bilateral superior oblique muscle paralysis
Introduction
Introduction to bilateral oblique numbness Bilateral superioroblique paralysis refers to dysfunction of the superior oblique muscle of both eyes due to congenital dysplasia or acquired factors. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: strabismus
Cause
Cause of paralysis of both eyes
(1) Causes of the disease
The cause of bilateral superior oblique palsy can be caused by congenital factors and acquired factors.
Congenital factor
Mainly due to abnormal development of nerves and muscles, such as partial or total absence of the oblique muscles, displacement of muscle attachment points, etc.; abnormal development of the trochlear nerve nucleus, but more manifested as unilateral.
2. acquired factors
Because the trochlear nerve has a long path in the skull, it is susceptible to inflammation, tumor, trauma, blood circulation disorder and other causes of injury. There are data on the etiology of acquired superior oblique paralysis strabismus: intracranial tumor and cerebrovascular disease accounted for 10 %, diabetes and ischemic diseases accounted for 20%, head trauma accounted for 40%, unexplained accounted for 20%, such as the carpal nerve crossing the hypothalamic level of the anterior pith injury, bilateral paralysis occurred.
(two) pathogenesis
Associated with muscle dysplasia or paralysis of the muscles that innervate the nerves.
Prevention
Prevention of bilateral oblique palsy
Acquired is mainly to prevent primary diseases, and there is no preventive method for congenital.
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Bilateral superior oblique palsy complications Complications
Often accompanied by V sign.
Symptom
Symptoms of upper oblique palsy of common eyes Common symptoms Eyeball vertical movement disorder Double vision strabismus
Clinical features
(1) The first eye position may have no or vertical strabismus: but the vertical inclination is small.
(2) Synaptic movement of both eyes is not normal: the performance of the double inferior oblique muscle is strong, the function of the superior oblique muscle is insufficient, the degree of the inferior oblique muscle function is too strong, or only the unilateral inferior oblique muscle function is too strong, the typical double The superior oblique palsy is characterized by horizontal movement of the eyes, and the internal rotation is higher than the external rotation, and vertical strabismus alternates.
(3) Bilateral Bielschowsky head position tilt test is positive: when the head is tilted to any side shoulder, the eye position is high; it can also be expressed as high eye position when both sides are inclined, or both sides are negative.
(4) often expressed as V-strabismus.
(5) There is obvious external squint: the external rotation is often greater than 10 ° ~ 15 ° (some people think that 8 ° ~ 10 °).
Clinical typing
William E. Scott's classification is more complicated, it is impossible to check the average strabismus clinically. Cui Guoyi proposed the following amendments based on the above classification and domestic literature and clinical experience:
(1) Symmetrical type: Where the double inferior oblique muscle function is too strong (2), the superior oblique muscle function is weak (2-), the vertical inclination is small (5), and those with V signs are classified as this type.
Class I: no symptoms, V sign in the first eye position to the upper eye position, strabismus 20 , double Maddox rod examination has the existence of rotational strabismus.
Class II: There are symptoms (rotary diplopia), V sign exists in the first eye position to the right below the eye position, the slope is 15.
Class III: There is a rotatory double vision, and the V sign exists directly above the eye to the eye position, and the slope is 25 ~ 40 .
(2) Asymmetric type: Where the lateral oblique muscle function is too strong (2), the other lateral oblique muscle function is too strong (<2), accompanied by obvious vertical strabismus, V sign and compensated head position That is to say this type.
(3) Concealed type: Any unilateral superior oblique palsy, after unilateral surgery, the other subtalar oblique muscle function is too strong, the upper oblique muscle function is insufficient or the opposite direction compensates for the head position.
Examine
Examination of bilateral oblique palsy
No special laboratory tests are required.
Vision, eye position, head position and eye movement examination.
Diagnosis
Diagnosis and differentiation of bilateral oblique palsy
The clinical diagnosis of double superior oblique paralysis is not difficult, but it is difficult for concealed type, mainly based on the following criteria.
1. When looking to the left and right side, the left and right eyes alternately squint vertically (the inner eye position is higher than the outer eye).
2. Bilateral Bielschowsky head position tilt test positive.
3. More accompanied by V-type strabismus.
4. The lower oblique muscles are too strong, the upper oblique muscles are weak or both.
5. For unilateral superior oblique palsy, use double Maddox rod to check when the external rotation is more than 10 ° ~ 15 °, bilateral paralysis should be suspected, should be followed up for regular observation, observation time 1 week to 1 year.
