Unilateral or Bilateral Superior Oblique Muscle Palsy in Ocular Torticollis? A case report

是單眼或雙眼的上斜肌麻痺導致眼性斜頸？— 病例報告

陳沛仁(Pei-Jen Chen)

《童綜合醫學雜誌》 10卷1期 (2016/06) Pp. 36-40

摘要

目的：報告一例眼性斜頸病患經雙眼下斜肌減弱手術後，成功改善斜頸的症狀。方法：病例報告。結果：一名4歲男童因患有頸部長期左側傾斜而來到我們的門診檢查。他因為斜頸接受一年的復健治療但症狀依然持續。雙眼光學檢查經睫狀肌麻痺後皆為球面鏡+0.5屈光度沒有散光。兩眼裸視視力皆為25/25。雙眼正視時可以檢查出右眼有上斜視。雙眼共視檢查可見右眼上斜肌麻痺合併右眼下斜肌亢進。頭右側傾斜檢查時可見右眼有大角度的上斜視（十五個稜鏡角度）。此外，還可發現有輕微V型斜視和雙眼眼底外旋性斜視。診斷為雙眼不對稱性上斜肌麻痺及雙眼次發性下斜肌亢進。因此他接受右眼下斜肌截短術和左眼下斜肌周邊切開減弱手術。手術前存在的眼性斜頸在術後獲得明顯改善。然而，術後六個月發現左眼上斜肌麻痺合併左眼下斜肌亢進變得較嚴重。結論：眼性斜頸代表因眼睛問題引起的不正常頭頸姿勢。最常見的眼性斜頸是上斜肌麻痺，不論單眼或是雙眼。雙眼上斜肌麻痺可能會非常不對稱導致輕微麻痺的一眼在手術前沒有被發現。正確的診斷必須依靠詳細的檢查，例如：頭傾斜測試，雙眼共視檢查，“V＂型斜視和眼底外旋性斜視。經由正確的診斷，眼性斜頸可以經由眼睛肌肉的開刀手術獲得改善。

關鍵字

斜頸 ； 上斜肌麻痺

並列摘要

Purpose: To report a case of ocular torticollis successfully treated by bilateral inferior oblique weakening surgery. Methods: Interventional case report. Results: A 4-year-old boy presented to our clinic with left head tilt over a prolonged period. He had received rehabilitation for torticollis for 1 year; however,the head tilt persisted. Cycloplegic refraction was +0.50D in both eyes without astigmatism. Bare visual acuity was 25/25 in both eyes. Right hypertropia was observed in the primary position. Ocular examination demonstrated right superior oblique palsy and right inferior oblique overactivity. Large right hypertropia (15 prism diopters) was observed on right head tilt testing. Further, slight V-pattern strabismus and bilateral fundus extorsion were found. Asymmetric bilateral superior oblique palsy with secondary inferior oblique overaction was initially diagnosed. The patient subsequently underwent right eye inferior oblique myectomy and left eye inferior oblique marginal myotomy. The preoperative abnormal head position was greatly improved following surgical intervention. However, left superior oblique muscle palsy with left inferior oblique muscle overactivity progressively worsened 6 months after surgery. Conclusion: Ocular torticollis is defined as an eye-related condition leading to abnormal head posture. The commonest causes of ocular torticollis are superior oblique palsies, either unilateral or bilateral. Bilateral superior oblique palsies can be so asymmetric that the lesser affected eye is almost masked preoperatively. Accurate diagnosis is dependent on careful physical examination, such as the head tilt test and ocular examination, and evaluation for signs of ＂V patten＂ strabismus or fundus extorsion. With accurate diagnosis, ocular torticollis can be curatively treated with extraocular muscle surgery.

並列關鍵字

Torticollis ； superior oblique muscle palsy