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BMJ：单侧间歇性瞳孔散大，什么原因？

2016-10-14 MedSci MedSci原创

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男性患者，19岁，因其母亲发现患者左眼瞳孔间歇性扩大一周而就诊与眼科急诊科（下图所示）。体格检查显示患者反应性右侧瞳孔直径为5mm，而左侧无反应性瞳孔直径为8mm。瞳孔单侧扩张，无反应，或可考虑外伤、第三神经麻痹、Adie瞳孔、良性间歇性瞳孔散大活药物副作用所致。进一步询问病史得知患者不久前哮喘发作，在吸入异丙托溴铵时不慎将药物喷洒至左眼。异丙托溴铵是一种抗胆碱药物，可抑制瞳孔括约肌，使得瞳孔长时

男性患者，19岁，因其母亲发现患者左眼瞳孔间歇性扩大一周而就诊与眼科急诊科（下图所示）。



体格检查显示患者反应性右侧瞳孔直径为5mm，而左侧无反应性瞳孔直径为8mm。瞳孔单侧扩张，无反应，或可考虑外伤、第三神经麻痹、Adie瞳孔、良性间歇性瞳孔散大活药物副作用所致。

进一步询问病史得知患者不久前哮喘发作，在吸入异丙托溴铵时不慎将药物喷洒至左眼。异丙托溴铵是一种抗胆碱药物，可抑制瞳孔括约肌，使得瞳孔长时间散大。使用毛果芸香碱收缩瞳孔失败，表明发生了药物散瞳。后续检查期间患者已恢复正常，且无进一步发作，患者出院。

原始出处：


Ruofan Connie Han,Andrew Pearson. A toddler with intermittent mydriasis. BMJ 2016; 355 doi: http://dx.doi.org/10.1136/bmj.i5083
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  1. [GetPortalCommentsPageByObjectIdResponse(id=1955002, encodeId=0b571955002d3, content=<a href='/topic/show?id=732f9e265d7' target=_blank style='color:#2F92EE;'>#间歇性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97265, encryptionId=732f9e265d7, topicName=间歇性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0361487, createdName=花花1366, createdTime=Wed Oct 26 20:00:00 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1848127, encodeId=9406184812e98, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Mon Oct 17 14:00:00 CST 2016, time=2016-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393214, encodeId=28541393214b5, content=<a href='/topic/show?id=34aae3121a7' target=_blank style='color:#2F92EE;'>#瞳孔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73121, encryptionId=34aae3121a7, topicName=瞳孔)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIpeueeYB1kem1yfEZrSYKBdZBoqac9USf0RxIgRICBIyDn4licyiaiakNnobeCDVpvwqaWgwTNeLRHA/132, createdBy=bb5e2500127, createdName=小几洁, createdTime=Sun Oct 16 02:00:00 CST 2016, time=2016-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148155, encodeId=ec4e1481558a, content=学习了，赞一个！, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Fri Oct 14 13:18:38 CST 2016, time=2016-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148141, encodeId=e8e3148141e5, content=学习了，赞一个！！, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Fri Oct 14 13:13:15 CST 2016, time=2016-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148102, encodeId=191d1481022f, content=学习啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9a3e1625700, createdName=18719ba4d5m, createdTime=Fri Oct 14 11:04:44 CST 2016, time=2016-10-14, status=1, ipAttribution=)]
    2016-10-26 花花1366

    #间歇性#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1955002, encodeId=0b571955002d3, content=<a href='/topic/show?id=732f9e265d7' target=_blank style='color:#2F92EE;'>#间歇性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97265, encryptionId=732f9e265d7, topicName=间歇性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0361487, createdName=花花1366, createdTime=Wed Oct 26 20:00:00 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1848127, encodeId=9406184812e98, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Mon Oct 17 14:00:00 CST 2016, time=2016-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393214, encodeId=28541393214b5, content=<a href='/topic/show?id=34aae3121a7' target=_blank style='color:#2F92EE;'>#瞳孔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73121, encryptionId=34aae3121a7, topicName=瞳孔)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIpeueeYB1kem1yfEZrSYKBdZBoqac9USf0RxIgRICBIyDn4licyiaiakNnobeCDVpvwqaWgwTNeLRHA/132, createdBy=bb5e2500127, createdName=小几洁, createdTime=Sun Oct 16 02:00:00 CST 2016, time=2016-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148155, encodeId=ec4e1481558a, content=学习了，赞一个！, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Fri Oct 14 13:18:38 CST 2016, time=2016-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148141, encodeId=e8e3148141e5, content=学习了，赞一个！！, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Fri Oct 14 13:13:15 CST 2016, time=2016-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148102, encodeId=191d1481022f, content=学习啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9a3e1625700, createdName=18719ba4d5m, createdTime=Fri Oct 14 11:04:44 CST 2016, time=2016-10-14, status=1, ipAttribution=)]
    2016-10-17 仁心济世

