糖尿病性眼肌麻痹临床分析

目的　探讨老年人糖尿病性眼肌麻痹的临床特点和发病机制。方法　常规眼科检查和眼肌专科检查及实验室生化检查确诊为糖尿病性眼肌麻痹 2 4例 (2 4只眼 ) ,部分病例辅以影像学检查。结果　 2 4例均匀单眼发病 ,受累颅神经以动眼神经最多见 13例 (13只眼 ) ,其次为外展神经 9只眼 ,滑车神经 1只眼。结论　老年人糖尿病患者易合并眼肌麻痹 ,其发病可能与微血管病变有关     

老年糖尿病性眼肌麻痹的临床分析

目的探讨老年人糖尿病性眼肌麻痹的临床特点和发病机制。方法对57例(57只眼)进行常规的眼科检查和眼肌学检查,以内科检查及实验室血生化检查确诊糖尿病;部分患者行头颅影像学检查。结果 57例老年糖尿病患者均为单眼患病,受累颅神经以动眼神经最多,占53%为30只眼,外展神经麻痹占24%为14只眼,滑车神经麻痹占16%为9只眼。复合颅神经(Ⅲ,Ⅳ)麻痹占7%为4只眼。动眼神经麻痹中7例为伴随上睑下垂和瞳孔变化的完全性动眼神经麻痹。大多数患者合并有高血压,高血脂症。结论老年糖尿病患者易合并眼肌麻痹,其微血管病变是临床发病的病理基础。     

老年人糖尿病性眼肌麻痹的临床分析

目的：探讨老年人糖尿病性眼肌麻痹的临床特点和发病机制。方法：常规的眼科检查和眼肌专科检查，内科行全身检查及实验室血生化检查以确诊糖尿病；部分病例辅以影像学检查。结果：３９例老年人糖尿病患者多数为单眼患病；受累颅神经以动眼神经最多２１例２３只眼，以后依次为外展神经１２例，滑车神经和复合神经麻痹各３例。动眼神经麻痹中５例为伴随上睑下垂和瞳孔变化的完全性动眼神经麻痹。大多数患者合并有高血压，近半数患者有     

50例眼肌麻痹病因与临床诊治分析

目的探讨眼肌麻痹的病因、临床特点及治疗效果。方法回顾性分析了50例（50只眼）眼肌麻痹患者的临床资料,根据病史、红玻片复视像检查、眼科检查、实验室检查、影像学诊断,分析发病原因,并对其进行相关治疗。结果 50例中神经血管源性眼肌麻痹42例（84%）,肌源性麻痹3例（6%）,全身免疫性麻痹3例（6%）,机械性麻痹2例（4%）。结论眼肌麻痹病因复杂,仔细分析临床特征,进行全面细致的眼科检查、影像学检查有助于病因诊断及有效的治疗。     

针刺治疗麻痹性斜视的临床体会

麻痹性斜视(paralytic)是由于神经核、神经或眼外肌本身器质性病变而引起的单条或多条眼外肌完全性或部分性麻痹(眼外肌功能减退但非完全瘫痪)所致的偏斜。中医称此病是由于“脏腑虚而邪入目”。现将笔者用针刺疗法治疗麻痹性斜视的临床体会报告如下。1　临床资料1.1　一般资料　本组共189例191眼,男105例107眼,女84例84眼,男∶女=1.3∶1;年龄7～68a,平均年龄35a±17.3a。其中,按斜视类型分:外斜视62只眼、内斜视71只眼,上斜视32只眼,下斜视26只眼。按病因分:外伤引起的眼肌麻痹93只眼,糖尿病引起的眼肌麻痹21只眼,动脉硬化、高血压引起的眼…     

糖尿病性眼肌麻痹32例临床分析

1临床资料 我院1996～2001年6月,共诊治糖尿病性眼肌麻痹32例,男24例,女8例,年龄48～76(平均62)岁。既往有糖尿病史者25例,病程1～27年。7例患者为出现眼肌麻痹後经检查确诊为糖尿病。Ⅰ型糖尿病4例,Ⅱ型28例。全部为急性起病,主要     

糖尿病眼肌麻痹的相关危险因素分析

目的：研究糖尿病眼肌麻痹发生的相关危险因素。

方法：回顾性分析2008-06/2017-06就诊于青岛市市立医院眼科的糖尿病眼肌麻痹患者120例120眼的临床资料,根据颅神经受累部位分为动眼神经麻痹组(Ⅲ组,66例)、外展神经麻痹组(Ⅵ组,41例)、复合神经麻痹组(Ⅲ+Ⅵ组,13例)。收集所有患者的临床资料并进行统计分析,筛选糖尿病眼肌麻痹的相关危险因素。

