Early surgical treatment of congenital paralytic strabismusDue to the dominance of the oculomotor nucleus, nerve and extraocular muscle para
Early surgical treatment of congenital paralytic strabismus
Due to the dominance of the oculomotor nucleus, nerve and extraocular muscle paralysis caused by strabismus itself, called paralytic strabismus. It is divided into two kinds of congenital and acquired.
Symptoms of congenital paralytic strabismus
1 eye position deviation of eye movement disorders when a certain extraocular muscle paralysis, the relative strength of the antagonistic muscle is too strong, the direction of the direction of the eye to the contrary. Limited rotation to the direction of the paralytic muscle. If the external rectus paralysis, then the external rotation of the eye is limited and the internal oblique; if the medial rectus palsy, the internal rotation is limited to the outside oblique.
2 due to the integration of function and lead to diplopia, diplopia, one object as two objects, directional orientation disorder, nausea and dizziness, unsteady gait, covering one eye when the symptoms were relieved or disappeared.
3 compensatory head position disturbance overcome diplopia, patients will head toward paralitic automatic side effects, at the same time also can face rotation caused by medial rectus paralysis or diplopia; chin lift or adduction, coupled with mild and complex as overcome inferior rectus paralysis caused by head to rotate; or the shoulder under the chin and crooked face and overcome inferior oblique muscle paralysis caused by diplopia. Its purpose is to obtain the binocular diplopia, and avoid series features.
4 when the oblique angle of the second angle is greater than that of the first oblique angle, the cerebral cortex needs to enhance the nerve impulse of the paralytic muscle when the eye is fixed.
1 eye movement examination for patients to diagnosis 6 eye position for watching paralysis, such as restricted movement of one eye to the nasal, temporal, temporal, temporal, nasal, nasal, respectively, medial and lateral, superior rectus, inferior rectus and inferior oblique muscle, superior oblique paralysis. If the eye is not fixed, the extraocular muscle paralysis.
2, as the first is the determination of complex determination of ipsilateral complex image or complex image will be *; horizontal separation or vertical separation, there is no complex image tilt, according to the 6 diagnostic positions found in and around the maximum separation range of any eye image.
3 Analysis of compensatory head position
(1) the right to left rotation is limited, in the same side as complex, the level of separation, the maximum separation range on the right, the surrounding image is right in the face to the right, is the right lateral rectus muscle paralysis.
(2) the right upper right rotation is limited, cross complex like vertical separation, the maximum separation range is right above the surrounding image is the right eye, with chin up, face to the left turn, left shoulder head slightly crooked, is the upper right rectus palsy.
(3) the right eye to nose above the rotation is limited, the same side like complex, vertical separation, like in temporal deflection, the maximum separation range is above the left temporal right above the nose, around the object belongs to the right of patients to the right shoulder head askew, chin up, face slightly to the right, is the right oblique muscle paralysis.
(4) tilt test can identify superior oblique paralysis and superior rectus paralysis in children.
(5) occlusion test can be used to determine the effect of correction after operation.
Congenital paralytic strabismus is very small baby parents will find the children to see things tilted, strabismus big child parents easy to find, take the child to the eye doctor, such a child is not easy to delay the disease, some degree of strabismus smaller children, mainly to see the parents easily Minow, take children to see the surgery or delayed treatment some of the children, even misdiagnosed breast papillary parallel cable surgery, after surgery the child still tilted, then parents and doctors will alert, please ophthalmic consultation result often makes parents and surgeon be startled at. At this time, if the eye surgery has missed the best time for the child surgery.
We usually identify a child is not due to strabismus caused by tilt in the clinic is one of the most simple way is to put a child's eyes covered with gauze cover, if the child's head symptoms reduce or disappear, then should cause vigilance congenital strabismus compensatory head posture.
For patients with a small number of upper slopes, we may consider using a three prism to correct the compensatory head position.
2, children with a greater degree of strabismus, should be considered early surgical treatment. This congenital paralytic strabismus surgery, foreign ophthalmologists advocate sub surgery, we live closer to the children, as well as the economic situation is better in patients with multiple surgery. For those who live in remote areas. And the economic situation is relatively poor children, for an operation to solve the problem. But this increases the difficulty of the operation. The operation of the design we must carefully before the operation and parents to discuss the peace talks, for parents to understand and cooperate.
Figure 1. Congenital paralytic strabismus of Magnolia
The theme of this picture is as follows:
Picture 2 Mulan after surgery
The theme of this picture is as follows: