ʻO Anisocoria kahi like ʻole i ke anawaena o nā haumāna ʻelua, ʻoi aku ka nui ma mua o 0,3 millimeters: ʻokoʻa ka nui o nā haumāna ʻelua. Hiki ke hoʻopili ʻia ʻo Anisocoria i ka mydriasis unilateral, ʻo ia hoʻi ka hoʻonui ʻana i ka nui o kekahi o nā haumāna ʻelua, a i ʻole, i ka miosis e liʻiliʻi ai ka haumāna ma mua o kekahi.

He ʻokoʻa nā kumu o ka anisocoria, mai nā aetiologies māmā a hiki i nā pathologies koʻikoʻi loa, e like me ka pōʻino neurological. ʻO nā ʻano hana like ʻole e ʻae i kahi hōʻailona pololei, pono e hoʻokumu koke ʻia i mea e pale ai i nā hopena koʻikoʻi, e like me ke ʻano o ka maʻi maʻi, a ʻo ka anisocoria kekahi hōʻailona.

He aha ka anisocoria

He anisocoria ko ke kanaka ke okoa ka nui o kana mau haumana elua: no ka mydriasis unilateral, nolaila ka mahuahua ana o ka nui o kekahi o kana mau haumana elua, a ma muli o ka miosis unilateral, oia hoi, o kona haiki. Hōʻike ʻo Anisocoria i kahi ʻokoʻa i nā anawaena pupillary ma mua o 0,3 millimeters.

ʻO ka haumāna ka puka i waenakonu o ka iris, kahi e komo ai ka mālamalama i ka lua hope o ka maka. ʻO ka iris, ka ʻāpana kala o ka ʻōpuʻu o ka maka, ua hana ʻia i nā cell e hāʻawi iā ia i kona kala (i kapa ʻia nā melanocytes) a me nā ʻiʻo ʻiʻo: ʻo kāna hana nui ka hoʻoponopono ʻana i ka nui o ka mālamalama e komo i ka ʻōpuʻu o ka maka. maka ma ka haumana.

ʻO ka ʻoiaʻiʻo, ʻo ka haumāna (ʻo ia hoʻi, "kanaka liʻiliʻi", no ka mea, ma laila ʻoe e ʻike ai iā ʻoe iho ke nānā ʻoe i kahi kanaka i ka maka), no laila ʻo ia ka puka waena o ka iris, ʻeleʻele no ka mea ke nānā ʻoe Ma o ka lens. , ʻo ia ka ʻaoʻao hope o ka maka e ʻike ʻia (choroid a retina), ʻo ia ka pigmented nui.

Hoʻoponopono nā reflexes i ka pupil cell, ma muli o ka ikaika o ke kukui: 

• i ka wā e hoʻoulu ai ka mālamalama ikaika i ka maka, ʻo ia ka parasympathetic fibers o ka ʻōnaehana nerve vegetative e komo i ka pāʻani. No laila, hoʻoulu ʻia nā lālā parasympathetic o ke aʻalolo oculomotor i ka ʻoki ʻana o nā ʻāpana pōʻai a i ʻole nā ​​mea annular o ka iris (a i ʻole nā ​​ʻiʻo sphincter o ka haumāna) e hoʻoulu ai i ka ʻoki ʻana o ka haumāna, ʻo ia hoʻi ka emi ʻana o ke anawaena pupillary.
• ʻO ka mea ʻē aʻe, inā nāwaliwali ke kukui, i kēia manawa ʻo ia nā neurons sympathetic o ka ʻōnaehana nerve vegetative i hoʻāla ʻia. Hoʻoulu lākou i nā ʻiʻo radiary a i ʻole nā ​​ʻiʻo dilator o ka haumāna, e hoʻoulu ai i ka hoʻonui ʻana o ke anawaena o ka haumāna.

Pono kekahi anisocoria i kahi loiloi ophthalmological a, pinepine, neurological a neuroradiological paha. No laila hiki ke hoʻopili ʻia ka anisocoria i kahi miosis o kekahi o nā haumāna ʻelua, ma muli o ka hoʻāla ʻia ʻana o ka ʻōnaehana parasympathetic e hoʻoulu ai i ka sphincter o ka iris, a i ʻole ka mydriasis o kekahi o nā haumāna, i hoʻoulu ʻia e ka ʻōnaehana sympathetic. ka ʻiʻo dilator o ka iris.

