Anisocoria ndi kusalingana m'mimba mwake mwa ana awiriwo, kupitirira mamilimita 0,3: ophunzira awiriwa ndi osiyana. Anisocoria ikhoza kulumikizidwa mwina ndi unilateral mydriasis, kutanthauza kuwonjezeka kwa kukula kwa mmodzi mwa ophunzira awiri, kapena, mosiyana, ndi miosis kupanga wophunzira kukhala wamng'ono kuposa winayo.

Zomwe zimayambitsa anisocoria ndizosiyana kwambiri, kuyambira pang'onopang'ono mpaka ku matenda oopsa kwambiri, monga kuwonongeka kwa minyewa. Njira zosiyanasiyana zimalola kuti munthu adziwe matenda olondola, omwe ayenera kukhazikitsidwa mwamsanga kuti ateteze zotsatira zoopsa, monga matenda a stroke, omwe anisocoria alinso chizindikiro.

Kodi anisocoria ndi chiyani?

Munthu ali ndi anisocoria pamene ophunzira ake awiri ali osiyana kukula: mwina chifukwa cha unilateral mydriasis, choncho kuwonjezeka kukula kwa mmodzi wa ophunzira ake awiri, kapena chifukwa cha unilateral miosis , ndiko kuti, kuchepa kwake. Anisocoria imadziwika ndi kusiyana kwa ma diameter a pupillary kuposa mamilimita 0,3.

Mwanayo ndiye potsegula pakati pa iris, momwe kuwala kumalowera kumbuyo kwa diso. Iris, gawo lachikuda la babu la diso, limapangidwa ndi maselo omwe amaupatsa mtundu wake (wotchedwa melanocytes) ndi ulusi wa minofu: ntchito yake yaikulu ndikuwongolera kuchuluka kwa kuwala komwe kumalowa mu babu la diso. diso kupyolera mwa mwana.

Ndipotu, wophunzira (kutanthauza kuti, "munthu wamng'ono", chifukwa apa ndi pamene mumadziwona nokha mukamayang'ana munthu m'maso), kotero kuti kutsegula kwapakati kwa iris, kumawoneka kwakuda chifukwa pamene muyang'ana kupyolera mu lens. , ndi gawo lakumbuyo la diso lomwe limawonekera (choroid ndi retina), lomwe lili ndi utoto wambiri.

Ma reflexes amawongolera cell cell, kutengera mphamvu ya kuwala: 

• pamene kuwala kwakukulu kumapangitsa diso, ndi mitsempha ya parasympathetic ya vegetative nervous system yomwe imalowa. Choncho, ulusi wa parasympathetic wa mitsempha ya oculomotor imapangitsa kuti mitsempha yozungulira kapena ya annular ya iris (kapena sphincter minofu ya wophunzira) ikhale yochepa, ndiko kuti kuchepetsa kwa pupillary diameter.
• mosiyana, ngati kuwala kuli kofooka, nthawi ino ndi mitsempha yachifundo ya mitsempha ya vegetative yomwe imayendetsedwa. Amalimbikitsa ulusi wonyezimira kapena minofu ya dilator ya wophunzira, kupangitsa kuti kukula kwa m'mimba mwake kwa wophunzira kuchepe.

Anisocoria iliyonse imafuna kuunika kwamaso ndipo, nthawi zambiri, minyewa kapena neuroradiological. Chifukwa chake, anisocoria imatha kulumikizidwa ndi miosis ya m'modzi mwa ophunzira awiriwo, chifukwa cha kuyambitsa kwa dongosolo la parasympathetic lomwe limapanga sphincter ya iris, kapena mydriasis ya m'modzi mwa ophunzira, yoyambitsidwa ndi dongosolo lachifundo loyambitsa. dilator minofu ya iris.

Pali physiological anisocoria, yomwe imakhudza pafupifupi 20% ya anthu.

Kodi kuzindikira anisocoria?

Anisocoria imazindikirika ndi maso chifukwa ophunzira awiriwa sali ofanana. Ophthalmologists ambiri amawona odwala angapo omwe ali ndi anisocoria patsiku lachidziwitso. Ambiri mwa anthuwa sadziwa za izi, koma ena amabwera kuti adzawunike.

Kuyesedwa pogwiritsa ntchito kuyatsa kumapangitsa kuti athe kudziwa kuti ndi mwana wotani wa pathological: motero, anisocoria yowonjezereka pakuwala kolimba idzawonetsa kuti wophunzira wapathological ndiye wamkulu kwambiri (kuchepa kwapang'onopang'ono kwa wophunzirayo), ndiyeno anisocoria yowonjezereka pakuwala kocheperako. zikuwonetsa kuti wophunzira wa pathological ndi wocheperako (kupumula kosauka kwa wophunzira wa pathological).

Zowopsa

Ponena za zinthu za iatrogenic (zokhudzana ndi mankhwala), ogwira ntchito zachipatala, monga anamwino ogwira ntchito m'zipatala, akhoza kukhala pachiopsezo chokhala ndi mankhwala amtundu wa anisocoria, omwe amawoneka kuti ndi owopsa, akutsatira mankhwala ena. mankhwala, monga scopolamine zigamba: izi zingayambitse anisocoria yomwe imachepa yokha m'masiku ochepa.

