Dukhayer S. Assessment of pupillography efficacy of autonomic nervous system state and the choice of treatment for accommodative disturbances in children

Object: disturbances of accommodation. Purpose: to increase the effectiveness of diagnosis and treatment of accommodation disorders in children based on the study of pupilography data to objectively assess the balance of autonomic innervation and the choice of treatment (mydriatics or electrical stimulation). Methods: ophthalmological (visometry, refractometry, determination accommodation reserves by Dashevsky, ultrasound echobiometry, ophthalmoscopy); autonomic nervous system Kerdo index; pupilometry on the OK-2 oculograph; statistical methods with «Statistica 8.0» soft. A method of computer pupilography for objective diagnosis of the accommodation-pupil system activity has been developed and normative values of accommodation pupillary reactions in healthy children 6-18 years old depending on age and autonomic nervous system tone have been determined. It was found that in healthy children the indices of accommodation pupillary response correlate with age and tone of the autonomic nervous system, while in accommodation spasms they correlate only with the tone of the autonomic nervous system. The pupil area in children with accommodation spasms is smaller (23.94 ± SD 5.5 mm2) than in children with accommodation weakness (49.3 ± SD13.8 mm2) by 106%, indicating an increase in the local effect of parasympathetic innervation in accommodation spasm. An algorithm of treatment of patients with accommodation spasms using mydriatic was proposed: 4 days of 2.5% phenylephrine instillation, 1 day of cyclopentolate instillation, 2 days – pause and follow-up repetition of this cycle for 1 month. Prolonged instillations of cyclopentolate 1% and phenylephrine 2.5% for the treatment of accommodation spasm have is more appropriate in children with parasympathotonia. A method of electrical stimulation of patients with weakness of accommodation on the ETRANS device was developed and the parasympathetic direction of its action was established, that substantiates the using this method in sympathotonics. The difference between the value of the pupil area in accommodation spasms (23.94 ± SD 5.5 mm2) and in accommodation weakness (49.3 ± SD 13.8 mm2) may be a criterion for choosing the type of treatment: in accommodation spasm and pupil area 22.8- 25.0 mm2 – mydriatics; in weakness of accommodation and pupil area 47,1-51,6 mm2 – electrostimulation. The results of the work are implemented in the practical work of the laboratory of binocular vision disorder of the SI «The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine». Scope – medicine, ophthalmology.