左眼无外直肌导致斜视病例一例.doc

左眼无外直肌导致斜视病例一例

斜视是指两眼视轴不正，有偏内、偏外或上、下不正的情形。属眼外肌疾病。可分为共同性斜视和麻痹性斜视两大类。前者以眼位偏向颞侧，眼球无运动障碍，无复视为主要临床特征;麻痹性斜视则有眼球运动受限、复视，并伴眩晕、恶心、步态不稳等全身症状。斜视病因复杂，现代西医学除针对病因及手术治疗，对病因不明者，尚无理想方法。
　　而内斜视一般俗称斗鸡眼。眼位向内偏斜。临床上可分为先天性与后天性斜视。在出生至内发生者称之为先天性内斜视。偏斜角度通常很大。后天性内斜视又分为调节性与非调节性，调节性内斜视常发生在2-3岁左右，通常会伴有中高度远视，或是异常的调节内聚力与调节比率;非调节性内斜视则和调节力与屈光状态无关。
　　现我们介绍一例先天性内斜视的病例给大家供大家参考。
　　患者，男，62岁。于1996年2月左眼出现异物感、刺痛等症状。患者于1997年5月16日入院。
　　眼部检查：结膜充血（+），无沙眼滤泡，角膜透明，KP（-），泪道通畅，眼底检查视盘较小。眼位：左眼瞳孔正对内眦角，斜视角》45°，只能轻度向外转动，右眼向各个方位转动正常。视力：右眼1.0，左眼光感。患者自诉生后左眼就出现明显内斜视，否认高烧抽搐病史，否认外伤及头面部手术史。
　　诊断为：（1）左眼先天性内斜视;（2）左眼弱视;（3）慢性结膜炎。
　　予以手术治疗，手术方法：（1）于左眼内眦沿角巩膜缘后作切口，分离至暴露出内直肌附着点，距其2mm处套环状缝合，断肌，将其后徒至角巩膜缘后10mm处固定;（2）沿外眦角巩膜缘后作一切口，分离至暴露出巩膜，一直分离到赤道部以后，上至上直肌，下至下直肌，其间巩膜表面光滑，均未找到外直肌及其附着点。术中又将内直肌缝线拆除，眼球基本回到正位，且能轻度左右活动。
　　术后随访3月，术前症状消失。
　　讨论
　　眼肌缺如的病例在临床上极其少见。本病例左眼先天性内斜视，外转受限，且斜视角》45°，系因无外直肌所致。手术中将内直肌缝线松解后，眼球无这组内外对抗性直肌，眼球方能回到正位。但左眼球能向左右轻度活动，向外为上下斜肌有外转的次要功能维持，向内为上下直肌有向内转的次要功能维持。

No result left lateral rectus strabismus case who

Strabismus refers to two visual axis is not correct, there are inner side, partial outer or upper and lower case is not correct. The case of extraocular muscle disease. Strabismus and can be divided into two major categories of paralytic strabismus. The former eye position deviation temporal side, no eye movement disorders, no diplopia main clinical features; paralytic strabismus you have limited eye movement, diplopia, and vertigo, nausea, unsteady gait and other symptoms. Strabismus causes complex, except for the cause and surgical treatment of unknown etiology, there is no ideal methods of modern Western medicine.
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The esotropia generally known as cross-eyed. Eye position inward deflection. It can be divided into congenital and acquired strabismus clinic. Born to occur within a person called congenital esotropia. Skew angle is usually large. Acquired strabismus is divided within the regulatory and non-regulatory, esotropia often occurs in about 2-3 years old, usually accompanied by a high degree of hyperopia, or abnormal regulation of cohesion and regulation ratio; non-accommodative esotropia and adjust the force has nothing to do with the refractive state.
Now we introduce the case within a case of congenital esotropia to everyone for your reference.
Patients, male, 62 years old. Eye foreign body sensation, tingling and other symptoms in February 1996. Patients in the May 16, 1997 admission.
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Eye examination: conjunctival hyperemia (+), follicular trachoma, corneal transparency, KP (-), lacrimal duct patency, fundus optic disc small. Eye position: left pupil positive internal canthal angle, oblique angle "45 °, can rotate outward slightly, the normal rotation to the right eye in all directions. Vision: right eye 1.0, left eye sense. After the patient left on significant private prosecution birth esotropia, denied a history of convulsions, high fever, head and face trauma and history denied surgery.
Diagnosis: (1) left congenital esotropia; (2) the left eye amblyopia; (3) chronic conjunctivitis.
Be surgery, surgical methods: (1) in the left canthus along limbal incision was made after the separation into the exposed rectus attachment point at 2mm from its sheath suture ring, broken muscle, only to be followed After the limbus at a fixed 10mm; later (2) along the outer canthus limbus made after all ports, separate to expose the sclera, has been isolated from the equatorial region, the supreme rectus, down to the inferior rectus, during scleral surface smoothness , were not found and the lateral rectus muscle attachment points. Intraoperative turn rectus suture removal within the eyeball basically back to normal position and can be mild or so activities.
Patients were followed up in March, preoperative symptoms disappeared.
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Discuss
Ocular absent in clinical cases extremely rare. This case left congenital esotropia, limited abduction and oblique angle "45 °, was due to no lateral rectus due. After surgery rectus suture will release within the eyeball without this set of inner confrontational rectus eye before being returned to the anteroposterior. But around the left eye can be mild to activities outside the upper and lower oblique muscle has a secondary function of maintaining outer turn inward to the upper and lower rectus have secondary functions sustain inward turn.