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Napísal MUDr. Iveta Katuščáková 02. december 2013

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Strabizmus možno definovať ako stav, pri ktorom nie sú osi očí vo všetkých pohľadových smeroch rovnobežné.

Pričom pohyblivosť očí môže byť neporušená – tkz. dynamické škúlenie, alebo obmedzená – tkz. paralytické škúlenie. U detí sa častejšie stretávame s prvým typom škúlenia , kedy je pohyblivosť očí neporušená a chýba len ich súhra.

Príčina strabizmu

Najčastejší, dôvodom býva refrakčná chyba , najmä ďalekozrakosť a tkz. anizometropia ( rozdielna hodnota dioptrií medzi očami) . Menej často sú príčinou očné ochorenia , napr. vrodený sivý zákal, alebo ochorenia sietnice a zrakového nervu. Vyskytuje sa rovnako u dievčat aj u chlapcov.

Osobitnú skupinu tvoria predčasne narodené deti a deti s neurologickým ochorením, u ktorých sa so strabizmom stretávame trikrát častejšie. Škúlenie u niektorých detí začína nepozorovane napr. pri únave, ale častejšie sa prvé príznaky prejavia po prekonanej chorobe spojenej s horúčkami. Čo sa týka veku, približne 75 % strabizmu sa prejaví u detí medzi 2.-4. rokom.
Často sa stretávame s otázkou, do akého veku možno považovať škúlenie za normálne . Od narodenia do 6 mesiacov nie je vyvinutá spolupráca očí a dieťa sleduje okolie raz jedným, raz druhým okom. Občasné zabiehanie u týchto detí možno považovať ešte za fyziologické, ale treba zdôrazniť, že pod obrazom škúlenia sa u detí v tomto veku môžu skrývať aj vážne očné ochorenia . Preto ak je zabiehanie oka prítomné v každom uhle pohľadu a nie je len občasné , nemal by rodič vyšetrenie u očného lekára odkladať.

Na čo si mám dať ako rodič pozor u malého dieťaťa? Ako môžem zistiť, že má problém so zrakom?

Sledujte pohyblivosť očí všetkými smermi, všímajte si reakciu dieťaťa na zrakový podnet, bráni sa zakrytiu jedného z očí? V prípade pozitívnej rodinnej anamnézy (dioptrická chyba , tupozrakosť, škúlenie , vrodené očné ochorenia ), by preventívne očné vyšetrenie malo absolvovať každé dieťa, a to čím skôr.

Ešte stále väčšina rodičov považuje škúlenie za kozmetický defekt. Čo je však pre budúcnosť dieťaťa dôležitejšie je fakt, že škúlenie býva spojené s poruchou vývoja centrálnej zrakovej ostrosti s tkz. tupozrakosťou (amblyopiou ) a s poruchou vývoja spolupráce očí . Jedine včasná diagnostika a správna liečba škúlenia zabezpečí predpoklady pre správny vývoj zrakových funkcií, ktorý prebieha a upevňuje sa v prvých 6 – 8 rokoch života. Oči treba kompletne vyšetriť, stanoviť refrakčnú chybu a zistiť stav binokulárnych funkcií. Pri dioptrickej chybe je potrebné nosiť okuliare trvale. Ak sa zistí tupozrakosť, k správnej okuliarovej korekcii sa pridáva tkz. okluzor. Zdravé oko sa prekrýva , aby bolo škúliace oko nútené namáhať sa . Na oklúziu nadväzujú pleoptické cvičenia.

View the embedded image gallery online at:
https://www.femme.sk/index.php/temy/dieta/item/5748-skulenie-u-deti?start=120#sigProIdeca256a2bd

Foto: Očné centrum UVEA

- Aktívne pleoptické cvičenia ako obkresľovanie, vystrihovanie, dokonca aj hranie počítačových hier ( je aj počítačový program pre domáce cvičenie tupozrakosti ) možno vykonávať doma.

- Pasívne pleoptické cvičenia sa vykonávajú na prístrojoch. Pokiaľ sa videnie zlepší, nasleduje ortoptická liečba, ktorej cieľom je spolupráca očí.

