primary congenital esotropia
Introduction
Introduction to primary common esotropia Co-internal strabismus (concomitantstrabismus) refers to the separation of the visual axis of both eyes, and the non-quality lesions of the inner muscles of the extraocular muscles. In all directions, regardless of the eye, the skewness is equal. Non-common strabismus, depending on the gaze, is not equal in skewness. For example, when the eye is gazing, the skewness is increased, and the extraocular muscle weakness or paralysis is the main cause of non-common strabismus. Other causes include extraocular muscle rejection, such as ocular back syndrome, and AV sign. Primary common esotropia (primary concomitantesotropia) is divided into two major categories of regulation and non-regulation. Regulatory internal oblique and partial refractive power and high AC / A. basic knowledge The proportion of illness: 0.06% Susceptible people: children Mode of infection: non-infectious Complications: Amblyopia
Cause
Primary common esotropia etiology
1. Adjustment theory:
The regulation of the eye and the collective action of the eye are interrelated, and certain adjustments bring the corresponding set. Often due to the regulation - the set reflection is too strong, the role of the inner rectus muscles exceeds the tendency of the lateral rectus muscles, and forms a common esotropia. When the nearsighted eye is close to the target, it is used less or not, and the collective force is simultaneously weakened. Therefore, the tension of the inner rectus muscle is reduced, and a common exotropia is sometimes formed.
2. Binocular reflexology:
Binocular single vision is a conditional reflection, which is accomplished by means of fusion function, which is acquired the day after tomorrow. If the visual acuity of the two eyes is different during the formation of the conditioned reflex, and the visual sensation or dyskinesia of the eye obstructs the function of the binocular single vision, a state of separation of the eye position, that is, strabismus, is generated.
3. Anatomy:
Excessive or hypoplasia of an extraocular muscle, abnormal attachment point of the extraocular muscle, development of the eyelid, abnormality of the fascia structure of the iliac crest, etc., can lead to imbalance of muscle strength and strabismus.
4. Genetics:
It is common in clinical practice that many people in the same family have common strabismus, and strabismus may be related to genetic factors.
Prevention
Primary common esotropia prevention
Early detection and timely and effective treatment of strabismus children are essential. Therefore, parents and teachers should pay attention to observe the abnormal signs of children. Children over the age of 3 should check their eyes regularly so that they can be discovered in time and treated early to avoid irreparable consequences. Experts suggest that in order to prevent children from strabismus and amblyopia, it is necessary to strengthen the child's eye health, use the eye reasonably and reasonably, and avoid overloading the eye.
Complication
Primary common esotropia complications Complications amblyopia
Finally, the intermittent intervertebral vision develops into a constant esotropia, monocular gaze, amblyopia in strabismus, dioptic adjustment of esotropia, and other eye muscle abnormalities, such as vertical deviation and AV sign.
Symptom
Primary common esotropia symptoms Common symptoms External oblique A sign irritability and diplopia
1. Refractive accommodative esotropia:
Refractive accommodative esotropia, more than 2 to 3 years old, the beginning of the internal oblique is intermittent, there may be temporary diplopia, children may appear irritability, irritability, and close a look, 2 to 3 days later The strabismus is initially inhibited, that is, the eye is no longer closed. After a long period of time, abnormal retinal correspondence may occur. At this time, the patient no longer produces sensory symptoms. When the child is orthotopic, the normal retina corresponds, and intermittent esotropia, For the abnormal retina, the abnormal retinal correspondence and the normal retina correspond alternately. Finally, the intermittent intervertebral oblique vision develops into constant esotropia, monocular gaze, strabismus amblyopia, refractive adjustment of esotropia, and other eye muscle abnormalities. Such as vertical skew and AV sign.
Should be a comprehensive examination of the child, measuring strabismus, refractive examination after ciliary muscle paralysis, ciliary muscle paralysis, using 0.5% ~ 1% atropine eye ointment or solution, should tell the parents to use atropine solution when pressing tears The cyst site, in order to avoid poisoning after systemic absorption, it is best to use eye ointment 3 times a day for 3 days.
