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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,眼外肌学,Extraocular Muscles,眼外肌,肌肉 主要作用 次要作用 神经支配,内直肌 内转 无 III,外直肌 外转 无 VI,上直肌 上转 内转,内旋 III,下直肌 下转 内转,外旋 III,上斜肌 内旋 下转,外转 IV,下斜肌 外旋 上转,外转 III,Synergistic Muscles（协同肌）,have the same field of action.,Antagonistic Muscles（拮抗肌）,restriction each other,Yoke Muscles（配偶肌）,for movement of both eyes in the same direction,Binocular Single Vision,（双眼单视）,Simultaneous perception,（,同时视）,:,the two dissimilar objects were imaged on the two,foveas,.,Sensory Fusion,（,融合）,:,whereby dissimilarities between the two images.,Stereopsis,（,立体视）,:,the cerebral integration of these two slightly dissimilar images.,Strabismus（斜视）,在正常双眼注视状态下，被注视的物体会同时在双眼的视网膜黄斑中心凹上成像。,在异常情况下，双眼不能协同，在双眼注视状态下出现偏斜，称为斜视。,斜视的检查：,病史,:,家族史、发病年龄、发生的类型、偏斜类型、偏斜性质、治疗过程等,视力检查,:,屈光检查,:,眼部一般情况,:,眼球位置和眼球运动,:,斜视检查,:,alternative cover test,（交替遮盖）,cover-uncover test,（遮盖去遮盖）,Hirschberg method,（角膜反光）,Prism reflex method（三棱镜）,synoptophore method（同视机）,diplopia test（复视试验）,Bielschowsky head-tilting test（歪头试验）,非手术治疗,:,treatment of,Amblyopia,（,弱视治疗）,optical devices:spectacles,prisms,（,配镜）,pharmacologic agents:,miotics,botulinum,toxin,（,散瞳、肉毒杆菌,）,治疗原则：,手术治疗,:,手术方式,:,resection and recession,（,后退和缩短）,shifting of point of muscle attachment,（,前移）,faden,procedure,（,后固定）,Choice of muscles for surgery,（,肌肉选择）,Adjustable sutures,（,调整缝线）,Recession,后退,Resection缩短,斜视的分类：,Esotropia,Exotropia and,Hypertropia,内,斜、外斜和上斜,Nonaccommodative,Accommodative and Partially Accommodative,非调节、调节和部分调节性,Commitant,and,Incomitant,共同和非共同性,Intermittent and Constant,间歇和恒定性,共同性内斜视,分为：,调节性内斜视,非调节性内斜视,部分调节性内斜视,第一斜视角等于第二斜视角,临床表现:,各方向的斜视度相等,无复视,无代偿头位,治疗:,optical devices,（,光学矫正）,treatment of,amblyopia,（,弱视治疗）,Surgery,（,手术）,Paretic Esotropia,麻痹性内斜视,原因:,外直肌麻痹,外展神经麻痹,眶内壁骨折,Duanes,后退综合征,高血压,糖尿病,diplopia,and dizzy,（,复视和头晕）,Paresis of the lateral,rectus,causes,esotropia,（,内斜）,head tilt,turn,or abnormal posture of the head,（,代偿头位）,the secondary deviation is greater than the primary deviation,（,第二斜视角大于第一斜视角）,limitation of the abduction,（,外转受限）,临床表现:,治疗:,treat the primary disease,（,治疗原发病）,occlusion the paretic eye,（,遮盖麻痹眼）,with prisms,（,使用三棱镜）,with,botulinum,toxin type A on medial,rectus,（,注射肉毒杆菌）,保守治疗,6,个月后无效可手术,共同性外斜视,分为,:,间歇性和恒定性,治疗:,手术治疗,临床表现:,各方向的斜视度相等,第一斜视角等于第二斜视角,无复视,无代偿头位,“A”&“V”patterns,水平位的偏斜程度与垂直方向有关。即向上方注视的水平偏斜角和向下方注视时的水平偏斜角不同，称为,A,或,V,型斜视,.,A,型相差,10,有临床意义，,V,型相差,15,有临床意义,临床上可分为外斜,A,征、外斜,V,征及内斜,A,征、内斜,V,征,“A”Esotropia,内斜A征,“V”Esotropia,内斜V征,垂直斜视,Paresis of left superior oblique,左上斜肌麻痹,Paresis of right superior oblique,右上斜肌麻痹,Paresis of left inferior oblique（左下斜肌麻痹）,Paresis of right inferior rectus（右下直肌麻痹）,Dissociated vertical deviation,（分离性垂直偏斜）,Pseudoesotropia,（假性内斜）,Amblyopia（弱视）,在视觉发育期间，由于各种原因造成视觉细胞的有效刺激不足，从而造成矫正视力低于同龄正常儿童，称为弱视。,弱视在青少年中的患病率为,2,4,，可通过早期诊断及治疗得到恢复。,Classification:,strabismic,amblyopia,（,斜视性）,anisometropic,amblyopia,（,屈光参差性）,ametropic,amblyopia,（,屈光不正性）,deprivation and occlusion,amblyopia,（,形觉剥夺和遮盖性）,slight(,amblyopia,)0.60.8,moderate 0.20.5,severe 0.1,临床表现:,Reduced visual acuity,（,视力下降）,Crowding phenomenon,（,拥挤现象）,Anomalous retinal correspondence,（,异常视网膜对应）,Abnormal of VEP,Abnormal of binocular vision,（,双眼单视异常）,治疗:,Should be instituted as soon as the diagnosis is made,（,尽早治疗）,.,Treat the primary disease.,Occlusion therapy,（,遮盖疗法）,Atropine therapy,（,压抑疗法）,Pleoptics,（,增视疗法）,After image therapy,（,后像疗法）,Nystagmus眼球震颤,A kind of involuntary oscillation of the eyeball.,Divided into:,Horizontal,（,水平）,vertical,（,垂直）,oblique,倾斜）,rotating,（,旋转）,and mixed,（,混合）,.,Treated with:,optical correction,（,光学）,Prism,（,三棱镜）,operative therapy,（,手术）,
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