Aia kahi anisocoria physiological, e pili ana i ka 20% o ka heluna kanaka.

Pehea e ʻike ai i ka anisocoria?

ʻIke ʻia ʻo Anisocoria ma muli o ka like ʻole o nā haumāna ʻelua. ʻIke ka hapa nui o nā ophthalmologists i kekahi mau maʻi me ka anisocoria i ka lā maʻamau o ke kūkākūkā. ʻAʻole ʻike ka hapa nui o kēia poʻe e pili ana, akā hele mai kekahi e loiloi.

ʻO nā hoʻāʻo e hoʻohana ana i nā kukui e hiki ai ke ʻike ʻo ia ka haumāna pathological: no laila, ʻo ka anisocoria i hoʻonui ʻia i ka mālamalama ikaika e hōʻike ana ʻo ka haumāna pathological ka nui loa (ka ʻoki maikaʻi ʻole o ka haumāna pathological), a ʻo ka hoʻonui ʻana i ka anisocoria i ka mālamalama haʻahaʻa. hōʻike ʻo ka haumāna pathological ka mea liʻiliʻi loa (poor relaxation of the pathological pupil).

Nā mea pilikino

Ma ke ʻano o nā mea iatrogenic (pili ʻia i nā lāʻau lapaʻau), hiki i nā limahana mālama ola, e like me nā kahu hānai e hana ana i nā halemai, hiki ke hoʻomohala i ke ʻano pharmacological-type anisocoria, ka mea i hoʻololi ʻia he benign, ma hope o ka ʻike ʻana i kekahi mau lāʻau. nā huahana, e like me nā ʻāpana scopolamine: hiki i kēia ke kumu i ka anisocoria e emi iho i loko o nā lā.

Eia kekahi, ma waena o nā mea mechanical, aia i loko o nā keiki, kahi pilikia o ka anisocoria ma muli o ka paʻakikī o ka hānau ʻana, ʻoiai ke hoʻohana ʻia nā forceps.

He ʻokoʻa loa nā etiologies o ka anisocoria: he hōʻailona ia o nā pathologies e hiki ke hele mai nā kumu maikaʻi a hiki i nā neurological a i ʻole nā ​​pilikia koʻikoʻi.

Anisocoria kino

ʻO kēia ʻano o ka anisocoria physiological, aia me ka loaʻa ʻole o kekahi maʻi pili, pili ma waena o 15 a 30% o ka heluna kanaka. Ua noho lōʻihi ia, a ʻo ka ʻokoʻa nui ma waena o nā haumāna ʻelua ʻaʻole ia ma mua o 1 millimeter.

Ocular etiologies wale nō

ʻIke maʻalahi nā kumu ocular o ka anisocoria i ka wā o ka nānā maka maʻamau:

• hoʻopaʻapaʻa;
• uvéite;
• glaucoma nui.

Anisocoria mīkini

Aia nā kumu mechanical o ka anisocoria, a laila hiki ke hoʻopili ʻia i ka mōʻaukala o ka trauma (me ka ʻoki ʻana), i ka mumū intra-ocular e hiki ke alakaʻi i nā adhesions ma waena o ka iris a me ka lens, a i ʻole i nā anomalies congenital. .

ʻO ka haumāna tonic a Adie

ʻO ka haumāna a Adie a i ʻole ʻo Adie's Syndrome he maʻi kakaʻikahi, ʻo ka mea maʻamau e pili ana i hoʻokahi maka wale nō: he haʻawina nui kēia maka, ākea ikaika, hoʻonāwaliwali a ʻaʻole hoʻi i ka hoʻoulu ʻana i ka māmā. ʻIke pinepine ʻia i nā wahine ʻōpio, a ʻike pinepine ʻia kona kumu. ʻO Begnene, hiki a ʻaʻole paha e hōʻike i nā hōʻailona ʻike, e like me ka pilikia i kekahi manawa ke heluhelu.

Nā haumāna i hoʻonui ʻia i ka pharmacologically

Aia nā haumāna ma muli o kahi lāʻau lāʻau lapaʻau ma nā ʻano ʻelua: ʻike ʻia i kahi lāʻau e hoʻopilikia i ka hana pupil-motor, a i ʻole ka ʻike ʻana i ka manaʻo.

