I-Anisocoria ukungalingani kububanzi babafundi ababili, bungaphezu kwamamilimitha ayi-0,3: abafundi ababili ngaleso sikhathi banosayizi ohlukile. I-Anisocoria ingaxhunyaniswa ne-unilateral mydriasis, okusho ukwanda kosayizi womunye wabafundi ababili, noma, ngakolunye uhlangothi, ne-miosis eyenza umfundi abe mncane kunomunye.

Izimbangela ze-anisocoria ziyahlukahluka kakhulu, kusuka kuma-aetiologies amancane kuya kuma-pathologies abucayi kakhulu, njengokulimala kwemizwa. Izindlela ezahlukahlukene zivumela ukuxilongwa okunembile, okumele kusungulwe ngokuphuthumayo ukuvimbela imiphumela engaba yingozi, njengaleyo yesifo sohlangothi, okuyi-anisocoria nayo eyisibonakaliso.

Yini i-anisocoria

Umuntu une-anisocoria lapho abafundi bakhe ababili besayizi ehlukile: kungaba ngenxa ye-unilateral mydriasis, ngakho-ke ukwanda ngosayizi womunye wabafundi bakhe ababili, noma ngenxa ye-unilateral miosis, okungukuthi, yokwehla kwayo. I-Anisocoria iveza umehluko kububanzi bama-pupillary obukhulu kunamamilimitha ayi-0,3.

Umfundi ukuvulwa maphakathi ne-iris, lapho ukukhanya kungena khona emgodini ongemuva wenhlamvu yeso. I-iris, ingxenye enemibala yesibani seso, yakhiwe ngamaseli ayinika umbala wayo (obizwa ngokuthi ama-melanocyte) kanye nemicu yemisipha: umsebenzi wawo omkhulu ukulawula inani lokukhanya elingena ku-bulb yeso. iso ngomfundi.

Eqinisweni, umfundi (okusho ukuthi, "umuntu omncane", ngoba kulapho uzibona khona lapho ubheka umuntu emehlweni), okuyikho okuyimbobo evulekile ye-iris, ubonakala emnyama ngoba uma ubheka ngelensi , yingxenye engemuva yeso evela (i-choroid ne-retina), enemibala kakhulu.

I-Reflexes ilawula iseli lomfundi, ngokuya ngamandla wokukhanya: 

• lapho ukukhanya okukhulu kuvusa iso, yimicu ye-parasympathetic yohlelo lwemizwa yezitshalo eqala ukusebenza. Ngakho-ke, imicu ye-parasympathetic ye-oculomotor nerve ivuselela ukusikwa kwemicu eyindilinga noma eyingqayizivele ye-iris (noma imisipha ye-sphincter yomfundi) eheha ukusikeka komfundi, okungukuthi ukunciphisa ubukhulu be-pupillary.
• ngakolunye uhlangothi, uma ukukhanya kubuthakathaka, kulokhu kungama-neurons anozwelo wohlelo lwezinzwa olusebenzisa imifino. Zivuselela imicu ye-radiary noma imisipha ye-dilator yomfundi, inciphisa ukunwetshwa kobubanzi bomfundi.

Noma iyiphi i-anisocoria idinga ukuhlolwa kwe-ophthalmological futhi, imvamisa, i-neurological noma i-neuroradiological. Ngakho-ke i-anisocoria ingaxhunyaniswa ne-miosis yomunye wabafundi ababili, ebangelwa ukwenziwa kohlelo lwe-parasympathetic olwenza lokho kwe-sphincter ye-iris, noma i-mydriasis yomunye wabafundi, ebangelwe uhlelo lokuzwelana olusebenzayo umsipha we-iris.

Kukhona i-anisocoria yomzimba, ethinta cishe i-20% yabantu.

Ungayibona kanjani i-anisocoria?

I-Anisocoria ibonakala ngokubonwa iqiniso lokuthi laba bafundi bobabili abalingani. Iningi lodokotela bamehlo libona iziguli eziningana ezine-anisocoria phakathi nosuku olujwayelekile lokubonisana. Iningi lalaba bantu alazi ngalo, kepha abanye beza ngqo ukuthi lihlolwe.

Ukuhlolwa okusebenzisa ukukhanyisa kuzokwenza ukuthi kubonakale ukuthi ngubani umfundi we-pathological: ngakho-ke, i-anisocoria eyandiswe ngokukhanya okuqinile izokhombisa ukuthi umfundi we-pathological mkhulu kunabo bonke (ukusikwa okuncane komfundi we-pathological), kanti i-anisocoria inyuke ngokukhanya okuphansi khombisa ukuthi umfundi we-pathological mncane kakhulu (ukuphumula okuncane komfundi we-pathological).

Izici zengozi

Ngokuphathelene nezici ze-iatrogenic (ezixhunywe nezidakamizwa), abasebenzi bezempilo, njengabahlengikazi abasebenza ezibhedlela, bangase babe sengcupheni yokuthuthukisa uhlobo lwe-pharmacological-anisocoria, okuvela ukuthi alunangozi, kulandela ukuchayeka emithini ethile. imikhiqizo, efana neziqephu ze-scopolamine: lezi zingabangela i-anisocoria ezoncipha yodwa phakathi nezinsuku.

Ngaphezu kwalokho, phakathi kwezinto ezenziwa ngomshini, kukhona, ezinganeni, ingozi ye-anisocoria ebangelwa ukubeletha okunzima, ikakhulukazi lapho kusetshenziswa i-forceps.

Ama-etiologies e-anisocoria ahluke kakhulu: kuyisifo sezinkinga zokugula ezingasukela ezimbangela ezinobungozi ziye eziphuthumayo zezinzwa noma ezibalulekile.

I-anisocoria yomzimba

Lo mkhuba we-anisocoria yomzimba, okhona ngaphandle kokuba kube nesifo esihambisanayo, uthinta abantu abaphakathi kuka-15 no-30%. Kube khona isikhathi eside, futhi umehluko wosayizi phakathi kwabafundi ababili ungaphansi kwe-1 millimeter.

Ama-etiology we-ocular kuphela

Izimbangela ze-anisocoria ezihlonziwe kalula zitholakala kalula ngesikhathi sokuhlolwa kwamehlo okujwayelekile:

• isiphithiphithi;
• uvéite;
• i-glaucoma ebukhali.

I-anisocoria yemishini

Kunezimbangela zemishini ye-anisocoria, engaxhunyaniswa nomlando wokuhlukumezeka (kufaka phakathi ukuhlinzwa), ukuvuvukala kwe-intra-ocular okungaholela ekubambeni phakathi kwe-iris nelensi, noma ngisho nokungahleleki kokuzalwa. .

Umfundi ka-Adie tonic

Umfundi ka-Adie noma i-Adie's syndrome yisifo esingajwayelekile, esivame ukuthinta iso elilodwa kuphela: leli iso linomfundi omkhulu, ovulekile kakhulu, osebenza kancane noma ongasebenzi uma kwenzeka kukhuthazeka ukukhanya. Kubonakala kaningi kwabesifazane abasebasha, futhi imvelaphi yayo kaningi ayaziwa. Bégnine, kungahle noma kungazivezi izimpawu ezibonakalayo, njengokungakhululeki kwesinye isikhathi lapho kufundwa.

Abafundi abahlanjululwe ngokwemithi

Abafundi abahlanjululwe ngenxa yento ekhemisi bakhona ezimweni ezimbili: ukuvezwa ngengozi kumenzeli othinta ukusebenza komfundi, noma ukuvezwa ngenhloso.

Amanye ama-ejenti aziwa ngokunciphisa umfundi yilawa:

• ama-scopolamine patches;
• wahogela ipratopium (umuthi wesifuba somoya);
• ama-vasoconstrictors acinene;
• i-glycopyrrolate (umuthi owephuza umsebenzi wesisu namathumbu);
• namakhambi, anjengoJimson grass, Angel's Trumpet noma nightshade.

