FEATURES OF THE NEURO-OPHTHALMOLOGICAL TREATMENT OF OCULAR TICS IN CHILDREN AND ADOLESCENT

Abstract

Purpose – to evaluate the features of neuro-ophthalmological treatment according to differential diagnosis of ocular tics in children and adolescent.

Material and methods
A total of 75 patients aged 5–17 years were examined, including 42 boys and 33 girls of prepubertal and pubertal age. All patients underwent a comprehensive ophthalmological examination: visual acuity assessment, retinoscopy, determination of dynamic refraction, correction of refractive errors, slit lamp biomicroscopy, ophthalmoscopy, and bacteriological culture of the conjunctival sac.

Results
Among the 75 patients with ocular tics, 38 (51%) were diagnosed with accommodation spasm (with mild astigmatism), 25 (33%) had bacterial blepharitis/chronic conjunctivitis, and 25 (33%) had a combination of these conditions. In 12 (12%) patients, no ocular pathology was detected; these children were diagnosed with attention deficit hyperactivity disorder (ADHD).

Microbiological examination revealed the following flora: Staphylococcus epidermidis was isolated in 22 patients (87%) with bacterial blepharitis/chronic conjunctivitis, while Staphylococcus aureus was identified in 3 patients (13%).

Dynamic refraction was assessed using a Plusoptix A09 refractometer before and after cycloplegia. Among the examined patients, convergence insufficiency was detected in 23 children, and exophoria in 15.

Conclusion
If ocular tics decrease following the prescription of corrective spectacles but do not disappear completely, the addition of gamma-aminobutyric acid (GABA) preparations and neuroleptics may lead to more effective results.

Our observations indicate that, in addition to neurological treatment, a combined therapy involving an ophthalmologist is necessary to prevent the progression of pseudomyopia, myopia, and strabismus, and to relieve undesirable neurological symptoms in affected children.

Early and timely differential diagnosis of ocular tics allows achieving effective treatment outcomes.