眼外肌伤和弱视哈尔滨医科大学课件

眼外肌病和弱视 严威 哈尔滨医科大学 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 眼外肌病和弱视 n正常的双眼协调运动是实现双眼单视功 能的基本条件之一 n双眼单视功能分为三级：同时知觉，融 像功能，立体视 n两眼12条眼外肌力量的平衡及密切合作 维持了双眼运动的协调并保持双眼单视 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 眼外肌病和弱视 n眼外肌的局部解剖 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 眼外肌病和弱视 n眼肌的神经支配 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 眼外肌病和弱视 n眼外肌作用 眼外肌主要作用次要作用 内直肌 外直肌 上直肌 下直肌 上斜肌 下斜肌 内转 外转 上转 下转 内旋 外旋 无 无 内转、内旋 内转、外旋 下转、外转 上转、外转 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 眼外肌病和弱视 n眼外肌作用 单独内直肌作用（右眼） Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 眼外肌病和弱视 n眼外肌作用 单独外直肌作用（右眼） Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 眼外肌病和弱视 n眼外肌作用 单独上直肌作用（右眼） Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 眼外肌病和弱视 n眼外肌作用 单独下直肌作用（右眼） Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 眼外肌病和弱视 n眼外肌作用 单独上斜肌作用（右眼） Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 眼外肌病和弱视 n眼外肌作用 单独下斜肌作用（右眼） Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 1 相关基础知识 n转动中心与转动轴 眼球的主要轴 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 1 相关基础知识 n眼球运动法则 nHering法则 配偶肌运动法则 nSherrington法则 拮抗肌运动法则 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 1 相关基础知识 n两眼运动的协调性 n单眼运动有内转、外转、上转、下转、内旋 和外旋运动 n两眼共同运动分为同向运动和异向运动 n同向运动：向右、向左、向上、向下、右旋 转、左旋转 n异向运动：集合、开散 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 1 相关基础知识 n两眼运动的协调性 n单眼运动相互协作肌叫协同肌 两眼相互协作的眼外肌称配偶肌 n单眼上起互相反作用的眼外肌称直接拮抗肌 另一眼上的拮抗肌称间接拮抗肌 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n斜视（strabismus） n斜视检查法 n共同性斜视 n非共同性斜视 n特殊类型斜视 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n斜视检查法 n基本状况：时间、年龄、诱因、发展变化、 治疗情况、屈光状态、家族史、治疗史 n眼球运动检查 n斜视的定量检查 n角膜映光法 n三棱镜加遮盖试验 n视野弧法 n三棱镜加马氏杆法 n同视机检查法 配画法，立体视画法 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n斜视检查法 眼球运动检查 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n斜视检查法 角膜映光法 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n斜视检查法 三棱镜加遮盖试验 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n共同性斜视 共同性斜视是指眼球运动无明显障碍，各注 视方向斜视程度无明显差异的眼位偏斜，第一斜 视角等于第二斜视角。 n根据偏斜持续方向分共同性内斜视、共同性外斜视 n根据眼位偏斜的时间分为单眼恒定性斜视、交替性 斜视、间歇性斜视 n根据偏斜与调节的关系分为调节性内斜视、非调节 性内斜视 n继发性斜视常见于肌肉或神经有轻度麻痹，日久产 生代偿性变化、继发于术后的欠矫或过矫、知觉性 斜视 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n共同性斜视 调节性内斜视 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n共同性斜视 部分调节性内斜视 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n非共同性斜视 非共同性斜视主要指麻痹性斜视 麻痹性斜视分为先天性和后天性两种 后天性：外伤、炎症、血管性疾病、肿瘤、 代谢性疾病 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n非共同性斜视 外直肌麻痹 右眼固视、左眼内斜遮盖右眼左眼不能正视 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n非共同性斜视 外直肌麻痹 双眼右转均正常左眼外展不能过中线 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n非共同性斜视 内直肌麻痹 左眼固视、右眼内斜婴儿代偿头位一面向右转 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n非共同性斜视 内直肌麻痹 左眼内转落后双眼左转均到位 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n共同性斜视与非共同性斜视的临床表现 共同性斜视非共同性斜视 共同性内斜视： 一眼偏向鼻侧，第一斜视角 等于第二斜视角 共同性外斜视： 间歇性外斜视则斜视角度变 化较大；恒定性外斜视发生 在幼年的，常交替注视，双 眼单视功能差；发生在成年 期的，术后可能获双眼单视 复视和眩晕 代偿头位 眼位偏斜 运动受限 第二斜视角大于第一斜视角 对麻痹性斜视的复像检查应 右眼戴红色镜片，左眼戴绿 色镜片，二者颜色互补 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n共同性斜视与非共同性斜视的治疗 共同性斜视非共同性斜视 共同性内斜视： 矫正屈光不正；治疗弱视眼 ；正位训练；手术治疗 共同性外斜视： 矫正屈光不正；小度数外斜 可以用三棱镜矫正；正位训 练；手术治疗 查明原因，进行治疗 药物治疗 小于10的斜视，可试用三 棱镜中和法消除复视，主要 矫正位于正前方及正下方的 复视 手术疗法 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n复像的分析 n复像分开最远的方位是麻痹肌行使功能的方 向 n内转肌麻痹为交叉性复像，外转肌为同侧性 复像 n离中心点较远的影像属于麻痹肌所在的眼球 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n复视像 外直肌 内直肌 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n复视像 上直肌 下直肌 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n复视像 上斜肌 下斜肌 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n特殊类型斜视 n眼外肌广泛纤维化综合征 nDuane眼球后退综合征 n垂直后退综合征 nBrown上斜肌鞘综合征 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n特殊类型斜视 Duane眼球后退综合征 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2 斜视 n特殊类型斜视 Brown上斜肌鞘综合征 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 3 弱视 n弱视 弱视是视觉系统发育过程中，受到某些因素 的干扰、抑制、视觉剥夺而未能得到适宜的视觉 信息和视觉刺激形成的发育障碍。 n弱视的病因与分类 n视觉剥夺 遮盖性弱视 n视网膜结像不清屈光不正性弱视 n单侧眼被抑制斜视性弱视 n单侧眼废用屈光参差性弱视 n视觉感受能力障碍 先天性视觉感受障碍性弱 视 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 3 弱视 n弱视 正常双眼单视 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 3 弱视 n弱视 遮盖性弱视 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 3 弱视 n弱视 屈光不正性弱视 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 3 弱视 n弱视 右眼外斜时形成斜视性弱视 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 3 弱视 n弱视 屈光参差性弱视 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 3 弱视 n弱视的诊断 n发病多在视觉发育未成熟的年龄段 n能检查到引起弱视的原因 n视功能低下 n鉴别诊断中排除其他引起视功能低下的疾病 n弱视的其他表现 n瞳孔直接对光反应改变 n采用婴幼儿特殊视力检查 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 3 弱视 n弱视的治疗原则 n针对病因治疗，消除治病因素 n进行视功能训练 n消除视觉剥夺性因素及遮盖性因素 n矫正屈光不正，使视网膜上结像清晰 n手术矫正斜视 n消除健眼对弱视眼的抑制 n消除弱视眼视网膜中心凹受到其周围区域的抑制 n使弱视眼