What is anisocoria, or why pupils are of different sizes and what does it threaten. Anisocoria

The human eye has a complex structure, its components are connected to each other and function according to a single algorithm. Ultimately, they form a picture of the surrounding world. This complex process works thanks to the functional part of the eye, the basis of which is the pupil. Pupils before death or after it change their qualitative state, therefore, knowing these features, it is possible to determine how long ago a person died.

Anatomical features of the structure of the pupil

The pupil looks like a round hole in the center of the iris. It can change its diameter by adjusting the area of ​​absorption of light rays falling on the eye. This opportunity is provided to him by the eye muscles: sphincter and dilator. The sphincter surrounds the pupil, and when contracted, it narrows. The dilator, on the contrary, expands, communicating not only with the pupillary opening, but also with the iris itself.

The pupillary muscles perform the following functions:

• Change the diametrical size of the pupil under the action of light and other stimuli that enter the retina.
• Set the diameter of the pupillary hole depending on the distance at which the image is located.
• Converge and diverge on the visual axes of the eyes.

The pupil and the muscles surrounding it work according to a reflex mechanism that is not associated with mechanical irritation of the eye. Since the impulses passing through the nerve endings of the eye are sensitively perceived by the pupil itself, it is able to respond to the emotions experienced by a person (fear, anxiety, fright, death). Under the influence of such a strong emotional arousal, the pupillary openings expand. If the excitability is low, they narrow.

Causes of narrowing of the pupillary openings

With physical and mental stress, the eye holes in people can narrow to ¼ of their usual size, but after rest they quickly recover to their usual dimensions.

The pupil is very sensitive to certain drugs that affect the cholinergic system, such as heart and sleeping pills. That is why the pupil temporarily narrows when they are taken. There is a professional deformation of the pupil in people whose activities are associated with the use of a monocle - master jewelers and watchmakers. In diseases of the eye, such as corneal ulcer, inflammation of the vessels of the eye, omission of the eyelid, internal hemorrhage, the pupillary opening also narrows. Such a phenomenon as a cat's pupil at death (Beloglazov's symptom) also passes through the mechanisms inherent in the eyes and muscles of those around them.

pupil dilation

Under normal circumstances, an increase in pupils occurs at night, in low light conditions, with the manifestation of strong emotions: joy, anger, fear, due to the release of hormones into the blood, including endorphins.

Strong expansion is observed with injuries, drug use and eye diseases. A constantly dilated pupil may indicate intoxication of the body associated with exposure to chemicals, hallucinogens. With craniocerebral injuries, in addition to a headache, the pupillary openings will be unnaturally wide. After taking atropine or scopolamine, their temporary expansion may occur - this is a normal side reaction. In diabetes mellitus and hyperthyroidism, the phenomenon occurs quite often.

Pupil dilation at death is a normal reaction of the body. The same symptom is characteristic of coma.

Classification of pupillary reactions

Pupils in a normal physiological state are round, of the same diameter. When the light changes, a reflex expansion or contraction occurs.

Constriction of the pupils depending on the reaction

What do pupils look like when you die?

The reaction of pupils to light at death passes first by the mechanism of field expansion, and then by their narrowing. Pupils during biological death (final) have their own characteristics when compared by pupils with a living person. One of the criteria for establishing a post-mortem examination is to check the eyes of the deceased.

First of all, one of the signs will be the "drying" of the cornea of ​​​​the eyes, as well as the "fading" of the iris. Also, a kind of whitish film is formed before the eyes, called “herring shine” - the pupil becomes cloudy and dull. This is due to the fact that after death, the lacrimal glands stop functioning, producing tears that moisturize the eyeball.
In order to fully ascertain the death, the victim's eye is gently squeezed between the thumb and forefinger. If the pupil turns into a narrow slit (a symptom of "cat's eye"), a specific reaction of the pupil to death is stated. In a living person, such symptoms are never detected.

Attention! If the deceased had the above signs, then death occurred no more than 60 minutes ago.

Near-death pupils will be unnaturally wide, without any reaction to lighting. With successful resuscitation, the victim will begin to pulsate. The cornea, whites of the eyes, and pupils acquire brownish-yellow stripes after death, called Larcher spots. They are formed if the eyes remain ajar after death and indicate a strong drying of the mucous membrane of the eyes.

Pupils at death (clinical or biological) change their characteristics. Therefore, knowing these features, one can accurately state the fact of death or immediately proceed to save the victim, more precisely, to cardiopulmonary resuscitation. The popular phrase “Eyes are the reflection of the soul” perfectly describes the human condition. Focusing on the reaction of the pupils, in many situations it is possible to understand what is happening to a person and what actions to take.

Video

The pupil is the round hole in the center of the iris. In a healthy person, the pupil reacts to light: in bright light it narrows, and in twilight it expands. This is due to the fact that different cells are responsible for daytime and twilight vision. So the rods of daytime vision are located in the center of the retina, and the cones of twilight vision are located on its periphery. The pupil dilates due to the “pupil dilator” muscle, narrows due to the “pupil sphincter”.

The pupil is an important part of the clinical picture of drug intoxication. When using opioid drugs, the pupil constricts. This is due to the fact that the opium alkaloids affect the circular smooth muscle tissue, and a spasm of the sphincters of the body occurs. So after taking opium drugs, a person cannot because of a spasm of the sphincter of the bladder, is disgusted with fatty foods due to a spasm of the sphincter of Oddi of the common bile duct. In the same way, a sharp spasm of the sphincter of the pupil occurs - and the pupil becomes "on the point", that is, very narrow. This spasm can last for several hours. Also, the effect of a constricted pupil may be present with an overdose of sedatives.

When using drugs of the cannabinoid group (,), psychostimulants, hallucinogens, on the contrary, the pupil expands. Narcotic substances of this group are mydriatics, that is, pupil dilators. The active substances contained in these drugs block the receptors of the pupil dilator, and it ceases to respond correctly to light, spasms and remains in an expanded state. Due to the abundance of bright light falling on the cones of twilight vision, the brain begins to “get lost” due to a discrepancy between the amount of light and the reaction of the pupil to it. At the same time, against the background of the aggressive effects of drugs on the brain, visual hallucinations may begin.

