Eye diseases. Diagnosis of cataracts in children (the most important)

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Eye diseases. Diagnosis of cataracts in children (the most important)

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55. Diagnosis of cataracts in children

When examining a child, it is important to find out how the mother’s pregnancy proceeded, whether there were any harmful effects on her body (rubella, influenza, chicken pox, oxygen starvation of the fetus as a result of heart disease in the mother, lack of vitamin A in the pregnant woman’s diet, etc. ), at what weight and whether the child was born full-term, and whether he was kept in an oxygen tent after birth. Find out the presence in the anamnesis of general (tuberculosis, diabetes, infectarthritis, etc.) and local (uveitis, trauma, etc.) processes that can cause the occurrence of sequential cataracts.

In young children, when it is not possible to determine vision by classical methods, one should pay attention to how they orient themselves in the environment, whether they have shaped vision (whether they reach for a toy that is shown at various distances from the eye, whether they move freely) . Visual acuity in older children and adults should be determined according to the tables (up to two units) with both narrow and wide pupils, with and without correction, since this is important in clarifying the indications and choosing the method of surgical intervention. If the patient has light projection, it should be established whether it is correct. If the projection of light on the eye with a cataract is incorrect and it is impossible to examine the deeper parts of the eye (vitreous body, retina, optic nerve, choroid) using visual methods, echo-ophthalography is performed, which allows to detect changes in the vitreous body, retinal detachment, etc.

The study of the visual field in patients with cataracts can be carried out on the projection-registration perimeter with an object of the greatest brightness and magnitude, as well as on the desktop perimeter with a luminous object or a candle.

During an external examination, attention is paid to the position and excursion of the eyeballs (in case of strabismus, the magnitude of the Hirschberg deviation is determined), the presence of nystagmus and other complications, as well as concomitant congenital anomalies.

Next, under conditions of mydriasis (caused by 0,10,25% scopolamine, 1% homatropine, etc.), an examination is carried out with a side lamp, a combined method and in transmitted light. While examining the eyes, you can see clouding of the lens in the form of a gray disk (zonular cataract) or a gray dot (anterior polar cataract), etc. You should pay attention to which direction the clouding shifts when the eye moves. This allows us to judge their topography in the lens. When the lens is subluxated (dislocated), its edge is visible; also, with dislocation, changes in the depth of the anterior chamber, trembling of the iris (iridodonesis), congestive injection of the eye are noticeable, and increased ophthalmotonus can be detected by palpation. When examining the cornea, scars may be detected. Particular attention is paid to the depth and uniformity of the anterior chamber. A deep and sometimes uneven chamber occurs with aphakia, lens dislocations, and iridodonesis (trembling of the iris) is often observed when the eye moves.

Author: Shilnikov L.V.

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