- Ortopticko – pleoptické cvičenia sa vykonávajú v ortoptických škôlkach alebo v ortoptických štúdiách.

Čím je dieťa mladšie, tým je úspech liečby vyšší. Asi v 50% prípadov sa postavenie očí upraví nosením správnej korekcie a cvičením. V prípade, že konzervatívna liečba nie je úspešná, treba operovať. Väčšina typov strabizmu sa operuje vo veku 4-6 rokov, sú však typy škúlenia, ktoré je potrebné operovať aj v mladšom veku. Škúlenie sa nedá operovať laserom. Operácia sa vykonáva pod mikroskopom v celkovej anestézii a je realizovaná na okohybných svaloch. Princíp operácie je oslabenie alebo posilnenie funkcie ohohybných svalov . Najmä pri veľkých uhloch škúlenia, alebo po operácii u malých detí sa môže stať, že jedna operácia nie je dostačujúca a po určitom čase je potrebné vykonať doplňujúci výkon.

Je pravdou, že škúlenie od narodenia môže byť následkom toxoplazmózy v tehotnosti?

Áno môže. Ak sa žena nakazí v priebehu tehotenstva, môže dôjsť k poškodeniu plodu prenosom infekcie cez placentu. Škúlenie ako jeden z príznakov môže byť následkom poškodenia mozgu alebo oka.

Viac informácii na www.uvea.sk

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15	JDatabaseDriver->loadResult()	JROOT/libraries/joomla/session/storage/database.php:45
14	JSessionStorageDatabase->read()	Rovnaké, ako volanie o riadok nižšie.
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3	Joomla\CMS\Application\SiteApplication->__construct()	JROOT/libraries/src/Application/CMSApplication.php:386
2	Joomla\CMS\Application\CMSApplication::getInstance()	JROOT/libraries/src/Factory.php:140
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11	JDatabaseDriver->loadObjectList()	JROOT/libraries/src/Component/ComponentHelper.php:445
10	Joomla\CMS\Component\ComponentHelper::Joomla\CMS\Component\{closure}()	Rovnaké, ako volanie o riadok nižšie.
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8	Joomla\CMS\Cache\Controller\CallbackController->get()	JROOT/libraries/src/Component/ComponentHelper.php:453
7	Joomla\CMS\Component\ComponentHelper::load()	JROOT/libraries/src/Component/ComponentHelper.php:519
6	Joomla\CMS\Component\ComponentHelper::getComponents()	JROOT/libraries/src/Component/ComponentHelper.php:44
5	Joomla\CMS\Component\ComponentHelper::getComponent()	JROOT/libraries/src/Component/ComponentHelper.php:103
4	Joomla\CMS\Component\ComponentHelper::getParams()	JROOT/libraries/src/Application/SiteApplication.php:594
3	Joomla\CMS\Application\SiteApplication->initialiseApp()	JROOT/libraries/src/Application/SiteApplication.php:212
2	Joomla\CMS\Application\SiteApplication->doExecute()	JROOT/libraries/src/Application/CMSApplication.php:225
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Databázové dotazy

Zaznamenané dotazy: 37 361.87 ms

Bolo nájdených 4 duplicít!

32 zaznamenaných typov dotazov, zoradené podľa výskytu udalosti.

VYBERTE tabuľky:

ĎALŠIE tabuľky:

#	Volacia funkcia	Súbor a číslo riadku
10	JDatabaseDriverMysqli->execute()	JROOT/libraries/joomla/database/driver.php:1506
9	JDatabaseDriver->loadAssocList()	JROOT/libraries/src/Access/Access.php:1063
8	Joomla\CMS\Access\Access::getAuthorisedViewLevels()	JROOT/libraries/src/User/User.php:458
7	Joomla\CMS\User\User->getAuthorisedViewLevels()	JROOT/libraries/src/Plugin/PluginHelper.php:318
6	Joomla\CMS\Plugin\PluginHelper::load()	JROOT/libraries/src/Plugin/PluginHelper.php:87
5	Joomla\CMS\Plugin\PluginHelper::getPlugin()	JROOT/libraries/src/Plugin/PluginHelper.php:129
4	Joomla\CMS\Plugin\PluginHelper::isEnabled()	JROOT/libraries/src/Application/SiteApplication.php:604
3	Joomla\CMS\Application\SiteApplication->initialiseApp()	JROOT/libraries/src/Application/SiteApplication.php:212
2	Joomla\CMS\Application\SiteApplication->doExecute()	JROOT/libraries/src/Application/CMSApplication.php:225
1	Joomla\CMS\Application\CMSApplication->execute()	JROOT/index.php:49