结果：年龄、性别、糖尿病病程、糖化血红蛋白(HbA1c)水平、合并糖尿病视网膜病变(DR)和高血压情况与糖尿病眼肌麻痹的发生相关,其中年龄≥45岁,男性,糖尿病病程≥10a,合并DR,HbA1c>7%是糖尿病眼肌麻痹发生的独立危险因素。

结论：糖尿病眼肌麻痹的发生与糖尿病患者的年龄、性别、糖尿病病程、是否合并DR及HbA1c水平相关。     

糖尿病性眼肌麻痹临床特点和治疗探讨

糖尿病性神经病变是糖尿病常见的并发症之一 ,其中颅神经病变引起眼肌麻痹在临床上并非多见 ,自1994年至 1997年 7月 ,我们诊治 2 1例糖尿病性眼肌麻痹 ,现报道如下 :临床资料(1)一般资料 :本文 2 1例病人中男性 13例 ,女性 8例 ,年龄 4 9～ 74岁 ,平均 6 1± 7.3岁 ,既往有糖尿病史者 16例 ,病程 1～ 2 5年 ,平均 7± 3.2年 ,另5例为出现眼肌麻痹后经检查确诊为糖尿病。合并糖尿病性视网膜病变者 6例 ,眼底 期、 期和 期病变者分别为 4例、 1例和 1例。 14例既往有高血压病史半年～ 2 0年。 (2 )临床表现 :2 1例患者均为急性起病 ,以复…     

80例以复视为首发症状的眼外肌麻痹病因分析

目的：探讨以复视为首发症状的眼肌麻痹患者的临床特征、鉴别诊断,探讨其病因及发病机制。方法回顾分析2008至2013年我院神经内科收治以复视症状为主症的眼肌麻痹患者80例,根据病史、详细的查体和眼部检查,分析其发病原因。结果80例病例中,糖尿病性眼肌麻痹24例（动眼神经麻痹16例,外展神经麻痹6例,合并动眼神经、外展神经麻痹2例）,脑血管病20例,动脉粥样硬化性动眼神经、外展神经麻痹18例,颅内动脉瘤者10例,重症肌无力眼肌型2例,躯体形式障碍1例,颅内肿瘤2例,多发性硬化1例,神经梅毒1例,脑干脑炎1例。结论很多神经系统疾病可引起复视的神经眼科体征,其中糖尿病性眼肌麻痹为最主要病因,脑血管病、动脉瘤眼肌麻痹、动脉粥样硬化也是重要原因,其他还有重症肌无力（眼肌型）、躯体形式障碍、颅内占位等。以复视为首发症状的急性眼外肌麻痹病因复杂,容易误诊,临床医生应高度重视,明确诊断,以达到正确治疗。     

眼肌麻痹的眼外相关病因分析

目的:探讨眼肌麻痹的眼外相关病因。方法:对157例眼肌麻痹患者采用三棱镜、同视机及红玻片等方法进行常规眼科和眼肌检查,辅以血液生化检查和影像学(CT,MRI,DSA)诊断。结果:眼肌麻痹的眼外相关病因主要有糖尿病(23.6%)、颅脑血管疾病(18.5%)、颅脑外伤(15.9%)、炎症性疾病(10.8%)、甲状腺性相关眼病(7.0%)、颅脑肿瘤(4.5%)、重症肌无力(1.9%)、鼻咽癌(1.9%)等。结论:眼肌麻痹病因复杂,对无法用眼部原因解释的双眼复像患者,应进行详细的全身和眼部检查,以明确病因。     

77例急性眼外肌麻痹临床与病因分析

目的 探讨急性眼外肌麻痹的病因特点。方法 采用三棱镜、同视机及红玻璃片等方法进行眼位、眼球运动和复像检查，辅以血液生化检查和影像学(CT、MRI)诊断。结果 77例中主要病因依次为神经源性麻痹50例(64．93％)，肌源性麻痹14例(18．18％)，机械性麻痹8例(10．39％)，全身免疫性5例(6．49％)。结论 急性眼外肌麻痹病因复杂，应对病人进行详细的全身和眼部检查。复视可能是系统性疾病的先兆或症状的一部分。     

