Single eye double lower muscle paralysis


Brief introduction of single eye double lower muscle paralysis

Double depressor paralysis refers to simultaneous paralysis of the inferior rectus muscle and the superior oblique muscle at one eye, resulting in an oblique or accompanied exudation of the eye.

basic knowledge

The proportion of illness: 0.001%

Susceptible people: no specific people

Mode of infection: non-infectious



The cause of monocular double lower muscle paralysis

(1) Causes of the disease

Monocular double-turning muscle paralysis has congenital and acquired nature, and the exact cause is still unclear.

(two) pathogenesis

From the operation, some patients with congenital paralysis found that the rectus muscles were dysplasia, the muscles were narrow, the muscle tension was significantly reduced, the muscle attachment points were farther than normal, some patients had muscle fibrosis, and the upper rectus muscles were mostly contracted without fibrosis, and the active contraction test showed The muscles of the oblique and inferior rectus muscles are weak. Electromyography still has a discharge phenomenon in the rectus muscle and the superior oblique muscle. Except for the absence of the inferior rectus muscle and the superior oblique muscle, the upper rectus muscle discharge can exclude the upper rectus muscle fibrosis. It is indicated that the cause of congenital disease is related to the development of inferior rectus muscle and inferior oblique muscle. The patients with acquired paralysis have a history of trauma and intrasacral inflammation (such as post-ball abscess).


Monocular double lower muscle paralysis prevention

Reducing and avoiding the irritating and accidental damage of adverse factors can play a preventive role


Single eye double lower muscle paralysis complications Complication

Can be combined with esotropia or exotropia.


Single eye double lower muscle paralysis symptoms Common symptoms Paralyzed ptosis strabismus amblyopia double vision

1. When the eye position is in the first eye position, the affected eye has an upper oblique position, the upper inclination is 10 80 80 , and the majority is greater than 20 . Exotropia and esotropia may be combined, and the external inclination is 10 ~ 60 . The internal slope is 30 to 60 .

2. Eye movements affected the eyes to turn down, down and inward and downward rotation were significantly limited. The same visual machine examination showed that the healthy eyes in the lower left and lower right directions were lower than the affected eyes.

3. When the patient with the ptosis is gazing, the eyelids are drooping.

4. Vision eye can be combined with amblyopia and refractive error, such amblyopia is mostly moderate, severe amblyopia.

5. Double vision of acquired patients with diplopia exists without amblyopia. The characteristics of this type of diplopia are: if the inferior rectus paralysis is dominant, the first eye position is considered to be significant by vertical crossover, and when looking down, The complex image spacing increases, and the complex image spacing becomes smaller or no double vision when looking inward and downward, or becomes vertical ipsilateral double vision; if the above oblique muscle paralysis is dominant, the first eye position is perpendicular to the same side. Vision, the complex image spacing increases when looking inward and downward, and the complex image spacing becomes smaller or no double vision or vertical cross-viewing when gazing outward and downward.

6. Compensatory head position Whether congenital or acquired monocular double-turning muscle paralysis has different degrees of compensatory head position, its (left eye as an example) features: if the following rectus muscle paralysis is the main, face left Turn, head tilted left, mandibular adduction; if the above oblique palsy is the main, turn right, head tilted right, mandibular adduction.


Examination of single eye double lower muscle paralysis

In addition to the above clinical features, the diagnosis of monocular double lower muscle paralysis should be checked to help diagnose:

1. Pulling test The passive pulling test showed that the superior rectus muscle was mechanically pinched, and the active contraction test showed that the inferior rectus muscle and the superior oblique muscle were weak.

2. EMG examination of the upper rectus muscle EMG discharge volume normal exclusion of muscle fibrosis, the lower rectus muscle and superior oblique muscle have discharge phenomenon, but the discharge is weak, eliminating the absence of the lower rectus and superior oblique muscle.


Diagnosis and differentiation of monocular double lower muscle paralysis

According to the clinical symptoms and the results of the pull test and the electromyogram examination, the diagnosis can be confirmed.

Differential diagnosis

1. Inferior rectus muscle paralysis congenital lower rectus paralysis is often mild, no obvious upward oblique in the early stage, only mild upper oblique or only vertical diplopia when looking downward to the sac, there may be mild compensation head Position, when decompensated, there may be double vision and obvious external strabismus in the eye. The movement of the eye outside the eye is limited. The same eye examination can be higher than the healthy eye in the first eye position and the lower eye position.

2. Separate superior oblique paralysis is more common in clinical practice. In mild paralysis, the first eye position can maintain double vision without strabismus. When the compensation head position is extremely light, it often does not attract attention. When directly antagonizing the inferior oblique muscle function, the eye position is deflected inwardly. When the upper oblique muscle is heavier, the double vision is obvious. The patient uses a certain degree of compensation for the head position to obtain binocular monocular, Bielschowsky skull. The test is positive, that is, the function is insufficient when the head moves inward and downward, and the function is too strong when the head is turned upward (the inferior oblique muscle function is hyperthyroidism), and the same eye machine is higher than the first eye position and the inner and lower position. Healthy eyes, accompanied by external rotation.

3. Congenital lower rectus muscle deficiency is the most common in the absence of congenital extraocular muscles. It can also be combined with the absence or internal of the inferior oblique muscle, the lateral rectus muscle is displaced downward and the congenital dysplasia of the eyeball The disease is up-regulated from birth or a few months after birth, and the upper oblique is aggravated with age. Most of the visual acuity is amblyopia or severe visual acuity. The upper slope is generally greater than 50, combined with horizontal strabismus, exotropia More common, external inclination 20 , no obvious compensatory head position, electromyography examination of the rectus muscle without discharge phenomenon, traction test showed that the upper rectus muscle is obviously contracted hyperthyroidism, so that the eye can not be turned down or only reach the midline .