id	select_type	table	type	possible_keys	key	key_len	ref	rows	Extra
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1	SIMPLE	b	range	idx_usergroup_nested_set_lookup	idx_usergroup_nested_set_lookup	4	NULL	2	Using where; Using index

#	Volacia funkcia	Súbor a číslo riadku
11	JDatabaseDriverMysqli->execute()	JROOT/libraries/joomla/database/driver.php:1550
10	JDatabaseDriver->loadColumn()	JROOT/libraries/src/Access/Access.php:980
9	Joomla\CMS\Access\Access::getGroupsByUser()	JROOT/libraries/src/Access/Access.php:1095
8	Joomla\CMS\Access\Access::getAuthorisedViewLevels()	JROOT/libraries/src/User/User.php:458
7	Joomla\CMS\User\User->getAuthorisedViewLevels()	JROOT/libraries/src/Plugin/PluginHelper.php:318
6	Joomla\CMS\Plugin\PluginHelper::load()	JROOT/libraries/src/Plugin/PluginHelper.php:87
5	Joomla\CMS\Plugin\PluginHelper::getPlugin()	JROOT/libraries/src/Plugin/PluginHelper.php:129
4	Joomla\CMS\Plugin\PluginHelper::isEnabled()	JROOT/libraries/src/Application/SiteApplication.php:604
3	Joomla\CMS\Application\SiteApplication->initialiseApp()	JROOT/libraries/src/Application/SiteApplication.php:212
2	Joomla\CMS\Application\SiteApplication->doExecute()	JROOT/libraries/src/Application/CMSApplication.php:225
1	Joomla\CMS\Application\CMSApplication->execute()	JROOT/index.php:49

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After opening tables	0.00 ms
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table lock	0.00 ms
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#	Volacia funkcia	Súbor a číslo riadku
12	JDatabaseDriverMysqli->execute()	JROOT/libraries/joomla/database/driver.php:1465
11	JDatabaseDriver->loadAssoc()	JROOT/libraries/src/Table/Table.php:747
10	Joomla\CMS\Table\Table->load()	JROOT/plugins/system/roksprocket/roksprocket.php:54
9	plgSystemRokSprocket->onAfterInitialise()	Rovnaké, ako volanie o riadok nižšie.
8	call_user_func_array()	JROOT/libraries/joomla/event/event.php:70
7	JEvent->update()	JROOT/libraries/joomla/event/dispatcher.php:160
6	JEventDispatcher->trigger()	JROOT/libraries/src/Application/BaseApplication.php:108
5	Joomla\CMS\Application\BaseApplication->triggerEvent()	JROOT/libraries/src/Application/CMSApplication.php:668
4	Joomla\CMS\Application\CMSApplication->initialiseApp()	JROOT/libraries/src/Application/SiteApplication.php:686
3	Joomla\CMS\Application\SiteApplication->initialiseApp()	JROOT/libraries/src/Application/SiteApplication.php:212
2	Joomla\CMS\Application\SiteApplication->doExecute()	JROOT/libraries/src/Application/CMSApplication.php:225
1	Joomla\CMS\Application\CMSApplication->execute()	JROOT/index.php:49

