Eye exercises for double vision. Diplopia: what is it. Binocular and monocular diplopia. How to treat these forms of the disease

Diplopia refers to an eye pathology characterized by impaired vision, uncoordinated movements of the eyeballs, and to be more precise, doubling of objects. The disease can develop in absolutely any person, regardless of gender and age. Diplopia is not an independent disease. The occurrence of a pathological process may be due to impaired functioning of the optic nerve, traumatic brain injury, neoplasm, infectious brain damage.

The disease is quite serious and requires immediate treatment. If you ignore the manifestations of diplopia, you risk losing your vision. Therefore, if you experience a feeling of double vision when looking at objects, strabismus, frequent dizziness, disorientation in space, immediately seek the help of an ophthalmologist.

In parallel with traditional therapy prescribed by a specialist, it is recommended to use traditional medicine. Treatment of diplopia with folk remedies is effective and will help in the speedy elimination of the pathology. Moreover, you can cook them yourself at home. However, they can be used only with the knowledge of a doctor and only in combination with medications. It is strictly forbidden to replace official medicine with unofficial one, because in this way you will harm yourself and aggravate the situation.

If diplopia occurs after an eye burn by welding, try applying.

Recipes "from the people" for the treatment of diplopia

1. Treatment of diplopia with folk remedies from lavender. To prepare the drug, you need to take 40 grams of dried finely chopped lavender leaves and the same amount of valerian rhizomes. The raw materials are mixed, after which they are poured into glass containers and filled with white grape wine - a liter. The remedy should be infused for three days. Do not forget to shake the composition periodically. Take a spoonful of strained preparation before each meal.

2. Application of flower pollen. The tool can be purchased at a pharmacy. Take 3 grams of the drug twice a day. The duration of the course is 30 days.

3. Vitamin collection. Mix equal proportions of viburnum and rosehip berries. Grind the raw materials and brew with freshly boiled water - 500 ml. Boil the composition for a quarter of an hour. After the product has cooled down, filter and drink half a glass of a healing drink half an hour before sitting at the table.

4. Eyebright is the best folk remedy for diplopia. Brew with boiled water - half a liter of 50 grams of finely chopped dry grass of the plant. Set the composition aside for a few hours. Drink 100 ml of infusion filtered through gauze folded in several layers three times a day.

5. Blueberries help heal. Pour 30 grams of dried leaves of the plant into the pan, cover with water, bring to a boil. Filter the cooled remedy and drink half a glass of medicine several times a day.

6. Calendula will help in the fight against the disease. Steam 20 grams of dried finely chopped flowers of the plant in five hundred milliliters of boiled water. After two hours, strain the composition and drink the composition during the day.

7. Eye grass - mint in the treatment of pathology. Leaves of the plant can be added to teas, and its juice mixed with a small amount of honey is recommended to be instilled into the eyes twice a day: in the morning and before going to bed (drop by drop). The duration of the course is two weeks.

Useful information in the article "".

Gymnastics for the eye muscles

Experts recommend doing special exercises to treat the disease. They contribute to the normalization of the functioning of the eye muscles, the elimination of unpleasant symptoms. Exercises must be done at least twice a day, either before a meal or after a long visual load: working at a computer, reading, watching TV.

1. Sit on a chair, straighten your back. Look up then down. At the same time, do not move your head and fix your eyes for a couple of seconds in each position.
2. Then move your eyes to the left and then to the right. Don't forget to fix your eyes.
3. Now repeat everything: up, down, left, right.
4. Then you need to make several circular movements in the clockwise direction. Do the same in reverse.
5. Imagine a square, move your eyes around its perimeter, first to one side, then to the other.
6. Blink quickly.
7. Close your eyes and open your eyes. Do this five times.

In order to prevent the development of diplopia, it is recommended to give your eyes a rest, especially if you sit at a computer for a long time.

If you have bad habits, in particular drinking alcohol, smoking, try to get rid of them as soon as possible. Lead an exceptionally healthy lifestyle, eat right, walk more in the fresh air, play sports, observe the regime of work and rest.

Include more spinach, sweet peppers, peaches, carrots, apricots, pumpkins in your diet. These products help to strengthen the body and have a beneficial effect on vision. And always coordinate the treatment of diplopia with folk remedies with your attending ophthalmologist.

Diplopia (as double vision is called in medical language) is a symptom characterized by the absence of friendly eye movement, which is designed to provide a comparison of the image of objects.

As a result of diplopia, one object is perceived by the patient as two autonomous images.

In addition, with doubling, dizziness, impaired orientation in space are also often observed, and distance may be incorrectly estimated.

Depending on the damaged eye muscle, diplopia is vertical, horizontal, diagonal.

Description of the symptom

The eyes see the same object from slightly different angles, but this difference is not noticeable to a healthy person. The brain processes the signals sent by the organs of vision and forms one accurate image from two pictures. With diplopia, a person sees both of these images at once, the brain does not process anything - this is the first and most important symptom of the disease.

