Anisocoria waa sinnaan la'aanta dhexroorka labada arday, oo ka weyn 0,3 milimitir: labada arday markaas waa kala cabbir duwan yihiin. Anisocoria waxaa lala xiriirin karaa mydriasis hal dhinac ah, taas oo ah in la yiraahdo kororka cabbirka mid ka mid ah labada arday, ama, liddi ku ah, miosis samaynta arday ka yar kan kale.

Sababaha anisocoria waa kuwo aad u kala duwan, oo u dhexeeya aetiologies khafiif ah ilaa cudurro halis ah oo suurtagal ah, sida dhaawaca neerfaha. Hababka kala duwan ayaa u oggolaanaya ogaanshaha saxda ah, kaas oo ay tahay in si degdeg ah loo sameeyo si looga hortago cawaaqibka khatarta ah, sida kuwa istaroogga, kaas oo anisocoria ay sidoo kale tahay calaamad.

Waa maxay anisocoria

Qofku wuxuu qabaa anisocoria marka labadiisa arday ay kala weyn yihiin: mid ka mid ah mydriasis hal dhinac ah, sidaas darteed kororka xajmiga mid ka mid ah labadiisa arday, ama sababtoo ah miosis hal dhinac ah, taas oo ah, cidhiidhigeeda. Anisocoria waxaa lagu gartaa farqiga dhexroorka ardayda ee ka weyn 0,3 millimitir.

Ardaygu waa daloolka dhexe ee iris-ka, kaas oo iftiinku ka soo galo daloolka dambe ee kubbadda isha. Iris, oo ah qaybta midabka leh ee guluubka isha, waxa ay ka kooban tahay unugyo siiya midabkeeda (oo loo yaqaanno melanocytes) iyo fiilooyinka murqaha: shaqadiisa ugu weyni waa in ay nidaamiso xadiga iftiinka gala guluubka isha. isha ardayga.

Dhab ahaantii, ardaygu (taas oo macnaheedu yahay, "qof yar", sababtoo ah tani waa meesha aad isku aragto markaad qofka isha ku hayso), taas oo ah furitaanka dhexe ee iris, waxay u muuqataa madow sababtoo ah markaad eegto muraayadda , waa qaybta dambe ee isha ee soo baxda (choroid iyo retina), taas oo aad u midabaysan.

Reflexes ayaa nidaamisa unugga ardayga, iyadoo ku xiran xoogga iftiinka: 

• Marka iftiin xoog leh uu kiciyo isha, waa fiilooyinka parasympathetic ee habdhiska neerfaha daaqsinka ah ee soo galaya. Sidaa darteed, fiilooyinka parasympathetic ee dareemaha oculomotor waxay kiciyaan foosha wareegga ama fiilooyinka annular ee iris (ama muruqyada sfincter ee ardayga) oo keena foosha ardayga, taas oo ah in la yiraahdo hoos u dhigista dhexroorka ardayga.
• Taa beddelkeeda, haddii iftiinku daciif yahay, markan waa neerfayaasha naxariista ee habdhiska dareenka daaqsinka kuwaas oo la hawlgeliyo. Waxay kiciyaan fiilooyinka shucaaca ama murqaha jeexjeexa ee ardayga, taasoo keenta in dhexroorka ardayga la furo.

Anisocoria kasta wuxuu u baahan yahay qiimeynta indhaha iyo, badanaa, neerfaha ama neerfaha. Sidaa darteed anisocoria waxaa lala xiriirin karaa miosis mid ka mid ah labada arday, oo ay keento firfircoonida nidaamka parasympathetic kaas oo abuura kan sphincter ee iris, ama mydriasis mid ka mid ah ardayda, oo uu kiciyay nidaamka naxariiseed ee firfircoonida. muruqa dilator ee iris.

Waxaa jira anisocoria physiological, kaas oo saameeya qiyaastii 20% dadweynaha.

Sidee loo aqoonsan karaa anisocoria?

Anisocoria waxaa muuqaal ahaan lagu aqoonsan karaa xaqiiqda ah in labada arday aysan isku qiyaas ahayn. Dhakhaatiirta indhaha intooda badani waxay arkaan bukaanno badan oo qaba anisocoria inta lagu jiro maalinta caadiga ah ee la-tashiga. Inta badan dadkan ma oga, laakiin qaar ayaa si gaar ah u yimaadda si loo qiimeeyo.