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Opening tables	0.02 ms
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init	0.03 ms
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#	Volacia funkcia	Súbor a číslo riadku
25	JDatabaseDriverMysqli->execute()	JROOT/libraries/joomla/database/driver.php:1662
24	JDatabaseDriver->loadObject()	JROOT/libraries/src/Helper/LibraryHelper.php:167
23	Joomla\CMS\Helper\LibraryHelper::Joomla\CMS\Helper\{closure}()	Rovnaké, ako volanie o riadok nižšie.
22	call_user_func_array()	JROOT/libraries/src/Cache/Controller/CallbackController.php:173
21	Joomla\CMS\Cache\Controller\CallbackController->get()	JROOT/libraries/src/Helper/LibraryHelper.php:175
20	Joomla\CMS\Helper\LibraryHelper::loadLibrary()	JROOT/libraries/src/Helper/LibraryHelper.php:43
19	Joomla\CMS\Helper\LibraryHelper::getLibrary()	JROOT/libraries/src/Helper/LibraryHelper.php:90
18	Joomla\CMS\Helper\LibraryHelper::getParams()	JROOT/libraries/src/Version.php:321
17	Joomla\CMS\Version->getMediaVersion()	JROOT/libraries/src/Factory.php:778
16	Joomla\CMS\Factory::createDocument()	JROOT/libraries/src/Factory.php:234
15	Joomla\CMS\Factory::getDocument()	JROOT/libraries/gantry5/classes/Gantry/Framework/Theme.php:116
14	Gantry\Framework\Theme->init()	JROOT/libraries/gantry5/classes/Gantry/Component/Theme/AbstractTheme.php:67
13	Gantry\Component\Theme\AbstractTheme->__construct()	JROOT/templates/g5_hydrogen/includes/theme.php:28
12	plgSystemGantry5->{closure}()	JROOT/libraries/gantry5/vendor/pimple/pimple/src/Pimple/Container.php:113
11	Pimple\Container->offsetGet()	JROOT/plugins/system/gantry5/gantry5.php:139
10	plgSystemGantry5->onAfterRouteSite()	JROOT/plugins/system/gantry5/gantry5.php:57
9	plgSystemGantry5->onAfterRoute()	Rovnaké, ako volanie o riadok nižšie.
8	call_user_func_array()	JROOT/libraries/joomla/event/event.php:70
7	JEvent->update()	JROOT/libraries/joomla/event/dispatcher.php:160
6	JEventDispatcher->trigger()	JROOT/libraries/src/Application/BaseApplication.php:108
5	Joomla\CMS\Application\BaseApplication->triggerEvent()	JROOT/libraries/src/Application/CMSApplication.php:1190
4	Joomla\CMS\Application\CMSApplication->route()	JROOT/libraries/src/Application/SiteApplication.php:796
3	Joomla\CMS\Application\SiteApplication->route()	JROOT/libraries/src/Application/SiteApplication.php:218
2	Joomla\CMS\Application\SiteApplication->doExecute()	JROOT/libraries/src/Application/CMSApplication.php:225
1	Joomla\CMS\Application\CMSApplication->execute()	JROOT/index.php:49

#	Volacia funkcia	Súbor a číslo riadku
20	JDatabaseDriverMysqli->execute()	JROOT/libraries/src/Helper/LibraryHelper.php:117
19	Joomla\CMS\Helper\LibraryHelper::saveParams()	JROOT/libraries/src/Version.php:372
18	Joomla\CMS\Version->setMediaVersion()	JROOT/libraries/src/Version.php:331
17	Joomla\CMS\Version->getMediaVersion()	JROOT/libraries/src/Factory.php:778
16	Joomla\CMS\Factory::createDocument()	JROOT/libraries/src/Factory.php:234
15	Joomla\CMS\Factory::getDocument()	JROOT/libraries/gantry5/classes/Gantry/Framework/Theme.php:116
14	Gantry\Framework\Theme->init()	JROOT/libraries/gantry5/classes/Gantry/Component/Theme/AbstractTheme.php:67
13	Gantry\Component\Theme\AbstractTheme->__construct()	JROOT/templates/g5_hydrogen/includes/theme.php:28
12	plgSystemGantry5->{closure}()	JROOT/libraries/gantry5/vendor/pimple/pimple/src/Pimple/Container.php:113
11	Pimple\Container->offsetGet()	JROOT/plugins/system/gantry5/gantry5.php:139
10	plgSystemGantry5->onAfterRouteSite()	JROOT/plugins/system/gantry5/gantry5.php:57
9	plgSystemGantry5->onAfterRoute()	Rovnaké, ako volanie o riadok nižšie.
8	call_user_func_array()	JROOT/libraries/joomla/event/event.php:70
7	JEvent->update()	JROOT/libraries/joomla/event/dispatcher.php:160
6	JEventDispatcher->trigger()	JROOT/libraries/src/Application/BaseApplication.php:108
5	Joomla\CMS\Application\BaseApplication->triggerEvent()	JROOT/libraries/src/Application/CMSApplication.php:1190
4	Joomla\CMS\Application\CMSApplication->route()	JROOT/libraries/src/Application/SiteApplication.php:796
3	Joomla\CMS\Application\SiteApplication->route()	JROOT/libraries/src/Application/SiteApplication.php:218
2	Joomla\CMS\Application\SiteApplication->doExecute()	JROOT/libraries/src/Application/CMSApplication.php:225
1	Joomla\CMS\Application\CMSApplication->execute()	JROOT/index.php:49