You can verify that each eye has its own angle of view by closing one eye and looking at your finger relative to the background. Then, closing the other eye, you can see that the finger "moved" relative to objects in the background. With diplopia, a person observes two images of one object not only horizontally, but also vertically, as well as inverted crosswise.

At risk are patients who have been injured or suffering from diseases that can weaken the oculomotor muscles.

Types of diplopia

There are several types of diplopia and their division into classifications depending on:

• type;
• pathogenesis;
• etiology;
• time of manifestation;
• the nature of the split.

Classification by etiology:

1. Neuroparalytic diplopia. This is a consequence of neuromuscular diseases such as multiple sclerosis.
2. Oculogenic. Associated with surgical intervention in the organ of vision.
3. Orbital, has a traumatic origin.
4. Strabogenic diplopia (accompanies strabismus).

By pathogenesis:

1. Touch. Such diplopia is associated with a limitation of the fusion amplitude.
2. Motor. Occurs when certain muscles of the eye are affected. This is a common type of diplopia.
3. Mixed. (Motor and sensory).

According to the time of clinical manifestation, bifurcation can be permanent and non-permanent. Intermittent or temporary double vision is a condition that can occur due to various injuries, a strong degree of alcohol intoxication, as a result of side effects from taking certain medications.

By the nature of the split:

1. Crossed diplopia or heterogeneous. With this type of disease, the image intended for the left eye is projected from the right side and vice versa.
2. Cyclodiplopia. Refers to a complex form, occurs with serious motor and sensory disorders, accompanies strabismus.
3. Binocular or the same name. Occurs when the parallelism of the visual axes is violated. It is not difficult to identify such a violation, the patient is asked to tilt and turn his head in different directions, thus the deviation of the eye becomes noticeable. A patient with a similar visual impairment sees a bifurcated picture, which disappears if one eye is covered and has a restriction in the movement of the eye orbit.

The monocular type of double vision stands somewhat apart from other types, differing in that the double picture is preserved if the healthy eye is covered. Such an anomaly occurs due to ophthalmic or mental diseases.

There is also the concept of volitional diplopia, it is caused by a person consciously. For example, looking into the distance through some object located at arm's length. Thus, it can be seen that this object is, as it were, bifurcated.

Reasons for the appearance

The causes of double vision can be different for each type.

The causes of neuroparalytic diplopia lie in neuromuscular diseases of a general nature, such as:

• multiple sclerosis;
• myasthenia gravis;
• polio;

and other similar diseases in which all the muscles of the body weaken.

The causes of sensory diplopia are most often associated with the development of strabismus in children with a congenital fusion defect, and the disease can also manifest itself after successful surgical intervention to eliminate strabismus,

Motor diplopia develops due to:

• paralysis associated with brain injury;
• paresis of extraocular muscles;
• neurosurgical operations;
• vascular diseases;
• infectious diseases of a general nature, including toxic ones;
• infectious pathologies in the eye cavities.

Of the infectious diseases leading to the development of diplopia, rubella, tuberculous meningitis, tetanus, diphtheria, vasculitis can be distinguished, among toxic ones - botulism, etc.

Paresis of the extraocular muscles can occur as a result of such diseases: Mobius syndrome, Graefe's disease and other diseases of the central nervous system.

Injury to the brain can cause damage to the nerve or eye muscles. Also, one of the causes of such diplopia is endocrine myopathy, which develops against the background of hypothyroidism.

The causes of temporary diplopia have already been mentioned, it can be added that double vision occurs in acute cerebrovascular accident, epilepsy. Eyeballs in an acute attack of such diseases deviate upward or to the side.

Monocular diplopia, a rare type of pathology, is associated with such ophthalmic diseases:

• clouding of the cornea of ​​the eye;
• cataract;
• iridodialysis;
• astigmatism;
• retinal breaks;
• palinopsia
• psychoneurotic diseases.

Diagnosis of diplopia

Diagnosis of double vision is carried out on the basis of complaints from patients by an ophthalmologist, which includes, in addition to the classic examination, an additional examination: computed tomography of the head, ultrasound examination of the eyeballs, etc.

The examination is carried out with the direction of the patient's gaze on a moving light source. An ophthalmologist determines the presence of damage to the muscles of the eye and prescribes treatment.

If no deviations are found in the line of ophthalmology, then in order to establish the cause of diplopia and prescribe the required treatment, the patient is referred to such specialists as an endocrinologist, traumatologist, neurologist, oncologist, rheumatologist, infectious disease specialist.

Treatment of the disease

Diplopia is a symptom that cannot be ignored, it is imperative to contact the clinic for a detailed examination and the appointment of appropriate medications.

Treatment of this disease is aimed at eliminating the causes that caused doubling. As mentioned earlier, the cause of diplopia is not always an eye disease.

With double vision in different directions (vertical, horizontal, diagonal), you can perform special exercises recommended by your doctor. Such exercises are most effective in the development of partial diplopia, perform them 3 times a day.

If double vision is observed in a child, then in this case you should immediately contact an ophthalmologist.

There are several classic ways to treat diplopia.