Tijaabooyin la isticmaalayo nalal ayaa suurtogal ka dhigaya in la ogaado oo ah ardayga cudurada wadnaha: sidaas darteed, anisocoria kor u kaca iftiinka xooggan wuxuu muujin doonaa in ardayga pathological uu yahay kan ugu weyn ( foosha xun ee ardayga cilmu-nafsiga ), iyo liddi ku ah anisocoria oo kordhay iftiin hooseeya. Tilmaan in ardayga cudur-sidaha ah uu yahay kan ugu yar (nasinta liidata ee ardada cudurada.

Waxyaabaha khatarta

Marka la eego qodobbada iatrogenic (ku xiran daawooyinka), shaqaalaha daryeelka caafimaadka, sida kalkaaliyayaasha caafimaadka ee ka shaqeeya isbitaallada, ayaa laga yaabaa inay halis ugu jiraan inay yeeshaan anisocoria nooca farmasiga ah, taas oo u soo baxda mid aan wanaagsanayn, ka dib soo-gaadhista daawooyinka qaarkood. Alaabooyinka, sida balastarrada scopolamine: kuwani waxay keeni karaan anisocoria oo iskeed isu dhimi doonta maalmo gudahood.

Waxaa intaa dheer, oo ka mid ah arrimaha farsamada, waxaa jira, carruurta, khatarta ansocoria ee ay keento dhalmada adag, gaar ahaan marka xoog loo isticmaalo.

Dabeecadaha anisocoria aad bay u kala duwan yihiin: waa calaamada cudurrada kuwaas oo u dhaxayn kara sababo aan fiicneyn ilaa neerfaha ama xitaa xaaladaha degdegga ah ee muhiimka ah.

Anisocoria jireed

Dhacdadan anisocoria physiological, oo jirta iyada oo aan jirin wax cudur ah oo la xidhiidha, waxay saamaysaa inta u dhaxaysa 15 iyo 30% dadweynaha. Waxay jirtay wakhti dheer, farqiga cabbirka ee u dhexeeya labada ardayna waa wax ka yar 1 millimitir.

Xanuunada indhaha oo kaliya

Sababaha indhaha ee kaliya ee anisocoria ayaa si fudud loo baaraa inta lagu jiro baaritaanka caadiga ah ee indhaha:

• murugo;
• uvéite;
• glaucoma ba'an.

Anisocoria makaanikada

Waxaa jira sababo farsamo oo ansocoria ah, kuwaas oo markaas lala xiriirin karo taariikhda dhaawacyada (oo ay ku jiraan qaliinka), bararka intra-ocular taas oo keeni karta in ay ku dhegto iris iyo leniska, ama xitaa cillado ku dhasha. .

Adie's tonic arday

Ardayga Adie's ama Adie's syndrome waa cudur naadir ah, kaas oo inta badan saameeya hal il oo kaliya: ishani waxay leedahay arday weyn, si xoog leh u furfuran, daciif ah ama aan falcelin lahayn haddii ay dhacdo kicinta iftiinka. Inta badan waxaa lagu arkaa dumarka da'da yar, asalkiisana inta badan lama yaqaan. Bégnine, waxaa laga yaabaa ama laga yaabaa inaysan soo bandhigin calaamadaha muuqaalka, sida mararka qaarkood raaxo la'aan markaad wax akhrinayso.

Ardayda farmashiilo ahaan balaadhay

Ardayda u kala balaartay maadada dawooyinka waxay u jiraan laba xaaladood: shilalka u soo-gaadhista wakiilka saameeya shaqada ardayga-matoorka, ama gaadhista ula kac ah.

Qaar ka mid ah wakiilada loo yaqaan inay kala furfuraan ardayga waa:

• boogaha scopolamine;
• ipratopium oo la nuugo (daawoyinka neefta);
• vasoconstrictors sanka;
• glycopyrrolate (dawo hoos u dhigta dhaqdhaqaaqa caloosha iyo mindhicirka);
• iyo geedo yaryar, sida cawska Jimson, buunka Angel ama nightshade.