#	Volacia funkcia	Súbor a číslo riadku
14	JDatabaseDriverMysqli->execute()	JROOT/libraries/joomla/database/driver.php:1740
13	JDatabaseDriver->loadResult()	JROOT/libraries/rokcommon/RokCommon/PlatformInfo/Joomla.php:31
12	RokCommon_PlatformInfo_Joomla->getDefaultTemplate()	JROOT/libraries/rokcommon/RokCommon/PlatformInfo/Joomla.php:105
11	RokCommon_PlatformInfo_Joomla->setPlatformParameters()	JROOT/libraries/rokcommon/RokCommon/Service.php:71
10	RokCommon_Service::getContainer()	JROOT/libraries/rokcommon/include.php:38
9	require_once JROOT/libraries/rokcommon/include.php	JROOT/plugins/system/rokcommon/rokcommon.php:96
8	plgSystemRokCommon->loadCommonLib()	JROOT/plugins/system/rokcommon/rokcommon.php:54
7	plgSystemRokCommon->__construct()	JROOT/libraries/src/Plugin/PluginHelper.php:280
6	Joomla\CMS\Plugin\PluginHelper::import()	JROOT/libraries/src/Plugin/PluginHelper.php:182
5	Joomla\CMS\Plugin\PluginHelper::importPlugin()	JROOT/libraries/src/Application/CMSApplication.php:667
4	Joomla\CMS\Application\CMSApplication->initialiseApp()	JROOT/libraries/src/Application/SiteApplication.php:686
3	Joomla\CMS\Application\SiteApplication->initialiseApp()	JROOT/libraries/src/Application/SiteApplication.php:212
2	Joomla\CMS\Application\SiteApplication->doExecute()	JROOT/libraries/src/Application/CMSApplication.php:225
1	Joomla\CMS\Application\CMSApplication->execute()	JROOT/index.php:49

#	Volacia funkcia	Súbor a číslo riadku
15	JDatabaseDriverMysqli->execute()	JROOT/libraries/joomla/database/driver.php:1740
14	JDatabaseDriver->loadResult()	JROOT/libraries/rokcommon/RokCommon/PlatformInfo/Joomla.php:31
13	RokCommon_PlatformInfo_Joomla->getDefaultTemplate()	JROOT/libraries/rokcommon/RokCommon/PlatformInfo/Joomla.php:67
12	RokCommon_PlatformInfo_Joomla->getDefaultTemplatePath()	JROOT/libraries/rokcommon/RokCommon/PlatformInfo/Joomla.php:106
11	RokCommon_PlatformInfo_Joomla->setPlatformParameters()	JROOT/libraries/rokcommon/RokCommon/Service.php:71
10	RokCommon_Service::getContainer()	JROOT/libraries/rokcommon/include.php:38
9	require_once JROOT/libraries/rokcommon/include.php	JROOT/plugins/system/rokcommon/rokcommon.php:96
8	plgSystemRokCommon->loadCommonLib()	JROOT/plugins/system/rokcommon/rokcommon.php:54
7	plgSystemRokCommon->__construct()	JROOT/libraries/src/Plugin/PluginHelper.php:280
6	Joomla\CMS\Plugin\PluginHelper::import()	JROOT/libraries/src/Plugin/PluginHelper.php:182
5	Joomla\CMS\Plugin\PluginHelper::importPlugin()	JROOT/libraries/src/Application/CMSApplication.php:667
4	Joomla\CMS\Application\CMSApplication->initialiseApp()	JROOT/libraries/src/Application/SiteApplication.php:686
3	Joomla\CMS\Application\SiteApplication->initialiseApp()	JROOT/libraries/src/Application/SiteApplication.php:212
2	Joomla\CMS\Application\SiteApplication->doExecute()	JROOT/libraries/src/Application/CMSApplication.php:225
1	Joomla\CMS\Application\CMSApplication->execute()	JROOT/index.php:49

