What Are the Different Types of Paralysis Treatment?

The strabismus caused by the paralysis of the nucleus, nerves, and extraocular muscles that govern eye movement is called paralytic strabismus. Obstacles with eye movements are typical. Belongs to a kind of non-common strabismus. Uncommon strabismus can be divided into two categories of spastic strabismus and paralytic strabismus according to its etiology. Strabismus due to primary muscle (nerve) spasm is extremely rare and is only occasionally seen in tetanus and neurosis. Therefore, most of the extraocular muscle spasms encountered clinically are secondary, so noncommon strabismus is generally referred to as paralytic strabismus.

Basic Information

English name

paralytic strabismus

Visiting department

Ophthalmology

Common locations

eye

Common causes

Paralysis of nerves that innervate extraocular muscles, direct damage to extraocular muscles, myogenic disorders

Common symptoms

Diplopia is confused with vision; vertigo and gait instability; hands cannot accurately contact objects

Causes of paralytic strabismus

Paralytic strabismus may be part of a systemic disease. Can be divided into two kinds of congenital and acquired. The former is a congenital dysplasia, and the latter is due to the following reasons:

Extraocular muscle paralysis

Paralysis occurs primarily from the nerves that innervate the extraocular muscles and is commonly found in:

(1) Trauma such as trauma to the base of the skull and orbit and concussion.

(2) Inflammation such as peripheral neuritis, brain and meningitis.

(3) Cerebrovascular diseases such as cerebral hemorrhage and thrombosis.

(4) Tumor orbital or intracranial tumor.

(5) Endotoxin and exotoxin such as lesion infection, alcohol, tobacco, lead, carbon monoxide, carrion poisoning, etc.

(6) Systemic diseases such as exophthalmic goiter, diabetes, etc.

2. Extraocular muscle injury and disease

Direct damage to extraocular muscles and myogenic disorders (such as myasthenia gravis).

Clinical manifestations of paralytic strabismus

Symptoms

(1) Diplopia and confusion in addition to congenital and paralytic strabismus that occurs early in life, diplopia and confusion are common symptoms in patients with paralytic strabismus.

(2) The causes of vertigo and gait instability are mainly caused by diplopia and confusion. When the eyeball moves, the oblique angle constantly changes so that the object being viewed cannot be stabilized. After covering one eye, the symptoms disappear. Due to the sudden deflection of the eye position, the visual positioning function is destroyed, and the patient's gait is unstable when walking, and often deviates in a certain direction.

(3) Abnormal projection When a paralytic strabismus patient looks at an object with the affected eye and tries to touch the object with his or her hand, the hand cannot always accurately contact the object and leans towards the side of the paralyzed muscle.

2. Signs

(1) Restricted movement Eye movement limitation is one of the main symptoms of paralytic strabismus. Paralyzed eyes have limited movement in the direction of paralysis muscle action.

(2) Oblique eye position Generally speaking, paralysis of the extraocular muscles will cause the affected eye to deflect in the opposite direction of paralyzed muscles.

(3) Different first and second oblique viewing angles. The first oblique viewing angle is also called primary deflection, which refers to the deflection of paralyzed eyes when watching with healthy eyes. If gazing with paralyzed eyes, the deflection of the healthy eye is called the second oblique view or secondary deflection.

(4) The degree of strabismus varies depending on the gaze direction. Due to the paralyzed extraocular muscle dysfunction, the rotation of the eyeball to the paralyzed muscle is restricted. During eye movement, the degree of strabismus changes depending on the gaze direction. When the eyeballs are turned in the direction of the paralyzed muscles, strabismus is significantly increased because of movement disorders in that direction. When turned in the opposite direction, there is no dyskinesia due to normal muscle function, so the strabismus is significantly reduced or even disappeared.

(5) Continued common strabismus after paralysis of one extraocular muscle can cause dysfunction and secondary changes in other muscles in the ipsilateral and contralateral eyes.

(6) Compensated head position Compensated head position is to compensate compensatory deficiencies of a certain extraocular muscle function by compensating gaze reflex, so as to prevent double vision within a certain range of fixation, and maintain the abnormal posture of monocular eyesight. In general, the face is turned to the direction where the compound distance is the smallest, that is, the direction in which the paralytic muscle acts.

Paralytic strabismus

No special laboratory inspection. Craniocerebral fluid examination can be performed with craniocerebral disease.

General inspection

(1) Visual acuity and refractive examination Some congenital or early postnatal paralytic strabismus may be combined with different degrees of amblyopia. The necessary amblyopia treatment should be performed after surgical correction of the eye position. In addition, for patients with refractive errors, refractive errors should be corrected before surgery.

(2) Examination of eyelid movement.

(3) Auxiliary neurological examination is a necessary measure to identify the cause of noncommon strabismus, especially for acquired paralysis.

2. Eye examination

Observing the eye position is the most useful preliminary check for various types of strabismus.

