Lyons C J, Tiffin P A, Oystreck D
Department of Ophthalmology, British Columbia's Children's Hospital, Vancouver, Canada.
Eye (Lond). 1999 Oct;13 ( Pt 5):617-20. doi: 10.1038/eye.1999.169.
To define the clinical characteristics of patients presenting with acute onset esotropia and features suggestive of possible underlying central nervous system pathology. To assess the prognosis for the return of binocular function and to consider the most appropriate management.
A prospective clinical study was carried out of all patients presenting to the department of paediatric ophthalmology at a university teaching hospital over the period January 1994 to April 1997. Each patient underwent a full ophthalmological examination (including assessment of sensory status). All patients were referred to a paediatric neurologist for examination and CT and/or MRI scan.
Ten patients presented during the study period. Uncorrected hypermetropia and/or decompensated monofixation syndrome were the commonest aetiological factors. One patient was found to have a cerebellar tumour. In 5 patients prescription of the full hypermetropic correction alone was sufficient to restore binocularity. Five patients required bilateral medial rectus recession. Binocular function was restored in all cases--in 5 cases with bifoveal fusion.
Decompensation of a pre-existing phoria or monofixation syndrome appears the commonest aetiology. Prescription of the full hypermetropic correction found at cycloplegic refraction forms an essential part of initial management. No single clinical sign can reliably indicate the rare patient harbouring a tumour. A high index of suspicion should be maintained and neuro-imaging considered in the absence of expected findings such as hypermetropia or fusion potential or in the presence of atypical features or neurological signs.
明确急性内斜视患者的临床特征以及提示可能存在潜在中枢神经系统病变的特征。评估双眼视功能恢复的预后并考虑最恰当的治疗方法。
对1994年1月至1997年4月期间在一所大学教学医院的小儿眼科就诊的所有患者进行了一项前瞻性临床研究。每位患者均接受了全面的眼科检查（包括感觉状态评估）。所有患者均被转诊至小儿神经科医生处进行检查以及CT和/或MRI扫描。
在研究期间有10例患者就诊。未矫正的远视和/或失代偿性单眼注视综合征是最常见的病因。1例患者被发现患有小脑肿瘤。5例患者仅给予完全远视矫正处方就足以恢复双眼视。5例患者需要双侧内直肌后徙术。所有病例的双眼视功能均得以恢复——5例实现了双黄斑融合。
既往潜在性隐斜视或单眼注视综合征失代偿似乎是最常见的病因。将睫状肌麻痹验光时发现的完全远视矫正处方作为初始治疗的重要组成部分。没有单一的临床体征能够可靠地提示罕见的肿瘤患者。应保持高度怀疑指数，在没有远视或融合潜能等预期发现时，或存在非典型特征或神经系统体征时，应考虑进行神经影像学检查。
