Anisocoria kusaenzana muhupamhi hwevadzidzi vaviri, yakakura kupfuura 0,3 millimita: vadzidzi vaviri vanobva vasiyana saizi. Anisocoria inogona kubatanidzwa kana kune unilateral mydriasis, kureva kuwedzera kwehukuru hwemumwe wevadzidzi vaviri, kana, zvakasiyana, kune miosis ichiita kuti mudzidzi ave mudiki pane mumwe.

Zvinokonzera anisocoria zvakasiyana-siyana, kubva kune zvinyoro-nyoro kusvika kune zvinogona kunge zvakakomba pathologies, zvakadai sekukuvara kwetsinga. Nzira dzakasiyana-siyana dzinobvumira kuongororwa kwakarurama, iyo inofanira kusimbiswa nekuchimbidza kudzivirira migumisiro yakakomba, yakadai seye sitiroko, iyo anisocoria iriwo chiratidzo.

Chii chinonzi anisocoria

Munhu ane anisocoria apo vadzidzi vake vaviri vane hukuru hwakasiyana: zvichida nekuda kweunilateral mydriasis, saka kuwedzera kwekukura kweumwe wevadzidzi vake vaviri, kana nekuda kwe unilateral miosis, kureva, kuderera kwayo. Anisocoria inoratidza mutsauko mu pupillary diameters yakakura kupfuura 0,3 millimeters.

Mudzidzi ( pupil) ndiyo inovhura pakati peiris, iyo chiedza chinopinda mumashure meziso reziso. Iris, chikamu chemavara chebhubhu yeziso, inoumbwa nemasero anopa ruvara rwayo (inonzi melanocytes) uye mhasuru fibers: basa rayo guru nderokugadzirisa huwandu hwechiedza chinopinda mubhobho reziso. ziso nemumwana.

Kutaura zvazviri, mudzidzi (zvinoreva kuti, "munhu mudiki", nokuti apa ndipo paunozviona iwe paunotarisa munhu muziso), iyo naizvozvo ndiyo nzvimbo yepakati yeiris, inoita dema nokuti paunotarisa kuburikidza nelens. , ndiyo chikamu chemashure cheziso chinoratidzika (choroid uye retina), iyo ine ruvara rwakanyanya.

Reflexes inodzora pupil cell, zvichienderana nekusimba kwechiedza: 

• apo chiedza chakanyanya chinokurudzira ziso, ndiyo parasympathetic fibers yevegetative nervous system inopinda. Nokudaro, iyo parasympathetic fibers yeoculomotor nerve inokurudzira kuputika kwechitenderedzwa kana annular fibers yeiris (kana sphincter muscles of the pupil) inokonzera kuputika kwemudzidzi, kureva kuderedzwa kwepupillary diameter.
• zvakasiyana, kana chiedza chisina simba, nguva ino ndiyo neurons inonzwira tsitsi yevegetative nervous system iyo inoshandiswa. Ivo vanosimudzira mafibhi eradiary kana dilator tsandanyama dzemudzidzi, zvichikonzera kuwedzera kwehupamhi hwemudzidzi.

Chero anisocoria inoda kuongororwa kweophthalmological uye, kazhinji, neurological kana neuroradiological. Iyo anisocoria inogona naizvozvo kubatanidzwa kune miosis yemumwe wevadzidzi vaviri, inokonzerwa nekushandiswa kweparasympathetic system iyo inogadzira iyo ye sphincter yeiris, kana kune mydriasis yemumwe wevadzidzi, inokonzereswa nekunzwira tsitsi system activate. dilator tsandanyama yeiris.

Kune physiological anisocoria, iyo inobata inenge 20% yevanhu.

Nzira yekuziva sei anisocoria?

Anisocoria inoonekwa nekuona kuti vadzidzi vaviri havana hukuru hwakafanana. Vazhinji veOphthalmologists vanoona varwere vakati wandei vane anisocoria pazuva rakajairwa rekubvunzana. Vazhinji vevanhu ava havazive nezvazvo, asi vamwe vanouya zvakananga kuti zviongororwe.

Miedzo uchishandisa mwenje ichaita kuti zvikwanise kuona kuti ndeupi mudzidzi wepathological: nekudaro, anisocoria yakawedzera muchiedza chakasimba inoratidza kuti iyo pathological pupil ndiye mukuru (murombo contraction yeiyo pathological pupil), uye neimwe nzira, anisocoria yakawedzera muchiedza chakaderera. ratidza kuti pathological pupil ndiye diki (pasina kuzorora kwepathological pupil).

Zvinhu zvinotyisa

Panyaya yeiatrogenic factor (yakabatana nemishonga), vashandi vehutano, vakadai sevanamukoti vanoshanda muzvipatara, vanogona kunge vari pangozi yekugadzira pharmacological-type anisocoria, iyo inoshanduka kuva isina kunaka, kutevera kuratidzwa kune mamwe mishonga. zvigadzirwa, senge scopolamine zvigamba: izvi zvinogona kukonzera anisocoria inozodzikira yega mukati memazuva.