3. Eye movement check

4. Compensation check

5. Cover the common test

Also known as the cover cooperative exercise test, it is a qualitative test designed based on Hering's law, that is, the same amount of nerve impulses reach the spouse muscles at the same time. Primary and secondary skew can also be determined.

6. Double image inspection and analysis

The purpose of diplopia examination is to judge paralyzed muscles, and to judge the degree of disease recovery and treatment effect, which can be confirmed with objective eye position and eye movement.

7. Crooked head test

A simple test to identify oblique and rectus paralysis.

8.Monocular and binocular visual field examination

The monocular visual field examination and the double visual field examination are both quantitative movement tests of one or a group of spouses' extraocular muscles using a curved peripheral perimeter. They are also a method of judging paralytic strabismus based on subjective perception.

9. Passive exercise test

Passive exercise test, also known as Dunnington-Berke traction test, eyeball rotation traction test, forced eye test, traction test, etc., is a test to identify adhesion, paralysis or spastic eye movement disorders. This method should also be used as a routine check before common strabismus and non-common strabismus.

10. Several simple diagnostic methods for vertical muscle paralysis

Including: Parks three-step test; Schwarting three-point test; Helveston two-step test; Urist three-step test.

11.Hess screen and Lancaster screen inspection method

(1) The Hess screen test is used to help check the relative state of nerve excitement during eye movements. It can detect insufficiently functioning muscles (paralysis muscles) and overly functioning muscles. It is a quantitative inspection method.

(2) Lancaster screen inspection measures the degree of shift, which is the actual deflection of strabismus.

12. Strabismus measurement

Quantitative examination of strabismus is very important for observing changes in the condition, designing the operation, and evaluating the effect of the operation.

(1) Corneal mapping method.

(2) Perimeter measurement method, also known as peripheral arc perimeter oblique measurement method, that is, the method of measuring the degree of obliquity by using the degrees on the perimeter arc.

(3) When the prism is placed with the triangular prism and covering method, the bottom direction is toward the paralyzed muscle, and the tip is inclined. If there are both horizontal and vertical oblique positions, the triangular prism should be eliminated separately, and the first oblique angle and the second oblique angle should be measured.

(4) Triangular prism plus Maddox rod method.

(5) Triangular prism elimination complex imaging method. For patients with paralytic strabismus with subjective diplopia, the prism can be used to eliminate double vision.

(6) Synoptic machine method Synoptic machine is the most commonly used instrument for the qualitative and quantitative inspection of strabismus. The use of synoptic machines to measure the conscious oblique angle and the other oblique angle is the most commonly used in the diagnosis of paralytic strabismus, observation of curative effects, and before and after surgery. Inspection Method.

13. Inspection of rotation slope

Fundus photo taken with a fundus camera. Measure the distance from the geometric center of the optic disc to the center of the macula and the vertical distance from the central meridian to the horizontal meridian of the optic disc. Rotation slope.

14. Binocular vision check

Methods for checking binocular monocular function are: Worth four-point light method, posterior image method, limbal traction method, triangular prism examination method, line mirror method and synoptic machine examination method, and stereo vision examination method include "stereogram" examination method.

15. Electromyography

During the inspection, a concentric needle electrode is used to pierce the muscle, and the potential changes generated by the muscle activity are displayed by an oscilloscope after being amplified by an amplifier, and can be permanently recorded by photography. Its potential is generally between 20 and 300 V, and its waveform is a biphasic spike. The phase is short, about 0.5ms, and the frequency can be as high as 350 cycles / second. The EMG has no stationary phase, and it also has action potentials when the eyeballs are in a resting state. It disappears only during deep sleep and anesthesia.

16. Glance exercise check

Examination of saccades is performed by using electrooculogram (EOG) or electronystagmogram (ENG) to record the amplitude of saccade motion to judge the muscle strength of extraocular muscles.

17. Extraocular muscle biopsy

18.CT scan

Paralytic strabismus treatment

For unknown reasons, antibiotics and corticosteroids can be tried. Supportive therapy: Oral or intramuscular injection of vitamin B ₁ , B ₁₂ and adenosine triphosphate, etc. to help nerve function recovery. Locally feasible physiotherapy, such as ultrasound, audio electrotherapy, to prevent paralysis muscle atrophy. Acupuncture can also be tried. During treatment, one eye should be continuously covered to prevent diplopia. Covering must be carried out in both eyes to prevent deterioration of binocular vision. If the cause has been eliminated, or it is known that the disease has not recovered or progressed, triangulation or surgical correction can be used.

Paralytic strabismus prevention

Preventing children's strabismus focuses on eliminating the conditions that cause strabismus, and try to keep children from looking at objects at close range and in the same direction. If you find that your child has had strabismus at 4 months, you can try the following simple methods to adjust: If it is esotropic, parents can talk to the child from a distant position, or hang some colorful toys in a slightly farther range, and Let the children see more moving things.