ʻO kekahi o nā mea hana i ʻike ʻia e hoʻonui i ka haumāna:

• nā ʻāpana scopolamine;
• inhaled ipratopium (kahi lāʻau hānō);
• nasal vasoconstrictors;
• glycopyrrolate (kahi lāʻau e hoʻolohi i ka hana o ka ʻōpū a me ka ʻōpū);
• a me nā mea kanu, e like me ka mauʻu Jimson, ka pū kani a Anela a i ʻole ka pō.

ʻIke ʻia nā haumāna haiki i ka wā o ka hoʻolaha ʻana me:

• ka pilocarpine;
• prostaglandins;
• opioids;
• clonidine (kahi lāʻau antihypertensive);
• nā lāʻau make organophosphate.

ʻO ka hiki ʻole o ka pilocarpine ke ʻoki i ka haumāna he hōʻailona iatrogenic dilation o ka haumāna.

ʻO Horner Syndrome

ʻO ka maʻi ʻo Claude-Bernard Horner kahi maʻi e hui pū ana i ka ptosis (hāʻule o ka lihilihi luna), miosis a me kahi manaʻo o enophthalmos (ke kaumaha ʻole o ka maka i ka orbit). He mea koʻikoʻi kona ʻike ʻana, no ka mea hiki ke hoʻopili ʻia me kahi maʻi ma ke ala ocular sympathetic ala, a laila hiki ke lilo i hōʻailona, ​​​​i waena o nā mea ʻē aʻe, o:

• nā ʻōpū a i ʻole mediastinal;
• neuroblastoma (ʻoi aku ka maʻamau i nā keiki);
• ka wehe ʻana o nā aʻa carotid;
• pōʻino thyroid;
• trigemino-dysautomatic headaches a me nā ganglionopathies autoimmune (e nānā ma lalo).

ʻO ka maʻi lolo

Hiki ke komo i ka ma'i lolo oculomotor i ka anisocoria.

Nā maʻi neurovascular 

• ʻO ka hahau ʻana: he kumu kēia e ʻike koke ʻia i hiki ke hana i loko o ʻeono mau hola o ka hahau ʻana;
• ʻO ka aneurysm aʻaʻa (a i ʻole ka puʻu).

Pourfor du Petit Syndrome

ʻO ka maʻi Pourfour du Petit, kahi maʻi hauʻoli o ka ʻōnaehana sympathetic, e hōʻike ana i ka mydriasis a me ka hoʻihoʻi ʻana o ka lihilihi: he maʻi maʻamau pinepine ma muli o kahi maʻi maʻi maʻi.

Trigemino-dysautomic headache

ʻO kēia mau poʻo poʻo i hōʻike ʻia e ka ʻeha ma ke poʻo a me ka hapa nui o ka manawa i hoʻokuʻu ʻia mai ka mucosa ihu a me ka hoʻokahe ʻana o nā waimaka. Hoʻopili ʻia lākou me ka miosis o ka haumāna ma 16 a 84% o nā hihia. Hiki iā lākou ke hōʻike ʻia e ke kiʻi. Manaʻo ʻia ke kūkākūkā me kahi neurologist a i ʻole neuro-ophthalmologist e alakaʻi i ka mālama ʻana a hōʻoia i ka maʻi maʻi i kekahi mau hihia atypical.

Autoimmune ganglionopathy o ka ʻōnaehana autonomic

Hōʻike ʻia kēia maʻi kakaʻikahi me nā autoantibodies e kuhikuhi ana i nā ganglia o ka ʻōnaehana neʻe autonomic. Hiki ke hoʻopili ʻia nā ʻōnaehana ʻelua, sympathetic a parasympathetic; E pili ana i nā anomalies haumāna, ʻo ia ka parasympathetic ganglia i hoʻopilikia pinepine ʻia. No laila, ʻo 40% o nā maʻi e hōʻike nei me nā hemahema o ka haumāna, me ka anisocoria. Aia kēia maʻi maʻi i kēlā me kēia makahiki, a hiki ke hōʻike ʻia me nā hōʻailona e like me ka encephalitis. Hiki ke ho'ōla wale 'ia, akā hiki ke ho'omau i ka pō'ino neuronal, no laila ka hō'ailona pinepine no ka immunotherapy.