1. Prismatic correction- with this method, the patient is shown wearing glasses with prisms that deflect the path of rays and thus shift the image. A variant of prismatic correction are Fresnel prisms - these are thin overlays for ordinary glasses. The advantage of such lenses is that when normal vision is restored, they are replaced by prisms with a different refraction.
2. Occlusion. This method is called "turning off" one eye. In the case where several nerves are affected, this method is one of the most practical options for getting used to changes in vision. Occlusion leads to a loss of 3D perception, but this does not mean at all that the patient will have to wear a pirate bandage: modern ophthalmology has special contact lenses, and you can also use a thin opaque tape on the lens of sunglasses or regular glasses.
3. Botulinum toxin injections. Such injections result in temporary as well as permanent relief in patients with symptoms of double vision. Botox is injected into one of the muscles of the eye under local anesthesia, which in the vast majority of cases helps to achieve the desired result and prevents the development of contractures.
4. Surgical intervention. In exceptional, most extreme cases, the possibility of surgical intervention is considered to restore the symmetry of the eye positions. This operation is performed under general anesthesia and usually leads to complete restoration of vision.

The described treatment is indicated only if the development of diplopia is associated with eye pathology, otherwise the treatment consists in stopping the causes that caused the disease:

• treatment of stroke, neuropathy, neuralgia, etc.,
• treatment of infectious diseases with the help of medicines such as antibiotics, diuretics, anti-inflammatory drugs, etc.,
• treatment of volumetric processes in the orbit (removal of tumors, hematomas).

Prevention of diplopia

The disease in question is characterized by the unpredictability of its development, therefore it is not advisable to carry out any preventive measures.

However, double vision can be avoided if:

• give up bad habits forever (social trouble - smoking, alcohol),
• lead a banal healthy and active lifestyle: it is recommended to conduct regular walks for at least 2 hours, engage in sports exercises, observe the night and day regimen,
• undergo a preventive examination by doctors,
• control blood pressure.

Exercises

There are many exercises that are aimed at relieving or improving the patient's condition with diplopia. This can be gymnastics directly for the eyes, for the muscles of the upper cervical spine, training for the perception of normal binocular vision.

Gymnastics for normal blood circulation of the brain and organs of vision 5-10 times. Each exercise is done smoothly, but at the same time quickly:

1. We look first to the right, then to the left, while turning the head, not the eyes.
2. We tilt our head to the left until it touches the shoulder or close to this position.
3. We tilt our head forward, then back, gently, without throwing it back.
4. We perform rotational movements of the head in one direction and the other.
5. We make circular movements with the shoulders with the arms lowered.
6. Again, circular movements with the shoulders, but now the hands need to be lowered onto the shoulders.

Eye exercises

Perform 5 to 20 times. Before each exercise, you need to blink slightly:

1. Training. Sit in a comfortable position, blink to relax your eyes.
2. Look up, then down, pausing for a second in extreme positions without moving your head.
3. Move your eyes to the right and left, also lingering in extreme positions.
4. Move your eyes along a diagonal line drawn in the air, it should turn out “crosswise”
5. Move your eyes clockwise, then against;
6. “Draw” a square with your eyes clockwise, then against.
7. Take the pen at arm's length, focus on it, bring the pen closer to touching the nose, continuing to look at it, slowly return to its original position. Then look at a distant object for 3 seconds.
8. Close your eyes tightly, then slowly open them.

Training of binocular vision in patients with diplopia

Normally, if you look at the outstretched hand, objects that are distant from the hand or close, bifurcate.

For the perception of normal physiological doubling without any pathologies, there are special exercises that must be performed every day 5 times for 15 minutes.

1. A small object is placed 15 cm from the patient, for example, a pen vertically at the level of his eyes. At some distance, after 3-5 meters, any object is installed, for example, a chair. You only need to look at the chair. If the pen does not double, then close one eye, then the other eye with your hand.

The patient's attention is focused on the fact that the handle "moves" then to the left then to the right. The patient is explained that since the pen is seen in different places by each eye, looking into the distance with both eyes, the pen should split in two.

The patient, alternating between overlapping eyes and looking at a chair in the distance with both eyes, should achieve a normal perception of the bifurcation of the handle. If it works out, then perform the second exercise or repeat until it works out.

2. Now you should look at the handle. If at the same time the patient does not observe doubling of the chair installed at a distance, then he needs to stretch out his arm and put the brush vertically after the handle and in front of the chair as a flap. He moves his hand in different directions from the handle, so that it coincides with the left edge of the palm, then with the right.

The patient is told that the stool also "moves" to the left, then to the right, and therefore, when looking with two eyes, the stool should split in two. Further, the patient, alternately moving the hand and removing it, fixes his eyes on the handle, should see the doubling of the stool. After persistent achievement of success, the third task is performed.

3. Colored pencils are attached to a bar about 1 meter long. This is done along the bar at a distance of 15 cm from each other, then the bar is set at the level of the patient's eyes parallel to his gaze (along), while the pencils are located vertically.

The patient looks at the pencil closest to him, slowly moves his gaze to the second one, etc., then in the reverse order. Only the pencil at which the patient is looking should be perceived, and it is imperative to see the bifurcation of the remaining pencils.

