Ophthalmoplegia

Introduction The so-called ophthalmoplegia is peripheral ophthalmoplegia: a single muscle or the same innervating muscle dyskinesia, autonomic movement and reflex movement are all obstacles, rarely accompanied by other neurological symptoms. Clinical features: pre-incidence before infection, cerebrovascular disease, diabetes, tumor, peripheral neuropathy and other incentives, acute, subacute, chronic or recurrent onset, clinical manifestations of diplopia, pupil dilated or reduced, eyelid or Eye movement disorder.

Cause

Causes of infection, cerebrovascular disease, diabetes, tumors, peripheral neuropathy, influenza, diphtheria, meningitis, cerebral thrombosis, etc. can cause eye muscle paralysis.

Chinese medicine believes that the disease is caused by two reasons:

1, the qi is not solid and the wind is cold, wet and evil.

2, the liver wind moves to the eye muscle paralysis.

The foot of the bladder, the foot Yangming stomach, the hand Yangming large intestine, the hand Shaoyang Sanjiao suffered from the wind and cold dampness and "to squat". The trick is that the bone is heavy, and the veins are bloody and not flowing, but the tendons are not stretched, but the meat is not benevolent, and the skin is cold.

an examination

Related inspection

Ophthalmology examination cerebrospinal fluid IgG/albumin ratio slit lamp function test head test

Intraocular muscle paralysis appears as ptosis, strabismus, pupil dilation, light reflection and regulation of reflex disappeared.

Lifting the diaphragmatic paralysis: The symptoms are caused by ptosis and strabismus in the eye, and the line of sight of the affected eye is blocked by the sag of the sag. Generally, no double vision is felt.

Ciliary muscle paralysis: The symptoms produced are that the lens is adjusted to cause obstruction, causing blurring of the near vision, pupil dilation, light reflection and adjustment of the reflection disappear.

Extraocular muscle paralysis Six extraocular muscles have a very low incidence of paralysis at the same time, most of which are one or two extraocular muscle paralysis; paralysis produces a variety of manifestations. If the eyeball is restricted inward, outward, downward, and upward, strabismus, diplopia, confusion, and the like may occur.

Diplopia, strabismus and visual confusion cause dizziness. When the eyeball moves, the oblique angle of view changes continuously. The object viewed cannot be stable and cause dizziness. In severe cases, nausea and vomiting may occur. When the visual positioning function is broken, the gait is unstable and the direction is unstable. Oblique oculomotor nerve paralysis: oculomotor palsy, manifested as the total ophthalmoplegia of the eye, the movement of the eye inward, downward, upward movement is limited, the ptosis, exotropia; intraocular muscle paralysis, showing dilated pupils, Light reflection and adjustment reflection disappear, and there is double vision.

Tracheal nerve palsy, combined with oculomotor nerve palsy, a single trochlear nerve palsy is rare, manifested as limited eyeball movement to the outside, there is diplopia, strabismus when looking downward and outward.

Abduction of nerve palsy, strabismus, double vision when looking inward and outward.

Differential diagnosis

Eye muscle paralysis confusing symptoms:

Peripheral ophthalmoplegia: oculomotor nerve paralysis, manifested as the total ophthalmoplegia of the eye, restricted movement of the eye inward, downward, upward movement, ptosis, exotropia; intraocular muscle paralysis, showing dilated pupils, Light reflection and adjustment of reflex disappeared, there is double vision; trochlear nerve paralysis, combined with oculomotor nerve paralysis, single trochlear nerve damage is rare, manifested as restricted eyeball movement to the lower side, there is diplopia; abductor nerve paralysis, showing esotropia, The eyeball can not be rotated outward, and there are diplopia, more common in inflammation, skull base tumor, aneurysm compression oculomotor nerve, peripheral neuropathy, multiple sclerosis (MS), paraneoplastic syndrome.

