眼科学-眼外肌病.ppt

继发性内、外斜视常见于肌肉或神经有轻度麻痹继发于术后欠矫或过矫知觉性斜视：一眼视力严重障碍，感知丧失发生眼位偏斜*InfantileEsotropiaEsotropia*治疗目的：恢复双眼视功能、获得正常眼位。因此，必须提高斜视眼的视力，恢复正常视网膜对应。矫正屈光不正，尤其在调节性内、部分调节性内斜患者治疗弱视眼正位训练手术治疗斜视眼戴镜半年至一年，斜视度不变者可手术治疗*矫正屈光不正**共同性外斜视concomitantexotropiaConcomitantexotropia与屈光不正、调节关系不大，发病年龄较分散。常有一间歇期，逐渐转为恒定性外斜视。Exotropia的度数有逐渐增加的趋势。*病因可能与中枢性辐辏兴奋、分开兴奋不平衡有关。调节、集合不平衡。如近视屈光不正时，视近不需调节，使调节性集合低下，导致外斜。屈光参差使双眼成像不等，影响融合。**Exotropia--straightExotropia--deviatedExotropiaVisiontrainingisaneffectivewaytomanagethiscondition*divergenceexcess(DE)Divergenceexcess(DE)ischaracterizedbyhighexotropiaatdistanceandlowexophoriaororthophoriaatnear.ItisassociatedwithahighAC/Aratio.Divergenceexcesscasescanbetreatedwithvisiontraining,BIprismfordistance,oradecreaseinpluspoweroranincreaseinminuspowerfordistance.*convergenceinsufficiency(CI)Convergenceinsufficiency(CI)isaconditioninwhichthepatientexhibitsapproximateorthophoriaatdistanceandhasamoderatetohighexotropiaatnear.ItisassociatedwithalowAC/Aratio.Typically,theNPCisreceded,andthereislikelytobealowpositivefusionalvergencereserve.Patientsymptomsmayincludevisualfatigue,drowsiness,andtransientdiplopiaaccompanyingprolongednearwork.*临床表现发病年龄分散间歇性外斜的斜视角变化较大少数人早期有复视，多数人因单眼抑制无复视幼年发病，视功能预后差；成年发病，因保留一部分融合功能，术后双眼单视功能较好可有异常视网膜对应和弱视*治疗矫正屈光不正小角度斜视或术后残留斜视可用三棱镜矫正。正位训练手术治疗*noncomitancy/incomitancyNonconcomitancyoccurswhenthedeviationchangeswithdifferentpositionsofgaze.Therefore,thereiseitherabnormalrestrictiontomovementoroveractionofoneormoreoftheextraocularmuscles.Clinically,ifthechangeindeviationismorethan5prismdiopters,thedeviationisconsideredtobenonconcomitant.*非共同性斜视

non-concomitantstrabismus指麻痹性斜视，是由于神经核、神经、眼外肌本身器质性病变，引起单条或多条眼外肌完全或部分麻痹，导致的眼位偏斜。偏斜角度在不同注视方向和距离有所不同，伴不同程度的眼球运动障碍。*病因先天性出生时或生后早期发生。由于先天发育异常、产伤、眼外肌缺如等。常有代偿头位。后天性发病急，有确切