Komanso, pakati pa zinthu zamakina, pali, mwa ana, chiwopsezo cha anisocoria chifukwa cha kubereka kovuta, makamaka pakagwiritsidwa ntchito mphamvu.

The etiologies a anisocoria ndi osiyana kwambiri: ndi chizindikiro cha ma pathologies amene angachokere zoyambitsa zabwino kwa minyewa kapena zofunika mwadzidzidzi.

Physiological anisocoria

Chodabwitsa ichi cha physiological anisocoria, chomwe chilipo popanda matenda okhudzana ndi matenda, chimakhudza pakati pa 15 ndi 30% ya anthu. Zakhalapo kwa nthawi yayitali, ndipo kusiyana kwa kukula pakati pa ana awiriwa ndi osachepera 1 millimeter.

Ocular etiologies okha

Zomwe zimayambitsa anisocoria zimazindikirika mosavuta pakuwunika kwamaso:

• kupindika;
• uvéite;
• pachimake glaucoma.

Mechanical anisocoria

Pali zomwe zimayambitsa anisocoria, zomwe zimatha kulumikizidwa ndi mbiri ya zowawa (kuphatikiza opaleshoni), kutupa kwamkati mwamaso komwe kungayambitse kumamatira pakati pa iris ndi mandala, kapenanso kubadwa kobadwa nako. .

Adie's tonic wophunzira

Adie's pupil kapena Adie's syndrome ndi matenda osowa, omwe nthawi zambiri amakhudza diso limodzi lokha: diso ili liri ndi mwana wamkulu, wotambasula kwambiri, wofooka kapena wosasunthika pakachitika kuwala. Zimapezeka kawirikawiri mwa atsikana, ndipo chiyambi chake sichidziwika. Bégnine, ikhoza kuwonetsa kapena kusawonetsa zizindikiro zowoneka, monga nthawi zina kusapeza bwino powerenga.

Pharmacologically dilated ana

Ana amafupikitsidwa chifukwa cha mankhwala a pharmacological amapezeka muzochitika ziwiri: kukhudzana mwangozi ndi wothandizira omwe amakhudza ntchito ya galimoto ya wophunzira, kapena kuwonetseredwa mwadala.

Ena mwa othandizira omwe amadziwika kuti amakulitsa wophunzira ndi awa:

• zigamba za scopolamine;
• inhaled ipratopium (mankhwala a mphumu);
• vasoconstrictors m'mphuno;
• glycopyrrolate (mankhwala omwe amachepetsa ntchito ya m'mimba ndi matumbo);
• ndi zitsamba, monga Jimson grass, Angel's Trumpet kapena nightshade.

Ana ocheperako amawonedwa panthawi yokhudzana ndi:

• pilocarpine;
• prostaglandins;
• opioids;
• clonidine (mankhwala antihypertensive);
• mankhwala organophosphate.

Kulephera kwa pilocarpine kukhudza wophunzira ndi chizindikiro cha kukula kwa iatrogenic kwa wophunzira.

Matenda a Horner Syndrome

Claude-Bernard Horner syndrome ndi matenda omwe amaphatikiza ptosis (kugwa kwa chikope chapamwamba), miosis ndi kumverera kwa enophthalmos (kukhumudwa kwa diso mumayendedwe). Kuzindikira kwake ndikofunikira, chifukwa kumatha kulumikizidwa ndi zilonda zam'maso mwachifundo, ndipo zitha kukhala chizindikiro, mwa zina, za:

• zotupa za m'mapapo kapena mediastinal;
• neuroblastoma (yofala kwambiri mwa ana);
• kusokonezeka kwa mitsempha ya carotid;
• kuwonongeka kwa chithokomiro;
• trigemino-dysautomatic mutu ndi autoimmune ganglionopathies (onani pansipa).

Kufooka kwamanjenje

Matenda a mitsempha ya Oculomotor angakhalenso nawo mu anisocoria.

Neurovascular pathologies 

• Stroke: ichi ndi chifukwa chomwe chiyenera kuzindikiridwa mofulumira kwambiri kuti muthe kuchitapo kanthu mkati mwa maola asanu ndi limodzi kuchokera ku sitiroko;
• Aneurysm ya mitsempha (kapena kuphulika).

Pourfour du Petit Syndrome

Pourfour du Petit syndrome, chisangalalo cha dongosolo lachifundo, makamaka mydriasis ndi kutsika kwa chikope: ndi matenda osowa nthawi zambiri chifukwa cha chotupa choopsa.

Trigemino-dysautomic mutu

Mitu imeneyi imadziwika ndi kupweteka kwa mutu ndipo nthawi zambiri imatuluka mucosa yamphuno ndi kukhetsa misozi. Amagwirizanitsidwa ndi miosis ya wophunzira mu 16 mpaka 84% ya milandu. Iwo akhoza kudziwika ndi kujambula. Kukaonana ndi nephrologist kapena neuro-ophthalmologist tikulimbikitsidwa kutsogolera chithandizo ndi kutsimikizira matenda ena atypical milandu.

