Zhang Xin, Wei Shihui
Department of Ophthalmology, First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou 310001.
Department of Ophthalmology, First Medical Center of PLA General Hospital, Beijing 100039, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2020 Dec 28;45(12):1425-1430. doi: 10.11817/j.issn.1672-7347.2020.190539.
Oculomotor nerve palsy is a kind of disease with many causes, showing eye movement disorders, abnormal eyelid position, and/or damage of the pupil. The etiology of oculomotor nerve palsy in different departments is different. The study discussed the etiology, localization of the lesion, and prognosis for oculomotor nerve palsy firstly diagnosed in department of ophthalmology.
Clinical data of 137 hospitalized patients with oculomotor nerve palsy at the Department of Ophthalmology, the First Medical Center of PLA General Hospital from 2009 to 2018 were retrospectively collected. The etiology and its distribution characteristics in different age groups, the location of the lesion, and the prognosis of patients were analyzed.
In 137 patients, the top 3 causes for oculomotor nerve palsy were head trauma (38.69%), cavernous sinus lesions (12.40%), and orbital inflammation (9.49%). Other causes included intracranial aneurysm, the intracranial space-occupying lesion, cerebral vessel diseases, infection, orbital tumors, diabetes, the operation of nasal cavity. Traumatic oculomotor nerve palsy was more common in young adults aged 20-49 years and in the patients with cerebral vascular disease in elderly people aged 60-69 years, while diabetic oculomotor nerve palsy is common in middle-aged and elderly people aged 50-69 years. The age distribution of other etiological types was relatively balanced. Seventy-five cases of orbital apex lesions were due to trauma, inflammation, infection, and tumor; 40 cases of cavernous sinus lesions were due to inflammation, tumor, and thrombosis; 6 cases of subarachnoid lesions were due to aneurysms, tumors, and trauma; 5 cases were oculomotor nucleus lesions were due to infarction; 11 cases could not be allocated because of unknown etiology. After treatment, the corrected visual acuity of oculomotor nerve palsy side was not significantly improved. The patients with oculomotor nerve palsy caused by intracranial aneurysm, cerebrovascular disease, and diabetes mellitus had the highest proportion of partial or complete recovery from ptosis and ocular dyskinesia.
Oculomotor nerve palsy is a common cause of ophthalmoplegia and diplopia. Head trauma, cavernous sinus lesions, and orbital inflammation are the most common causes for oculomotor nerve palsy first diagnosed in ophthalmology department. Traumatic oculomotor nerve palsy is common in adolescents. Oculomotor nerve palsy caused by diabetes and cerebrovascular disease are common in the middle-aged and elderly people. Most of the lesions locate in the orbital apex and cavernous sinus. The prognosis of corrected visual acuity is poor. The prognosis of ptosis and ocular dyskinesia caused by intracranial aneurysm, cerebrovascular disease, and diabetes is good. Figuring out the cause timely and accurately is the basis and key to treat oculomotor nerve palsy.
动眼神经麻痹是一种病因多样的疾病，表现为眼球运动障碍、眼睑位置异常和/或瞳孔损害。不同科室的动眼神经麻痹病因有所不同。本研究探讨眼科初诊的动眼神经麻痹的病因、病变定位及预后。
回顾性收集2009年至2018年解放军总医院第一医学中心眼科住院的137例动眼神经麻痹患者的临床资料。分析不同年龄组的病因及其分布特征、病变部位和患者预后。
137例患者中，动眼神经麻痹的前3位病因是头部外伤（38.69%）、海绵窦病变（12.40%）和眼眶炎症（9.49%）。其他病因包括颅内动脉瘤、颅内占位性病变、脑血管疾病、感染、眼眶肿瘤、糖尿病、鼻腔手术。外伤性动眼神经麻痹在20 - 49岁的年轻人中较为常见，而60 - 69岁老年人中脑血管疾病导致的动眼神经麻痹较为常见，糖尿病性动眼神经麻痹在50 - 69岁的中老年人中较为常见。其他病因类型的年龄分布相对均衡。眶尖病变75例，病因包括外伤、炎症、感染和肿瘤；海绵窦病变40例，病因包括炎症、肿瘤和血栓形成；蛛网膜下腔病变6例，病因包括动脉瘤、肿瘤和外伤；动眼神经核病变5例，病因是梗死；11例因病因不明无法归类。治疗后，动眼神经麻痹侧矫正视力无明显改善。由颅内动脉瘤、脑血管疾病和糖尿病引起的动眼神经麻痹患者，上睑下垂和眼球运动障碍部分或完全恢复的比例最高。
动眼神经麻痹是眼肌麻痹和复视的常见原因。头部外伤、海绵窦病变和眼眶炎症是眼科初诊的动眼神经麻痹最常见的病因。外伤性动眼神经麻痹在青少年中常见。糖尿病和脑血管疾病所致动眼神经麻痹在中老年人中常见。大多数病变位于眶尖和海绵窦。矫正视力预后较差。颅内动脉瘤、脑血管疾病和糖尿病所致上睑下垂和眼球运动障碍预后较好。及时准确地明确病因是治疗动眼神经麻痹的基础和关键。