Eye relaxation

This is an equally important part that helps fight and prevent eye pathologies. Relaxing the eye muscles with the help of darkness can be done at home or at work, it will take about 5 minutes.

1. Sit comfortably at a table with your elbows resting on its surface.
2. Rub your palms together to feel warmth.
3. Cover your eyes with your palms so that the light does not pass through your fingers. In this case, the hands are superimposed on each other so that the fingers cross, and tightly pressed against the face, but the eyes should not be pinched and rotate freely under the eyelids.

If you can’t sit comfortably, with a flat back, you need to put soft objects of the right height on the table. After a few minutes, slowly open your eyes and blink.

Conclusion

With double vision, you should definitely consult an ophthalmologist for advice. It should be remembered that diplopia can occur for a variety of reasons; to understand and eliminate them in time means to save oneself from adverse consequences.

In order not to face such a disease, it is necessary to monitor the state of health, treat infectious and other diseases in time. If most of the time is spent sitting at the computer or work requires constant increased attention, then you need to regularly perform eye exercises.

Associate Professor of the Department of Eye Diseases. | Site Editor-in-Chief

He specializes in emergency, outpatient and elective ophthalmology. Carries out diagnostics and conservative treatment of farsightedness, allergic diseases of the eyelids, myopia. Performs probing, removal of foreign bodies, examination of the fundus with a three-mirror lens, washing of the nasolacrimal canals.

Diplopia is an eye pathology in which vision is impaired, an inconsistent movement of the eyeballs occurs, or rather, the image of a visible object begins to fork.

Due to the deviation of the eyeball, the image shifts to a different place on the retina, and not to the central eye fossa.

Such a disorder is characteristic of binocular vision, when the doubling effect disappears when one eye is closed. Sometimes monocular diplopia occurs, when one eye sees a doubling of the object and when the eye is closed, it does not disappear.

Causes of diplopia

Causes leading to such a pathology, there can be various diseases of the central parts of the visual analyzer.

They occur if there is a weakening of the functions of the eye muscles, due to which the eye begins to shift to the side or its mobility is limited. Diplopia is also caused by pathological processes that occur in the orbit itself.

The most common cause of this disease is weakening of the muscles that move the eye, or their complete paralysis, as a result of which the parallel movements of the apples of the eyes are disturbed. In addition, the following conditions may be the causes of diplopia:

• diseases of the cavity of the orbit, which led to the displacement of the eyeball;
• aneurysm of the carotid artery, leading to compression of the oculomotor nerve;
• tumors and hematomas that help limit the movement of the apple of the eye or cause its immobility;
• injury to the oculomotor nerve.

The causes of diplopia may be neurological pathologies, such as tuberculous meningitis or intracranial tumors.

Such visual impairment is sometimes a symptom of botulism, thyrotoxicosis, diabetes mellitus, drug or alcohol intoxication, multiple sclerosis. In addition, trauma or surgery on the brain, surgical treatment of retinal detachment, cataracts can be the cause of diplopia.

Symptoms

Diplopia manifests itself as follows:

• double vision;
• dizziness;
• difficulty in determining the location of various objects.

Symptoms of the disease depend on where the pathological process originated. With the defeat of the oblique muscles, doubling of objects will occur one above the other. If there was a lesion of the rectus muscles, then parallel doubling appears. Diplopia is characterized by varying degrees of deviation of the eye to the side, which is opposite from the affected muscle. This is manifested by the restriction or complete absence of movement of the apple of the eye towards the affected muscle. Usually a person, trying to get rid of double vision, begins to turn or tilt his head in the pathological direction.

Types of diplopia

This pathology is divided into monocular and binocular diplopia. Most often, a binocular form of pathology develops, which is characterized by a violation of the parallelism of the visual axes of the eyes. When they shift in a person, the image begins to double.

Much less common is diplopia of one eye (monocular), in which an image disturbance appears when seeing only one organ. The cause of this form of diplopia is the subluxation of the lens of the eye or its partial clouding. In addition, the following diseases can cause such a pathology: iridodialysis or polycoria.

To get rid of diplopia, the underlying disease should be cured. Since the disease develops as a result of impaired functioning of the optic nerve, the treatment is carried out by an ophthalmologist and a neuropathologist.

Diplopia is reduced with prismatic correction. For this purpose, special glasses are made, selected individually. But such treatment can reduce visual acuity.

To improve vision, it is recommended to do additional exercises at home. To do this, the patient must sit down a meter from a light wall, on which a sheet with a black stripe is hung. A person must choose a position in which the strip will not double for him. After that, you need to focus your vision on this strip and slowly turn your head from side to side. At the same time, it is necessary to keep the strip undivided for as long as possible by volitional efforts. Such an exercise is considered effective only with partial diplopia.

If such measures do not bring the desired result, then they resort to surgical treatment. In this case, there are several options, for example, it may be a recession of the eye muscles, when the muscles are moved back a little and the tendons are sutured to the sclera.

Diplopia: treatment with folk remedies

Application of lavender. To prepare the preparation, take 40 grams of finely chopped dry lavender leaves and the same amount of valerian rhizomes.