In addition to the size of the pupil, drug addicts also change the photoreaction - the reaction of the pupil to light. In a healthy person, the pupil reacts to light instantly - it narrows if you shine a dim flashlight into the eyes, expands if you cover your eyes from the light with your palms. Such a photoreaction is called alive. If a person has taken drugs recently, then the reaction to light will be very sluggish. This is especially noticeable when taking opioids - in some cases, it is impossible to notice the attempt of the pupil to expand in the shade with the naked eye. This effect sometimes lasts for several hours. When taking mydriatic drugs, the effect of dilated pupil and sluggish photoreaction passes rather quickly.

However, you can't label a person as a "drug addict" whose pupils seem "wrong-sized" to you. There are diseases in which the pupils can be narrowed, dilated, or even of different sizes and with jagged edges.

Sources:

• When using cannabis

Normally, a person's pupils should respond to bright light and its complete absence with certain changes. In the presence of any diseases, there may be certain restrictions on night or day light perception.

Instruction

The pupil is a kind of hole located in the center of the diaphragm of the eye and allows light to pass through itself into the retina of the eye. It visually appears black, due to the fact that many beams of light that enter the pupil are completely absorbed by the tissues located inside the eye. In humans, the pupil has a round shape, but in nature there are other types of it, for example, the pupil is shaped like a small slit.

The pupillary response to light is a very important test that characterizes the function of the brain. At the moment bright light is directed to the light-sensitive cells of the retina, special photoreceptors send a certain signal to the nerve (which performs the function of eye movement) to the circular iris of the sphincter muscles. These muscles make contractions, thereby reducing the size of the pupil.

To check the pupillary reflex to light, use an ophthalmoscope mirror or a slit lamp illuminator. If there are suspicions of a one-sided weakness of the reaction of the pupil, with a beam of light directed directly, the friendly reaction of the other is checked. If the severity of the direct and consensual reactions is the same, the reaction of the pupil to light is considered normal.

Pupil constriction is directly related to near vision. In bright light, the pupils constrict to prevent aberration (evasion) of light rays and thus achieve the expected vision. In the dark, this is not particularly necessary, so the expansion of the pupils is associated only with the passage of a sufficient flow of light into the eyes.

In the dark, the pupil becomes wider, if in the light it has a diameter of 3 to 5 millimeters, then in the dark it expands to 4-9 millimeters. Pupils react differently to light in different age groups. For example, at age 15, a dark-adapted pupil can vary in size from 4 to 9 millimeters. After age 25, the average pupil size decreases slightly, but not at a constant rate.

A condition in which the optic nerves are partially damaged is called chronic dilated pupils, and occurs by reducing the ability of the optic nerves to respond to light. With sufficient lighting, people with this disease have dilated pupils, and in bright light, pain can occur. People suffering from chronic dilated pupils have problems with vision at night and in the absence of lighting. They should be especially careful when moving in the dark due to the inability to see objects in full.

1. Simultaneous violation of the reaction of pupils to light, convergence and accommodation is clinically manifested by mydriasis. With a unilateral lesion, the reaction to light (direct and friendly) on the diseased side is not caused. This immobility of the pupils is called internal ophthalmoplegia. This reaction is due to damage to the parasympathetic pupillary innervation from the Yakubovich-Edinger-Westphal nucleus to its peripheral fibers in the eyeball. This type of pupillary reaction disorder can be observed in meningitis, multiple sclerosis, alcoholism, neurosyphilis, cerebrovascular diseases, and traumatic brain injury.
2. Violation of the friendly reaction to light is manifested by anisocoria, mydriasis on the affected side. In the intact eye, the direct reaction is preserved and the friendly reaction is weakened. In the diseased eye, there is no direct reaction, and the friendly one is preserved. The reason for this dissociation between direct and friendly pupillary response is damage to the retina or optic nerve before the optic chiasm.
3. Amaurotic immobility of the pupils to light is found in bilateral blindness. At the same time, both direct and friendly reaction of the pupils to light is absent, but to convergence and accommodation is preserved. Amaurotic pupillary areflexia is caused by a bilateral lesion of the visual pathways from the retina to the primary visual centers inclusive. In cases of cortical blindness or damage on both sides of the central visual pathways running from the external crankshaft and from the thalamus to the occipital visual center, the reaction to light, direct and friendly, is completely preserved, since the afferent optic fibers end in the region of the anterior colliculus. Thus, this phenomenon (amaurotic immobility of the pupils) indicates a bilateral localization of the process in the visual pathways up to the primary visual centers, while bilateral blindness with the preservation of a direct and friendly reaction of the pupils always indicates damage to the visual pathways above these centers.
4. The hemiopic reaction of the pupils consists in the fact that both pupils contract only when the functioning half of the retina is illuminated; when illuminating the fallen half of the retina, the pupils do not contract. This reaction of the pupils, both direct and friendly, is due to damage to the optic tract or subcortical visual centers with the anterior tubercles of the quadrigemina, as well as crossed and non-crossed fibers in the chiasm. Clinically almost always combined with hemianopsia.
5. The asthenic reaction of the pupils is expressed in rapid fatigue and even in the complete cessation of constriction with repeated light exposure. Such a reaction occurs in infectious, somatic, neurological diseases and intoxications.
6. The paradoxical reaction of the pupils is that when exposed to light, the pupils dilate, and narrow in the dark. It occurs extremely rarely, mainly with hysteria, even sharp with dorsal tabes, strokes.
7. With an increased reaction of the pupils to light, the reaction to light is more lively than normal. It is sometimes observed with mild concussions of the brain, psychoses, allergic diseases (Quincke's edema, bronchial asthma, urticaria).
8. The tonic reaction of the pupils consists in an extremely slow expansion of the pupils after their constriction during light exposure. This reaction is due to increased excitability of the parasympathetic pupillary efferent fibers and is observed mainly in alcoholism.
9. Myotonic pupillary reaction (pupillotonia), Adie-type pupillary disorders can occur in diabetes mellitus, alcoholism, beriberi, Guillain-Barré syndrome, peripheral autonomic disorder, rheumatoid arthritis.
10. Pupillary disorders of the Argyle Robertson type. The clinical picture of Argyle Robertson syndrome, which is specific for syphilitic lesions of the nervous system, includes such signs as miosis, slight anisocoria, lack of reaction to light, pupillary deformity, bilateral disturbances, constant pupil sizes throughout the day, lack of effect from atropine, pilocarpine and cocaine . A similar picture of pupillary disorders can be observed in a number of diseases: diabetes mellitus, multiple sclerosis, alcoholism, cerebral hemorrhage, meningitis, Huntington's chorea, pineal gland adenoma, pathological regeneration after paralysis of the oculomotor muscles, myotonic dystrophy, amyloidosis, Parino syndrome, Münchmeier syndrome (vasculitis, which underlies interstitial muscle edema and subsequent proliferation of connective tissue and calcification), Denny-Brown sensory neuropathy (congenital absence of pain sensitivity, lack of pupillary response to light, sweating, increased blood pressure and increased heart rate with severe pain stimuli), pandysautonomy, family dysautonomy Riley-Day, Fisher's syndrome (acute development of complete ophthalmoplegia and ataxia with a decrease in proprioceptive reflexes), Charcot-Marie-Tooth disease. In these situations, Argyle Robertson's syndrome is called non-specific.
11. Premortal pupillary reactions. Of great diagnostic and prognostic value is the study of pupils in coma. With a deep loss of consciousness, with severe shock, a coma, the reaction of the pupils is absent or sharply reduced. Immediately before death, the pupils in most cases are greatly constricted. If, in a coma, miosis is gradually replaced by progressive mydriasis, and there is no pupillary reaction to light, then these changes indicate the proximity of death.