先天性双上转肌麻痹的临床表现和手术治疗探讨

目的 探讨先天性双上转肌麻痹的临床表现和不同手术方式的疗效.方法 回顾性分析1987年10月～2011年1月收治的先天性双上转肌麻痹的病例.结果 共20例,临床表现和相关检查结果分别为(例/例):弱视:16/20;真、假性、混合性上睑下垂:4、8、1;代偿头位:3/20;合并水平斜视:13/20;同视机检查同时视、融合和立体视:10/20,7/20,4/20;随机点图立体视检查8例仅1例阳性.17例接受下直肌徙后或/和上斜肌鞘内切腱术为主选术式共计25次手术.结论 对视力和双眼视机能损害较重,应尽早手术.分期手术为常规.下直肌徙后或/和上斜肌鞘内切腱联合垂直肌手术疗效满意.     

Surgical treatment of diplopia caused by fractures of the orbital floor

Oculomotor disturbance resulting from orbital floor fractures have different etiologic factors, sometimes damage of one of the ocular motor nerves, caused by direct injury to the orbit; this damage occurs also to one or more of the extrinsic ocular muscles, especially the obliques; frequently, the diplopia is caused by prolapsed orbital tissues with or without muscle entrapment or by a muscle fibrosis; when the diplopia appears after orbital floor reconstruction there is often a palsy of the inferior rectus muscle in front of silicone implant or bone graft on the orbital floor. In oculomotor disturbance after orbital floor fracture, the first stage will be to recognize the mechanism of the diplopia by a clinical examination, motility in the nine positions, Hess Charts, binocular vision and field, forced duction, radiography and sometimes coronal computed tomography which also allow visualization of soft tissues densities, including all extraocular muscles. If there is an indication of orbital surgery, it will be done always in first; oculomotor surgery will be done if necessary at the second stage, if there is a permanent diplopia without evolution during six months. The purpose of the treatment is to obtain orthophoria in primary position and in down gaze. A series of cases of fracture of the orbital floor with resulting diplopia are described. The method, the time, and the indications of orbital or oculomotor surgery are discussed according the variety of cases.     

动眼神经麻痹32例临床分析

目的 分析动眼神经麻痹的病因，临床特点，辅助检查，治疗及预后。方法 对2000年1月至2002年12月在本院住院治疗的32例动眼神经麻痹患者进行回顾性分析。结果 首诊眼科12例。神经内科15例，神经外科5例。病因包括脑血管微梗塞19例；上呼吸道感染性神经炎2例；脑外伤4例；脑膜瘤2例；动脉瘤1例；病毒性脑膜炎2例；蛛网膜下腔出血2例。愈后以上呼吸道感染性神经炎和脑血管微梗塞患者为最明显。结论 (1)眼科医生要重视动眼神经麻痹的病因检查，协同相关科室对症治疗，有利于功能早期恢复；(2)头颅CT和MRI是主要的病因诊断手段。     

Ocular myasthenia presenting as superior oblique weakness

We diagnosed ocular myasthenia in a 39-year-old man whose presenting symptom was vertical diplopia. Unrecognized weakness of the right superior oblique and secondary overaction of the right inferior oblique caused a right hypertropia, which was worse on left gaze. One week later left blepharoptosis, right medial rectus weakness, and bilateral obicularis oculi weakness were found on ocular examination. All findings were partially reversed by the injection of Tensilon. Superior oblique muscle palsy simulating a fourth cranial nerve palsy is infrequently reported in patients with ocular myasthenia. Pseudofourth nerve palsy is another sign of myasthenia gravis.     