The raw materials are mixed, poured into glass containers and poured with a liter of white grape wine. The remedy is infused for three days, while it is recommended to shake it periodically. It should be taken in a spoonful before meals.

Vitamin collection. Rosehip and viburnum berries are mixed in equal proportions. Raw materials are crushed, pour 500 ml of boiling water and boil for 25 minutes. As soon as the remedy has cooled, it is filtered and taken half a glass 30 minutes before meals.

The use of eyebright. This herb is considered the best folk remedy for diplopia. 50 g of crushed dry grass is poured into 0.5 liters of boiling water and left for several hours. Filter and take 100 ml of infusion three times a day.

The use of blueberries. 30 g of dried leaves of the plant are poured into the pan, poured with water, boiled, filtered and consumed several times a day for half a glass.

Also, the treatment is carried out with the help of eye grass. The leaves of this plant are added to teas, and its juice is mixed with a small amount of honey and instilled into the eyes twice a day.

In this way, diplopia is a pathology, which gives a person significant discomfort, since there is a split vision. This contributes to the rapid fatigue of the eyes from the image itself and from the need to constantly “adjust” it. There are quite a few reasons for this condition and it is necessary to treat such a pathology.

Among the causes of diplopia, paralysis of the muscles responsible for eye movement appears most often. In this case, there are two options for the development of events: either the muscle structures were directly affected by some pathology, or the nerves were affected, and then the neurologist should deal with the therapy.

Separately, the following pathologies that can contribute to the development of diplopia are distinguished:

• various traumatic injuries of the orbit itself, leading to infringement of nerve bundles or muscle fibers;
• various diseases of the orbital cavity, due to which the eyeball is displaced;
• an aneurysm that affects the internal carotid artery and puts pressure on the oculomotor nerve;
• various head injuries leading to damage to the oculomotor nerve.

The causes of double vision can lie solely in neurology without the participation of the eyes themselves. This happens, for example, with tumor processes inside the skull or meningitis of tuberculous origin. There may be complaints about this symptom in diabetes mellitus, various types of intoxication, hyperthyroidism and other diseases.

Symptoms

Double vision is the main symptom that indicates any violations in this visual pathology. Symptoms of diplopia can also include attacks of dizziness and difficulty, if necessary, to determine the position of an object.

The severity of doubling and its features depend on which structures were affected. For example, when the oblique muscles are involved, two objects are seen in the vertical axis, and when the rectus muscles are involved, the objects are located horizontally.

Kinds

Double vision can be binocular or monocular. This is the basic principle of the division of pathology.

The binocular type is the most common. With binocular diplopia, the parallelism of the visual axes of the eye becomes unusable. Because of this, the patient begins to see double images of the same object. Binocular pathology is divided into several more varieties depending on the origin, severity, temporality.

Sometimes diplopia of the monocular type occurs. In this case, only one eye is affected, while the patient himself sees only with one eye, the second is non-functional. One eye can receive an image on the retina in two different places, which explains the occurrence of the disease.

Monocular diplopia occurs with various injuries of a single visual organ, may be congenital or develop against the background of other diseases.

Which doctor treats diplopia?

Regardless of whether there is a double effect in one eye or in both, you should first contact an ophthalmologist. It is this specialist who treats all pathologies of vision.

If a non-ophthalmic cause is identified, other doctors may need to be consulted. So, for example, if the nerves are damaged, you will need consultation and treatment with a neurologist, if the orbit is traumatized, it is better to contact a surgeon or traumatologist, and in case of systemic diseases - to the appropriate doctors.

Diagnostics

If there is a split in the eyes vertically or horizontally, it is imperative to see a doctor. He, having assessed the accompanying symptoms, complaints, the general condition of the patient, will be able to draw conclusions about the nature of the disease and recommend the best methods of correction.

The basis of additional diagnostics is the study of visual function, in which the patient must observe a moving light source. The doctor registers the coordinates along which the focus of the gaze moves and, thanks to this, can determine which of the muscles is affected by the pathology.

The ophthalmic coordimeter is a more modern way to determine the pathology of the extraocular muscle unit.

It is impossible to determine double vision without additional examinations. So, for example, the mobility of the eyelids, refraction, and normal visual acuity are necessarily assessed.

Treatment

Therapy for diplopia begins with the treatment of the underlying disease.

The treatment of double vision as the main pathology is in the hands of either a surgeon or a neurologist. It can also be treated under the supervision of an ophthalmologist if the cause is trauma. Moreover, all corrective operations are carried out no earlier than 6 months after the injury was received.

Non-surgical correction of pathology is possible. This is done with the help of prismatic glasses, which are selected by an ophthalmologist. Additionally, it is recommended to perform, as well as use the medicines recommended by the attending physician to relieve symptoms.

