Cross gaze

Introduction The first eye position has alternating gaze, and the two eyes have equal vision. When looking at the two sides, there is cross-gaze, that is, when looking to the right, the left eye is watching, and when looking to the left, the right eye is watching. Cross-gaze is a clinical manifestation of primary non-regulatory esotropia. Congenital esotropia usually occurs within a few days after birth or within a few days after birth. Because the parents rarely see a doctor during the neonatal period, congenital esotropia is rarely seen clinically. It is more common in early postnatal period. It was found to have strabismus. Because the parents of the child are unable to make accurate and objective judgments on the situation of the eyes of the baby within one year of age, it is possible to mistake the instability of the binocular visual axis as a congenital internal oblique. In addition, during the baby period, because the nose is not yet fully developed, there are many internal suede and pseudo strabismus, which is also easy to cause confusion. Some acquired strabismus can also occur at this time, all of which can cause confusion in diagnosis.

Cause

The disease is a congenital disease with no obvious cause.

an examination

Related inspection

vision

1. Most patients with congenital esotropia: the first eye has alternate fixation, the eyes have equal vision, and there are cross-gaze when looking at the sides, that is, when looking to the right, the left eye is watching, when looking to the left, right Eyes gaze. A small number of patients have no alternating gaze, amblyopia can occur in strabismus, the incidence of amblyopia is about 40%, and the degree of amblyopia is deep, accompanied by paracentral gaze.

2, the oblique angle of view is large; generally greater than 30 , about 50% of patients exceed 50 , the distance between the distance and the angle of view is equal, and stable, unaffected by the adjustment, occasionally the oblique angle has changed significantly within a few months. It should be noted that the eyes of the child are often unable to abduct, but this is not a bilateral abductor nerve paralysis, but a result of secondary cross-gaze. In another case, children with congenital esotropia have a large degree of skewness and amblyopia, but no cross-gaze. This is easy to mistake the paracentral gaze as one side of abductor nerve paralysis. In fact, congenital unilateral or bilateral abducens nerve palsy is rare.

Congenital internal oblique should also be identified with eyeball regression syndrome, Mobius syndrome, and abducens nerve paralysis. The identification method is as follows:

1 Fix the child's head in an upright position, so that the child's head is slightly horizontally fast and slowly rotating, giving the road a stimulus, especially the horizontal semicircular canal. A slight abduction movement can occur in an instant, and the hair can be closely observed. Find;

2 Children with congenital internal obliques with cross-sectional gaze, including one eye for a few days, can produce abduction exercises in the other eye;

3 traction test, under general anesthesia, children with congenital internal oblique with cross-gaze, normal traction test, passive resistance during abduction. If the anesthesia is deepened, the esotropia can disappear and the external oblique can be present.

3, often combined with vertical strabismus: children with congenital esotropia to 2 to 3 years old, there may be separated vertical strabismus (dissociated vertigo deviation (DVD), manifested as non-gaze eyes up, external rotation, gaze down, Internal rotation; 78% of patients with excessive inferior oblique muscle function; also visible nystagmus, rotational or horizontal, tremor is sometimes recessive, appear only after covering one eye, or nystagmus during adduction Increased nystagmus during outreach.

4, ciliary muscle paralysis refractive examination proved that mild, moderate hyperopia accounted for 90%, both eyes of the refractive similar, astigmatism or myopia can also exist.

5. AC/A is normal.

Differential diagnosis

It is differentiated from primary common esotropia and common exotropia. Congenital internal oblique should also be identified with eyeball regression syndrome, Mobius syndrome, and abducens nerve paralysis.

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