or sebaceous gland on the eyelid, not contagious, appears when immunity decreases. Most often it affects children from 7 to 17 years old. In adolescents during puberty, the secretion of the sebaceous gland becomes more viscous, it clogs the outlet and causes inflammation. The disease lasts about a week and ends with the opening of the abscess.
- – inflammation of the cartilage due to blockage of the sebaceous gland in the upper (usually) or lower eyelid. It manifests itself as swelling and redness, then an inflamed pea appears. Most often occurs in children 5-10 years old. Treated with massage, heating, drops. If necessary, the operation is performed under local anesthesia.
- Glaucoma It can be congenital or secondary, and includes more than 60 diseases with impaired outflow of intraocular fluid. Because of this, intraocular pressure increases, which leads to optic nerve atrophy and blindness. In children it is most often congenital; after 3 years it is very rarely diagnosed. More than 50% of children diagnosed with congenital glaucoma will become blind by 2 years of age without surgery.
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(myopia)– the most common eye disease in children. With this disease, the baby has trouble seeing objects located far away.
It occurs mainly in children over 9 years of age and progresses in adolescence due to rapid growth and hormonal changes.
May be due to heredity birth defects, constant voltage eyes, poor nutrition. Corrected with glasses or lenses.
- – blurry vision of objects near. All children under 7-9 years of age are farsighted from birth, but this indicator decreases as the eye system develops. If eyeball develops incorrectly, farsightedness does not decrease with age. Corrected by wearing glasses or contacts.
- – irregular shape of the cornea, eye or lens. Because of this, objects appear distorted. It is treated by wearing special glasses, using orthokeratology, and from the age of 18 you can perform laser surgery.
- - violation of the patency of the lacrimal canals. Because of this, fluid accumulates in the canal and begins purulent inflammation. It can be congenital and acquired, acute and chronic. In the acute form, on day 2-3, a hole forms in the corner of the eye through which fluid breaks out.
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Nystagmus– inability to fix the eyeball in one position. The vibration can be horizontal or vertical, indicating diseases of the nervous system.
It does not appear immediately, but closer to 2-3 months. In most children, nystagmus goes away on its own. In severe cases, surgery is indicated.
- – weakness of the eye muscles, in which the eyes look into different sides. In the first months this is considered normal, especially in premature babies, and then it is corrected by surgery.
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Neonatal retinopathy– retinal development disorder. Occurs in 20% of children born before 34 weeks weighing less than 2 kg due to the fact that the eyeball has not yet fully formed. About 30% of children survive this disease without further consequences for vision.
The rest develop complications: myopia, astigmatism, glaucoma, cataracts, retinal detachment.
- Ptosis- weakness of the muscle that lifts upper eyelid. If this congenital anomaly, then most often it is combined with other diseases. The eye may close completely or just a little. This feature is corrected surgically at the age of 3-4 years.
- localization of the lesion (relative to the optic nerve);
- the extensiveness of the process;
- stages of the disease - a total of 5 stages are distinguished, of which in the first two the disease can self-heal, which happens in 65–75% of children; Stage 3 is threshold, after which the disease enters the scar phase (stages 4–5) and at this time the child needs urgent surgical treatment;
- clinical course - has 3 phases:
- active (acute);
- regression;
- cicatricial.
- 1st degree - minimum changes in parts remote from the central zone of the fundus, visual functions are almost completely preserved;
- 2nd degree - characterized by displacement of the central part of the retina and degenerative changes peripheral zones, which can subsequently provoke secondary detachment of the membrane;
- 3rd degree - manifests itself as severe damage to the area where the optic nerve enters the retina, its significant displacement and degenerative changes not only in the peripheral zones, but also in the central ones;
- 4th degree - rough scars of the retina are formed, leading to significant deterioration of vision;
- Grade 5 - absolute retinal detachment, leading to complete loss of vision.
- severe infections suffered by the mother during pregnancy;
- hypoxia, asphyxia, cerebral hemorrhage that occurred due to complications during pregnancy and childbirth.
- change in pupil color (becomes gray);
- development of strabismus (if one eye is more affected than the other);
- child behavior disorder:
- stops fixing the gaze on objects;
- does not respond to light;
- does not distinguish at all large objects located at a short distance from him.
- Indirect ophthalmoscopy (examination of the fundus). Before the procedure, mydriatics (dilators that dilate the pupil, for example, Atropine) are instilled into the eyes. Using this method, the doctor assesses the condition of the retina and choroid of the eye, the condition of the optic nerve head.
- Ultrasound is used additionally at stages 3–5 of pathology and to determine the effectiveness of therapy.