Uyezve, pakati pezvinhu zvemagetsi, kune, muvana, njodzi ye anisocoria inokonzerwa nekubereka kwakaoma, kunyanya kana kushandiswa kwesimba.

Etiologies ye anisocoria yakasiyana zvikuru: chiratidzo chezvirwere zvinogona kubva kune zvikonzero zvisingabatsiri kusvika kuhutano hwepfungwa kana kunyange zvakakosha.

Physiological anisocoria

Ichi chiitiko che physiological anisocoria, iyo iripo pasina kuve nechero chirwere chakabatana, inokanganisa pakati pe15 ne30% yehuwandu. Yave iripo kwenguva yakareba, uye mutsauko wehukuru pakati pevadzidzi vaviri uri pasi pe1 millimeter.

Ocular etiologies chete

Zvikonzero zveanisocoria zvinoonekwa zviri nyore panguva yekuongororwa kweziso:

• contusion;
• uvéite;
• acute glaucoma.

Mechanical anisocoria

Pane zvinokonzeresa zvinokonzerwa neanisocoria, izvo zvinozobva zvabatanidzwa nenhoroondo yekushungurudzika (kusanganisira kuvhiyiwa), kune kuzvimba kwemukati memaziso izvo zvinogona kutungamira mukunamatira pakati peiris nelenzi, kana kunyange kukuzvarwa anomalies. .

Adie's tonic mudzidzi

Adie's pupil kana Adie's syndrome chirwere chisingawanzoitiki, icho chinowanzobata ziso rimwe chete: ziso iri rine mudzidzi mukuru, wakanyura zvakasimba, usina simba rekuita kana kuti usingaiti muchiitiko chekukurudzira chiedza. Inoonekwa kakawanda muvakadzi vaduku, uye mavambo ayo anowanzozivikanwa. Bégnine, inogona kana kusaratidza zviratidzo zvekuona, senge dzimwe nguva kusagadzikana paunenge uchiverenga.

Pharmacologically dilated vadzidzi

Vana vakawedzerwa nekuda kwechinhu chemishonga chiripo mumamiriro maviri: kusangana netsaona kune agent inokanganisa pupil-motor basa, kana kuratidzwa nemaune.

Mamwe emaajenti anozivikanwa kudzikisa mudzidzi ndeaya:

• scopolamine zvigamba;
• inhaled ipratopium (mushonga weasthma);
• nasal vasoconstrictors;
• glycopyrrolate (mushonga unoderedza basa remudumbu uye mumatumbo);
• nemakwenzi, akadai seJimson grass, Angel's Trumpet kana nightshade.

Vana vakatetepa vanoonekwa panguva yekusangana ne:

• iyo pilocarpine;
• prostaglandins;
• opioids;
• clonidine (antihypertensive drug);
• organophosphate mishonga yezvipembenene.

Kukundikana kwepilocarpine kubata mudzidzi chiratidzo cheiatrogenic dilation yemudzidzi.

Horner Syndrome

Claude-Bernard Horner syndrome chirwere chinobatanidza ptosis (kudonha kwemaziso epamusoro), miosis uye kunzwa kweanophthalmos (kuora mwoyo kusingawanzoitiki kweziso mu orbit). Kuongororwa kwayo kwakakosha, nekuti inogona kusanganiswa neronda panzira yetsitsi, uye inogona kuva chiratidzo, pakati pezvimwe zvinhu, che:

• mapapu kana mediastinal tumors;
• neuroblastoma (yakajairika muvana);
• kuparadzaniswa kwe carotid arteries;
• thyroid kukanganisa;
• trigemino-dysautomatic headaches uye autoimmune ganglionopathies (ona pazasi).

Nervous paralysis

Oculomotor nerve palsy inogonawo kubatanidzwa mu anisocoria.

Neurovascular pathologies 

• Stroke: ichi ndicho chikonzero chinofanira kuzivikanwa nekukasira kuti ugone kuita mukati memaawa matanhatu ekurohwa;
• Artery aneurysm (kana bulge).

Pourfour du Petit Syndrome

Pourfour du Petit syndrome, an excitation syndrome yetsitsi system, inopa kunyanya mydriasis uye kudzoreredza kweziso: iri risingawanzoitika syndrome kazhinji nekuda kwebundu rakashata.

Trigemino-dysautomic headache

Iyi misoro yemusoro inoratidzwa nekurwadziwa mumusoro uye nguva zhinji inobuda kubva mumhino mucosa uye kubuda kwemisodzi. Vanobatanidzwa ne miosis yemwana mu16 kusvika 84% yematambudziko. Vanogona kuonekwa nemifananidzo. Kubvunzurudza neurologist kana neuro-ophthalmologist inokurudzirwa kutungamira kurapwa uye kusimbisa kuongororwa mune dzimwe nyaya dzeatypical.