Abafundi abancishisiwe babonakala ngesikhathi sokuchayeka nge:

• i-pilocarpine;
• ama-prostaglandins;
• ama-opioid;
• i-clonidine (isidakamizwa esinciphisa umfutho wegazi);
• izinambuzane ze-organophosphate.

Ukwehluleka kwe-pilocarpine ukuthola inkontileka yomfundi kuyisibonakaliso sokukhula komfundi iatrogenic.

IHorner Syndrome

I-Claude-Bernard Horner syndrome yisifo esihlanganisa i-ptosis (ukuwa kwejwabu leso eliphezulu), i-miosis kanye nomuzwa we-enophthalmos (ukucindezeleka okungavamile kwamehlo emzileni). Ukuxilongwa kwayo kubalulekile, ngoba kungahlotshaniswa nesilonda esendleleni yozwela ocular, bese kungaba yisibonakaliso, phakathi kwezinye izinto, se:

• izimila zamaphaphu noma zesisu;
• i-neuroblastoma (ejwayelekile ezinganeni);
• ukuhlukaniswa kwemithambo ye-carotid;
• ukulimala kwe-thyroid;
• ikhanda le-trigemino-dysautomatic kanye ne-autoimmune ganglionopathies (bheka ngezansi).

Ukukhubazeka kwemizwa

I-Oculomotor nerve palsy nayo ingabandakanyeka kwi-anisocoria.

Izifo ze-Neurovascular pathologies 

• I-Stroke: lesi yisizathu okufanele sikhonjwe ngokushesha okukhulu ukuze sikwazi ukusabela kungakapheli amahora ayisithupha isifo sohlangothi;
• I-artery aneurysm (noma i-bulge).

I-Pourfour du Petit Syndrome

I-Pourfour du Petit syndrome, i-excitation syndrome yohlelo lokuzwelana, iveza ikakhulukazi i-mydriasis nokubuyiselwa emuva kwejwabu leso: kuyisifo esingajwayelekile kaningi ngenxa yesimila esibi.

Ikhanda le-Trigemino-dysautomic

Lezi zinhlungu zekhanda zibonakala ngobuhlungu obusekhanda futhi isikhathi esiningi sikhipha emakhaleni omlomo nasekhaleni lezinyembezi. Zihlotshaniswa ne-miosis yomfundi kuma-16 kuya kuma-84% wamacala. Bangabonakala ngezithombe. Ukubonisana nodokotela wezinzwa noma i-neuro-ophthalmologist kunconywa ukuqondisa ukwelashwa nokuqinisekisa ukuxilongwa ezimweni ezithile ze-atypical.

I-autoimmune ganglionopathy yohlelo lokuzimela

Lesi sifo esingajwayelekile siveza nama-autoantibodies abhekise kwi-ganglia yohlelo lokuzimela oluzimele. Zombili izinhlelo, ezwelana no-parasympathetic, zingathinteka; Mayelana nokungahambi kahle kwabafundi, yi-gangasy ye-parasympathetic ethinteka kakhulu. Ngakho-ke, iziguli ezingama-40% zikhona ngokungajwayelekile kwabafundi, kufaka phakathi i-anisocoria. Le pathology ikhona kunoma yisiphi isikhathi, futhi ingabonisa ngezimpawu ezifana ne-encephalitis. Ingaphulukiswa ngokuzenzekelayo, kepha umonakalo we-neuronal ungahlala, yingakho inkomba ejwayelekile yokuthola i-immunotherapy.

Akunabungozi bangempela benkinga ngokwayo ye-anisocoria, izingozi zokuxakaniseka yilezo zezifo ezihlobene nayo. Uma i-anisocoria kwesinye isikhathi iyimbangela ebucayi, futhi ingaba uphawu lwezifo ezingaba zimbi kakhulu, ikakhulukazi uma zinemizwa. Ngakho-ke lezi yizimo eziphuthumayo, okumele zitholwe ngokushesha okukhulu, ngezivivinyo ezahlukahlukene:

• Ukufanekisa izivivinyo ezifana neMRI yobuchopho kungadinga ukuthi kusetshenziswe ngokushesha okukhulu, ikakhulukazi uma kusolwa unhlangothi, futhi kwesinye isikhathi i-angiography yekhanda nentamo (ekhombisa izimpawu zemithambo yegazi).