The following are pupillary disorders associated with impaired parasympathetic function.

1. The response to light and pupil size under normal conditions depend on adequate light reception in at least one eye. In a completely blind eye, there is no direct reaction to light, but the size of the pupil remains the same as on the side of the intact eye. In the case of complete blindness in both eyes, with a lesion in the area anterior to the lateral geniculate bodies, the pupils remain dilated, not reacting to light. If bilateral blindness is due to destruction of the cortex of the occipital lobe, then the light pupillary reflex is preserved. Thus, it is possible to meet completely blind patients with a normal reaction of pupils to light.

Lesions of the retina, optic nerve, chiasm, optic tract, retrobulbar neuritis in multiple sclerosis cause certain changes in the functions of the afferent system of the light pupillary reflex, which leads to a violation of the pupillary reaction, known as the pupil of Marcus Gunn. Normally, the pupil reacts to bright light with a rapid constriction. Here the reaction is slower, incomplete and so short that the pupil may immediately begin to expand. The reason for the pathological reaction of the pupil is to reduce the number of fibers that provide a light reflex on the side of the lesion.

1. The defeat of one optic tract does not lead to a change in the size of the pupil due to the preserved light reflex on the opposite side. In this situation, illumination of intact areas of the retina will give a more pronounced reaction of the pupil to light. This is called Wernicke's pupillary reaction. It is very difficult to cause such a reaction due to the dispersion of light in the eye.
2. Pathological processes in the midbrain (area of ​​the anterior tubercles of the quadrigemina) can affect the fibers of the reflex arc of the pupil's reaction to light that intersect in the region of the cerebral aqueduct. The pupils are dilated and do not react to light. Often this is combined with the absence or limitation of upward movement of the eyeballs (vertical gaze paresis) and is called Parino's syndrome.
3. Argyle Robertson Syndrome.
4. With complete damage to the third pair of cranial nerves, pupil dilation is observed due to the absence of parasympathetic influences and ongoing sympathetic activity. At the same time, signs of damage to the motor system of the eye, ptosis, deviation of the eyeball in the lower lateral direction are detected. Causes of gross lesions of the III pair can be an aneurysm of the carotid artery, tentorial hernia, progressive processes, Tolosa-Hunt syndrome. In 5% of cases with diabetes mellitus, an isolated lesion of the third cranial nerve occurs, while the pupil often remains intact.
5. Adie's syndrome (pupillotonia) - degeneration of the nerve cells of the ciliary ganglion. There is a loss or weakening of the pupil's reaction to light with a preserved reaction to the setting of the gaze near. One-sidedness of the lesion, pupil dilation, its deformation are characteristic. The phenomenon of pupillotonia lies in the fact that the pupil narrows very slowly during convergence and especially slowly (sometimes only within 2-3 minutes) returns to its original size after the cessation of convergence. Pupil size is not constant and changes throughout the day. In addition, the expansion of the pupil can be achieved by a long stay of the patient in the dark. There is an increase in the sensitivity of the pupil to vegetotropic substances (a sharp expansion from atropine, a sharp narrowing from pilocarpine).

Such hypersensitivity of the sphincter to cholinergic agents is detected in 60-80% of cases. Tendon reflexes are weakened or absent in 90% of patients with tonic Eidi pupils. This weakening of the reflexes is common, affecting the upper and lower extremities. In 50% of cases, there is a bilateral symmetrical lesion. Why tendon reflexes are weakened in Adie's syndrome is not clear. Hypotheses are proposed about widespread polyneuropathy without sensory disturbances, about degeneration of fibers of the spinal ganglia, a peculiar form of myopathy, and a neurotransmission defect at the level of spinal synapses. The average age of the disease is 32 years. More commonly seen in women. The most common complaint, other than anisocoria, is near blurred vision when looking at closely spaced objects. Approximately in 65% of cases, residual paresis of accommodation is noted on the affected eye. After several months, there is a pronounced tendency to normalize the force of accommodation. Astigmatism can be provoked in 35% of patients with each attempt to look close at the affected eye. Presumably this is due to segmental paralysis of the ciliary muscle. When examining in the light of a slit lamp, one can note some difference in the sphincter of the pupil in 90% of the affected eyes. This residual reaction is always a segmental contraction of the ciliary muscle.

As the years pass, pupillary constriction appears in the affected eye. There is a strong tendency for a similar process to occur in the other eye after a few years, so that the anisocoria becomes less noticeable. Eventually both pupils become small and poorly responsive to light.

It has recently been found that the dissociation of the pupillary response to light and accommodation, often observed in Adie's syndrome, can only be explained by the diffusion of acetylcholine from the ciliary muscle into the posterior chamber towards the denervated pupillary sphincter. It is likely that the diffusion of acetylcholine into the aqueous humor contributes to the tension of the movements of the iris in Adie's syndrome, but it is also quite clear that the dissociation mentioned cannot be explained so unambiguously.

The pronounced reaction of the pupil to accommodation is most likely due to pathological regeneration of accommodation fibers in the sphincter of the pupil. The nerves of the iris have an amazing ability to regenerate and reinnervate: a fetal rat heart transplanted into the anterior chamber of an adult eye will grow and contract in a normal rhythm, which can change depending on the rhythmic stimulation of the retina. The nerves of the iris can grow into the transplanted heart and set the heart rate.