Ardayda cidhiidhi ah ayaa lagu arkaa inta lagu jiro soo-gaadhista oo leh:

• pilocarpine;
• prostaglandins;
• opioids;
• clonidine (daawooyinka ka hortagga hypertensive);
• organophosphates.

Ku guuldareysiga in pilocarpine uu qandaraas ku qaado ardayga waa calaamad muujinaysa fidinta iatrogenic ee ardayga.

Horner Syndrome

Claude-Bernard Horner syndrome waa cudur isku darka ptosis (dhacitaanka daboolka sare ee isha), miosis iyo dareenka enophthalmos (niyad-jab aan caadi ahayn oo isha ku haysa wareegga). Cilad-sheegiddeeda waa lama huraan, sababtoo ah waxay la xiriiri kartaa nabar ku yaal dariiqa naxariista indhaha, ka dibna waxay calaamad u noqon kartaa, waxyaabo kale,:

• sambabada ama burooyinka dhexdhexaadka ah;
• neuroblastoma (oo aad ugu badan carruurta);
• kala-baxa halbowlayaasha carotid;
• dhaawaca tayroodh;
• madax xanuunka trigemino-dysautomatic iyo ganglionopathy autoimmune (hoos eeg).

Curyaaminta neerfaha

Curyaanka dareemayaasha oculomotor ayaa sidoo kale laga yaabaa inuu ku lug yeesho anisocoria.

Cudurrada neerfaha 

• Istaroog: tani waa sabab ay tahay in si degdeg ah loo garto si loo awoodo in uu uga falceliyo lix saacadood gudahooda ee istaroogga;
• Halbowleyaasha aneurysm (ama barar).

Pourfour du Petit Syndrome

Pourfour du Petit syndrome, cillad kicinta nidaamka naxariista, waxay soo bandhigaysaa gaar ahaan mydriasis iyo dib u noqoshada daboolka indhaha: waa cillad naadir ah oo marar badan ay sabab u tahay buro xun.

Madax xanuunka trigemino-dysautomic

Madax xanuunkan waxaa lagu gartaa xanuunka madaxa iyo inta badan oo ka soo baxa xabka sanka iyo daadashada ilmada. Waxay la xiriiraan miosis ee ardayga 16 ilaa 84% kiisaska. Waxay ku sifoobi karaan sawir-qaadis. La-talinta dhakhtarka neerfaha ama dhakhtarka indhaha ayaa lagula talinayaa si loo hago daawaynta loona xaqiijiyo ogaanshaha xaaladaha qaarkood ee aan caadiga ahayn.

Ganglionopathy autoimmune ee nidaamka autonomic

Cudurkan naadirka ah wuxuu soo bandhigayaa unugyada difaaca jirka ee lagu beegsanayo ganglia ee habdhiska dareemeyaasha. Labada hab, naxariis iyo parasympathetic, waa la saameyn karaa; Marka la eego cilladaha ardayda, waa ganglia-ga parasympathetic ganglia kuwa inta badan ay saameyso. Sidaa darteed, 40% bukaannada waxay la kulmaan cillado aan caadi ahayn, oo ay ku jiraan anisocoria. Cudurkaan wuxuu jiraa da' kasta, wuxuuna soo bandhigi karaa calaamado ay ka mid yihiin kuwa encephalitis. Si iskiis ah ayaa loo daweyn karaa, laakiin dhaawaca neerfaha ayaa laga yaabaa inuu sii jiro, sidaas awgeed calaamadda joogtada ah ee daaweynta difaaca jirka.

Ma jirto khatar dhab ah oo ah isku-darka laftiisa ee anisocoria, khataraha dhibka ayaa ah kuwa cudurada la xidhiidha. Haddii anisocoria mararka qaarkood ay tahay sabab aan fiicneyn, waxay sidoo kale noqon kartaa calaamad muujinaysa cudurro aad u daran, gaar ahaan marka ay yihiin neerfaha. Haddaba kuwani waa xaalado degdeg ah, kuwaas oo ay tahay in lagu ogaado sida ugu dhakhsaha badan ee suurtogalka ah, iyada oo la marayo baadhitaano kala duwan:

• Tijaabooyinka sawirka sida MRI ee maskaxda ayaa laga yaabaa inay u baahdaan in si degdeg ah loo isticmaalo, gaar ahaan haddii istaroog laga shakiyo, iyo mararka qaarkood angiography ee madaxa iyo qoorta (taas oo muujinaysa calaamadaha xididdada dhiigga).

