Miller Marilyn T, Ventura Liana, Strömland Kerstin
Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA.
Birth Defects Res A Clin Mol Teratol. 2009 Aug;85(8):667-76. doi: 10.1002/bdra.20609.
Thalidomide is a very potent teratogen capable of causing severe systemic malformations if the fetus is exposed during the sensitive period. Although structural anomalies of the eye can occur from thalidomide exposure, the most frequent eye complication is secondary to damage to the cranial nuclei in the brain stem, resulting in aberrant neurologic connections causing a condition of abnormal ocular movement, Duane syndrome. A less frequent anomalous neurologic complication is tearing when eating (paradoxical gustolacrimal tearing or "crocodile tears") or lack of emotional tearing. The involvement of the 6th and 7th cranial nerves, often seen together in the thalidomide-affected individual, is also characteristic of Möbius syndrome/sequence. This syndrome usually occurs sporadically, but characteristic findings of this condition have also been observed in South American children who were born after an unsuccessful attempt to induce abortion with the prostaglandin drug misoprostol (Cytotec). Aberrant tearing also occurs in some individuals with Möbius syndrome. Autism spectrum disorder (ASD), an unexpected associated finding in a Swedish thalidomide study, is now also noted in Möbius studies, in patients both with and without exposure to misoprostol.
沙利度胺是一种非常强效的致畸剂，如果胎儿在敏感期接触到它，能够导致严重的全身畸形。虽然接触沙利度胺可引起眼部结构异常，但最常见的眼部并发症继发于脑干颅神经核的损伤，导致神经连接异常，引起眼球运动异常的病症，即杜安综合征。一种不太常见的异常神经并发症是进食时流泪（反常性味觉性流泪或“鳄鱼泪”）或缺乏情感性流泪。在受沙利度胺影响的个体中经常同时出现的第6和第7颅神经受累，也是莫比乌斯综合征/序列的特征。这种综合征通常散发出现，但在南美洲使用前列腺素药物米索前列醇（喜克溃）引产失败后出生的儿童中也观察到了这种病症的特征性表现。一些莫比乌斯综合征患者也会出现反常性流泪。自闭症谱系障碍（ASD）是瑞典一项沙利度胺研究中意外发现的相关病症，现在在莫比乌斯综合征研究中也有发现，无论患者是否接触过米索前列醇。