In most cases, Adie's syndrome is idiopathic and no cause can be found. Secondarily, Adie's syndrome can occur in various diseases (see above). Familial cases are extremely rare. Cases of the combination of Adie's syndrome with autonomic disorders, orthostatic hypotension, segmental hypohidrosis and hyperhidrosis, diarrhea, constipation, impotence, and local vascular disorders are described. Thus, Adie's syndrome can act as a symptom at a certain stage in the development of a peripheral autonomic disorder, and sometimes it can be its first manifestation.

Blunt trauma to the iris can lead to rupture of short ciliary branches in the sclera, which is clinically manifested by the deformation of the pupils, their dilation and impairment (weakening) of the reaction to light. This is called post-traumatic iridoplegia.

The ciliary nerves can be affected in diphtheria, leading to dilated pupils. This usually occurs on the 2-3rd week of the disease and is often combined with paresis of the soft palate. Pupillary dysfunction usually recovers completely.

Pupillary disorders associated with impaired sympathetic function

The defeat of the sympathetic pathways at any level is manifested by Horner's syndrome. Depending on the level of the lesion, the clinical picture of the syndrome may be complete or incomplete. The complete Horner's syndrome looks like this:

1. narrowing of the palpebral fissure. Reason: paralysis or paresis of the upper and lower tarsal muscles receiving sympathetic innervation;
2. miosis with normal pupillary response to light. Reason: paralysis or paresis of the muscle that expands the pupil (dilator); intact parasympathetic pathways to the muscle that narrows the pupil;
3. enophthalmos. Cause: paralysis or paresis of the orbital muscle of the eye, which receives sympathetic innervation;
4. homolateral anhidrosis of the face. Reason: violation of the sympathetic innervation of the sweat glands of the face;
5. hyperemia of the conjunctiva, vasodilation of skin vessels of the corresponding half of the face. Reason: paralysis of the smooth muscles of the vessels of the eye and face, loss or insufficiency of sympathetic vasoconstrictor influences;
6. heterochromia of the iris. Reason: sympathetic insufficiency, as a result of which the migration of melanophores to the iris and choroid is disrupted, which leads to a violation of normal pigmentation at an early age (up to 2 years) or depigmentation in adults.

Symptoms of incomplete Horner's syndrome depend on the level of the lesion and the degree of involvement of sympathetic structures.

Horner's syndrome can be central (damage to the first neuron) or peripheral (damage to the second and third neurons). Large studies among patients hospitalized in neurological departments with this syndrome revealed its central origin in 63% of cases. It has been linked to stroke. In contrast, researchers who observed outpatients in eye clinics found the central nature of Horner's syndrome in only 3% of cases. In domestic neurology, it is generally accepted that Horner's syndrome with the greatest regularity occurs with peripheral damage to sympathetic fibers.

Congenital Horner's syndrome. The most common cause is birth trauma. The immediate cause is damage to the cervical sympathetic chain, which can be combined with damage to the brachial plexus (most often its lower roots - Dejerine-Klumpke palsy). Congenital Horner's syndrome is sometimes combined with facial hemiatrophy, with anomalies in the development of the intestine, cervical spine. Congenital Horner's syndrome can be suspected by ptosis or heterochromia of the iris. It also occurs in patients with cervical and mediastinal neuroblastoma. All newborns with Horner's syndrome are offered to diagnose this disease by performing chest radiography and screening method to determine the level of excretion of mandelic acid, which in this case is elevated.

For congenital Horner's syndrome, the most characteristic is heterochromia of the iris. Melanophores move into the iris and choroid during embryonic development under the influence of the sympathetic nervous system, which is one of the factors affecting the formation of melanin pigment, and thus determines the color of the iris. In the absence of sympathetic influences, the pigmentation of the iris may remain insufficient, its color will become light blue. Eye color is established a few months after birth, and the final pigmentation of the iris ends by the age of two. Therefore, the phenomenon of heterochromia is observed mainly in congenital Horner's syndrome. Depigmentation after impaired sympathetic innervation of the eye in adults is extremely rare, although isolated well-documented cases have been described. These cases of depigmentation testify to a kind of sympathetic influence on melanocytes that continues in adults.

Horner's syndrome of central origin. A hemispherectomy or a massive infarction in one hemisphere can cause Horner's syndrome on that side. The sympathetic pathways in the brainstem along its entire length run adjacent to the spinothalamic tract. As a result, Horner's syndrome of stem origin will be observed simultaneously with a violation of pain and temperature sensitivity on the opposite side. The causes of such a lesion can be multiple sclerosis, pontine glioma, stem encephalitis, hemorrhagic stroke, thrombosis of the posterior inferior cerebellar artery. In the last two cases, at the onset of vascular disorders, Horner's syndrome is observed along with severe dizziness and vomiting.

When involved in the pathological process, in addition to the sympathetic pathway, the nuclei of the V or IX, X pairs of cranial nerves, analgesia, termanesthesia of the face on the ipsilateral side or dysphagia with paresis of the soft palate, pharyngeal muscles, and vocal cords will be noted, respectively.

Due to the more central location of the sympathetic pathway in the lateral columns of the spinal cord, the most common causes of lesions are cervical syringomyelia, intramedullary spinal tumors (glioma, ependymoma). Clinically, this is manifested by a decrease in pain sensitivity in the hands, a decrease or loss of tendon and periosteal reflexes from the hands, and bilateral Horner's syndrome. In such cases, first of all, ptosis on both sides attracts attention. The pupils are narrow and symmetrical with a normal reaction to light.

Horner's syndrome of peripheral origin. Damage to the first thoracic root is the most common cause of Horner's syndrome. However, it should be immediately noted that the pathology of the intervertebral discs (hernia, osteochondrosis) is rarely manifested by Horner's syndrome. The passage of the I thoracic root directly above the pleura of the apex of the lung causes its defeat in malignant diseases. Classic Pancoast syndrome (cancer of the apex of the lung) is manifested by pain in the axilla, atrophy of the muscles of the (small) arm, and Horner's syndrome on the same side. Other causes are neurofibroma of the root, accessory cervical ribs, Dejerine-Klumpke paralysis, spontaneous pneumothorax, and other diseases of the lung apex and pleura.

The sympathetic chain at the cervical level can be damaged due to surgical interventions on the larynx, thyroid gland, injuries in the neck, tumors, especially metastases. Malignant diseases in the zone of the jugular foramen at the base of the brain cause various combinations of Horner's syndrome with damage to the IX, X, XI and CP pairs of cranial nerves.

