Diagnosis and treatment of esotropia with diplopia in young users of smart devices

Abstract

Currently, due to the popularity of smart mobile devices, the frequency of calls from patients with signs of maladaptation of the binocular visual system has increased significantly.

The aim of the study. To assess the state of the binocular visual system in patients with esotropia and diplopia, as well as to search for effective methods of treating this pathology.

Material and methods. There were 20  patients aged 15 to  36  years (Me 24.5 [15.3; 30.3]) with complaints of permanent diplopia. The use time of smart devices in all patients was more than 6 hours per day (Me 7.8 [4.3; 11.3] hours). Refraction in all patients was myopic, and the corrected acuity of both eyes was 1.0. The angle of strabismus according to Hirschberg varied from +5 to +15° (Me 10 [5.5; 10]°). As a control group, 15 patients aged 15 to 36 (Ме 23.4 [16.3; 30.5]) years with moderate myopia without oculomotor disorders were examined. Along with the standard ophthalmological examination, the thickness of the extraocular muscles was additionally assessed in all patients according to ultrasound data. The algorithm for treating patients with esotropia included orthopto-diploptic treatment. If  the  measures were ineffective, surgical treatment was performed at the second stage.

Results. Comparing the thickness of the oculomotor muscles found that the internal rectus muscle in patients with esotropia has, on average, a significantly greater thickness than in patients in the control group (p = 0.02), and the thickness of the external rectus muscle is comparable on average (p = 0.33). A positive result after the first stage of treatment was obtained in 2 patients, in the remaining 18 patients, tenoscleroplasty of the internal rectus muscle with partial median myotomy was performed as the second stage of treatment. As a result of the treatment, all patients achieved binocular vision and stereo vision.

Conclusion. The  presented data demonstrate the  possibility of  the  formation of persistent violations of binocular functions in patients with myopia and impaired accommodation against the background of prolonged visual tension, which requires the use of a special algorithm of diagnostic and therapeutic measures.