ʻAʻohe pilikia maoli o ka hoʻopiʻi ʻana iā ia iho o ka anisocoria, ʻo nā pilikia o ka hoʻopiʻi ʻana i nā pathologies e pili ana me ia. Inā he kumu maikaʻi ka anisocoria i kekahi manawa, he hōʻailona ia o nā maʻi hiki ke koʻikoʻi loa, ʻoiai inā he neurological lākou. No laila he mau ulia pōpilikia kēia, pono e ʻike koke ʻia, ma o nā hoʻokolohua like ʻole:

• Pono e hoʻohana koke ʻia nā hoʻāʻo kiʻi e like me MRI o ka lolo, ʻoiai inā kānalua ʻia kahi hahau, a i kekahi manawa ka angiography o ke poʻo a me ka ʻāʻī (e hōʻike ana i nā hōʻailona o nā kīʻaha koko).

Pono kēia mau ho'āʻo a pau e hiki ke hoʻonohonoho i ka maʻi i ka hikiwawe e pale aku i nā pilikia nui, e like me nā mea ma hope o ka hahau ʻana, no ka mea inā mālama ʻia i loko o ʻeono mau hola, ʻoi aku ka nui o nā hopena. A eia kekahi, no ka pale ʻana i nā hoʻokolohua kiʻi pono ʻole i kekahi manawa, ʻoi aku ka maikaʻi o ka hoʻohana ʻana i nā kulu maka:

• No laila, pharmacological anisocoria, ma muli o kahi lāʻau, hiki ke hoʻokaʻawale ʻia mai ka pupillary dilation o ke kumu neurological ma o ka hoʻohana ʻana i nā kulu maka hoʻāʻo me 1% pilocarpine: inā ʻaʻole e emi ka haumāna dilated ma hope o kanakolu mau minuke, he hōʻike ia o ka pharmacological blockade o ka ʻiʻo iris.
• ʻO nā hoʻāʻo e hoʻohana ana i nā kulu maka hiki ke alakaʻi i ka ʻike o ka Horner's Syndrome: inā kānalua, pono e hoʻokomo ʻia kahi kulu o 5 a 10% cocaine i loko o kēlā me kēia maka, a pono e nānā ʻia nā loli o nā anawaena pupillary: cocaine kumu mydriasis of the haumāna maʻamau, ʻoiai he liʻiliʻi a ʻaʻohe hopena i ka maʻi Horner. He mea pono no hoi na kulu maka o Apraclodine no ka hooiaio ana i ka ma'i o Horner, ua oi aku ia mamua o ka hoao cocaine. ʻO ka hope, hiki i ke kiʻi kiʻi ke ʻike i ke ala aloha holoʻokoʻa i mea e ʻike ai i ka maʻi ʻo Horner: i kēia lā he hōʻike koʻikoʻi.

ʻO ka loiloi o ka mydriasis unilateral a i ʻole ka miosis hiki ke lilo i pilikia diagnostic a manaʻo ʻia he pilikia neurological. Ma o ka moʻolelo o ka mea maʻi, kāna auscultation kino a me nā noiʻi like ʻole, hiki ke hoʻokumu ʻia nā diagnoses a kuhikuhi i ka lāʻau kūpono.

I ke au o ka lāʻau lapaʻau hou, i ka wā o ka hahau ʻana, ʻo ka tissue plasminogen activator kahi lāʻau lapaʻau i hiki ai ke holomua nui i ka mālama ʻana. Pono e hoʻoponopono mua - i loko o 3 a 4,5 mau hola ma hope o ka hoʻomaka ʻana o nā hōʻailona. Pono e hoʻokūpaʻa ʻia ke koʻikoʻi o ka maʻi maʻi: no ka mea, ʻo ka hoʻokele ʻana o kēia mea hoʻoulu plasminogen tissue, e loaʻa i nā maʻi kūpono ʻole, nā hopena i hiki ke pōʻino, e like me ka piʻi ʻana o ke koko.

I ka ʻoiaʻiʻo, e kikoʻī loa nā lāʻau lapaʻau i kēlā me kēia ʻano o ka pathology e hōʻike ana i kahi hōʻailona o anisocoria. I nā hihia a pau, pono e nīnau ʻia ke kauka inā he anisocoria, a laila nā loea, e like me nā neurologists a me nā neuro-ophthalmologists, a i ʻole nā ​​​​ophthalmologists, hiki ke hoʻokumu i ka mālama kūikawā no kēlā me kēia maʻi. Pono e hoʻomanaʻo ʻia he hōʻailona kēia e pono e mālama koke ʻia, no ka mea ʻoiai hiki iā ia ke ʻike i nā maʻi benign, hiki ke hoʻopili ʻia i nā pilikia pilikia.