If the fibers that go as part of the plexus of the internal carotid artery are damaged above the superior cervical ganglion, Horner's syndrome will be observed, but only without sweating disorders, since the sudomotor pathways to the face go as part of the plexus of the external carotid artery. Conversely, sweating disorders without pupillary abnormalities will occur when fibers of the external carotid plexus are involved. It should be noted that a similar picture (anhidrosis without pupillary disorders) can be observed with damage to the sympathetic chain caudal to the stellate ganglion. This is explained by the fact that the sympathetic paths to the pupil, passing through the sympathetic trunk, do not descend below the stellate ganglion, while the sudomotor fibers going to the sweat glands of the face leave the sympathetic trunk, starting from the superior cervical ganglion and ending with the superior thoracic sympathetic ganglia.

Injuries, inflammatory or blastomatous processes in the immediate vicinity of the trigeminal (Gasser) node, as well as syphilitic osteitis, carotid aneurysm, alcoholization of the trigeminal node, herpes ophthalmicus are the most common causes of Raeder's syndrome: damage to the first branch of the trigeminal nerve in combination with Horner's syndrome. Sometimes the lesion of the cranial nerves of the IV, VI pairs joins.

Pourfure du Petit syndrome is the inverse of Horner's syndrome. At the same time, mydriasis, exophthalmos and lagophthalmos are observed. Additional symptoms: increased intraocular pressure, changes in the vessels of the conjunctiva and retina. This syndrome occurs with the local action of sympathomimetic agents, rarely with pathological processes in the neck, when the sympathetic trunk is involved in them, as well as with irritation of the hypothalamus.

Special forms of pupillary disorders

This group of syndromes includes cyclic oculomotor paralysis, ophthalmoplegic migraine, benign episodic unilateral mydriasis, and "tadpole" pupil (intermittent segmental dilator spasm lasting several minutes and recurring several times a day).

Pupils of Argil-Robertson

The pupils of Argyle-Robertson are small, unequal in size and irregularly shaped pupils with poor reaction to light in the dark and good reaction to accommodation with convergence (dissociated pupillary response). A distinction should be made between Argyle-Robertson's sign (a relatively rare sign) and Eddie's bilateral tonic pupils, which are more common.

If the pupil reacts poorly to light and anisocoria increases in bright light, this means that the sphincter of the pupil is paralyzed. If we exclude local damage (trauma, inflammatory diseases of the eye), there are three causes of paralysis of the sphincter of the pupil:

1. damage to the oculomotor nerve (for example, compression);
2. violation of the parasympathetic innervation of the sphincter of the pupil in case of injury or damage to the ciliary ganglion;
3. medicinal mydriasis.

On examination, they first look for symptoms of damage to the oculomotor nerve: ptosis, diplopia and paresis of the oculomotor muscles. But even their absence does not exclude damage to the oculomotor nerve: for example, an enlarged, poorly responsive or unresponsive pupil may indicate compression of the oculomotor nerve in temporotentorial herniation or aneurysm of the posterior communicating artery. Therefore, with a recent or sudden dilation of the pupil, an urgent examination is indicated, especially in the presence of a headache or other neurological symptoms.

If the pupil has been dilated for several weeks or more and there is tonic pupil reaction(weak reaction of the pupil to light with accommodation preserved and slow pupil expansion when the object is moved away), it is probable Holmes-Adie syndrome. This is a benign, usually unilateral condition, which can be confirmed by hypersensitivity to pilocarpine (instillation of a 0.1% solution of this drug into the eye causes marked pupillary constriction). Sometimes, due to disturbances of accommodation, it is difficult for patients to read, but usually there are no complaints and a violation of pupillary reactions is detected by chance. Apparently, the Holmes-Eidy syndrome occurs due to a viral infection or vascular lesions of the ciliary ganglion.

In drug-induced mydriasis, the pupil reacts poorly to light and convergence and does not constrict under the influence of 1% pilocarpine, which makes it possible to exclude Holmes-Eidy syndrome and damage to the oculomotor nerve, in which pilocarpine constricts the pupil. Another reason for pupil dilation is trauma to the sphincter of the pupil or its nerves. The sphincter of the pupil can be damaged during eye surgery, penetrating injury or blunt trauma to the eyeball.

Damage to the iris can be detected by examination with a slit lamp. Pupil reaction to pilocarpine may be intact. The pupil may dilate as a result of previous diseases of the eye, such as iritis, iridocyclitis, rubeosis of the iris. Less commonly, persistent pupillary dilatation is caused by anomalies in the development of the eye, denervation atrophy of the iris, and damage to the anterior chamber of the eye by a tumor.

Prof. D. Nobel

All the secrets of the eye. Olga_Mo's blog on 7ya.ru

Psychological observations show that during personal contacts, the interlocutors are not able to look at each other constantly, but only no more than 60% of the total time. However, the time of eye contact can go beyond these limits in two cases: in lovers and in aggressive people. Therefore, if an unfamiliar person looks at you for a long time and intently, most often this indicates hidden aggression. The duration of visual contact depends on the distance between the interlocutors. The greater the distance, the...

The child (4 months) has different pupils. Those. expand one more, the other less. In bright light, they seem to be the same size, but in dimming, they are different. We noticed about a month, but the neurologist did not pay attention to this during the examination last week, and we forgot to ask. I called the pediatrician - she says that this is just a feature of the person, she called the neurologist - he said that this could be a symptom of some diseases, but he did not say which ones. He ordered him to show his son again. Maybe someone can suggest...

Girls, I decided to write here, I know that Vitalka's mother, Bumsik's children have vision problems. My Sofiyka has partial visual atrophy. nerves, the ophthalmologist says - the discs are completely pale, and no improvement is observed, the look is poorly fixed, and now Sabril has also been introduced - I am very afraid of side effects. One herbalist stood up for us and brought us a collection of eyebright - this grass is so low, it blooms, it is difficult to see it in the tall grass, you can see what it is on the Internet. I asked her...

Discussion

We also have visual atrophy. nerves. But, it seems to me, after remission, our vision improves markedly. The young lady has clearly begun to look into the distance, and in the near field she shows interest in rather small objects. So, I hope Sofiyka will still improve.
Have you tried all sorts of flashlights and "black boxes"? It is easier to concentrate the gaze there, and with the ability to concentrate the gaze and blood supply to the eyes improves.
(about the black box: "A dark box - everyone can do it: a cardboard box, large enough. A hole for a UV lamp is cut out at the top (a piece of cardboard is left for shielding). Inside the box is upholstered with a black non-shiny cloth. Toys - or luminous rods (in Rehab - 8 pieces - 2-3 thousand), or make it yourself from a simple white fabric, it will glow cool). In such a dark room or in a dark box, practice daily for 10 minutes.)