Folk methods

If diplopia has developed, treatment with folk remedies can also be effective. The following simple recipes are recommended:

• You can mix 40-50 g of lavender leaf with the same amount of valerian rhizome (previously chopped everything finely) and, pouring everything with a liter of wine, insist for three to four days, then drink a tablespoon three times a day before eating.
• Within a month, you can drink 3 g of pollen daily by purchasing the drug at a pharmacy.
• Blueberries are known for their healing properties in terms of treating vision, and therefore you can pour 30 g of leaves of the plant with water, boil, filter the broth and drink ½ cup three times a day.
• If it starts to get into the eyes, you can apply mint by adding it to tea or dripping a cool decoction of the plant into the eyes (for greater effectiveness, a little honey can be added to the mint decoction).

The use of folk remedies is possible only after the cause of the symptom is understood. It is strictly forbidden to engage in therapy without knowing the reasons.

Prevention

Double vision is difficult to prevent, as there are many reasons for its development. Patients are advised not to strain their eyes, to treat systemic and ophthalmic diseases in a timely manner, to give up malnutrition and bad habits, and to lead a healthy lifestyle.

When the first symptoms of pathology appear, doctors recommend contacting an ophthalmologist. If the doctor deems it necessary, he will send the patient to another specialist. Timely consultation will help not only get rid of an unpleasant symptom, but also preserve vision.

Useful video about diplopia

As already noted, diploptic exercises are aimed at restoring the bifixation reflex in natural conditions, which is the basis for the formation of binocular vision.

Treatment consists in excitation in patients with double vision (diplopia) by stimulating various parts of the retina with the help of prisms and developing the ability to merge double images. Diplopia can also be caused by the use of color filters.

1) Exercises with prisms- this is the main of diplopticheskih techniques. E.S. Avetisov, T.P. Kashchenko, M.M. Tarastsova (1985) developed guidelines “Method of restoring the mechanism of bifixation in strabismus”, in which this treatment technique is described in detail. We present it verbatim in accordance with the methodological recommendations.

The indication for treatment according to this method is: concomitant accommodative or partially accommodative strabismus, since with these types of strabismus, the process of functional inhibition is especially pronounced with a symmetrical or close to it (up to 5-7 degrees according to Hirschberg) eye position achieved by previous treatment ( operation, optical correction, penalization).

The necessary conditions for treatment are: the presence of a sufficiently high visual acuity in the squinting eye (at least 0.5), the presence of bifoveal fusion under haploscopy (or unstable functional scotoma). Persistent functional scotoma, especially of a total nature, requires preliminary treatment by other methods (the method of binocular sequential images, haploscopic exercises on the synoptophore, etc.).

The treatment method includes three stages:
1. Excitation of diplopia.
2. Development of the bifixation reflex, that is, the ability to merge double images.
3. Fixation of the bifixation reflex.

Such a division into stages is very conditional; a smooth transition from one stage of treatment to another is usually carried out.

1. First stage- excitation of diplopia.
The patient is seated at a distance of 1 - 2 meters from the object of fixation, located at the level of his eyes (on the wall, screen, sheet of paper, etc.). The test object can be any drawing or object that is interesting to the child. The approximate size of the test is 1-3 cm. The smaller and more contrast the test, the easier it is to double. Therefore, at the first stage, smaller and brighter colored (red, green) tests are used.

In front of one (more often in front of the fixing) eye, a prism of 8 prism diopters or 10 pr diopters is presented. base to the nose, mounted in a special handle.

The prism is presented for 2-3 seconds with an interval of 1-3 seconds. The presentation of the prism should be accompanied by the appearance of the phenomenon of doubling of the object of fixation. The procedure is carried out for 1-2 minutes. Then change the direction of the base of the prism to the temple and repeat the procedure.

A similar procedure is carried out when installing a prism in front of the other eye.
Double vision usually occurs within the first two to three days of treatment.
The duration of one exercise is 15-20 minutes.

If double vision occurs with difficulty, the following techniques are used to stimulate it:
- luminous test object;
- a colored (red) light filter in front of one eye of the subject during fixation of a luminous test object;
- prisms of vertical action.
In the event of vertical doubling, the prisms are again set in a horizontal position. If doubling occurs on the luminous test, they again proceed to exercises on real tests.

The first stage of treatment usually takes 2-3 days.

2. Second phase- development of the bifixation reflex. The occurrence of doubling is a condition for the fusion of double images and the transition to the second stage of treatment.

To facilitate the ability to merge, the following techniques are used:
- use tests of a larger size (3-6 cm in diameter);
- use prisms of weak prismatic action (2 pr. diopters, 4 pr. diopters, 6 pr. diopters), consistently increasing their strength;
- increase the time of presentation of the prism (up to 5-10 seconds).

Increasing the prism presentation time facilitates the merging of double images. Prisms are presented with an interval of 3-5 seconds.

Treatment begins with the presentation of prisms in 3 - 4 diopters. Every 2-3 minutes change the direction of the base of the prism (towards the nose, towards the temple). This procedure is carried out first in front of one, and then in front of the other eye (for 5-10 minutes).

