2015年 · 第51卷第06期

Strabismus is a common clinical disease in ophthalmology, with a prevalence of about 3%. There are many kinds of strabismus, and there is no perfect clinical classification method at present. Different authors and monographs at home and abroad have different degrees of differences in the classification of strabismus due to different emphases and factors considered, which often confuse beginners and non-strabismus ophthalmologists and produce certain troubles for clinical work.

In order to standardize and unify the writing of examination records and medical records of strabismus, make them in line with international standards, so as to make the analysis and clinical diagnosis of strabismus cases more clear and definite, and better promote the academic exchange of strabismus specialty, after discussion with all experts of strabismus and pediatric ophthalmology group of Chinese Medical Association Ophthalmology Branch, the English abbreviations of international commonly used terms related to strabismus and the examination recording methods were introduced^[1,2,3,4,5]The summary is summarized below.

The sclera is mainly composed of collagen fibrous tissue, and its inflammatory response should belong to the category of collagen fibrosis in nature, that is, autoimmune or autoallergic diseases^[1]。 Zhou Yumei et al^[2]The published "Clinical Analysis of 90 Cases of Superficial Scleritis and Scleritis" summarizes a series of cases of superficial scleritis and scleritis from the aspects of clinical manifestations, complications and related diseases, and provides important data for us to comprehensively understand the inflammatory response of sclera. In the preliminary analysis of the etiology of scleral inflammatory reaction, the study found that local infectious factors (especially postoperative infection) accounted for 11.1% of patients with scleritis, which shows that infectious scleritis cannot be ignored in the clinical diagnosis and treatment. Since this article does not carry on more in-depth research and discussion on infectious scleritis, in view of the characteristics of complicated clinical manifestations, difficult treatment and poor prognosis of infectious scleritis, the author will analyze, summarize and differentiate the diagnosis and treatment points of infectious scleritis and immune scleritis.

The patient was a 19-year-old male. On February 25, 2009, he was transferred from the local hospital to the Department of Ophthalmology, Dongfang Hospital, Beijing University of Traditional Chinese Medicine for integrated Chinese and Western medicine treatment due to traumatic optic neuropathy in both eyes caused by head and face trauma for 5 months. The patient suffered from blurred vision in his right eye and reduced vision in his left eye after injuring his head and face in a car accident 5 months ago, accompanied by mild redness in his right eye, no eye pain, eye swelling, headache and vomiting. He was treated with drugs to nourish nerves and improve circulation (details unknown) with "multiple comminuted fractures of his right head and face and traumatic optic neuropathy in both eyes" in the local hospital, but the binocular visual function did not improve significantly. Past physical health, denied history of refractive error, chronic conjunctivitis, denied history of hypertension, diabetes, heart disease, no history of high-dose glucocorticoid use, no family history of glaucoma. Examination after admission, visual acuity: 0.05 in the right eye, correction did not improve, and 1.0 in the left eye. IOP: 26 mmHg (1 mmHg =0.133 kPa) in the right eye and 17 mmHg in the left eye. Absence of bone in the right frontotemporoparietal bone and orbital bone. There is no protrusion or depression in the right eye, and the conjunctiva is mild congested (Figure 1), the cornea is transparent, the anterior chamber is mid-deep, the pupil is round, 5 mm in diameter, the reflex to light is retarded, and the lens is transparent. No abnormalities were observed in the anterior segment of the left eye. The papilla of both eyes was pale in color, with clear borders, cup-to-disc ratio of 0.3, retinal vascular movement was roughly normal, arteriovenous vascular diameter ratio was 2: 3, and the macular center was unclear. Dynamic visual field examination: the right eye could not be detected, and the left eye had temporal 1/2 quadrant visual field defect. Electrophysiological examination showed that the peak latency of the right eye flash VEP and the left eye pattern VEP P100 was delayed and the amplitude decreased. OCT examination showed thinning of optic nerve fibers in both eyes. Anterior chamber gonioscopy: Both eyes were open angles, pigment grade II, no neovascularization and no angular recession were seen. Preliminary diagnosis: traumatic optic neuropathy in both eyes; Primary open-angle glaucoma in right eye to be examined; Ocular hypertension in the right eye to be examined.