- Electroretinogram - displays the bioelectrical activity of retinal neurons obtained in response to light stimulation.
- Diaphanoscopy - transillumination of eye tissue to detect pathology of the retina.
- Study of visual evoked potentials (VEP) - computer diagnostics, which makes it possible to determine in which area of the visual analyzer the impulse transmission is disrupted.
- OCT (optical coherence tomography) - scanning the retina with infrared rays to determine the degree of its detachment.
- retinoblastoma ( malignant tumor retina);
- intracranial hypertension;
- Criswick-Skepens disease (familial exudative vitreoretinopathy) is a genetic pathology that causes retinal detachment;
- retinal hemorrhage, which occurs during complicated labor;
- peripheral uveitis - inflammation of the choroid of the eye.
- electrophoresis with antioxidants;
- magnetic stimulation to improve recovery processes;
- electrooculostimulation - exposure to weak currents for normalization metabolic processes and improving blood supply to the eyeball.
- myopia (nearsightedness);
- amblyopia (poor vision, the so-called lazy eye);
- retinal dystrophy, late detachment;
- strabismus;
- glaucoma - serious illness associated with increased intraocular pressure as a result of which the fibers of the optic nerve are affected and complete loss of vision occurs;
- Cataract is clouding of the lens, leading to decreased visual acuity.
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Young children may also have problems with their eyes. Therefore, you will find articles on the following topics useful:
Even more useful information O eye diseases Children will learn from the following video clip:
Most eye diseases in children can be successfully treated if diagnosed early. Even developing blindness can be stopped and corrected if you pay attention to signs of deteriorating vision in a child in time.
Modern medicine has made great progress and now prematurely born babies are successfully nursed. However, the body of such children is vulnerable, since many organs and systems are not yet fully formed. Because of this, premature babies can develop various pathological conditions. One of these pathologies occurs against the background of underdevelopment of the retina of the eye and is called retinopathy.
What is retinopathy
The formation of the retina of the eye ends only by the 4th month of a child’s life, therefore, if the baby is not born on time and the impact on the body of a premature baby is negative external factors(atmosphere, oxygen, lighting), the retina is almost always damaged.
The pathology was first described at a time when doctors learned to care for children born prematurely. Initially, the retinal lesion due to prematurity was called retrolental fibroplasia. It was believed that the disease developed as a result of the use of incubators with high level oxygen. Later doctors found that the disease is also associated with insufficient duration of the intrauterine period, low birth weight of the child (less than 1.5 kg) and various disorders of the normal course of pregnancy.
Under the influence of the above reasons, deviations occur in proper development the retina, in particular, its vascularization (formation of blood vessels) is disrupted. The development of healthy vessels, which should provide good nutrition mesh shell. Compensatory mechanisms activated as a result of this disorder lead to the formation of new defective vessels that cannot cope with their functions, grow into the vitreous body, are often damaged and cause hemorrhages.
Due to insufficient nutrition of the retina, fibrotic changes begin (the growth of connective, scar tissue) on its surface and in the inner layers. These scars can cause tears and detachment of the membrane, and ultimately lead to complete loss of vision. Typically, both eyes are affected. If one eye is involved in the process more than the other, the baby develops strabismus.
Retinopathy occurs in one in five babies born prematurely, and about 8% of them suffer severe forms this pathology.
The development of fetal retinal vessels begins in the second trimester of pregnancy (at 16 weeks) and occurs from the optic disc to the borders of the eye. This process is completed by the time the baby is born (40 weeks). How earlier baby was born, the smaller the area of the retina with normally developed vessels, the larger the avascular (devoid of blood vessels) zones, and the higher the likelihood of the disease occurring.
The onset of retinopathy usually occurs at the end of the first month of life of a premature baby, and the peak occurs in the eighth week.
Classification of pathology + degrees
Pathology is classified according to the following criteria:
In 80% of cases, the disease has a classic course and goes through all 5 stages one by one. But sometimes retinopathy occurs atypically.
High degree of aggressiveness of the pathology and fast speed its development is designated by the special term “plus-disease”. Clinically, this symptom is characterized by dilation and severe tortuosity of the retinal vessels in the area of the optic nerve, and extensive hemorrhages. The appearance of these signs can occur at any stage of the disease; very often they appear even before the onset of stage 1. This indicates that the pathology has a fulminant, malignant nature.
There is also a symptom –"plus-disease" - borderline state between normally developed vessels and the changes that occur during “plus disease”.