Zonke lezi zivivinyo kufanele zikwenze ukwazi ukuqondisa ukuxilongwa ngokushesha okukhulu ngangokunokwenzeka ukugwema izinkinga ezinkulu, njengalezo ezilandela ukushaywa unhlangothi, ngoba uma zinakekelwa kungakapheli amahora ayisithupha, imiphumela izobe ingabalulekanga kangako. Futhi ngaphezu kwalokho, kwesinye isikhathi ukugwema izivivinyo zokucabanga ezingadingekile, izivivinyo zisebenzisa amaconsi wamehlo ziyasebenza:

• ngakho-ke, i-anisocoria yezemithi, ngenxa yesidakamizwa, ingahlukaniswa nokwanda kwamapayipi okuvela emithanjeni yegazi ngokusebenzisa ukuhlolwa kwamaconsi wamehlo nge-1% pilocarpine: uma umfundi oxegisiwe enganciphi ngemuva kwemizuzu engamashumi amathathu, kungubufakazi bokuvinjelwa kwemithi imisipha ye-iris.
• Ukuhlolwa okusebenzisa amaconsi wamehlo nakho kungahola ukuxilongwa kwe-Horner's syndrome: uma kwenzeka ungabaza, ukwehla kwethonsi le-5 noma le-10% le-cocaine kufanele kufakwe esweni ngalinye, futhi kufanele kuguqulwe izinguquko zamadayimane e-pupillary: i-cocaine ibanga i-mydriasis umfundi ojwayelekile, ngenkathi unomphumela omncane noma awunamphumela ku-Horner syndrome. Amaconsi wamehlo e-Apraclodine nawo ayasiza ekuqinisekiseni i-Horner's syndrome, manje sekuncamela ukuhlolwa kwe-cocaine. Ekugcineni, ukucabanga manje kwenza kube nokwenzeka ukubona ngeso lengqondo yonke indlela ezwelayo ukuze kutholakale i-Horner's syndrome: namuhla isivivinyo esibalulekile.

Ukuhlolwa kwe-unilateral mydriasis noma i-miosis kungaba yinselelo yokuxilonga futhi kubhekwa njengesimo esiphuthumayo sezinzwa. Ngomlando wesiguli, usizo lwaso lomzimba kanye nophenyo oluhlukahlukene, ukuxilongwa kungasungulwa futhi kuqondiswe ekwelashweni okufanele.

Ngesikhathi semithi yesimanje, uma kwenzeka isifo sohlangothi, i-activator ye-tissue plasminogen yindlela yokwelashwa evumele intuthuko enkulu ekwelashweni. Ukuphatha kufanele kube kusenesikhathi - kungakapheli amahora amathathu kuya kwayi-3 okuqala kwezimpawu. Ukubaluleka kokuxilongwa kumele kugcizelelwe lapha: ngoba ukuphathwa kwalesi sishoshovu se-plasminogen izicubu kuzoba, ezigulini ezingafanelekile, imiphumela engaba yinhlekelele, njengengozi eyengeziwe yokopha.

Eqinisweni, izindlela zokwelashwa zizocaciswa kakhulu ohlotsheni ngalunye lwezifo ezethula uphawu lwe-anisocoria. Kuzo zonke izimo, kufanele kuthintwe udokotela uma kwenzeka kwenzeka i-anisocoria, lapho-ke ongoti, njengodokotela bezinzwa kanye neuro-ophthalmologists, noma ophthalmologists, abangabeka ukunakekelwa okuthile kwesifo ngasinye. Kufanele kukhunjulwe ukuthi lesi yisimpawu okufanele silashwe ngokuphuthumayo, ngoba yize ingabonakalisa izifo ezinobungozi, ingaxhunyaniswa nezimo eziphuthumayo ezisongela impilo.