aneurysm is a common localized cystic dilatation disease of arterial vessels. The etiology is often related to arterial vascular injury, disease (such as atherosclerosis or sepsis) or congenital defect. Due to the anatomical course of the internal carotid artery in the cranium, aneurysm of internal carotid artery (AICA) may cause ocular manifestations such as oculomotor nerve paralysis, abducent nerve paralysis, significant decrease in visual acuity, visual field defect, etc^[1,2]And even cause serious complications such as subarachnoid hemorrhage^[3]Ophthalmologists sometimes have insufficient understanding of this disease, and misdiagnosis and missed diagnosis will occur. Three misdiagnosed cases of internal carotid artery aneurysm causing visual impairment diagnosed and treated by the Department of Ophthalmology of Peking Union Medical College Hospital are reported as follows.

The patient was a 65-year-old female. Because the visual acuity of both eyes gradually decreased for 6 months and aggravated for 3 months, he went to the Department of Ophthalmology of the Fourth Hospital of Xi' an. The patient had no history of eye surgery and trauma, and his parents were not close relatives, and there was no family history. The whole body examination showed no obvious abnormalities. Eye examination: naked eye visual acuity was 0.25 for the right eye and 0.25 for the left eye; The corrected visual acuity was 0.4 for the right eye and 0.3 for the left eye; IOP was 16.4 mmHg (1 mmHg =0.133 kPa) in the right eye and 12.4 mmHg in the left eye; The cornea of both eyes is transparent, the anterior chamber is clear, the pupil is round, and it is sensitive to light. The lens is opaque, and the retina is vaguely flat in the fundus of the eye. After dilated pupil examination, the right eye lens peripheral defect from 1: 00 to 3: 00 (Quintessence Picture 1), and there was no obvious defect in the lens of the left eye. Ultrasound biomicroscopy showed that the right eye lens echo was enhanced, morphology was abnormal, and there was a partial defect above the nose, but no obvious abnormality was found. Clinical diagnosis: right eye lens defect; Age-related cataract in both eyes.

The patient was a 76-year-old male. Because of blurred vision in his right eye for 1 year, he went to Tianjin Eye Hospital. History of trauma and systemic medical history were denied. Eye examination: right eye visual acuity 0.4, intraocular pressure 11 mmHg (1 mmHg =0.133 kPa); The conjunctiva was not congested, the sclera was not yellowed, the corneal epithelium was intact, the stroma was not edema, the endothelium was transparent, and there was no retrocorneal deposition; The peripheral anterior chamber is of varying depth and clear water; The pupil was round, with a diameter of 6 mm. There was no iris atrophy and adhesion after drug-induced dilatation of the pupil, and iris tremor was seen. The lens cortex and nucleus are opaque, displaced to the nasal side, and the lens suspensory ligament is visible on the temporal side (Quintessence Picture 1）； The fundus of the eye is vaguely visible, the boundary of the papilla is clear, the retina is in place, and the macular area is not clearly seen. For ultrasound bioscopy, seeQuintessence Picture 2。 B-ultrasound examination revealed vitreous opacity in the right eye. Clinical diagnosis: right eye lens subluxation; Cataract in the right eye.

The patient was a male, 8 years old. Because of poor vision in both eyes since childhood, he went to Tianjin Eye Hospital. Eye examination: visual acuity was 0.6 for the right eye and 0.2 for the left eye; The conjunctiva of both eyes is not congested, the cornea is transparent, the anterior chamber is clear, and the lens is transparent; For fundus examination, seeQuintessence Picture 1。 Coherence optical tomography examination is shown inQuintessence Picture 2。 Clinical diagnosis: congenital retinoschisis in both eyes.