There is a separate, rare, severe, rapidly progressive form - posterior aggressive retinopathy of prematurity. This form is an independent variant of the flow active phase diseases. She has extremely poor prognosis and often leads to irreversible blindness.
Video - What is retinopathy of prematurity
The active phase, as a rule, lasts from 1 month to six months and can end with complete regression of the symptoms of the disease (in the first 2 stages) or a scar phase with various changes fundus until complete detachment of the retina.
Scar changes can have 5 degrees:
Scar changes in the retina can be either minor and have almost no effect on visual acuity, or lead to complete detachment of the retina and loss of vision
Causes of the disease and risk factors
Back in 1951, a connection between the disease and the aggressive influence of high concentrations of oxygen in incubators for newborns was identified. In the retina of the eye, metabolic processes occur without the participation of oxygen - through glycolysis (oxygen-free breakdown of glucose with the release of energy). Under the influence of oxygen, so necessary for nursing premature babies, glycolysis is significantly inhibited and the retina dies, gradually being replaced by connective tissue.
This discovery marked the beginning of new research and today it is known that retinopathy of prematurity is a multifactorial disease, the occurrence of which is influenced by many different processes. The risk group includes babies weighing less than one and a half kilograms and those born before 32 weeks. Moreover, the risk of developing the disease is much higher if the child received mechanical ventilation (artificial pulmonary ventilation) for more than 3 days and long-term oxygen therapy.
Provoking factors are also:
One of the factors that can influence the occurrence of retinopathy is the exposure of the immature retina of a premature baby to light. IN natural conditions The development of the retina is completed in the dark, in utero, and excess illumination has a detrimental effect on the eyes.
Symptoms and signs in a child
The only manifestations of retinopathy in the first stages of development (stages 1–3) are objective data from ophthalmological examinations, therefore they are usually regarded as symptoms of the disease. On early stages eye symptoms(decreased vision, pain in the eyes) are absent.
The vision of a baby, even one born on time, develops gradually. A newborn only has general feeling light, a child can determine its source at one and a half to two months. The ability to follow objects develops by three to four months, and by six months, objective vision appears: the baby reaches out to the object that interests him with his hand. In the future, visual functions continue to improve and this process is completely completed only by 6 years. Therefore, neither the mother, nor the pediatrician, nor the neonatologist can notice the first stages of retinopathy, which usually start at four weeks of age. This can only be done by an ophthalmologist using appropriate examination equipment..
In its development, retinopathy of prematurity goes through five stages in turn, external manifestations which can be noticed only starting from the third, fourth or fifth
Outwardly, manifestations of retinopathy can be noticed only in the last stages of the disease - at stages 4 and 5, when cicatricial changes in the retina have already formed. To such visible signs include:
These symptoms indicate that the moment is favorable for effective treatment, may have already been missed and the process has gone too far, that is, the threshold third stage is left behind. Therefore, timely diagnosis is very important, which consists of an initial examination of the baby by an ophthalmologist (no later than one and a half months) and regular examinations in the future.
The task of parents is to show the premature baby to the doctor on time, even if he is discharged from the maternity hospital in good condition.
Development of the disease by stages - table
| Stages of the disease | Symptoms and manifestations |
| Stage 1 | Onset of the disease: the formation of a restrictive (demarcation) line between the part of the retina with normally developed vessels and the zone without vessels. The pathology may not develop further and healthy blood vessels maybe over time continue to grow correctly. |
| Stage 2 | A thickening (ridge, shaft) forms at the site of the dividing line. The (defective) vessels continue to grow, but incorrectly: they twist and grow into the ridge. During this period, the disease can still spontaneously regress. Visual functions the baby is slightly disturbed. |
| Stage 3 | The newly formed vessels grow into the vitreous body; in the area of the dividing shaft, which thickens significantly, fibrous tissue develops, slowly growing throughout the retina. Retinopathy becomes irreversible. There is a decrease in vision, the child does not fix his gaze well and does not follow objects. Hemorrhages are possible, which show themselves as sudden redness of the sclera of the eyes. |
| Stage 4 | Retinal detachment begins (the resulting scar tissue literally “pulls” the retina out of its place). Visual functions are sharply reduced. |
| Stage 5 | Total detachment of the retina. The pupil does not respond to the light source. Vision may be lost forever. |
Diagnosis of the disease
The diagnosis can only be made by an ophthalmologist. Examination of the baby begins at 3–4 weeks of life, then examinations are repeated twice a month until the doctor is convinced that the development of the retinal vessels has been successfully completed.
Having discovered the initial symptoms of the disease, the ophthalmologist examines the baby every week until they disappear in case of regression or until the end of the active phase. At aggressive course pathologies (“plus disease” or posterior retinopathy), examinations are carried out after 2–3 days.