成人双眼复视117例临床分析

目的 探讨引起双眼复视的斜视的类型以及病因学的诊断.方法 回顾性病例研究.117例双眼复视患者,年龄20～82岁,年龄中位数为47岁.采用三棱镜、红球片、Hess屏及同视机等方法分析复像;辅以血液生化检查、新斯的明试验和头颅影像学）和磁共振血管造影,必要时进行胸腺MRI检查来辅助诊断.结果 117例复视中非共同性斜视包括麻痹性斜视、限制性斜视.麻痹性斜视包括展神经麻痹（35例,29.9％）、单纯动眼神经麻痹（28例,23.9％）、滑车神经麻痹（19例,16.2％）、多颅神经麻痹共存（8例,6.8％）;限制性斜视包括限制性下斜视（18例,15.4％）和限制性外斜视（2例,1.7％）.共同性斜视主要是间歇性外斜视早期（4例,3.4％）和急性共同性内斜视（3例,2.6％）.主要的病因依次为糖尿病（32例,27.4％）、脑血管疾病（20例,17.1％）、脑以及眼眶骨折（15例,12.8％）、颅脑肿瘤（11例,9.4％）、病毒感染（10例,8.6％）、眼眶肿瘤（9例,7.7％）、甲状腺相关眼病（TAO）（9例,7.7％）、重症肌无力（5例,4.3％）、白血病化疗期间（2例,1.7％）和不明原因（4例,3.4％）.结论 引起复视的原因较复杂,需要结合眼外肌运动、红绿玻璃试验和HESS屏检查等来诊断麻痹的眼外肌.     

A multi-disciplinary study of the ocular, orthopedic, and neurologic causes of abnormal head postures in children

PURPOSE: To determine the relative frequency that abnormal head postures in children are caused by orthopedic, ophthalmologic, or neurologic disorders, respectively. DESIGN: A prospective, consecutive case series. METHODS: Children found to have an abnormal head posture on routine pediatric examination underwent an evaluation by a pediatric ophthalmologist, pediatric orthopedist, and pediatric neurologist. The study was conducted in northwestern Italy. RESULTS: In the 63 children evaluated, the cause of the abnormal head posture was orthopedic in 35, ocular in 25, and neurologic in 5. In 8 patients, no specific cause could be found. The most common orthopedic cause was congenital muscular torticollis, which accounted for 31 patients. The most common ocular cause was superior oblique muscle palsy, which accounted for 12 patients. In 2 patients neck muscle contracture suggested an orthopedic cause, however, the tight neck muscles were secondary to a head tilt caused by superior oblique muscle palsy. CONCLUSIONS: When the cause of an abnormal head posture is not obvious, a multi-disciplinary approach including ophthalmologic, neurologic, and orthopedic specialists may be helpful.     

Ocular motor nerve palsy: a clinical and etiological study

PURPOSE: To clinically describe cases of ocular motor nerve palsy and to determine the possible causes. MATERIALS AND METHODS: Thirty-one consecutive patients with ocular motor nerve palsies were investigated. All underwent complete ophthalmological, as well as neurological, otorhinolaryngological and general examination. Computerised tomography (CT)-scan of the brain and complementary laboratory tests were obtained from each participant. RESULTS: Paralysis of the sixth (38.4%) and the third (35.3%) cranial nerve were the most common. The Lees screen test was found to be very sensitive, confirming the diagnosis of ocular motor nerve palsy, even in cases with minimal manifestations. Complete ptosis and full mydriasis were mostly seen in isolated cases of the third cranial nerve palsy. The majority of eyes (63.2%) with third cranial nerve palsy had pupil sparing. Overall, an etiological diagnosis was made in 93.5% of cases. The common causes were vascular conditions (25.8%), otorhinolaryngologic diseases (19.7%) and trauma (12.9%). CT scan failed to reveal any abnormality in 54.8% of cases. CONCLUSION: Patients with ocular motor nerve palsy should be carefully examined in close collaboration with other specialists, especially where sophisticated, complementary investigations are impossible.     

先天性上斜肌麻痹的手术治疗

目的探讨先天性上斜肌麻痹的各种手术方法与疗效及适应症。方法回顾性分析112例先天性上斜肌麻痹患者分别行患眼下斜肌断腱、下斜肌部分切除、下斜肌后徙转位、下斜肌后徙转位联合健眼下直肌后徙术的术后效果。结果术后平均随访22月（7～36月）,下斜肌断腱术22例,术后满意率86.36%,下斜肌部分切除术16例,术后满意率87.5%,两者治疗效果相当,无明显统计学差异;下斜肌后徙转位54例,术后满意率88.89%;下斜肌后徙转位联合健眼下直肌后徙术20例,术后满意率80%。结论先天性上斜肌麻痹患者应根据术前垂直斜视度的大小选用不同的手术治疗方法,且应该早期治疗。下斜肌断腱和下斜肌部分切除术治疗效果相当,适用于矫正垂直斜视度〈15~△者;下斜肌后徙转位适用于矫正垂直斜视度15~△～25~△者;下斜肌后徙转位联合健眼下直肌后徙术适用于矫正垂直斜视度〉25~△者。