can't open eyes
Introduction
Introduction Due to the influence of certain diseases, the clinical manifestations of the eyes can not be opened. Diseases such as cervical spondylosis can cause eye problems. Cervical spondylosis, also known as cervical vertebra syndrome, is a general term for cervical osteoarthritis, proliferative cervical spondylitis, cervical nerve root syndrome, and cervical disc herniation. It is a disease based on degenerative pathological changes. Mainly due to long-term cervical vertebrae strain, bone hyperplasia, or disc herniation, ligament thickening, resulting in cervical spinal cord, nerve root or vertebral artery compression, a series of clinical syndromes of dysfunction. The manifestations of cervical disc degeneration and its secondary pathological changes, such as vertebral instability, loosening; nucleus protruding or prolapse; spur formation; ligament hypertrophy and secondary spinal stenosis, etc., stimulated or oppressed Adjacent nerve roots, spinal cord, vertebral artery, and cervical sympathetic nerves, and cause a variety of symptoms and signs of the syndrome.
Cause
Cause
Pathological changes:
The basic pathological change of cervical spondylosis is the degeneration of the intervertebral disc. The cervical vertebra is located between the skull and the thorax. The cervical disc has frequent activities under load-bearing conditions and is susceptible to excessive micro-injury and strain.
The main pathological changes are: early cervical disc degeneration, decreased water content of the nucleus pulposus and fibrous swelling and thickening of the annulus fibrosis, followed by glassy degeneration and even rupture. After cervical disc degeneration, the pressure resistance and tensile strength are reduced. When subjected to the gravity of the skull and the pulling force of the muscles of the head and chest, the degenerated disc can undergo localized or extensive bulging to the periphery, narrowing the intervertebral disc space, overlapping the articular processes, dislocation, and the longitudinal diameter of the intervertebral foramen. Become smaller. As the traction resistance of the intervertebral disc becomes weaker, when the cervical vertebra moves, the stability between adjacent vertebrae decreases and the intervertebral instability occurs, the mobility between the vertebral bodies increases and the vertebral body has a slight slippage, which then appears Bone hyperplasia of the posterior facet joint, hook joint and lamina, degeneration of the ligamentum flavum and ligament, cartilage and ossification. Because the cervical disc is bulging around, the surrounding tissues (such as the anterior and posterior longitudinal ligaments) and the vertebral periosteum can be picked up, and a gap is formed between the vertebral body and the protruding intervertebral disc and the ligament tissue that is picked up, called the ligament disc. "Gap", in which the accumulation of tissue fluid, coupled with the bleeding caused by micro-damage, makes this bloody fluid mechanized and then calcified, ossified, thus forming the epiphysis. The relaxation of the anterior and posterior ligaments of the vertebral body makes the cervical spine unstable, which increases the chance of trauma and gradually increases the callus. The epiphysis together with the bulging annulus fibrosus, the posterior longitudinal ligament and the edema or fibrous scar tissue caused by the traumatic reaction, forming a mixture in the spinal canal at the site corresponding to the intervertebral disc, may exert an oppressive effect on the spinal nerve or the spinal cord. The epiphysis of the hook joint can protrude from the anterior to the posterior to the intervertebral foramen to compress the nerve root and the vertebral artery. The epiphysis of the anterior border of the vertebral body generally does not cause symptoms, but there are reports of such anterior epiphysis affecting swallowing or hoarseness in the literature. After the spinal cord and nerve roots are compressed, they are only functional changes at the beginning. If the pressure is not relieved in time, it will gradually produce irreversible changes. Therefore, if non-surgical treatment is ineffective, surgery should be performed promptly.
The pathogenesis of cervical spondylosis:
1. Degenerative changes of the cervical spine.
2. Trauma factors.
3. Chronic strain.
4. Cold and humid.
Supplementary note: Cervical spondylosis is mainly caused by degenerative changes of the cervical disc and cervical vertebrae and their accessory structures. The pathogenesis of cervical spondylosis, like lumbar disc herniation, cannot be explained by mechanical compression alone, and vascular and chemical factors are at work, causing edema and inflammation or aggravating neurological symptoms.
Examine
an examination
Related inspection
Ophthalmoscopy, synovial fluid, visual inspection
Insufficient examination of the eye:
The diagnosis of cervical spondylosis mainly depends on clinical manifestations and image examination.
The symptoms of cervical spondylosis are very rich, diverse and complex. Most patients begin to have milder symptoms, which gradually worsen later, and some of them have more severe symptoms. This is related to the type of cervical spondylosis, but often the type is simple, with one type as the main cum and one to several types mixed together, called mixed cervical spondylosis, so the symptoms are very rich and diverse. complicated.
