Skew综合征的临床表现和治疗

Clinical manifestations and treatment of Skew deviation

Skew综合征是一种核上性、共同性或非共同性眼位的垂直偏斜，常常伴有眼球旋转斜视、头位倾斜，经典的Skew综合征是眼倾斜反应的一部分。病因多为后颅窝病变，常是脑干、小脑和周围前庭系统疾病的最初表现。临床分共同性、非共同性、阵发性（间歇性）、周期性（缓慢交替性）、侧方交替性和暂时性的新生儿Skew综合征。需要与上斜肌麻痹、下斜肌麻痹以及原发性斜肌功能亢进等眼科常见斜视类型相鉴别。大部分的Skew综合征是暂时的并可以自发缓解，持续存在的Skew综合征引起的垂直复视可采用三棱镜、肉毒素和垂直肌肉后退等方法治疗。

Skew deviation is a vertical strabismus caused by supranuciear lesions. It is often associated with ocular torsion and head tilt, which together constitute the ocular tilt reaction. Skew deviation can result from any injury within the posterior fossa, and is often the initial manifestation of diseases that affect the brainstem, cerebellum, or peripheral vestibular system. Clinical subtypes include comitant, incomitant, paroxysmal （intermittent）, periodic or slowly alternating, lateral alternating and transient neonatal skew deviation. It should be differentiated from superior oblique muscle palsy, inferior oblique muscle palsy and primary oblique muscle overaction. Most skew deviations are transient and spontaneous recovery. Prisms, botulinum toxin, and vertical rectus muscle recession have all been used for vertical diplopia secondary to persistent skew deviation.