眼科首诊糖尿病性眼肌麻痹18例临床分析

目的探讨以复视为首诊的糖尿病患者的诊断、鉴别诊断及发病机制。方法对18例患者行眼科常规检查,包括视力、裂隙灯显微镜检查、眼底检查、屈光检查、视远视近眼位、眼球运动、红镜片法复视像分析、眼B超检查,全身检查包括血常规、血糖、血脂、血生化、甲状腺功能测定,常规行头颅CT。结果 18例患者经临床相关检查排除颅内占位性病变、脑血管病变、Graves病、重症肌无力、鼻咽癌等,确诊为糖尿病。全部为单眼发病,其中动眼神经麻痹者14例（77.7%）,均无瞳孔改变,外展神经麻痹者3例（16.7%）,滑车神经麻痹者1例（5.6%）。结论随着人口的老龄化,饮食结构改变,糖尿病的发病率越来越高,糖尿病性眼肌麻痹应该引起眼科医生的重视,以免误诊和漏诊。

Newly diagnosdd diabetes in ophthalmology ophthalmoplegia analysis of 18 cases

Objective To explore the diplopia as a first diagnosis of diabetes diagnosis,differential diagnosis and pathogenesis.Methods 18 patients underwent routine ophthalmic examinations,including visual acuity,slit lamp microscopy,fundus examination,refraction,as hyperopia close eye position,eye movement,red lens on complex video analysis,eye-B ultrasonic examination,systemic examination,including blood routine,blood glucose,blood lipids,blood biochemistry,thyroid function test,routine head CT.Results 18 patients were excluded by clinical examination related to intracranial lesions,cerebrovascular disease,Graves disease,myasthenia gravis,and nasopharyngeal cancer,diagnosed with diabetes.All the monocular disease,which oculomotor nerve palsy in 14 cases,accounting for 77.7%,no pupil change,abducens nerve palsy in 3 cases,16.7%,trochlear nerve palsy in 1 case,5.6%.Conclusion With the aging of the population,dietary changes,increasing incidence of diabetes,diabetic ophthalmoplegia caused by an ophthalmologist should focus in order to avoid misdiagnosis and missed diagnosis.