von Noorden G K, Murray E, Wong S Y
Arch Ophthalmol. 1986 Dec;104(12):1771-6. doi: 10.1001/archopht.1986.01050240045037.
In 270 patients with superior oblique paralyses treated between 1973 and 1984, congenital and traumatic causes were most frequent, and one fourth of all traumatic cases had bilateral involvement. Among the diagnostic features distinguishing bilateral from unilateral paralysis were a right hypertropia in left gaze and left hypertropia in right gaze, and a positive Bielschowsky test on tilting the head toward either shoulder. However, absence of either sign did not exclude bilateral paralysis. Large excyclotropia and a V-pattern esotropia are suggestive of but not diagnostic for bilateral paralysis. Complaints about cyclotropia are limited to acquired paralysis. Cyclotropia in the normal eye, head tilt toward the involved side, or absence of any abnormal head posture limits the diagnostic value of these associated signs. Overshoot of the contralateral superior oblique occurred in 19% of the patients and is thought to be caused by contracture of the ipsilateral superior rectus muscle. Surgical treatment in 112 patients resulted in an 85% cure rate with an average of 1.45 operations per patient.
在1973年至1984年间接受治疗的270例上斜肌麻痹患者中,先天性和外伤性病因最为常见,所有外伤性病例中有四分之一为双侧受累。区分双侧与单侧麻痹的诊断特征包括向左注视时右眼上斜视和向右注视时左眼上斜视,以及向任一肩部倾斜头部时Bielschowsky试验阳性。然而,任一体征的缺失并不排除双侧麻痹。大度数外旋转斜视和V型内斜视提示双侧麻痹,但不能确诊。关于旋转斜视的主诉仅限于后天性麻痹。正常眼的旋转斜视、向受累侧倾斜头部或无任何异常头位会限制这些相关体征的诊断价值。19%的患者出现对侧上斜肌过冲,被认为是由同侧上直肌挛缩引起的。112例患者接受手术治疗,治愈率为85%,平均每位患者接受1.45次手术。