Eyes can't move at will
Introduction
Introduction Eye movements can be divided into synergistic movement disorders and eye movement disorders caused by extraocular tendons. When the normal eyeball turns inward, the inner edge of the pupil can reach the straight line connecting the small and the small punctum. When the outer turn is turned, the cornea can reach the outer corner, and the range of upward and downward movement is about 5rnm. If the above range is not reached, it is an eye movement disorder. Pay attention to eye hygiene and rest. Usually pay attention to eye habits, regular breaks, continuous time in front of the computer screen should not be too long, every 5 hours to rest for 5-10 minutes, try to relax in the gap. Avoid contact with sources of pollution such as fluorescent radiation or exhaust gases.
Cause
Cause
The cause of the eyeball not being able to move at will:
(1) Damage to the eye movement nerve:
1, peripheral eye muscle spasm: oculomotor nerve paralysis, trochlear nerve palsy, abductor nerve paralysis and ocular eye, trochlear and abductor nerve simultaneous paralysis (complete eye muscle spasm) and extraocular tendon. Found in cavernous sinus disease, aneurysm, brain stem tumor, posterior fossa tumor, inflammatory birth injury, increased intracranial pressure or reduction, multiple sclerosis, and myasthenia gravis, eye muscle type, extraocular tendon and so on.
2, nuclear eye muscle spasm: oculomotor nucleus, abductor nucleus and its adjacent nerves such as facial nerve, trigeminal nerve, medial bundle and pyramidal tract. Mainly found in a variety of brain stem lesions, such as inflammation, tumors, trauma, vascular disease and so on.
3, internuclear ophthalmoplegia: the inner bundle of brain stem damage, mainly found in a variety of brain stem lesions, such as inflammation, tumors, trauma, vascular lesions.
4, supranuclear eye muscle spasm: mainly found in the brain stem, frontal lobe, upper hill and other parts of inflammation, tumors, cerebrovascular disease, trauma, degenerative diseases, multiple sclerosis.
(2) Eye movement disorders caused by other causes:
Intracranial trauma, especially near the eyelid fracture, foreign body, hematoma, tumor, etc. at the tip of the ankle, myasthenia gravis, congenital ophthalmoplegia, endocrine diseases such as diabetes, thyroid or pituitary dysfunction.
Examine
an examination
Related inspection
Ultrasound examination of the eyeball and eyelids Total triiodothyronine (TT3) slit lamp brain ultrasound examination of the eye and temporal CT examination
The eyeball can not be randomly checked and diagnosed:
First, medical history:
There are many diseases involved in abnormal eye movement function. Various information about the medical history should be inquired in detail. Past history should pay attention to the history of infection, tuberculosis history, and prodromal symptoms of infection, which contribute to meningitis, encephalitis, and brain. Diagnosis of dry inflammation, multiple encephalitis, and cavernous sinus thrombosis. Atherosclerosis, diabetes, etc. contribute to the diagnosis of cerebrovascular disease. Early maturity, diabetes insipidus and other factors contribute to the diagnosis of endocrine abnormalities, such as pineal gland and pituitary tumors. Chronic headache with nausea, vomiting and papilledema should be suspected of tumors in the brain.
For eye movement dysfunction, ask whether there is volatility, such as morning sputum re-emergence in myasthenia gravis, such as the course of repeated remission and recurrence should be suspected of multiple sclerosis.
The course of abnormal eye movement function is chronic and progressive, and the course of tumor or myogenic disease is more common. Acute eye disease dysfunction is more common in inflammation and cerebrovascular disease.
Children with brain stem tumors, inflammation, cerebrovascular malformations, myasthenia gravis are more common. Young and middle-aged people have tumors and inflammation. Myasthenia gravis, multiple sclerosis, arterial malformation, etc. are more common. The elderly are more common with cerebrovascular disease and tumor or tumor metastasis.
Second, physical examination:
1. Abnormal eye movement: It should be noted that the degree of eye movement limitation is one or both sides, which is abnormal in nerve function, and should distinguish the nature of eye movement abnormality. The difference is the eye-opening collar, the trochlear nerve paralysis, and the abduction. Neurological paralysis and oculomotor, trochlear and abductor nerves are paralyzed simultaneously, or nuclear eye muscle spasm. Is it estimated that the involved nuclear nucleus is the oculomotor nucleus, or the abductor nucleus, whether it is adjacent to the facial nerve, trigeminal nerve, medial longitudinal Bundles and pyramidal bundles, whether it is a supranuclear orbital. Fatigue tests can be performed if necessary.
2, accompanying symptoms and signs: such as eyeballs, eyelid edema, sputum conjunctiva, congestion, tears, edema, meningeal irritation, and signs of nervous system. There are no tumors, infections, malignant lesions, etc. in the whole body.
Third, auxiliary inspection:
1, the head X-ray flat: Sometimes some intracranial tumors such as bone destruction can be found.
2, brain CT or MRI: can detect brain tumors, cerebrovascular disease, and some inflammation, and can make qualitative and local diagnosis of the location, nature, range of the lesion.
3, cerebrospinal fluid examination: for intracranial inflammation such as cavernous sinus thrombosis, meningitis, encephalitis, multiple sclerosis, subarachnoid hemorrhage diagnosis.
4, EEG: can make a diagnosis of inflammation, epilepsy and dysfunction in the brain.
5, EMG: Diagnostic significance for myasthenia gravis and muscle disease.
6, blood sugar, blood endocrine examination: for eye muscle paralysis caused by diabetes, endocrine function abnormalities caused by abnormal eye movements have a diagnostic significance.
Diagnosis
Differential diagnosis
The eyeball can not be arbitrarily confused and confused.
1. The head rotates faster than the eye movement when looking at fast moving objects: The typical manifestation of pediatric ataxia telangiectasia syndrome is that when the patient looks at a fast moving object, the head rotates faster than the eye movement.
2. Eye movement deflection and torsion: due to various reasons, the muscle strength of the eye wall is unbalanced and the eye movement is deflected and twisted.