When moving from one session to another, as the double images merge with prisms 2 pr. diopters, 3 pr. diopters, 4 pr. diopters. or 6 ave. diopters. they switch to stronger prisms (8-10 pr. diopters) with the same mode (frequency) of their presentation. For example: for 3 days they carry out exercises with a prism of 2 diopters. and 4 pr. diopters, the next 3 days - with a prism of 6 pr. diopters, the next 3 days - with a prism of 8 pr. diopters, the next
3 days - with a prism of 10 ave. diopters.

The choice of the prism presentation mode (its strength and frequency) is determined by the doctor individually, as it depends on the ability to merge double images, which manifests itself differently in different subjects and depends on the degree of binocular vision impairment.

Some patients can quickly learn the ability to merge and move from a 2 pr diopter prism in one session. to a prism 4-6 pr. diopters.

The duration of the second stage of treatment is also individual, but, as a rule, it is much longer than the first stage (10-15 days).

Z. Third stage- fixation of the bifixation reflex.
At the third stage, the patient is taught the ability to merge double images under increasing load.

For this, the following methods are used:
- use prisms of great strength (8-10 pr. diopters);
- increase the frequency of presentation of the prism, that is, shorten the time of its presentation to 3-5 seconds with an interval of 2-3 seconds;
- reduce the size of the test object (from 3-6 cm to 1-3 cm);
- increase the distance to the test object (from 1-2 m to 3-4 m).

If there is a slight deviation, the treatment is carried out under conditions of prismatic correction of the angle of strabismus.
After treatment in this way, it is advisable to move on to exercises for the development of fusion reserves using prisms of variable strength, for example, an ophthalmic compensator (OKP-1).
At the Moscow Research Institute of Eye Diseases, a device was designed for exercises to restore the bifixation mechanism - a phase prismograph (Fig. 42).

Rice. 42. Phasoprismophore for exercises to restore the mechanism of bifixation.

We somewhat simplified the practical implementation of the bifixation restoration technique using prisms (N.B. Nesterova, 1996). Prisms from 2 pr. diopters. up to 10 diopters we pasted on the skiascopic ruler opposite the holes, but after removing the optical glasses from them. The bases of all prisms are directed in one direction, the rotation of the skiascopic ruler by 180 degrees provides the same rotation of the base of each prism. Thanks to this, the patient has the opportunity to use the prism of the required diopter without the procedure for changing the prism in the holder.
The rest of the treatment is carried out according to the described method.

2) Recovery of bifoveal fusion using binocular sequential images according to the method of T.P. Kashchenko

The essence of the method developed by T.P. Kashchenko (1965) is that successive images called from the macular zone of each eye contain the same elements that create a tendency to merge, and additional marks that can be used to differentiate images belonging to the right and left eye.

The author proposed to evoke sequential images using a large reflexless ophthalmoscope, into which a ball 3 mm in diameter with a lateral horizontal rod 3 mm long was introduced. The illumination of the right eye is carried out in the position of the horizontal rod to the right, the left eye - in the position to the left, at the maximum brightness of the light for 15-20 seconds. The other eye is closed when exposed to light.

After the illumination, the patient shifts his gaze to a white screen located at a distance of 40 cm, and observes two successive images: first dark (positive successive images), and then light (negative successive images). The sequential image of the right eye looks like a circle with a strip to the right, the left one looks like a circle with a strip to the left. The patient's task is to merge two consecutive images into one, which will look like a circle with two stripes in both directions (Fig. 43).

Fig. 43 Negative sequential images during treatment according to the method of T.P. Kashchenko
a) left eye b) right eye, c) confluent.

Observation of successive images is carried out under conditions of intermittent illumination. After the disappearance of successive images, a similar procedure is carried out two more times. For a course of treatment 20 - 30 exercises.

We are convinced of the effectiveness of this technique and widely use it to restore bifoveal fusion during the formation of binocular vision. We slightly modified the methodology of T.P. Kashchenko. We illuminate the eyes not on a large non-reflex ophthalmoscope, but with a flash lamp through a hole in the cardboard, which has the shape of a tennis racket. When the right eye is illuminated, the handle of the "racquet" is directed to the right, when the left eye is illuminated - to the left.
The patient observes consecutive images of both eyes on a white screen. Positive successive images look like light "rackets", negative - dark "rackets" that are well perceived on a white screen. We encourage the patient to merge the negative consecutive images of both eyes into a single image (dark circle with dashes to the right and left (Fig. 44).

During one session we carry out 3 illuminations. There are 15 flashes for a course of treatment.
In some cases, if the patient does not have the opportunity to visit the treatment room, we prescribe this technique for home treatment.

3) Exercises with the use of color filters of different saturation according to the method of V.I. Serdyuchenko

The technique was developed at the Odessa Research Institute of Eye Diseases. acad. V.P. Filatov.
To provoke diplopia in natural conditions, V.I. Serdyuchenko used red film light filters on a polymer basis, placing them instead of optical glasses in a skiascopic ruler: in hole No. 1 - 1 layer of film, in hole No. 2 - 2 layers of film, etc. , in hole No. 9 - 9 layers of film.

The patient looks at a point source of light with both eyes. In front of the best eye there is a light filter of the highest saturation - No. 9. The task is to split the light bulb, see red and white. Gradually, moving to less saturated light filters, you need to strive to maintain doubling and get it without a light filter, that is, in natural conditions. In the future, the patient should try to merge the bifurcated image of the light source into one.

