Anisocoria yog qhov tsis sib xws ntawm txoj kab uas hla ntawm ob tus menyuam kawm ntawv, ntau dua 0,3 millimeters: ob tug menyuam kawm ntawv yog qhov sib txawv. Anisocoria tuaj yeem txuas mus rau unilateral mydriasis, uas yog hais tias qhov loj ntawm ib tug ntawm ob tug menyuam kawm ntawv, los yog, conversely, rau miosis ua ib tug me nyuam kawm ntawv me dua lwm tus.

Qhov ua rau anisocoria yog qhov sib txawv heev, xws li los ntawm me me aetiologies mus rau qhov muaj peev xwm loj heev pathologies, xws li kev puas hlwb neurological. Ntau txoj hauv kev tso cai rau kev kuaj mob kom raug, uas yuav tsum tau tsim kho sai kom tsis txhob muaj qhov tshwm sim loj, xws li mob stroke, uas anisocoria kuj yog cov tsos mob.

Dab tsi yog anisocoria

Ib tug neeg muaj anisocoria thaum nws ob tug menyuam kawm ntawv muaj qhov sib txawv: txawm yog vim yog mydriasis unilateral, yog li ntawd qhov loj ntawm ib tug ntawm nws ob tug menyuam kawm ntawv, los yog vim unilateral miosis, uas yog, ntawm nws nqaim. Anisocoria characterizes qhov sib txawv ntawm cov menyuam yaus txoj kab uas hla ntau dua 0,3 millimeters.

Cov menyuam kawm ntawv yog qhov qhib nyob rau hauv nruab nrab ntawm lub iris, los ntawm qhov uas lub teeb nkag mus rau lub posterior kab noj hniav ntawm lub qhov muag. Lub iris, cov xim ntawm lub qhov muag, yog tsim los ntawm cov hlwb uas muab nws cov xim (hu ua melanocytes) thiab cov leeg nqaij fibers: nws lub luag haujlwm tseem ceeb yog tswj cov teeb pom kev zoo uas nkag mus rau lub qhov muag. qhov muag ntawm tus menyuam kawm ntawv.

Qhov tseeb, cov menyuam kawm ntawv (uas txhais tau hais tias, "tus neeg me", vim tias qhov no yog qhov koj pom koj tus kheej thaum koj saib ib tus neeg ntawm lub qhov muag), uas yog li ntawd lub hauv paus qhib ntawm iris, zoo li dub vim thaum koj saib los ntawm lub lens. , nws yog ib feem ntawm lub qhov muag uas tshwm (choroid thiab retina), uas yog heev pigmented.

Reflexes tswj cov tub ntxhais kawm ntawm tes, nyob ntawm qhov siv ntawm lub teeb: 

• Thaum lub teeb khaus nkoos lub qhov muag, nws yog cov parasympathetic fibers ntawm lub paj hlwb uas nkag mus rau hauv kev ua si. Yog li, parasympathetic fibers ntawm lub paj hlwb oculomotor txhawb kev sib cog lus ntawm cov voj voog lossis cov kab nruab nrab ntawm cov iris (los yog cov leeg sphincter ntawm cov menyuam kawm ntawv) inducing ib tug contraction ntawm cov menyuam kawm ntawv, uas yog hais tias yuav txo tau ntawm lub pupillary txoj kab uas hla.
• conversely, yog hais tias lub teeb tsis muaj zog, lub sij hawm no nws yog lub sympathetic neurons ntawm lub vegetative paj hlwb uas yog activated. Lawv txhawb cov radiary fibers los yog dilator cov leeg ntawm cov menyuam kawm ntawv, inducing dilation ntawm txoj kab uas hla ntawm cov menyuam kawm ntawv.

Ib qho anisocoria xav tau kev ntsuam xyuas ophthalmological thiab, feem ntau, neurological lossis neuroradiological. Yog li ntawd, anisocoria tuaj yeem txuas mus rau ib qho miosis ntawm ib qho ntawm ob tus menyuam kawm ntawv, tshwm sim los ntawm kev ua kom lub cev parasympathetic uas ua rau lub sphincter ntawm lub iris, los yog rau mydriasis ntawm ib tug ntawm cov menyuam kawm ntawv, tshwm sim los ntawm lub sympathetic system activating. lub dilator nqaij ntawm iris.

Muaj physiological anisocoria, uas cuam tshuam txog 20% ​​ntawm cov pejxeem.

Yuav ua li cas paub txog anisocoria?

