摘要
目的 观察眼肌麻痹患者的临床表现,探讨其发病机制。方法 回顾性病例研究。收集本科2009年3月~2012年5月37例(41眼)眼肌麻痹患者的相关资料,包括病史、视力、瞳孔、眼底、眼睑、眼球运动、代偿头位、视野、同视机、眼肌超声、颈动脉和球后多普勒超声、眼眶断层扫描(CT)、头部断层扫描血管成像(CTA)、头部磁共振成像(MRI)及纵隔CT检查以及血液生物化学和免疫学检查。结果 本组眼肌麻痹患者中,既往有糖尿病史者12例、高血压病史者15例、高血脂病史者11例、心脏病病史者9例、缺血性脑血管病史者4例、甲亢病史者1例。眼球运动受限检查:水平方向受限17例(20眼),垂直方向受限16例(16眼),水平和垂直方向都受限4例(5眼)。微血管缺血性病变引起的眼肌麻痹患者具有较高比例的糖尿病、心脑血管疾病史,同时伴有球后血流速度减低、颈动脉狭窄和斑块形成;特发性颅内压增高患者具备双眼视盘水肿、眼球水平运动受限和视野生理盲点扩大;颅内垂体肿瘤压迫导致眼肌麻痹伴双眼视神经萎缩;甲状腺相关眼病引起的眼肌麻痹者可发现双侧多条眼肌肥厚。结论 眼肌麻痹患者的临床表现复杂多样,应进行详细的眼科检查和影像学检查,寻找原发病因,才能进行有针对性的治疗。
Objective To observe the clinical features of ophthalmoplegia and analyze its etiology. Methods A retrospective study was performed. Thirty-seven cases (41 eyes) who had been diagnosed as ophthalmoplegia in Department of Ophthalmology from March 2009 to May 2012 were recruited in this study. The clinical data were recorded including the medical history, visual acuity, pupil, fundus, eyelid, eye movement, acting countervail head, visual field, synoptophore, ultrasound of ocular muscle and carotid artery, computed tomography of the obit, computed tomography angiography and magnetic resonance imaging of the brain, and blood biochemistry and immunologic tests. Results The medical history disclosed that diabetic mellitus was found in 12 cases, hypertension in 15 cases, hyperlipidemia in 11 case, heart diseases in 9 cases, ischemic cerebrovascular disease in 4 cases and hyperthyroidism in 1 case. The horizontal restriction was manifested in 17 cases with 20 eyes, vertical restriction in 16 cases with 16 eyes, and horizontal-and-vertical restriction in 4 cases with 5 eyes. Decreased retrobulbar blood flow velocity, the formation of carotid artery stenosis and plaques were found in more than half of the cases with microvascular ischemic ophthalmoplegia. Bilateral papilledema was the characteristic appearance in the idiopathic intracranial hypertension cases with horizontal eye movement restriction and enlargement of physiological blind spot. Ophthalmoplegia and bilateral optic nerve atrophy was caused by the pituitary tumor compression. Hypertrophy of multiple extraocular muscles was the characteristic in cases with hyperthyroidism. Conclusions The clinical manifestation was complicated in ophthalmoplegic cases. The detailed medical imaging examinations were essential as well as the ophthalmic ones, which were helpful in finding the etiology and providing the targeted therapy.
出处
《中国眼耳鼻喉科杂志》
2013年第4期229-232,共4页
Chinese Journal of Ophthalmology and Otorhinolaryngology
关键词
眼肌麻痹
临床表现
病因
Ophthalmoplegia
Clinical manifestation
Etiology