Nuclear ophthalmoplegia: Nuclear damage manifests as part of the ophthalmoplegia that is dominated, mostly bilateral, with adjacent structural damage, cross-caries, more common in cerebrovascular disease, inflammation, and tumors. Internuclear ophthalmoplegia: pre-nuclear internuclear and posterior internuclear ophthalmoplegia. The former is medial longitudinal beam injury. The ipsilateral eyeball can be abducted, the contralateral side can not adduct, and the abduction side can have nystagmus. The collection reflex is normal; the latter is the fibrous damage between the lateral brain center of the pons and the ipsilateral abductor nucleus, which shows that the ipsilateral eyeball can not be abducted, and the contralateral side can be adducted. More common in cerebrovascular disease, multiple sclerosis (MS), brain stem tumors.

Nuclear ophthalmoplegia: manifested as conjugated dyskinesia in both eyes, not in the eye muscles: oculomotor (III), trochleat (IV), and abduction (VI). The cranial nerves dominate the eye muscles. The motor nerve, head injury can affect the extraocular muscles and III, IV, VI on the cranial nerve and cause various forms of eye tendon. When the nerve is damaged, eye movement disorder (eye muscle spasm) and pupil dilation function are abnormal. The damage of the eye movement nerve can be divided into three types: peripheral type, karyotype and nuclear type. Mainly do eye examination, brain CT to exclude intracranial organic lesions.

Nuclear vertical eye muscle spasm: seen in juvenile type (C type chronic neurotype) Niemann-Pick's disease, more common in children, a small number of children or juvenile onset, cherry erythema or supranuclear vertical eye muscles can be seen in the fundus. Younger type (C type chronic neurotype) Niemann-Pick's disease, more common in children, a small number of children or adolescents. After birth, the development is more normal, and a few have early jaundice. Often the first hepatosplenomegaly, most of the symptoms of neurological symptoms in 5 to 7 years old (may be earlier or late in adolescence). Mental decline, language barriers, learning difficulties, emotional variability, gait instability, ataxia, tremors, muscle tension and hyperreflexia, convulsions, dementia, cherry erythema or supranuclear vertical eye muscles. Can live to 5 to 20 years old, and individual can live to 30 years old. The cumulative amount of SM is 8 times normal, and the enzyme activity is up to 50% of normal, which is also close to normal or normal.

The ptosis of the upper jaw: due to the insufficiency or loss of the diaphragmatic muscles, or some or all of the upper jaw can not be lifted, the occlusion of some or all of the pupils is called the ptosis. In normal people, the upper margin covers 2 mm of the upper edge of the cornea, and the average width of the split is about 7.5 mm. In order to estimate the function of lifting the diaphragm, the position of the upper eyelid when the eyeball is extremely upward and downward is measured under the premise of offsetting the contraction strength of the frontal muscle. Normal people should be more than 8mm apart. If the difference between the front and the back is less than 4mm, it means that the diaphragmatic function is severely incomplete. At the same time, horizontally to the left, to the right or vertical movement; no double vision, both eyes are involved at the same time, but the reflex movement still exists, more common in cerebrovascular disease, tumor and inflammation.

Extraocular muscle paralysis occurs in diabetic patients with ophthalmoplegia, that is, 80% intraocular muscle paralysis, 20% intraocular muscle paralysis; aneurysm compression is mostly intraocular muscle paralysis, and extraocular muscle paralysis may occur as the disease progresses; brain stem tumor There may be nuclear, internuclear and supranuclear ophthalmoplegia; parathyroid syndrome may have various forms of ophthalmoplegia; multiple sclerosis (MS) internuclear, peripheral ophthalmoplegia, may be associated with vision Obstruction; inflammation can occur nuclear, peripheral ophthalmoplegia; cerebrovascular disease can occur nuclear, internuclear, nuclear ophthalmoplegia; peripheral nerve damage of the eye muscle paralysis are peripheral ophthalmoplegia.

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