To control binocular fusion, the author uses striped Bagolini glasses placed in a frame in mutually perpendicular directions (on the right eye at an angle of 45 degrees, on the left eye - 135 degrees). Looking at a point source of light, the patient sees two luminous stripes - red and white. If binocular fusion is achieved, then the stripes form the figure of an oblique cross. If the merger has not occurred, then only one luminous band is visible, or two non-merged bands, or other combinations of them.
The duration of the course of treatment is 3 weeks.

After analyzing the results of treatment using this method in 85 patients, the author notes that in 91.8% of them, diplopia was provoked on the first day of treatment, and in 11.8%, doubling was noted not only on all filters, but also in natural conditions. . In other patients, it was possible to provoke diplopia in natural conditions only on the 2nd - 7th day of treatment.
After 1-3 courses of this treatment, binocular vision developed in 47% of patients, simultaneous - in 53%.
We use V.I. Serdyuchenko’s technique using red and blue light filters. The results of treatment are positive, similar to the data of the author of this technique.

4) Exercises to strengthen the separation between accommodation and convergence.

Exercises to enhance the separation between accommodation and convergence are indicated in cases where, with convergent accommodative strabismus, under conditions of optical correction, the eyes are symmetrical and there is binocular vision, and after removing the glasses, a deviation of one of the eyes occurs again and binocular vision is impaired.

This condition is due to the presence of a strong connection between accommodation and convergence, as well as a weakened fusion, which is not able to counteract the increased accommodation and convergence in hyperopic refraction.

The goal of therapeutic exercises in such conditions is to weaken the connection between accommodation and convergence. This is achieved by increasing the load on accommodation in the same state of convergence while maintaining binocular vision.

The exercise technique was developed at the Moscow Research Institute of Eye Diseases. Helmholtz and is as follows.
The patient fixes an object at a distance of 30-40 cm from the eyes - a circle with a diameter of 5 mm. A trial spectacle frame is put on, into which corrective glasses are inserted. After that, negative lenses are placed on both eyes - 0.5 D, with which the patient continues to look at the object for 2-3 minutes, then the lenses increase in steps - 1.0 D, -1.5 D, -2.0 D, etc. d. until the object splits. Then the exercises are repeated. In total, 20-30 exercises are carried out daily or every other day.

To control the state of binocular vision during exercise, it is recommended to use the color test of the device "POZB - 1" (a device for determining visual functions for near). Exercises are first carried out from a distance of 25 cm, then - 33 cm (Fig. 45).

Fig.45. Device for exercises to strengthen the separation between accommodation and convergence.

The subject observes the color test through red-green glasses mounted on the forehead. If binocular vision is disturbed when loaded with minus glasses, then the central circle of the color test, covered by a white matte filter, is perceived as double. The patient is encouraged to merge the double images. As they merge, the negative lenses are stepped up by 0.5D until an insurmountable doubling appears. Exercises are repeated 3 times.

To consolidate binocular vision, exercises according to the described method should be carried out with incomplete correction of ametropia or without spherical corrective lenses.

Odessa Research Institute of Eye Diseases. acad. V.P. Filatov, control over the state of binocular vision, at the suggestion of V.I. Serdyuchenko (1984), is carried out with the help of banded Bagolini glasses. A patient in corrective glasses fixes a point light source located 33 cm from the eyes. A frame is put on top of the glasses, into which bagolini striped glasses are inserted, oriented perpendicular to each other: the right glass is 45 °, the left glass is 135 °. In the presence of binocular vision, the patient should see an "oblique" cross of their two luminous bands with a light bulb in the center.

The patient is given a load on accommodation with the help of gradually increasing negative lenses. If binocular vision is upset at the same time, then the image of the light bulb can split in two, and the stripes can move apart. Through mental effort, the patient must connect the bifurcated images of the light bulb and keep in the field of vision a cross of two luminous stripes.

This technique brings the treatment conditions closer to natural conditions, since Bagolini glasses have a significantly less dissociating effect than red-green glasses.

5) Exercises to develop fusion stability.

After the restoration of binocular fusion and the development of a sufficient width of the fusion, it is advisable to conduct exercises to strengthen its stability. E.S. Avetisov and T.P. Kashchenko (1973) developed a special device for this (Fig. 46), in which there is an optical device in front of one eye that changes the size of the monocular image, and in front of the second - a prism of variable strength.

The patient observes an object - a circle with a diameter of 15 or 5 mm - at a distance of 30-100 cm from the eyes. With the help of a prismatic device, a deviation of one eye towards convergence or divergence is caused and at the same time the monocular image of the second eye is reduced. The procedure is carried out stepwise until the object is bifurcated, trying to keep the object merged as long as possible.

The aim of the exercise is to maximize the strength of the prism and the difference in image size leading to fusion failure. Procedure within 10-15 minutes. is repeated many times. Treatment is carried out daily or every other day for 15-30 days.

Figure 46. A device for determining and training the strength of the fusion.