Anisocoria yog qhov pom kev pom los ntawm qhov tseeb tias ob tus menyuam kawm ntawv tsis yog qhov loj. Cov kws kho mob feem ntau pom ntau tus neeg mob nrog anisocoria thaum lub sij hawm ib hnub ntawm kev sab laj. Feem ntau ntawm cov neeg no tsis paub txog nws, tab sis qee qhov tshwj xeeb tuaj yeem ntsuas nws.

Kev ntsuam xyuas siv teeb pom kev zoo yuav ua rau nws muaj peev xwm txheeb xyuas qhov twg yog cov tub ntxhais kawm pathological: yog li, anisocoria nce hauv lub teeb muaj zog yuav qhia tau tias cov tub ntxhais kawm pathological yog qhov loj tshaj (tsis zoo ntawm cov menyuam kawm ntawv pathological), thiab qhov sib txawv ntawm anisocoria nce hauv qhov tsis tshua muaj teeb pom kev zoo. qhia tias cov menyuam kawm ntawv pathological yog qhov tsawg tshaj plaws (kev so tsis zoo ntawm cov menyuam kawm ntawv pathological).

Risk yam tseem ceeb

Hais txog iatrogenic yam (txuas mus rau cov tshuaj), cov neeg ua haujlwm kho mob, xws li cov kws saib xyuas neeg mob ua haujlwm hauv tsev kho mob, tej zaum yuav muaj kev pheej hmoo ntawm kev tsim tshuaj anisocoria, uas hloov mus ua benign, tom qab raug rau qee yam tshuaj. cov khoom lag luam, xws li scopolamine thaj ua rau thaj: cov no tuaj yeem ua rau anisocoria uas yuav ntsws ntawm nws tus kheej hauv hnub.

Ntxiv mus, ntawm cov khoom siv tshuab, muaj, hauv cov menyuam yaus, muaj kev pheej hmoo ntawm anisocoria los ntawm kev yug menyuam nyuaj, tshwj xeeb tshaj yog thaum siv forceps.

Lub etiologies ntawm anisocoria muaj ntau haiv neeg: nws yog ib tug tsos mob ntawm pathologies uas muaj xws li los ntawm benign ua rau neurological los yog tseem ceeb heev thaum muaj xwm ceev.

Physiological anisocoria

Qhov tshwm sim ntawm physiological anisocoria, uas yog tam sim no tsis muaj ib yam kab mob cuam tshuam, cuam tshuam ntawm 15 thiab 30% ntawm cov pejxeem. Nws tau muaj nyob rau lub sijhawm ntev, thiab qhov sib txawv ntawm ob tus menyuam kawm ntawv tsawg dua 1 millimeters.

Ocular etiologies nkaus xwb

Purely ocular ua rau anisocoria tau yooj yim kuaj tau thaum lub sij hawm kuaj qhov muag:

• kis kab mob;
• uvéite;
• mob glaucoma.

Mechanical anisocoria

Muaj cov neeg kho tshuab ua rau anisocoria, uas tuaj yeem txuas mus rau keeb kwm ntawm kev raug mob (nrog rau kev phais), rau qhov mob hauv qhov muag uas tuaj yeem ua rau adhesions ntawm iris thiab lub lens, lossis txawm tias muaj kev tsis haum xeeb. .

Adie's tonic cov tub kawm ntawv

Adie's cov menyuam kawm ntawv lossis Adie's syndrome yog ib yam kab mob uas tsis tshua muaj tshwm sim, uas feem ntau cuam tshuam rau ib lub qhov muag: qhov muag no muaj cov menyuam kawm ntawv loj, muaj zog dilated, tsis muaj zog lossis tsis muaj zog thaum lub teeb stimulation. Nws pom ntau zaus hauv cov poj niam hluas, thiab nws keeb kwm feem ntau tsis paub. Begnine, tej zaum nws yuav lossis tsis tuaj yeem pom cov tsos mob, xws li qee zaum tsis xis nyob thaum nyeem ntawv.

Pharmacologically dilated cov menyuam kawm ntawv

Cov menyuam kawm ntawv dilated vim muaj cov tshuaj pharmacological muaj nyob rau hauv ob qhov xwm txheej: raug mob rau tus neeg sawv cev uas cuam tshuam rau cov menyuam kawm ntawv lub cev muaj zog, lossis txhob txwm raug.

Qee tus neeg sawv cev paub kom nthuav dav tus menyuam kawm ntawv yog:

• scopolamine thaj ua rau thaj;
• inhaled ipratopium (ib qho tshuaj kho mob hawb pob);
• qhov ntswg vasoconstrictors;
• glycopyrrolate (ib yam tshuaj uas ua rau lub plab thiab cov hnyuv ua haujlwm qeeb);
• thiab tshuaj ntsuab, xws li Jimson nyom, Angel's Trumpet los yog nightshade.

