Ludwig Irene H, Smith Joe Frank
Department of Ophthalmology, Louisiana State University Eye Center, New Orleans, Louisiana, USA.
Trans Am Ophthalmol Soc. 2004;102:159-65; discussion 165-7.
To determine whether sinus disease may cause acquired strabismus.
Patients with idiopathic acquired (nonaccommodative) esotropia and/or hypotropia were questioned in detail about possible contributing factors (trauma; family history of strabismus; thyroid, neurologic, or rheumatologic disorders). Acute versus chronic onset was ascertained. Those without obvious cause of strabismus were investigated for possible sinus disease with sinus computed tomographic scan and otolaryngologic consultation.
Over a period of 5 years, 59 patients were identified with sinus disease that correlated to their strabismus pattern(s). Twenty-three had "possible" sinus-related strabismus. They had sinus findings that correlated with the strabismus pattern (eg, hypotropia and adjacent maxillary sinus disease). Twenty-six had "likely" sinus-related strabismus. These patients had additional features, such as their own recognition that strabismus worsened along with sinus symptoms, or unusually severe sinus disease. Ten were diagnosed with "very likely" sinus-related strabismus. They had strong correlation between treatment of sinus disease and strabismus improvement. Eighteen patients required sinus surgery owing to failure of medical control. Age at onset of strabismus ranged from 6 months to 81 years. Forty patients required strabismus surgery. All had restriction of motility on forced duction testing under anesthesia. Control of sinus disease combined with range-of-motion eye exercise improved symptoms in 19 who did not require strabismus surgery.
Occult sinus disease may cause acquired strabismus. Perhaps sinusitis leads to inflammation and secondary contracture in adjacent extraocular muscles. Although difficult to prove owing to the high frequencies of both strabismus and sinus disease, the association between the two may prove significant to strabismus treatment and long-term control.
确定鼻窦疾病是否可能导致后天性斜视。
对患有特发性后天性（非调节性）内斜视和/或下斜视的患者详细询问可能的相关因素（创伤；斜视家族史；甲状腺、神经或风湿性疾病）。确定急性起病与慢性起病情况。对那些无明显斜视病因的患者进行鼻窦计算机断层扫描及耳鼻喉科会诊，以排查可能的鼻窦疾病。
在5年期间，确定了59例鼻窦疾病与斜视类型相关的患者。23例有“可能”的鼻窦相关性斜视。他们的鼻窦检查结果与斜视类型相关（例如，下斜视与相邻上颌窦疾病）。26例有“很可能”的鼻窦相关性斜视。这些患者有其他特征，比如他们自己意识到斜视随鼻窦症状加重，或鼻窦疾病异常严重。10例被诊断为“极有可能”的鼻窦相关性斜视。他们的鼻窦疾病治疗与斜视改善之间有很强的相关性。18例因药物治疗无效而需要进行鼻窦手术。斜视发病年龄从6个月至81岁不等。40例患者需要进行斜视手术。所有患者在麻醉下的被动牵拉试验中均有眼球运动受限。鼻窦疾病得到控制并结合眼球运动范围训练使19例不需要斜视手术的患者症状得到改善。
隐匿性鼻窦疾病可能导致后天性斜视。也许鼻窦炎会导致相邻眼外肌炎症及继发性挛缩。尽管由于斜视和鼻窦疾病的高发性难以证明，但两者之间的关联可能对斜视治疗和长期控制具有重要意义。