I have a couple of anecdotes about my Katya and vision:
Katya didn’t see anything for up to a year, she didn’t react to light with her pupils, but I, like an exemplary mother, despite our attacks, shone a flashlight into her eyes. And Katya not only didn’t follow, but even somehow almost dodged. Of course, I decided that I wasn’t upset at all, that there was no reaction to the light, well, it’s not necessary, and we’ll manage like that :)) and then I somehow accidentally spun this 100-bucks climbing flashlight so that the light was in my eyes hit. It turned out, SUCH A SPOTLIGHT!!! It somehow immediately became clearer to me why Katya is not trying to follow him with her eyes :))
and there was a story: we have already seen, but still very bad. And then, after a month of classes, our speech therapist comes not as a blonde, but as a redhead (crimson :))
Katya's eyes are dumbfounded, she can't understand anything. The voice is the same :)) She convinces her that it is she (the speech therapist) who is :)) In the end, Katya seemed to believe, but she came out with such an expression on her face! And on the face it was clearly read: "Yes, it seems that visual analyzers cannot be trusted !!!"

lyceum 1571 program 1-3

Going to school in 2015 to first class. We really need feedback about the program 1-3. Primary school for 3 years. How big is the load? What is the amount of homework? What should be in your opinion the initial level for a comfortable study in this program? Are there those who are disappointed, unable to cope? We have already passed the testing, there is an opportunity to go to this program, the choice is ours. Many thanks in advance to everyone who answers!

Discussion

Good afternoon! My daughter also studies in this class with S.P. Ghetto. That's right. One such Redhead wrote. If he reads, writes, thinks and wants to learn, then you can try. But it all depends on the teacher, of course. Well, depending on your mood.

Since we are studying exactly according to such a program, I am ready to tell :)

At first, the load was very noticeable. And this happened because for the whole of September, all first-graders - and ours too - studied 3 lessons a day. And we had, for a minute, 5-6! So we had to catch up at home. The recipes especially interfered with life :)

BUT! Six months passed - and somehow everyone learned to write, nothing terrible happened :)

After the first quarter, the load has noticeably decreased - this is objective. Plus, the kids got involved.

After the first half of the year, two children left the class, while objectively only one child of these two could not cope.

Now I am not overjoyed at our program. The kids in the class are quick and smart, and stretching out for 4 years would make them desperately bored and lose interest in learning. Now they are very motivated to study, to gain knowledge.

Of course, a lot depends on the parents. The first class (passed in six months) still needs to be studied with the child - either after school or on weekends. We have children in our class who would never think (and this is because PARENTS would never think of it!!!) to use solution books or some ready-made essays. The goal is to gain knowledge.

And, of course, the teacher must be chosen. We were very lucky with our Svetlana Petrovna, she managed to create a comfortable atmosphere under a heavy load and make the class friends, making the children interested in learning.

It was I who spread my thoughts along the tree, and the idea can be stated in a lapidary way: if the child reads, writes and is efficient, go to 1-3, you do not lose anything and at any time you can change the program to 1-4. If you think that the child "will reach for strong students and catch up" - this is not your option, the load will be too strong, and the child will hate school.

A new view of the world or how I saw the light.

Girls, everything turned out quickly and unexpectedly. But that's even better. The background was short - the husband took the doctor's phone from a friend, who restored his vision six months ago - from a big minus to 100%. The doctor is one of the best in Russia, so the place of the operation did not bother us - Kostroma. Immediately I give a link to the website of the Yablokov clinic: [link-1] You will find answers to most of your questions there. Mikhail Gennadievich, not without pride, said that the clinic, which opened in February of this year, is his brainchild ...

Discussion

I went through this 14 years ago, but my vision was restored from a very big minus - from minus 9-10 in each eye. The most unpleasant yes - to put an expander. The flashes of the laser are a little painful on the nerves, then the eyes feel like sand is full. But for the sake of restored vision, you can endure all this.
The duration of recovery depends on how many diopters were removed. The more, the longer, of course. My brother also went through this, but they removed -1.75 from him. A week later he was completely normal. It took me a month to start to see normally both near and far. And then another 4 months to restore twilight vision. The first months it was at twilight that it was seen very badly, day and night - normal, but at twilight the guard was simple. But that has also been restored.
Another friend was removed minus 8. But she had problems with recovery, her cornea was depleted - for many years before the operation she almost constantly wore lenses.
After 14 years, vision is normal. The minus was not completely removed for me, somewhere up to -0.5. That's pretty much how it is now. When they check my eyesight, I see the last line ... Previously, I could hardly distinguish only the uppermost letters))
So don't worry, everything will be fine)))

These dilators in the eye - brought almost to a loss of pulse (. And so .. I really want to take off these glasses !!!

Does childish jealousy exist?

Does childish jealousy exist? Good afternoon, dear readers of my baby blog. The birth of a child is a great joy. Mom and dad are very happy about this birth, because a brother or sister has appeared for the eldest child. But how does the older child react to this? Because now everything will change. You will need to share not only your own space, entertainment, but also the love of mom and dad. At first, the older child has nothing to do with this newborn. For him, the baby is no more ...

Daytime sleep: how much sleep the child needs to get enough sleep.

For the health and full development of an infant, the smallest details matter. Moms study entire volumes on caring for a baby, consult a doctor and consult with friends, but still it is impossible to get answers to all questions. An urgent problem can be daytime sleep: how much sleep a child needs to get enough sleep - any mother who is raising her first child and not only thinks about this. Search engines of Internet resources are simply clogged with such requests and women's forums are overflowing ...

Paternity. Olga_Mo's blog on 7ya.ru

The period of pregnancy in the life of every couple is special, and the role of a man in it is quite significant. Already at the stage of pregnancy planning, it becomes clear that the bearing and birth of a child is not only a matter for women and doctors. First of all, it is the business of a married couple. The period of pregnancy in the life of every couple is special, and the role of a man in it is quite significant. Already at the stage of pregnancy planning, it becomes clear that the bearing and birth of a child is not only a matter for women and doctors. AT...

9 (learning to photograph).