Dhammaan tijaabooyinkan waa inay suurtogaliyaan in sida ugu dhakhsaha badan ee suurtogalka ah loo jiheeyo cudurka si looga fogaado dhibaatooyin badan, sida kuwa ka dambeeya istaroogga, maadaama haddii lagu daryeelo lix saacadood gudahood, cawaaqibta aad ayey u yar tahay. Intaa waxaa dheer, si mararka qaarkood looga fogaado imtixaannada sawir-qaadista ee aan loo baahnayn, imtixaannada la isticmaalayo dhibcaha indhaha ayaa waxtar leh:

• sidaas darteed, anisocoria pharmacological, ay sabab u tahay daroogada, waxaa lagu kala saari karaa dilation pupillary ee asalka neerfayaasha iyadoo la isticmaalayo baaritaanka dhibcaha isha ee 1% pilocarpine: haddii ardayga dillaacsan ma hoos u dhaco ka dib soddon daqiiqo, waa caddaynta xannibaad pharmacological ee muruqa iris.
• Tijaabooyin la isticmaalayo dhibcaha indhaha ayaa sidoo kale hagi kara ogaanshaha cudurka Horner's syndrome: haddii shaki jiro, dhibic 5 ama 10% dhibcaha kokain waa in lagu shubaa isha kasta, iyo isbeddelada dhexroorka ardayda waa in la arkaa: kookeynta waxay sababtaa mydriasis of ardayga caadiga ah, halka uu wax yar ama aan wax saameyn ah ku yeelan Horner syndrome. Dhibcaha indhaha ee Apraclodine ayaa sidoo kale faa'iido u leh xaqiijinta Horner's syndrome, hadda waa la doorbidaa baaritaanka kookeynta. Ugu dambeyntii, sawir-qaadista hadda waxay suurtogal ka dhigaysaa in la sawiro dhammaan dariiqa naxariista si loo ogaado cudurka Horner's syndrome: maanta waa imtixaan lama huraan ah.

Qiimaynta mydriasis hal dhinac ah ama miosis waxay noqon kartaa caqabad ogaanshaha waxaana loo arkaa xaalad degdeg ah oo neerfaha ah. Iyadoo loo marayo taariikhda bukaanka, muuqaalkiisa jireed iyo baaritaanno kala duwan, baaritaannada waxaa la samayn karaa oo toos ah daaweynta habboon.

Xilligii daawada casriga ah, haddii ay dhacdo istaroog, unugga plasminogen activator waa daaweyn u ogolaatay horumar weyn oo daaweyn ah. Maamulka waa inuu hore u ahaadaa - 3 ilaa 4,5 saacadood gudahooda ka dib bilawga calaamadaha. Muhiimadda ogaanshaha waa in halkan lagu caddeeyaa: sababtoo ah maamulka unugyada plasminogen activator wuxuu yeelan doonaa, bukaanada aan u qalmin, cawaaqibka kuwaas oo noqon kara masiibo, sida khatarta sii kordheysa ee dhiigbaxa.

Dhab ahaantii, daaweyntu waxay noqon doontaa mid gaar ah nooc kasta oo pathology ah oo soo bandhigaya calaamadda anisocoria. Xaaladaha oo dhan, dhakhtar waa in lala tashadaa haddii ay dhacdo anisocoria, ka dibna takhasusle, sida dhakhaatiirta neerfaha iyo neuro-ophthalmologists, ama dhakhaatiirta indhaha, kuwaas oo samayn kara daryeel gaar ah cudur kasta. Waa in maskaxda lagu hayaa in tani ay tahay calaamad ay tahay in si degdeg ah loo daweeyo, sababtoo ah iyada oo lagu sifayn karo cudurrada aan fiicneyn, waxay sidoo kale lala xiriirin kartaa xaaladaha degdegga ah ee nolosha.