Its main symptoms are sore head, neck, shoulders, back, arms, neck and neck, and limited mobility. Neck and shoulder pain can be radiated to the head and upper parts of the head, some with dizziness, house rotation, severe with nausea and vomiting, bedridden, a few can have dizziness, tripping. Some of the face is hot, and sometimes sweating is abnormal. The shoulders and back are heavy, the upper limbs are weak, the fingers are numb, the skin of the limbs is weakened, the grip is weak, and sometimes the unconscious grip falls. Other patients have weak limbs, unstable walking, numb feet, and feeling like walking cotton when walking. When cervical spondylosis involves sympathetic nerves, dizziness, headache, blurred vision, dilated eyes, dry hair, open eyes, tinnitus, ear block, balance disorder, tachycardia, palpitation, chest tightness, There are even symptoms such as flatulence. A small number of people have large, urinary out of control, sexual dysfunction, and even quadriplegia. Also have difficulty swallowing, dysphonia and other symptoms. These symptoms have a certain relationship with the degree of onset, the length of onset, and the physical condition of the individual. Most of them are light and not taken seriously by people. Most of them can recover on their own, and they are light and heavy. Only when the symptoms continue to increase and cannot be reversed, it will only attract attention when it affects work and life. If the disease is cured for a long time, it will cause psychological damage, resulting in insomnia, irritability, anger, anxiety, depression and other symptoms.
Lumbar spondylosis such as cervical spondylosis and lumbar disc herniation and lumbar spinal stenosis are both degenerative changes of the spine, both of which are prone to neuralgia. However, there are more obvious differences between the two. In general, cervical spondylosis is more complicated and variable than the symptoms and signs of lumbar spondylosis, and it is more likely to be ignored by patients and missed diagnosis and misdiagnosis by doctors. Symptoms and signs caused by cervical spondylosis are more extensive and severe than lumbar spondylosis.
Special condition examination: The diagnosis of cervical spondylosis mainly relies on clinical manifestations and image examinations. However, when conditions permit, some auxiliary methods can be used to determine the nature, location and differential diagnosis of the lesions, such as the Kuigen test and the spinal cord. Contrast, vertebral angiography, selective spinal angiography, cervical venography.
The Kuegan test determines the presence or absence of obstruction by measuring the pressure of cerebrospinal fluid by penetrating the lumbar 4 to 5 into the subarachnoid space of the spinal canal. It is also possible to infer the degree of obstruction from the biochemical examination of cerebrospinal fluid according to the increase in the amount of protein, and to understand the spinal cord compression, thereby contributing to the diagnosis and differential diagnosis of cervical spondylosis.
Myelography is the injection of iodine preparation or air into the spinal canal for myelography. It can help to diagnose and differentially diagnose various diseases in the spinal canal and spinal canal, such as spinal cord disease, spinal cord compression and spinal canal measurement caused by cervical spondylosis, and can also identify the site and extent of spinal cord compression. . However, because the spinal canal itself can cause a series of side effects, the use of contrast agents can occur in a variety of reactions, with certain risks, the clinical must be strictly controlled.
Vertebral angiography is performed by vertebral artery, subclavian artery, puncturing, or incision of the radial or femoral artery for intubation. Mainly used for the diagnosis and differential diagnosis of vertebral artery type cervical spondylosis. It is also a routine examination before decompression, which can determine the location and extent of the operation.
Diagnosis
Differential diagnosis
Symptoms that are confusing and confusing:
1, can not continue to blink: four-level facial muscle spasm, can have severe paralysis and dysfunction, patients can not continue to blink because they can not read. The facial muscle spasm is twitching on one side of the face (some people have bilateral sputum), the more nervous the spirit, the more severe the excitement. Because the initial symptoms of hemifacial spasm are eyelid beating, the folks also have the title of left eye jumping for money and right eye jumping for disasters, so they generally do not attract peoples attention. After a period of lesion formation, they develop into hemifacial spasm. Move to the corner of the mouth, severely with the neck. The hemifacial spasm can be divided into two types, one is the original facial muscle spasm, and the other is the facial muscle spasm caused by facial sequelae. Both types can be distinguished from symptom manifestations. The facial hair spasm of the original hair can also occur in a static state, relieved after a few minutes, and is uncontrolled; the facial muscle spasm caused by facial sequelae is only caused by blinking, raising eyebrows and the like.
2, eye muscle spasm: eye movement (III), trochle (IV) and abduction (VI) three cranial nerves are the motor nerves that control the eye muscles, skull damage can affect the extraocular muscles and III, IV, VI causes various forms of eye tendon to the cranial nerve.
