upper phoria
Introduction
Introduction to the upper slant Hyperphoria is the tendency of the eye to have an upward deflection. Normally, the two eyes can be controlled by corrective fusion reflex so that the oblique position does not occur and the binocular monocular can be maintained. Generally, the symptoms are more than 2 , and in the occult patients, the upper oblique occlusion accounts for 15% to 30%. If the degree of slanting degree is large, the patient often suppresses the image of one eye, and can form amblyopia for a long time; as the number of slanting angles is not large, the vertical complex image is relatively difficult to suppress, so the moderate slanting ratio is obliquely large. More likely to produce symptoms. 1~2 occlusion oblique, generally can be controlled by fusion reflex, but the vertical muscle fusion reserve force is very small, in 2.5 or more can appear symptoms, so the upper slant angle is more likely to cause eye muscle fatigue than the internal and external slanting, upper oblique Patients look far, see near vision fatigue, especially near to the near, such as the degree of hidden slope is large, patients often take a look at the image of the eye, can form amblyopia for a long time, such as the degree of hidden slope is not large, vertical complex It is relatively difficult to suppress, so moderate occultation is more prone to symptoms than slanting on large degrees. Upper slanting causes blurred vision, headache, eye pain, and nausea. In severe cases, stereopsis may be lacking. basic knowledge The proportion of sickness: 0.004% - 0.005% Susceptible people: children Mode of infection: non-infectious Complications: blepharitis
Cause
Inclination
The main reasons for strabismus during childhood:
(1) Insufficient development: children, especially infants, have imperfect development of binocular vision, and can not coordinate eye muscles well. Any unstable factors can cause strabismus. People's single vision function is gradually acquired. Developed, this function is built up like the visual function. It is repeatedly stimulated by the clear image of the outside world. It gradually develops and matures. Only two months after the baby is born, there is only a general fusion. The establishment of the precise fusion function lasts until 5 After the age, stereoscopic vision is established at the latest, and it is only 6 to 7 years old to get close to adults. Therefore, it is the high incidence period of children's strabismus during the period when the single-eye function is not perfect before the age of five.
(2) congenital anomalies: this strabismus is mostly caused by abnormal development of the position of the extraocular muscles, abnormal development of the extraocular muscles, incomplete differentiation of the mesoderm, poor separation of the eye muscles, abnormalities of the muscle sheath and fibrosis, or It is caused by nerve paralysis that governs muscles, and some of them cause brain punctate hemorrhage due to the use of forceps to cause head and face damage in the production process or excessive force in the mother's production. The bleeding is just in the nucleus that dominates the eye movement. It causes extraocular muscle paralysis. In addition, there are also genetic factors. The strabismus is not inherited in the family. This defect is often indirectly transmitted to the next generation of children. It is usually strabismus called congenital strabismus within 6 months of birth. It does not have the basic conditions for establishing binocular vision, and it is the most harmful to the development of visual function.
(3) The characteristics of eyeball development make children susceptible to strabismus: because children's eyeballs are small, the axis of the eye is short, mostly for hyperopia, and because of the large refractive power of the cornea and crystal of the child, the contraction of the ciliary muscle is strong, that is, the adjustment force is strong. Children need more adjustment force when they want to see the object. At the same time, the eyes also force to turn inward to produce excessive convergence, which is easy to cause esotropia. This type of internal oblique is called adjustment of internal oblique.
(4) Insufficient eye control ability of the eye movement: If the collection is too strong or the abduction is insufficient or both exist, the internal oblique is generated; on the contrary, if the abduction is too strong, the collection is insufficient or both exist at the same time, the external oblique is generated.
Upper oblique pathology:
1. One or more vertical muscles have mild paralysis, and White considers 98%.
2. The attachment point of the medial rectus or lateral rectus muscle is higher in one or two eyes.
3. Anatomical abnormalities or abnormal attachment points of the superior and inferior rectus muscles or the superior and inferior oblique muscles.
4, other such as eyelid asymmetry, trauma or sputum mass caused by, but rare, and there is no obvious relationship with refractive error.
Prevention
Upper oblique prevention
The visual reflex of both eyes in infancy and early childhood is unstable, and the fluctuations gradually decrease afterwards. The 5-year-old basically stops, and the 8-year-old volatility period basically ends. If there are no serious obstacles, it will remain for life, but in this unstable period, any influence on both eyes Single visual obstacles can lead to strabismus, and any strabismus can lead to loss of monocular function in both eyes. On the other hand, due to the unstable formation of binocular monocular function during this period, it is easy to lose and easy to recover. If strabismus is found, early treatment, as early as possible Treatment can not only correct strabismus, but also restore the loss or dysplasia of the binocular monocular function, thus achieving the ideal purpose of functional cure. Conversely, if the treatment is delayed and the visual function development period is missed, the binocular monocular function is lost. The skeletal deformity and the compensated head position can not be restored. Even if the strabismus is corrected by surgery, it is only a cosmetic correction, and there is no "adhesive" effect of the binocular single vision function, and there is still the risk of strabismus again.
Complication
Upper slant complication Complications
Patients with severe occlusion can develop blepharitis.
Symptom
Symptoms of slanting symptoms common symptoms eye pain nausea fatigue
Clinical practice has shown that it is best to check the upper slanting with a hidden inclinometer, even if it is 0.5 .
1. Because of the large rectus muscle effect when looking far, the number of oblique slopes in the far-end is greater than the number of oblique slopes in the near-term, indicating that the rectus muscle is involved.
2, because the effect of seeing the oblique muscles in the near future, so the number of hidden oblique degrees when looking near is greater than the number of oblique inclination when looking far, indicating the oblique muscle involvement.
3. If the number of upper oblique angles in one eye fixation is greater than the degree of hidden inclination in the fixation of the other eye, according to the principle that the second oblique angle is greater than the first oblique angle, the fixation eye with a large number of upper oblique angles is affected eyes. According to the above three principles, the affected eye and the affected muscle can be analyzed.
1~2 occlusion oblique, generally can be controlled by fusion reflex, but the vertical muscle fusion reserve force is very small, in 2.5 or more can appear symptoms, so the upper slant angle is more likely to cause eye muscle fatigue than the internal and external slanting, upper oblique Patients look far, see near vision fatigue, especially near to the near, such as the degree of hidden slope is large, patients often take a look at the image of the eye, can form amblyopia for a long time, such as the degree of hidden slope is not large, vertical complex It is relatively difficult to suppress, so moderate occultation is more likely to cause symptoms than slanting on large degrees. Upper slanting causes blurred vision, headache, eye pain, nausea. In severe cases, stereoscopic function is lacking, and the patient's face is light. The posture is up, so that the eye position is lower than the level to overcome the partial slant.
Examine
Obscure inspection
1. Physical examination: the application of alternating cover method, Mars rod inspection law to determine the presence or absence of hidden oblique; triangular prism method, hidden oblique meter can accurately determine the degree of hidden slope.
2. Auxiliary examination: The refractive state should be checked.
Diagnosis
Diagnostic diagnosis
diagnosis:
Diagnosis can be performed based on clinical manifestations and examinations.
Differential diagnosis:
1. Refractive error: line alternately cover method to check, when the cover is covered, there is no movement.
2. Intermittent exotropia: Observing the external oblique is obvious at a distance, but it can generally be imaged at close range, and does not appear as an eyeball skew.
