Poonyathalang Anuchit, Khanna Sangeeta, Leigh R John
Department of Ophthalmology, Ramathibodi Hospital, Bangkok, Thailand.
Clin Ophthalmol. 2007 Dec;1(4):415-20.
Recent discoveries about the orbital tissues prompt a re-evaluation of the way that clinicians think about disorders affecting the extraocular muscles, their nerves and motoneurons in the brainstem. The revolutionary discovery that the orbital layers of the extraocular muscles insert not onto the eyeball, but into fibromuscular pulleys that guide the orbital layers, provides explanations for the kinematic properties of eye rotations and clinical findings in some patients with strabismus. The demonstration that all extraocular fibers types, except pale global fibers, lack synaptic folding provides an explanation for why saccades may remain fast in patients with limited ocular mobility due to myasthenia gravis. More than one mechanism may account for the observation that patients with disorders affecting the eye muscles or their nerves can present with the appearance of central disorders of ocular motility, such as internuclear ophthalmoplegia. New approaches to analyzing saccades in patients with disjunctive eye movements provide the means to identify disorders affecting the peripheral or central components of the ocular motor system, or both.
近期关于眼眶组织的发现促使临床医生重新审视他们对影响眼外肌、其神经以及脑干运动神经元的疾病的思考方式。一项具有革命性的发现是，眼外肌的眼眶层并非附着于眼球，而是插入引导眼眶层的纤维肌性滑车，这为眼球旋转的运动学特性以及一些斜视患者的临床症状提供了解释。研究表明，除了苍白的整体纤维外，所有眼外肌纤维类型均缺乏突触折叠，这解释了为何重症肌无力导致眼球活动受限的患者其扫视运动仍可能快速。影响眼肌或其神经的疾病患者可能表现出诸如核间性眼肌麻痹等眼球运动中枢性疾病的症状，这一现象可能由多种机制导致。分析眼球分离运动患者扫视运动的新方法为识别影响眼动系统外周或中枢成分或两者的疾病提供了手段。