3, eyelid relaxation: blepharochalasis syndrome (blepharochalasis syndrome), also known as dermatolysis palpebrarum (dermatolysis palpebrarum), atrophic eyelid ptosis (ptosis atrophica), is a rare eyelid disease, characterized by recurrent episodes of eyelid edema The skin of the eyelids becomes thinner, the elasticity disappears, the wrinkles increase, the color changes, and the clinical manifestations of lacrimal gland prolapse, ptosis and shortening of the cleft palate can be complicated. In 1807, Beer first described the disease. In 1896, Fuchs called it eyelid retardation. Because the syndrome affects the appearance of the eyelids, it is the main reason for patients to require treatment. The understanding of their clinical manifestations and pathogenesis can help to adopt appropriate methods for treatment.
4, morning upper and lower eyelid adhesion: Reiter syndrome eye manifestations conjunctivitis is usually the first symptom of the eye, the general symptoms are mild, often accompanied by a slight burning sensation, morning and the upper eyelid adhesion, mostly bilateral involvement.
The diagnosis of cervical spondylosis mainly depends on clinical manifestations and image examination.
The symptoms of cervical spondylosis are very rich, diverse and complex. Most patients begin to have milder symptoms, which gradually worsen later, and some of them have more severe symptoms. This is related to the type of cervical spondylosis, but often the type is simple, with one type as the main cum and one to several types mixed together, called mixed cervical spondylosis, so the symptoms are very rich and diverse. complicated.
Its main symptoms are sore head, neck, shoulders, back, arms, neck and neck, and limited mobility. Neck and shoulder pain can be radiated to the head and upper parts of the head, some with dizziness, house rotation, severe with nausea and vomiting, bedridden, a few can have dizziness, tripping. Some of the face is hot, and sometimes sweating is abnormal. The shoulders and back are heavy, the upper limbs are weak, the fingers are numb, the skin of the limbs is weakened, the grip is weak, and sometimes the unconscious grip falls. Other patients have weak limbs, unstable walking, numb feet, and feeling like walking cotton when walking. When cervical spondylosis involves sympathetic nerves, dizziness, headache, blurred vision, dilated eyes, dry hair, open eyes, tinnitus, ear block, balance disorder, tachycardia, palpitation, chest tightness, There are even symptoms such as flatulence. A small number of people have large, urinary out of control, sexual dysfunction, and even quadriplegia. Also have difficulty swallowing, dysphonia and other symptoms. These symptoms have a certain relationship with the degree of onset, the length of onset, and the physical condition of the individual. Most of them are light and not taken seriously by people. Most of them can recover on their own, and they are light and heavy. Only when the symptoms continue to increase and cannot be reversed, it will only attract attention when it affects work and life. If the disease is cured for a long time, it will cause psychological damage, resulting in insomnia, irritability, anger, anxiety, depression and other symptoms.
Lumbar spondylosis such as cervical spondylosis and lumbar disc herniation and lumbar spinal stenosis are both degenerative changes of the spine, both of which are prone to neuralgia. However, there are more obvious differences between the two. In general, cervical spondylosis is more complicated and variable than the symptoms and signs of lumbar spondylosis, and it is more likely to be ignored by patients and missed diagnosis and misdiagnosis by doctors. Symptoms and signs caused by cervical spondylosis are more extensive and severe than lumbar spondylosis.
Special circumstances check the diagnosis of cervical spondylosis mainly depends on clinical manifestations and image examination, but when the conditions permit, the use of some auxiliary methods can help determine the nature, location and differential diagnosis of the lesion, such as Kuigen's test, myelography , vertebral angiography, selective spinal angiography, cervical venography and so on.
The Kuegan test determines the presence or absence of obstruction by measuring the pressure of cerebrospinal fluid by penetrating the lumbar 4 to 5 into the subarachnoid space of the spinal canal. It is also possible to infer the degree of obstruction from the biochemical examination of cerebrospinal fluid according to the increase in the amount of protein, and to understand the spinal cord compression, thereby contributing to the diagnosis and differential diagnosis of cervical spondylosis.
Myelography is the injection of iodine preparation or air into the spinal canal for myelography. It can help to diagnose and differentially diagnose various diseases in the spinal canal and spinal canal, such as spinal cord disease, spinal cord compression and spinal canal measurement caused by cervical spondylosis, and can also identify the site and extent of spinal cord compression. . However, because the spinal canal itself can cause a series of side effects, the use of contrast agents can occur in a variety of reactions, with certain risks, the clinical must be strictly controlled.
Vertebral angiography is performed by vertebral artery, subclavian artery, puncturing, or incision of the radial or femoral artery for intubation. Mainly used for the diagnosis and differential diagnosis of vertebral artery type cervical spondylosis. It is also a routine examination before decompression, which can determine the location and extent of the operation.