The following methods are used for examination:
For differential diagnosis with diseases causing atrophy of the optic nerve or abnormalities of its development, other examination methods are used:
Retinopathy of newborns is differentiated from the following diseases:
Late stages of retinopathy, when scars have already formed, are difficult to distinguish from primary persistent hyperplastic vitreous.
Treatment of pathology
To date, approaches to the treatment of neonatal retinopathy in different clinics somewhat different. One part of the experts argues that the initial stages only require conservative therapy and observation, and surgery is needed only when the threshold stage 3 is reached, while another part of the doctors insists on the need for surgical intervention as a preventive measure at stages 2 and even 1 of the disease.
Conservative
In the early stages of the development of retinopathy, antioxidants are prescribed in order to protect the walls of blood vessels from the aggressive action of oxygen - Emoxypine, vitamin E, ascorbic acid. When activating the process, apply hormonal agents in drops - Dexamethasone, Hydrocortisone, Maxidex, vascular drugs - Dicynon, in lately Some experts recommend prescribing vascularization (vascular formation) blockers - Lucentis or Avastin.
Photos of drugs for the treatment of retinopathy of prematurity
Hormonal drug for the treatment of the initial stages of retinopathy of prematurity 
Dicinone is used for retinopathy if there is a risk of hemorrhage 
Dexamethasone drops are prescribed to relieve symptoms in the initial stages of retinopathy 
Ascorbic acid used as an antioxidant for protection vascular walls from the influence of oxygen 
Emoxipin is a synthetic antioxidant used to resolve minor hemorrhages and protect the retina from excess light. 
Vitamin E is one of the most powerful natural antioxidants
In regressive and rehabilitation period The baby is given anti-inflammatory and disinfectant medications, and physiotherapy is used:
Surgical intervention
In order to coagulate (block) avascular zones, laser or cryosurgical treatment is performed. These techniques make it possible to stop the development of the disease and stabilize the process.
Cryocoagulation (freezing liquid nitrogen areas of the retina in which there are no vessels) is performed under anesthesia, rarely under local anesthesia. The procedure is associated with a certain risk, since general anesthesia has an extremely negative effect on the infant’s respiratory and cardiac system. Therefore, most ophthalmologists prefer to perform surgical treatment using laser coagulation, which is less traumatic, gives less side effects and better results.
Laser coagulation is painless, after it there is no swelling of tissues, as after freezing, it has a minimal effect negative influence on the functioning of the heart and respiratory system.
Most often, laser treatment or freezing in the first stages gives good results. If it is not possible to stop the progression of retinopathy and the disease has entered the scar phase, then doctors are forced to resort to transciliary vitrectomy or circular filling of the sclera.
Scleral filling involves applying a “patch” to the site of retinal detachment and pulling the retina to this area. The technique shows good results even in the last stages and helps to significantly improve the child’s vision.
In case of failure of scleroplasty or impossibility of its implementation, vitrectomy is used. The operation is aimed at excision of the affected vitreous body and scars from the surface of the retina to weaken its tension and detachment. In case of incomplete retinal detachment, this operation has a chance to preserve at least a small percentage of vision. In case of total detachment, the operation may not bring results.
All surgical procedures are effective only in the first year of a child’s life; in the future, they may be useless for preserving or restoring visual functions.
If the disease has reached last stage and the degree of scar changes is high, then as a result of the operation, the perception of light simply improves, the ability to navigate in the room and the ability to follow objects that are directly in front of the eyes appear.
Video - New approaches to the treatment of retinopathy of prematurity
Complications and consequences of retinopathy
Even those children who have suffered the mildest stages of the disease may subsequently develop complications (by 6–10 years):
Parents of a premature baby need to remember that their baby’s retina will never be the same as that of a full-term baby, so any negative factors, such as an eye injury, can cause unpredictable consequences. A child who has suffered retinopathy should be regularly observed by an ophthalmologist until the age of 18.
In a child who even suffered mild degree retinopathy, possible development of long-term consequences
Prevention
Main preventive measures in relation to retinopathy - this is the prevention of untimely births, gynecological therapy aimed at maintaining pregnancy up to 40 weeks.
For premature babies should be applied correct techniques nursing, timely initial examination pediatric ophthalmologist and dynamic follow-up.
Retinopathy of prematurity is a disease that can either spontaneously regress or lead to complete loss vision. What the consequences will be for the child depends on the quality medical care and the responsibility of parents, who must ensure timely examination and treatment of the baby.