Cov menyuam kawm ntawv uas muaj mob hnyav tau pom thaum raug nrog:

• pilocarpine;
• prostaglandins;
• tshuaj opioids;
• clonidine (ib qho tshuaj antihypertensive);
• organophosphate insecticides.

Kev ua tsis tiav ntawm pilocarpine rau kev cog lus rau cov menyuam kawm ntawv yog ib qho kev qhia ntawm iatrogenic dilation ntawm cov menyuam kawm ntawv.

Horner Syndrome

Claude-Bernard Horner syndrome yog ib yam kab mob uas ua ke nrog ptosis (poob ntawm daim tawv muag sab sauv), miosis thiab kev xav ntawm enophthalmos (kev nyuaj siab ntawm lub qhov muag nyob rau hauv orbit). Nws qhov kev kuaj mob yog qhov tseem ceeb, vim tias nws tuaj yeem cuam tshuam nrog qhov mob ntawm txoj kev ocular sympathetic, thiab tom qab ntawd tuaj yeem yog ib qho cim, ntawm lwm yam, ntawm:

• mob ntsws los yog mediastinal;
• neuroblastoma (ntau dua hauv cov menyuam yaus);
• dissections ntawm cov hlab ntsha carotid;
• thyroid puas;
• trigemino-dysautomatic mob taub hau thiab autoimmune ganglionopathies (saib hauv qab).

Ntshai tuag tes tuag taw

Oculomotor paj hlwb palsy kuj tuaj yeem koom nrog hauv anisocoria.

Neurovascular pathologies 

• Mob stroke: qhov no yog qhov ua rau uas yuav tsum tau txheeb xyuas sai heev thiaj li yuav tuaj yeem hnov ​​​​mob nyob rau hauv XNUMX teev tom qab mob stroke;
• Artery aneurysm (los yog bulge).

Pourfour du Petit Syndrome

Pourfour du Petit Syndrome, ib qho kev mob siab rau ntawm txoj kev sib koom siab, nthuav tawm tshwj xeeb ntawm mydriasis thiab tshem tawm ntawm daim tawv muag: nws yog ib qho mob tsis tshua muaj tshwm sim vim mob qog nqaij hlav.

Trigemino-dysautomic mob taub hau

Cov mob taub hau no tshwm sim los ntawm qhov mob hauv lub taub hau thiab feem ntau tawm ntawm qhov ntswg mucosa thiab los ntawm cov kua muag. Lawv cuam tshuam nrog miosis ntawm cov menyuam kawm ntawv hauv 16 txog 84% ntawm cov neeg mob. Lawv tuaj yeem ua tus cwj pwm los ntawm kev kos duab. Kev sab laj nrog ib tus kws kho mob hlwb lossis tus kws kho mob neuro-ophthalmologist tau pom zoo los qhia kev kho mob thiab lees paub qhov kev kuaj mob hauv qee yam mob atypical.

autoimmune ganglionopathy ntawm lub autonomic system

Cov kab mob tsis tshua muaj tshwm sim nrog autoantibodies tsom rau ganglia ntawm lub paj hlwb autonomic. Ob qho tib si lub cev, kev xav thiab kev xav, tuaj yeem cuam tshuam; Hais txog cov menyuam kawm ntawv anomalies, nws yog tus parasympathetic ganglia uas feem ntau cuam tshuam. Yog li, 40% ntawm cov neeg mob muaj qhov txawv txav ntawm cov menyuam kawm ntawv, suav nrog anisocoria. Cov kab mob no muaj nyob rau txhua lub hnub nyoog, thiab tuaj yeem tshwm sim nrog cov tsos mob xws li mob encephalitis. Nws tuaj yeem kho nws tus kheej, tab sis kev puas tsuaj neuronal yuav nyob twj ywm, yog li qhov qhia nquag rau kev tiv thaiv kab mob.

Tsis muaj kev pheej hmoo tiag tiag ntawm qhov teeb meem hauv nws tus kheej ntawm anisocoria, qhov txaus ntshai ntawm qhov teeb meem yog cov ntawm cov kab mob cuam tshuam nrog nws. Yog tias anisocoria qee zaum ntawm qhov ua rau tsis zoo, nws tuaj yeem yog cov tsos mob ntawm cov kab mob uas tuaj yeem loj heev, tshwj xeeb tshaj yog thaum lawv mob hlwb. Cov no yog cov xwm txheej ceev, uas yuav tsum tau kuaj kom sai li sai tau, ntawm ntau yam kev ntsuam xyuas:

• Kev ntsuam xyuas cov duab xws li MRI ntawm lub hlwb yuav tsum tau siv sai heev, tshwj xeeb tshaj yog tias xav tias mob stroke, thiab qee zaum angiography ntawm lub taub hau thiab caj dab (uas qhia pom cov hlab ntsha).