id	select_type	table	type	possible_keys	key	key_len	ref	rows	Extra
1	SIMPLE	xref	ref	tagID,itemID	itemID	4	const	1	Using where
1	SIMPLE	tag	eq_ref	PRIMARY,published	PRIMARY	4	yy039000db.xref.tagID	1	Using where

id	select_type	table	type	possible_keys	key	key_len	ref	rows	Extra
1	SIMPLE	a	ref	idx_state,idx_access,idx_context	idx_state	1	const	1	Using where; Using temporary; Pomocou filesort
1	SIMPLE	l	eq_ref	idx_langcode	idx_langcode	21	yy039000db.a.language	1	Using where
1	SIMPLE	uc	eq_ref	PRIMARY	PRIMARY	4	yy039000db.a.checked_out	1
1	SIMPLE	ag	eq_ref	PRIMARY	PRIMARY	4	yy039000db.a.access	1	Using where
1	SIMPLE	ua	eq_ref	PRIMARY	PRIMARY	4	yy039000db.a.created_user_id	1	Using where
1	SIMPLE	g	eq_ref	PRIMARY	PRIMARY	4	yy039000db.a.group_id	1	Using where

#	Volacia funkcia	Súbor a číslo riadku
14	JDatabaseDriverMysqli->execute()	JROOT/libraries/src/Table/Table.php:1264
13	Joomla\CMS\Table\Table->hit()	JROOT/components/com_k2/models/item.php:833
12	K2ModelItem->hit()	JROOT/components/com_k2/views/item/view.html.php:146
11	K2ViewItem->display()	JROOT/libraries/src/MVC/Controller/BaseController.php:664
10	Joomla\CMS\MVC\Controller\BaseController->display()	JROOT/components/com_k2/controllers/controller.php:20
9	K2Controller->display()	JROOT/components/com_k2/controllers/item.php:78
8	K2ControllerItem->display()	JROOT/libraries/src/MVC/Controller/BaseController.php:702
7	Joomla\CMS\MVC\Controller\BaseController->execute()	JROOT/components/com_k2/k2.php:64
6	require_once JROOT/components/com_k2/k2.php	JROOT/libraries/src/Component/ComponentHelper.php:402
5	Joomla\CMS\Component\ComponentHelper::executeComponent()	JROOT/libraries/src/Component/ComponentHelper.php:377
4	Joomla\CMS\Component\ComponentHelper::renderComponent()	JROOT/libraries/src/Application/SiteApplication.php:194
3	Joomla\CMS\Application\SiteApplication->dispatch()	JROOT/libraries/src/Application/SiteApplication.php:233
2	Joomla\CMS\Application\SiteApplication->doExecute()	JROOT/libraries/src/Application/CMSApplication.php:225
1	Joomla\CMS\Application\CMSApplication->execute()	JROOT/index.php:49

id	select_type	table	type	possible_keys	key	key_len	ref	rows	Extra
1	SIMPLE	m	ref	PRIMARY,published,newsfeeds	published	1	const	25	Using index condition; Using where; Pomocou filesort
1	SIMPLE	mm	ref	PRIMARY	PRIMARY	4	yy039000db.m.id	1	Using where; Using index
1	SIMPLE	e	ref	element_clientid,element_folder_clientid	element_clientid	303	yy039000db.m.module,const	1	Using index condition; Using where