Comment from a student: My first portrait... I asked my son to pose in a photo cube :) + natural light from the window. Framing. Comment from the teacher: Nice, expressive photo! Great emotion in the frame. Technically, the picture is well done. Soft light is great for photographing children, softly portraying the volume of their faces. I would advise to lighten up a little in post-processing the attention-grabbing black nose of the toy, so that the main attention of the viewer is drawn to...

If you remember, I already wrote here about how an ironing board fell on our kitty. Two weeks passed. Firstly, her pupils are dilated, they almost do not react to light. Secondly, increased sensitivity. She does not allow herself to be stroked, touched, it is unpleasant for her. She plumped up a lot. Eats a lot and moves little. The doctor prescribed more injections for her. B1 and cocarboxylase 0.5 ml intramuscularly. But I can not. As soon as I prick her a little, she already escapes terribly and screams. I have no idea how to give her injections. More...

Discussion

An ironing board fell on two one month old kittens. Will they survive? One tries to walk, but sleeps almost all the time, does not suck the cat. The second one is completely down. Head down. What to do?

Hello, please help, the child threw a British kitten ... after the fall, the kitten does not hold its head well, does not rise to its paws and does not open its eyes ... tries to open it, but it does not work as if they are stuck together ... please tell me what to do

Paints. Parables from Sergei Shepel.

In one box were tubes of paints. Once white paint said to black, the tube of which lay closest to her: - Sister, what kind of misfortune happened to you? Why are you so dirty? - I'm not dirty, that's my color, - answered the black paint. - Then you have the wrong paint and the color you have is wrong. Look at me, this is what the true color should be, and in general, all colors are descended from white, so there is nothing higher than white, to become like which one should strive ...

If you have no complaints, plan your first visit to a pediatric ophthalmologist at 1-3 months. The second visit is usually prescribed by the doctor himself - it depends on whether any disease has been identified. Although I look at children up to a year in my clinic twice: up to 3 months and at 6 months, while always expanding the pupil. The next examinations are at 1 and 2 years. Then, at 3 years old, it is already possible to check visual acuity according to the table. Further examination by an ophthalmologist at the age of 6, before school. This examination often reveals decreased visual acuity in one eye. The reason may be, for example, the incorrect seating of the child while drawing, watching TV, playing games on the computer, etc...
... Big eyes in a baby - "saucers" - can be a symptom of increased intraocular pressure, the treatment of which cannot be postponed until later. During the first year of life, the baby grows and develops intensively, and with it the size of the eyes changes and visual functions improve. Therefore, it is important for the mother to monitor how the child reacts to light, how he watches the toy. If the baby negatively perceives light changes, he develops irritation, lacrimation, photophobia, then this should alert parents. In such cases, I strongly recommend contacting a specialist. The vast majority of children are born farsighted, due to the short anteroposterior axis of the eyeball. Further,...

Discussion

The question, in my opinion, was this?

I have been a regular reader of yours for several years now. I often re-read old issues, as the child grows and new questions arise that did not bother me before. Today I am worried about my daughter's poor eyesight. She is only three years old - has her eyesight really deteriorated? Will the glasses help her? I would like to get advice from an experienced ophthalmologist on the pages of the magazine. Olga D., St. Petersburg

Where is the answer? The whole article is devoted to already known facts - heredity, diseases of a pregnant woman, correct posture. And how to help vision not to progress already in childhood, and not in infancy (after three years, as the author of the question writes), including whether glasses will help - NOT A WORD! I am also interested in this question, though about the age of 8 years, so I began to read with interest. And what? Where are the answers to the questions?

In the presence of these symptoms, the patient cannot be tolerated and disturbed, trying to bring him to consciousness. Call an ambulance immediately! How about a fracture? A spinal fracture is indicated by severe back pain, numbness, and paralysis of the body below the injury site. Check the reaction of the pupils to light: if they narrow, this is a good sign. Is the pupillary reflex slight or completely absent? Get the child to a general hospital as soon as possible. Just transport it correctly! Your actions. Carefully place the victim on a hard surface (wide board, plywood sheet, door removed from the hinges). Fix your neck by placing a rolled up towel, shirt, beach robe under it. To prevent traumatic shock, give the child painkillers at the age dose....

Discussion

Water from the respiratory tract cannot be removed by pressing on the ribs. You can only remove water from the stomach, so that the distended stomach does not “squeeze” the lungs.
And the reaction of the pupils to light has nothing to do with a fracture of the spine.
And in general, everything is somehow dumped into a heap.

Tip: Don't put up with inconvenience when wearing lenses. With redness of the eyes, itching, burning, excessive dryness, tearing, do not self-medicate, but immediately contact a specialist. In a new color Would you like to change your eye color? Choose colored lenses. They are produced both with diopters and without them, they have their own classification, features of selection and wearing. For owners of light eyes, tinted lenses of the lightest tones are suitable. They are translucent, have a weak uniform color over the entire surface except for the edge. It is usually left transparent so that the lens does not stand out against the background of the sclera (eye protein). But they have one feature - they cover the pupil with the colored part ....
...They have a special reflective layer to block the natural color, on top of which the image of the iris is applied. Attention! In colored lenses for dark eyes, the place where the pupil is located is always transparent. This zone is no more than 5 mm in diameter. Suppose you have brown eyes and wear blue lenses. In bright light, the pupil will narrow, and then a natural brown shade will become visible in the transparent zone. You need to either come to terms with this, or choose a shade in which the contrast between the lens and the color of the eyes will be less noticeable. Fashion accessory Experts suggest trying on decorative contact lenses for those who like to shock. They depict a dollar sign, a vertical pupil ("cat's eye"), stars, hearts ... With their help, actors ...

After all, at this time there is a hormonal restructuring of the body, which affects everyone in different ways. And the eyes are one of the organs that are affected by it. Ophthalmologists strongly recommend, regardless of how you see and whether you have any vision complaints, to undergo an examination at 10-14 weeks of pregnancy. In addition to a general examination of the visual system, the diagnosis of the fundus with a dilated pupil is mandatory. If the results of the diagnosis do not reveal any deviations, then experts advise to undergo a second examination of vision closer to the end of pregnancy - at 32-36 weeks. However, if you have myopia, then ophthalmologists recommend to be observed monthly. During pregnancy, the entire body of a woman undergoes changes, including ...
...During pregnancy, the whole body of a woman, including her eyesight, undergoes changes. Therefore, the visual system requires special attention from the expectant mother. During pregnancy, the main threat to the visual system is possible problems with the retina. The retina is a thin layer of nervous tissue located on the inside of the back of the eyeball and absorbing light. The retina of the eye is responsible for perceiving the image and converting it into nerve impulses, which are then transmitted to the brain. The main problems with the retina are dystrophy, rupture or detachment. Therefore, examination by specialists can prevent formidable complications from the side of vision. What will the birth be like? Will it be possible to ro...