Tag nrho cov kev ntsuam xyuas no yuav tsum ua kom nws muaj peev xwm taw qhia qhov kev kuaj mob sai li sai tau kom tsis txhob muaj teeb meem loj, xws li cov tom qab mob stroke, vim yog tias nws tau saib xyuas tsis pub dhau rau teev, qhov tshwm sim yuav tsis tseem ceeb. Thiab tsis tas li ntawd, qee zaum zam kev kuaj pom tsis tsim nyog, kev sim siv qhov muag tee yog qhov zoo:

• Yog li, pharmacological anisocoria, vim yog cov tshuaj, tuaj yeem paub qhov txawv ntawm cov menyuam yaus dilation ntawm lub paj hlwb los ntawm kev siv qhov muag tee nrog 1% pilocarpine: yog tias cov menyuam kawm ntawv dilated tsis ntsws tom qab peb caug feeb, nws yog pov thawj ntawm pharmacological blockade ntawm tus menyuam kawm ntawv. iris cov leeg.
• Kev ntsuam xyuas siv qhov muag tee kuj tuaj yeem qhia qhov kev kuaj mob ntawm Horner's syndrome: nyob rau hauv cov ntaub ntawv ntawm kev tsis ntseeg, ib tug poob ntawm 5 los yog 10% cocaine qhov muag tee yuav tsum tau instilled nyob rau hauv txhua lub qhov muag, thiab cov kev hloov nyob rau hauv pupillary diameters yuav tsum tau soj ntsuam: yeeb tshuaj ua rau mydriasis ntawm lub qhov muag. Cov menyuam kawm ntawv ib txwm muaj, thaum nws muaj me me lossis tsis muaj teebmeem hauv Horner syndrome. Apraclodine qhov muag tee kuj tseem muaj txiaj ntsig hauv kev lees paub Horner's syndrome, tam sim no nws zoo dua rau kev sim tshuaj yeeb. Thaum kawg, kev kos duab tam sim no ua rau nws tuaj yeem pom tag nrho txoj hauv kev muaj siab xav txhawm rau txheeb xyuas Horner's syndrome: nws yog hnub no qhov kev sim tseem ceeb.

Kev ntsuam xyuas ntawm unilateral mydriasis los yog miosis tuaj yeem yog qhov nyuaj rau kev kuaj mob thiab suav tias yog qhov xwm txheej ntawm lub paj hlwb. Los ntawm tus neeg mob keeb kwm, nws lub cev auscultation thiab ntau yam kev tshawb nrhiav, kev kuaj mob tuaj yeem tsim thiab ncaj qha rau kev kho kom haum.

Nyob rau hauv lub era ntawm cov tshuaj niaj hnub no, nyob rau hauv cov ntaub ntawv ntawm mob stroke, cov ntaub so ntswg plasminogen activator yog ib qho kev kho mob uas tau tso cai rau kev kho kom zoo. Kev tswj hwm yuav tsum ntxov - tsis pub dhau 3 mus rau 4,5 teev ntawm qhov pib tshwm sim. Qhov tseem ceeb ntawm kev kuaj mob yuav tsum tau hais txog ntawm no: vim tias kev tswj hwm ntawm cov ntaub so ntswg plasminogen activator yuav muaj, hauv cov neeg mob tsis tsim nyog, qhov tshwm sim uas yuav muaj kev puas tsuaj, xws li kev pheej hmoo los ntshav.

Qhov tseeb, cov kev kho mob yuav qhia tshwj xeeb rau txhua hom kab mob uas qhia txog cov tsos mob ntawm anisocoria. Nyob rau hauv txhua rooj plaub, tus kws kho mob yuav tsum tau sab laj nyob rau hauv cov kev tshwm sim ntawm anisocoria, ces cov kws kho mob tshwj xeeb, xws li neurologists thiab neuro-ophthalmologists, los yog ophthalmologists, uas muaj peev xwm institute tshwj xeeb kev saib xyuas rau txhua tus kab mob. Nws yuav tsum nco ntsoov tias qhov no yog cov tsos mob uas yuav tsum tau kho sai, vim hais tias thaum nws tuaj yeem ua tus yam ntxwv zoo, nws tuaj yeem cuam tshuam rau kev muaj xwm txheej ceev.