Paralysis of the unilateral double uprotator
Introduction
Brief introduction of monocular double upper muscle paralysis Monoelevator paralysis refers to the simultaneous numbness of the superior rectus and the inferior oblique muscle in one eye. The clinical manifestations are strabismus in the eye, and more horizontal strabismus and ptosis. This ptosis is mostly false or mixed. Sexuality, easy to misdiagnose congenital ptosis. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific people Mode of infection: non-infectious Complications: strabismus
Cause
The cause of monocular double-upper muscle paralysis
(1) Causes of the disease
Single eye double upper muscle paralysis has congenital and acquired nature, the real cause is not very clear.
(two) pathogenesis
Some people think that it may be part of the paralysis of the oculomotor nerve paralysis during the recovery process. In terms of congenital, according to the anatomy of the oculomotor nerve, the oculomotor nucleus is the upper iliac muscle and the superior rectus muscle. And the inferior oblique nucleus, which has an inner rectus muscle and a lower rectus muscle nucleus on the inner and lower sides. It may be interfered by certain factors during the mother's pregnancy, causing damage to the above-mentioned nerve nucleus and oculomotor nerve and oculomotor nerve paralysis. Sexually, it can cause oculomotor palsy due to trauma, brain inflammation, tumor and other factors. Regardless of congenital or acquired nature, there is a certain order of recovery after oculomotor nerve paralysis. Generally, the recovery of the diaphragm is the earliest and fastest. Later, the medial rectus muscle, the inferior rectus muscle and the pupil sphincter, and the superior rectus muscle and the inferior oblique muscle recover the latest or not, so it shows the characteristics of monocular double-upper muscle paralysis, due to the superior rectus muscle and the upper iliac muscle. It is differentiated from one muscle, although the function of the diaphragm has been restored, and the pseudo-sagging state is exhibited due to the function of the superior rectus muscle. The mixed and true ptosis may be associated with the levator Neurological work Can be recovered incomplete or not recovered.
Prevention
Monocular double-upper muscle paralysis prevention
The true sag is drooping, and the Bell phenomenon is improved after the correction of the eye position. It is feasible to put on the diaphragm shortening or the frontal muscle flap suspension for the sake of beauty, but the amount of surgery is not caused by the exposure.
Complication
Monocular double-upper muscle paralysis complications Complications
Can be combined with esotropia, exotropia or pseudo ptosis.
Symptom
Single eye double upper muscle paralysis symptoms Common symptoms Upper ptosis strabismus amblyopia eyelid sag binocular Bell now...
1. Eye position: In the first eye position, the affected eye has a downward oblique position, and the lower oblique degree is large, often combined with external strabismus. The lower slope is generally greater than 30 degrees, and the external slope is more than 20 degrees.
2. Eye movement: When the eye is in the first eye position and the two eyes move in the same direction, the upward movement of the superior rectus muscle and the inferior oblique muscle are obviously restricted. The same visual machine examination mainly shows that the upper left and upper right directions are higher than the healthy eye. In the eye, the lower rectus muscle of the eye was not mechanically restricted, and the contraction of the superior rectus and inferior oblique muscle of the active contraction test was weak or completely weak.
3. The ptosis of the upper eyelid: The eye is often accompanied by true, false or mixed ptosis, covering the healthy eye with the eye of the eye, the ptosis of the eye disappears. At this time, the eyelid is more than the eye, which is false. Sexual ptosis; if the eye gaze is better when the eye is gazing, it still does not reach the normal cleavage height and is smaller than the healthy eye is the mixed ptosis; if the eyelid sag is still no improvement, it is true ptosis.
According to Hering's law, the nerve impulses from the brain are determined according to the needs of the gaze. When the monocular double-upper muscle paralysis is paralyzed, the normal nerve impulses in the brain are suitable for healthy eyes, but this impulse is the double-upper palsy muscle of the affected eye. Insufficient impulses, can not cause normal contraction and turn backward, and at the same time, there are fewer nerve impulses to lift the diaphragm. Therefore, when the eye is gazing, the eye will appear ptosis, cover the healthy eyes, and when the eyes are gazing, In order to maintain the gaze position of the paralyzed eye, the brain must strengthen the nerve impulses of the double-upper muscles, and at the same time strengthen the nerve impulses of the upper jaw muscles. At this time, the sag of the upper jaw disappears, so the pseudo-capsule is drooping, and the healthy eye accepts Excessive nerve impulses, the cleft palate is often greater than the affected eye.
4. Vision: Because of the slanting of the eye and the combination of external oblique and ptosis, the healthy eye is mostly gaze, so amblyopia often occurs, and about 50% of cases are accompanied by amblyopia.
5. Bell phenomenon: The phenomenon of Bell in both eyes is asymmetrical, and the eyes are often poor or disappear.
6. Lower jaw changes: Due to the pinching of the inferior rectus muscle, the fascia ligament is transmitted to the lower jaw, and the affected eye often appears to have wrinkles or deepening of the skin of the inferior temporal margin when looking down; or the lower jaw retracts.
Examine
Examination of single eye double upper muscle paralysis
No special laboratory tests are required, including eyesight, eye position and eye movements.
Diagnosis
Diagnosis and differentiation of monocular double-upper muscle paralysis
Monocular double-rotating muscle paralysis is rare in clinical practice. According to its clinical features and necessary examinations, it is not difficult to diagnose such as visual acuity and traction test.
Differential diagnosis
1. Separate superior rectus paralysis: The performance is that the eye is tilted when the eye is gazing, the eye is oblique when the eye is gazing, the eye movement is visible, and the eye is insufficiently rotated upwards, and the contralateral eye partner muscle (inferior oblique muscle) can be secondary. Or the direct antagonistic muscle (lower rectus muscle) of the ipsilateral eye is too strong, and the rotation of the upper and lower sides is not limited. The same visual inspection of the eye is only slightly lower than the healthy eye, and may be combined with the ptosis, but it is mostly true. .
2. Inferior oblique palsy: It is characterized by low eye position, limited upward inward rotation of the affected eye, excessive upper oblique muscle, and positive Bielschowsky taro test, that is, the eye is more oblique when the head is tilted to the healthy side. The upturn is normal, without the ptosis.
3. Inferior oblique muscle and inferior rectus muscle adhesion syndrome: It is characterized by low eye position in the affected eye, limited in the upper and lower eyes of the affected eye, and the rectus muscle has obvious resistance under the pulling test, without the upper eyelid. Drooping.
4. Congenital ptosis: Congenital ptosis is divided into light, moderate and severe, except for severe amblyopia, general congenital ptosis without strabismus, high refractive error and anisometropia Amblyopia rarely occurs, and the congenital ptosis of the upper iliac muscle is weak, and will not disappear due to changes in the gaze.
5. Bottom fracture: accompanied by extraocular muscle and surrounding tissue incarceration, manifested as vertical diplopia, limited eyeball upturn, traction test eyeball up, down and rotation are limited, orbital CT scan and X The flat film can detect the fracture site, shape, range, and the presence or absence of sputum content.