How to choose the right sunglasses to protect your eyesight

Immediately after birth, the child sees very little: while he only reacts to light (turning his head briefly towards it), and also tries to follow large moving objects. However, very soon the picture will change in the most decisive way: at 2-5 weeks the baby will confidently look at the light, by the end of the 2nd month he will look at large objects, at three months he will perk up when he notices his mother’s breast or a bottle, at four he will grab objects , proportionate to the palm. The real exam How to understand what ...
...The transparent structures of the eye include the lens, the vitreous body and intraocular fluid. The fibrous membrane consists of an opaque white part - the sclera and the cornea - the anterior, transparent part of the outer shell of the eye. The iris, located behind the cornea, is a membrane with a hole in the center - the pupil. In bright light, the pupil constricts, and in the dark, it expands to let more light through to the retina. Behind the iris is an elastic dense formation - the lens. It is transparent, has the shape of a biconvex lens and, together with the cornea, makes up the optical system of the eye. The retina lines the fundus of the eye and is part of the central nervous system. Through the cornea and lens, the rays from the objects in question enter the retina and form ...

It is necessary to monitor the vision of the baby from the very birth. Regular preventive examinations by a competent ophthalmologist using modern diagnostic equipment can detect any disease at an early stage. And the younger the child, the more gentle and effective treatment is. What we have Good vision in both parents significantly reduces the likelihood of...
...What do we get? False myopia is called overstrain of the eye muscles, which often occurs with chronic visual fatigue occurs. The child begins to see worse, may complain of a headache, act up. When diagnosing without studying the state of the fundus (that is, without instilling special drops into the eyes to expand the pupil, which relax the spasmodic muscles and allow the doctor to determine the true visual acuity), doctors in the district clinic or the Optics store, equipped with the simplest device for computer diagnostics, may even mistakenly prescribe glasses for a child. However, with false myopia, the visual acuity of the baby may be ideal. In this case, the points are only...

Discussion

the last fragment is some kind of nonsense, neglected strabismus, which does not manifest itself in any way ...
I myself have such garbage, congenital amblyopia, treatment began almost from birth, all my childhood in glasses, with a blindfold on my eye, that’s what really complexes can appear from, but it didn’t help a bit, I can see with one eye, and that’s bad
and you know, nothing, mental development was not very affected, she received a red diploma from Moscow State University, although she was half-blind
no need to exaggerate the possibilities of modern medicine, that's the moral

If the pupillary reflex is present, then it is clearly visible how the dilated pupil narrows rapidly. The pupillary reflex is especially evident in bright light; in low light, use a flashlight if possible. The only situation when the pupil is dilated and does not react to light in a living person is blindness. Usually, with proper resuscitation, the pupillary reflex is restored after 1-2 minutes. How long does resuscitation take? At one time, I came across a wonderful formulation: "Resuscitation should be carried out until spontaneous breathing and heartbeat appear, or reliable signs of irreversible death, or specialists." I will clarify that reliable signs of irreversible death are ...

Discussion

The international criteria for first aid is following the ABCD method:
A - airway - release the breath. ways;
B - breathing - restore breathing;
C - circulation - restore blood circulation;
D - drugs - medicines.

Overnight at the Children's Infectious Diseases Hospital (St. Petersburg). The nurses went to sleep in the treatment room, I am alone in the ward with a one-month-old baby, the child has whooping cough. Every 20 minutes the child has coughing attacks. After each attack, you need to suck the saliva from the child's mouth through the preparation .Once it didn’t work out, he hung in my arms like a crab, dangling his arms and began to turn blue. Before that, students and a doctor came with them, she also told how to act in cases of respiratory arrest. It was proposed to induce vomiting in a child. so I immediately caused a gag reflex with my other hand. which saved the child, he breathed. I think. that it would not be superfluous to know as much as possible about everything related to the resuscitation of people in life, especially for mothers.

The eye perceives light reflected from objects. First, it passes through the optical part of the eye, which is a lens system: the cornea and the lens. The strongest lens is the cornea (anterior transparent shell), it is the first to refract the light rays entering the eye. The light then passes through the pupil, the round hole in the iris, which not only determines eye color, but also regulates pupil width. The pupil can contract and dilate to regulate the amount of light entering the eye. Behind the pupil is the lens. The lens is an amazing lens that can shrink and straighten, thereby focusing our eyes at the right distance - near or far. Normally, the lens is absolutely transparent, so it is not visible behind the pupil without sleep.

Discussion

I think it will be interesting for everyone to see the operation through the eyes of the patient http://www.nlv.ru/work/oponline

Of course, like all physical interventions in the human body, laser vision correction has its drawbacks, certain risks and no guarantees that vision will not deteriorate again. Here everyone must decide for himself. I had poor eyesight from 8 to 25 years old, it constantly fell and as a result I saw the first line in the table only from a distance of two steps. The glasses made me dizzy, they constantly fell off my nose because of the thick glasses, and still I didn’t see anything in them, the lenses are a good way out, but troublesome with them. I just got tired of suffering, I wanted to live a full life right now, in general, I did laser correction and I don’t regret it a bit, two years have passed and so far my vision remains 100%. And I'm just happy. It's hard to believe in the Norbekovs and others, but if it helps others, then I'm very happy for them.

The most rapid development of the visual system occurs in the first months of a baby's life, while the very act of vision stimulates its development. Only the eye, on the retina of which the surrounding world is constantly projected, is able to develop normally. First and second weeks of life. Newborns practically do not react to visual stimuli: under the influence of bright light, their pupils constrict, their eyelids close, and their eyes wander aimlessly. However, it has been noticed that from the first days of the newborn, the oval shape and moving objects with shiny spots are attracted. This is not a puzzle at all, just such an oval corresponds to a human face. The child can follow the movements of such a "face", and if at the same time they are talking to him, he blinks. But although the child pays attention to the shape, it looks like ...

Optometrist in due time is when? In our babies, too, nothing was detected, they were routinely checked, and looked straight at the year. And the pupils, yes, if compared at dusk - they were different, I paid attention. Until the strabismus clearly got out, it was followed by diagnoses - abliopia with astigmatism. Congenital. And where the ophthalmologist looked before remained not clear.