Autoimmune ganglionopathy ya autonomic system

Matenda osowawa amakhala ndi ma autoantibodies omwe amayang'ana pagulu la autonomic nervous system. Machitidwe onsewa, achifundo ndi parasympathetic, akhoza kukhudzidwa; Pankhani ya zovuta za ana, ndi parasympathetic ganglia yomwe imakhudzidwa kwambiri. Chifukwa chake, 40% ya odwala amakhala ndi vuto la ana asukulu, kuphatikiza anisocoria. Matendawa amapezeka pa msinkhu uliwonse, ndipo amatha kuwonetsa zizindikiro monga za encephalitis. Itha kuchiritsidwa yokha, koma kuwonongeka kwa neuronal kumatha kukhalabe, chifukwa chake nthawi zambiri amawonetsa immunotherapy.

Palibe chiwopsezo chenicheni chokhala ndi vuto lokha la anisocoria, kuwopsa kwazovuta ndizomwe zimakhudzidwa ndi izi. Ngati anisocoria nthawi zina imakhala yowopsa, imatha kukhalanso chizindikiro cha matenda omwe amatha kukhala oopsa, makamaka akakhala ndi minyewa. Izi ndizochitika zadzidzidzi, zomwe ziyenera kuzindikirika mwachangu momwe zingathere, kudzera mu mayeso osiyanasiyana:

• Mayeso oyerekeza monga MRI yaubongo angafunikire kugwiritsidwa ntchito mwachangu, makamaka ngati akukayikira sitiroko, ndipo nthawi zina angiography yamutu ndi khosi (yomwe imawonetsa zizindikiro za mitsempha yamagazi).

Mayesero onsewa ayenera kupangitsa kuti athe kuwongolera matendawa mwachangu momwe angathere kuti apewe zovuta zazikulu, monga zomwe zimachitika pambuyo pa sitiroko, chifukwa ngati atasamaliridwa mkati mwa maola asanu ndi limodzi, zotsatira zake sizikhala zofunikira kwambiri. Ndipo kuphatikiza apo, kuti nthawi zina mupewe mayeso osafunikira azithunzi, mayeso ogwiritsira ntchito madontho amaso ndi othandiza:

• Choncho, pharmacological anisocoria, chifukwa cha mankhwala, akhoza kusiyanitsidwa ndi pupillary dilation wa minyewa chiyambi pogwiritsa ntchito diso madontho mayeso ndi 1% pilocarpine: ngati dilated wophunzira sakuchepa pambuyo mphindi makumi atatu, ndi umboni wa pharmacological blockade. iris minofu.
• Mayeso ogwiritsira ntchito madontho a m'maso amathanso kuwongolera matenda a Horner's syndrome: ngati mukukayika, dontho la 5 kapena 10% la madontho a cocaine m'diso liyenera kuyikidwa m'diso lililonse, ndipo kusintha kwa ma diameter a ana kuyenera kuwonedwa: cocaine imayambitsa mydriasis of the wophunzira wabwinobwino, pomwe ili ndi zotsatira zochepa kapena zilibe kanthu mu Horner syndrome. Madontho a m'maso a Apraclodine ndi othandizanso potsimikizira matenda a Horner's, tsopano ndikwabwino kuposa kuyesa kwa cocaine. Pomaliza, kujambula tsopano kumapangitsa kukhala kotheka kuwona njira yonse yachifundo kuti muzindikire matenda a Horner's: lero ndi mayeso ofunikira.

Kuwunika kwa unilateral mydriasis kapena miosis kungakhale vuto lachidziwitso ndipo limawonedwa ngati vuto la minyewa. Kupyolera mu mbiri ya wodwalayo, thupi lake auscultation ndi kufufuza zosiyanasiyana, matenda akhoza kukhazikitsidwa ndi mwachindunji kwa mankhwala oyenera.

Munthawi yamankhwala amakono, ngati sitiroko, minofu ya plasminogen activator ndi chithandizo chomwe chalola kupita patsogolo kwamankhwala. Kuwongolera kuyenera kuchitika msanga - mkati mwa maola 3 mpaka 4,5 chiyambireni zizindikiro. Kufunika kwa matendawa kuyenera kutsindika apa: chifukwa kachitidwe ka plasminogen activator iyi, mwa odwala osayenerera, zotsatira zake zingakhale zoopsa, monga kuwonjezeka kwa magazi.

M'malo mwake, chithandizocho chidzakhala chachindunji ku mtundu uliwonse wa matenda omwe akuwonetsa chizindikiro cha anisocoria. Nthawi zonse, dokotala ayenera kukaonana ndi anisocoria, ndiye akatswiri, monga neuro-ophthalmologists, kapena ophthalmologists, omwe angathe kuyambitsa chisamaliro chapadera pa matenda aliwonse. Ziyenera kukumbukiridwa kuti ichi ndi chizindikiro chomwe chiyenera kuthandizidwa mwamsanga, chifukwa ngakhale kuti chikhoza kuwonetsa matenda oopsa, chikhoza kugwirizanitsidwa ndi zoopsa zomwe zingawononge moyo.