Autoimmune ganglionopathy ye autonomic system

Ichi chirwere chisingawanikwe chinouya nemaautoantibodies akananga ganglia ye autonomic nervous system. Zvose zvirongwa, tsitsi uye parasympathetic, zvinogona kukanganiswa; Nezve pupil anomalies, ndiyo parasympathetic ganglia ndiyo inowanzobatwa. Nokudaro, 40% yevarwere vanouya nekukanganisa kwevadzidzi, kusanganisira anisocoria. Iyi pathology iripo pazera ripi zvaro, uye inogona kuratidza nezviratidzo senge zve encephalitis. Inogona kurapwa yega, asi neuronal kukuvadzwa kunogona kuramba, saka kazhinji chiratidzo che immunotherapy.

Iko hakuna njodzi chaiyo yekukanganisika mukati mayo anisocoria, njodzi dzekukanganisika ndedziya dzepathologies dzakabatana nazvo. Kana anisocoria dzimwe nguva iine chikonzero chisina kunaka, inogona zvakare kuve chiratidzo chezvirwere zvinogona kunge zvakakomba, kunyanya kana iine tsinga. Saka izvi ndezve emergency, izvo zvinofanirwa kuongororwa nekukurumidza sezvinobvira, kuburikidza neakasiyana bvunzo:

• Miedzo yekufungidzira yakadai seMRI yeuropi ingada kushandiswa nekukurumidza, kunyanya kana sitiroko ichifungidzirwa, uye dzimwe nguva angiography yemusoro nemutsipa (iyo inoratidza zviratidzo zvetsinga).

Ese aya bvunzo anofanirwa kuita kuti zvikwanise kutarisisa kuongororwa nekukurumidza sezvinobvira kudzivirira matambudziko akakura, akadai seaya anotevera sitiroko, nekuti kana ikachengetwa mukati memaawa matanhatu, mhedzisiro yacho inenge isinganyanyi kukosha. Uye nekuwedzera, dzimwe nguva kudzivirira bvunzo dzisina kufanira dzekufungidzira, bvunzo uchishandisa madonhwe eziso inoshanda:

• saka, pharmacological anisocoria, nekuda kwemushonga, inogona kusiyaniswa kubva pakuputika kwepupillary yetsinga nekushandisa madonhwe emeso bvunzo ne1% pilocarpine: kana mwana akareruka asingaderedze mushure memaminitsi makumi matatu, ihwo humbowo hwekuvharwa kwemishonga. iris muscle.
• Miedzo inoshandisa madonhwe emeso inogonawo kutungamira kuongororwa kweHorner's syndrome: kana paine kusahadzika, donhwe re5 kana 10% cocaine madonhwe emeso anofanirwa kuiswa muziso rega rega, uye shanduko ye pupillary diameters inofanirwa kucherechedzwa: cocaine inokonzera mydriasis ye mudzidzi wenguva dzose, nepo iine zvishoma kana kuti isina mhedzisiro muHorner syndrome. Madonhwe eziso eApraclodine anobatsirawo mukusimbisa Horner's syndrome, ikozvino yakanakira kune cocaine bvunzo. Chekupedzisira, kufungidzira iko zvino kunoita kuti zvikwanise kufungidzira nzira yese yekunzwira tsitsi kuitira kuongorora Horner's syndrome: nhasi bvunzo yakakosha.

Kuongororwa kweunilateral mydriasis kana miosis inogona kuve dambudziko rekuongorora uye inoonekwa seyechimbichimbi yetsinga. Kuburikidza nenhoroondo yemurwere, kusimba kwake kwemuviri uye nekuferefeta kwakasiyana-siyana, kuongororwa kunogona kusimbiswa uye kunanga kune kurapwa kwakakodzera.

Munguva yemishonga yemazuva ano, kana paine sitiroko, tishu plasminogen activator kurapwa kwakabvumira kufambira mberi kukuru mukurapa. Kutonga kunofanira kunge kuri kwekutanga - mukati me3 kusvika kumaawa 4,5 ekutanga kwezviratidzo. Kukosha kwekuongororwa kunofanira kusimbiswa pano: nokuti kutungamirirwa kweiyi tissue plasminogen activator ichava, muvarwere vasingakwanisi, migumisiro inogona kuva yakaipa, yakadai sekuwedzera kwengozi yekubuda ropa.

Muchokwadi, marapirwo acho achave akanyatso kurudziro yega yega pathology inopa chiratidzo che anisocoria. Muzviitiko zvose, chiremba anofanira kubvunzurudzwa kana anisocoria, ipapo nyanzvi, dzakadai seneurologists uye neuro-ophthalmologists, kana ophthalmologists, vanogona kutanga kutarisirwa kwechirwere chimwe nechimwe. Inofanira kuchengetwa mupfungwa kuti ichi chiratidzo chinofanira kurapwa nokukurumidza, nokuti kunyange zvazvo chinogona kuratidza zvirwere zvisingafadzi, zvinogonawo kubatanidzwa nenjodzi dzinotyisa.