    #BMJ#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1955002, encodeId=0b571955002d3, content=<a href='/topic/show?id=732f9e265d7' target=_blank style='color:#2F92EE;'>#间歇性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97265, encryptionId=732f9e265d7, topicName=间歇性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0361487, createdName=花花1366, createdTime=Wed Oct 26 20:00:00 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1848127, encodeId=9406184812e98, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Mon Oct 17 14:00:00 CST 2016, time=2016-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393214, encodeId=28541393214b5, content=<a href='/topic/show?id=34aae3121a7' target=_blank style='color:#2F92EE;'>#瞳孔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73121, encryptionId=34aae3121a7, topicName=瞳孔)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIpeueeYB1kem1yfEZrSYKBdZBoqac9USf0RxIgRICBIyDn4licyiaiakNnobeCDVpvwqaWgwTNeLRHA/132, createdBy=bb5e2500127, createdName=小几洁, createdTime=Sun Oct 16 02:00:00 CST 2016, time=2016-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148155, encodeId=ec4e1481558a, content=学习了，赞一个！, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Fri Oct 14 13:18:38 CST 2016, time=2016-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148141, encodeId=e8e3148141e5, content=学习了，赞一个！！, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Fri Oct 14 13:13:15 CST 2016, time=2016-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148102, encodeId=191d1481022f, content=学习啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9a3e1625700, createdName=18719ba4d5m, createdTime=Fri Oct 14 11:04:44 CST 2016, time=2016-10-14, status=1, ipAttribution=)]
    2016-10-16 小几洁

    #瞳孔#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1955002, encodeId=0b571955002d3, content=<a href='/topic/show?id=732f9e265d7' target=_blank style='color:#2F92EE;'>#间歇性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97265, encryptionId=732f9e265d7, topicName=间歇性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0361487, createdName=花花1366, createdTime=Wed Oct 26 20:00:00 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1848127, encodeId=9406184812e98, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Mon Oct 17 14:00:00 CST 2016, time=2016-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393214, encodeId=28541393214b5, content=<a href='/topic/show?id=34aae3121a7' target=_blank style='color:#2F92EE;'>#瞳孔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73121, encryptionId=34aae3121a7, topicName=瞳孔)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIpeueeYB1kem1yfEZrSYKBdZBoqac9USf0RxIgRICBIyDn4licyiaiakNnobeCDVpvwqaWgwTNeLRHA/132, createdBy=bb5e2500127, createdName=小几洁, createdTime=Sun Oct 16 02:00:00 CST 2016, time=2016-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148155, encodeId=ec4e1481558a, content=学习了，赞一个！, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Fri Oct 14 13:18:38 CST 2016, time=2016-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148141, encodeId=e8e3148141e5, content=学习了，赞一个！！, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Fri Oct 14 13:13:15 CST 2016, time=2016-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148102, encodeId=191d1481022f, content=学习啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9a3e1625700, createdName=18719ba4d5m, createdTime=Fri Oct 14 11:04:44 CST 2016, time=2016-10-14, status=1, ipAttribution=)]
    2016-10-14 lietome1

    学习了，赞一个！

    0

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    2016-10-14 1dd8a7c5m95(暂无匿称)

    学习了，赞一个！！

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1955002, encodeId=0b571955002d3, content=<a href='/topic/show?id=732f9e265d7' target=_blank style='color:#2F92EE;'>#间歇性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97265, encryptionId=732f9e265d7, topicName=间歇性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0361487, createdName=花花1366, createdTime=Wed Oct 26 20:00:00 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1848127, encodeId=9406184812e98, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Mon Oct 17 14:00:00 CST 2016, time=2016-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393214, encodeId=28541393214b5, content=<a href='/topic/show?id=34aae3121a7' target=_blank style='color:#2F92EE;'>#瞳孔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73121, encryptionId=34aae3121a7, topicName=瞳孔)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIpeueeYB1kem1yfEZrSYKBdZBoqac9USf0RxIgRICBIyDn4licyiaiakNnobeCDVpvwqaWgwTNeLRHA/132, createdBy=bb5e2500127, createdName=小几洁, createdTime=Sun Oct 16 02:00:00 CST 2016, time=2016-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148155, encodeId=ec4e1481558a, content=学习了，赞一个！, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=841a1636000, createdName=lietome1, createdTime=Fri Oct 14 13:18:38 CST 2016, time=2016-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148141, encodeId=e8e3148141e5, content=学习了，赞一个！！, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Fri Oct 14 13:13:15 CST 2016, time=2016-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148102, encodeId=191d1481022f, content=学习啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9a3e1625700, createdName=18719ba4d5m, createdTime=Fri Oct 14 11:04:44 CST 2016, time=2016-10-14, status=1, ipAttribution=)]
    2016-10-14 18719ba4d5m

    学习啦

    0