儿童双眼复视239例的病因及特征分析

The analysis of etiology and characteristics in 239 children with binocular diplopia

目的分析239例儿童双眼复视的病因及临床特征。方法回顾性病例系列研究。收集2018年1月至2021年5月于南京医科大学附属儿童医院眼科就诊的主诉双眼复视患儿239例的临床资料。其中男性145例,女性94例;年龄3~18(10.2±3.68)岁。对其临床表现、复视特征及复视原因进行分析。结果本研究双眼复视患儿多伴有上睑下垂、视力下降及眼痛,常常遮挡一眼或采用代偿头位。以水平复视(180/239)及持续性复视(174/239)多见。多数合并明显或轻度斜视(207/239),部分患儿需反复交替遮盖或遮盖一眼后发现眼位偏斜(15/239)。病因主要以非麻痹性斜视为主(138/239),22例发现危及视力或生命的疾病(9.2%)。危及视力或生命的疾病所致复视往往较非麻痹性斜视和颅神经麻痹性复视更易合并神经系统症状(χ^(2)=6.16,12.78;P=0.012,<0.001)。治疗以手术及配戴三棱镜为主。结论双眼复视多由非麻痹性斜视引起。部分患儿双眼复视并伴有神经系统症状应考虑其为危及视力或生命的疾病。

Objective To analyse the etiology and clinical characteristics of binocular diplopia in 239 children.Methods This was a retrospective case series study.The clinical data of 239 children with binocular diplopia hospitalized from Jan.2018 to May 2021 in Children’s Hospital of Nanjing Medical University were analyzed.There were 145 male and 94 females.The age ranged from 3 to 18 years,with an average of(10.2±3.68)years.The clinical manifestations,characteristics and etiology of binocular were analyzed.Results In this study,children with binocular diplopia were mostly accompanied by ptosis,reduction of vision and eye pain,and often presented with one eye closure or compensatory head position.The horizontal diplopia(180/239)and persistent(174/239)diplopia were common in children with binocular diplopia.The majority of patients presented with obvious or mild deviation(207/239),some children with strabismus were only found after being covered on one eye or with alternate repetition on both eyes(15/239).Non-paralytic strabismus was regarded as the most common cause of diplopia in children.The vision-or life-threatening diseases were found in 22 patients,which was more likely to have neurological symptoms than non-paralytic strabismus and cranial nerve palsies(χ^(2)=6.16,12.78;P=0.012,<0.001).Therapeutic management were mainly based on surgery and prism.Conclusion The majority of children with biocular diplopia caued by non-paralytic strabismus being the most common diagnosis.Some patients with binocular diplopia and neurological symptoms are highly suspected of a vision or life-threatening disease.