首诊于眼科的急性双眼盲原因探讨

Causes of acute bilateral blindness

目的对以双眼视力突然下降至盲为主诉、并首诊于眼科的患者进行病因分类及预后观察。方法对2015年5月至2017年5月间就诊于北京友谊医院眼科急诊,以双眼突然视物不见为主诉的12例患者进行回顾性分析。结果患者男性6例,女性6例。年龄最小5岁,最大79岁,双眼视力无光感4例,光感至0.01者3例,0.01<0.05者4例,双眼视力损伤不等1例:右眼手动/30 cm,左眼0.05。6例瞳孔对光反射正常,6例患者瞳孔对光反射消失。诊断:双侧枕叶脑梗死2例,双眼球后视神经炎2例,垂体瘤卒中1例,一氧化碳中毒性皮质盲1例,癔症性黑朦2例,放疗性视神经病变1例,脑膜转移癌1例。肝性皮质盲1例,Leber病1例。结论双眼骤盲是眼部少见的症状,病因多样,涉及眼科及神经科,除外伤及医源性损伤视路损伤外,本文双眼骤盲归因于:各类原因造成的皮质盲、急性双侧视神经病变、恶性肿瘤、心因性盲等。眼科医师应具备分辨能力,争取早期治疗的时机避免至死致残。

Objective Acute bilateral blindness is an emergency that may signify life-threatening diseases.This article reviewed emergency medicine approaches to patients with acute bilateral blindness and discussed its classification and prognosis.Methods We retrospectively analyzed 12 patients who first presented to ophthalmic emergency in Beijing Friendship Hospital between May 2015 and May 2017because of acute bilateral vision loss.Results Patients were 6 males and 6 females.The youngest age was 5 years old and the oldest was 79-year-old.4 patients were found to have no light perception bilaterally;3 patients had vision between light perception and 0.01 bilaterally,and 4 patients between 0.01 and 0.05 bilaterally.One patient had nonsymmetrical vison loss-hand motion at 30cm in right eye and 0.05 in left eye.Pupillary light reflex was normal in 6 eyes and absent in other 6 eyes.Causes of the vision loss included bilateral occipital lobe infarction(n=2),bilateral optic neuritis(n=2),pituitary apoplexy(n=1),delayed onset encephaopahy after acute carbon monoxide poisoning(n=1),hysterical amaurosis(n=2),radiation optic neuropathy(n=1),meningeal carcinomatosis(n=1),hepatic encephalopathy(n=1),and Leber congenital amaurosis(n=1).Conclusions Acute bilateral blindness is rare and can result from either or both ophthalmic and neurologic causes.Except trauma to visual pathway and iatrogenic injuries,the causes in this study included cortical blindness,acute bilateral optic neuropathy,cancer,and psychogenic blindness.Ophthalmologists should have the ability to distinguish different causes in order to treat early and to avoid catastrophic consequences.