Fundus examination after ciliary muscle paralysis, it should be remembered that children with chalk disease, may have secondary esotropia, for example, early manifestations of retinoblastoma may be esotropia.
Regulatory esotropia refraction can range from +2 to +6D, and most of the refractive error is large. A group of studies proves that the average distance is considered to be +4.75D.
It should be measured to see the distance and the near-integration spread. The normal fusion spread should be greater than 3 when looking far, and should be 8 when looking close.
2, high AC / A regulatory esotropia:
The patient should be thoroughly examined, and the occlusion of the far and near eyes should be measured by the alternating occlusion plus the prism method. The ciliary muscle paralysis should be examined, the AC/A ratio should be determined, and the fundus should be examined to exclude the fundus disease.
In addition, when the high AC/A accommodative slanting and the V sinus are not inclined, the number of internal inclinations increases when looking down or looking close.
3, part of the regulatory esotropia:
In a sense, all internal medicines are partially accommodative esotropia, because giving a positive spherical lens can reduce strabismus, but traditionally, some accommodative esotropia refers to: 1 infantile esotropia (infantile esotropia) In addition to a regulatory component; 2 decompensated accommodative esotropia, that is, the regulatory internal oblique plus a non-compensatory million.
In infants with esotropia, its regulatory components are usually most obvious at 2 to 3 years of age, which is the peak of regulated esotropia. Decompensated regulatory esotropia is caused by hypertrophy or contracture of bilateral rectus muscles, regardless of its The reason, part of the regulatory esotropia, usually constancy, often accompanied by inhibition, abnormal retinal correspondence and amblyopia.
Examine
Primary common esotropia
1. Inspection of binocular vision function
(1) The three-level situation in which the same vision machine is used in the country to check the binocular vision function.
(2) Quantitative measurement of the stereoscopic vision function, and the stereoscopic sharpness is measured by the stereoscopic quantitative picture of the same machine or the random point stereogram of the Young's.
2. Refractive examination
Atropine paralyzed ciliary muscle optometry: to understand whether there is amblyopia and the relationship between strabismus and refraction.
3. Determination of eye position and oblique angle
Determine which type of strabismus it is. The size of the oblique viewing angle must be checked for surgical design.
4. Eye movement check
Determine the function of the extraocular muscles and see if the eye movements are in place.
5. Is there a compensatory head position?
Help diagnose which extraocular muscle paralysis.
6. Determine the examination of the paralysis muscles
Check the movement function of the eyeball, the gaze angle of the eyes, and the squint angle of the eye in all directions. It can be determined by the red lens test or the Hess screen method.
7. Pull test
(1) Estimate postoperative diplopia and patient tolerance after pulling the eyeball to the ortho position before surgery.
(2) Passive pull test can be used to understand whether there is mechanical contraction of the extraocular muscles or muscle spasm.
(3) Active contraction test to understand the function of the muscle.
8. Obscure inspection
Quantitative determination was made using a hidden inclinometer. Detection of collection points: Helps diagnose muscle fatigue.
9. Regulatory set/adjustment (AC/A) ratio determination
Help determine the relationship between strabismus and adjustment and collection.
Diagnosis
Diagnosis of primary common esotropia Diagnosis can be diagnosed based on clinical performance and laboratory tests.
Differential diagnosisIt is differentiated from primary non-adjusted esotropia and common exotropia.
Congenital internal oblique should also be identified with eyeball regression syndrome, Mobius syndrome, and abducens nerve paralysis.
Eyeball regression syndrome is a horizontal rectus dyskinesia disease characterized by eyeball retreat with eyeball retreat and lateral inferior or inferior palpebral fissure, accompanied by other congenital eyes or whole body. Symptoms of dysplasia. Also known as Duane syndrome.
