帕金森病（Parkinson’s disease, PD）作为仅次于阿尔茨海默病的第二大神经退行性疾病，其眼部表现近年来逐渐成为跨学科研究热点。以往医生多关注运动迟缓、静止性震颤和肌强直等PD典型症状，但大量临床研究表明，眼睑异常、眼球运动障碍、视觉功能异常等眼部表现不仅普遍存在于PD患者中，更可能在典型运动症状出现前就已显现。长期以来，这些眼部症状因其他症状的掩盖往往被忽视，进一步降低了患者的生活质量。本综述系统梳理PD患者眼部表现的三大方面：首先，眼睑异常方面，PD患者瞬目频率降低，61.1%患者出现干眼症状，导致PD患者的生活质量进一步下降。其次，眼球运动障碍表现为特征性的阶梯式方波急跳、集合功能减退以及反向扫视错误率增加，其中反向扫视潜伏期延长对步态冻结的发生具有预测价值。最后，视觉功能障碍方面，PD患者可出现视敏度下降、色觉异常、对比敏感度受损和视幻觉。影像学检查观察到视网膜神经节细胞层变薄，伴随视网膜微血管密度降低，这些结构性改变与PD患者的视觉功能障碍有关，作为生物标志物具有独特潜力。神经内科-眼科联合诊疗模式不仅有助于PD的早期诊断和预后评估，更有助于临床医生全面理解PD的疾病机制和表现，为未来诊疗策略的优化提供客观依据。
Parkinson’s disease (PD), the second most common neurodegenerative disorder after Alzheimer’s disease, has increasingly garnered interdisciplinary research attention due to its ocular manifestations. While the classical triad of motor symptoms—bradykinesia, resting tremor, and rigidity—remains the diagnostic hallmark, accumulating clinical evidence indicates that ocular abnormalities, including eyelid dysfunction, oculomotor disturbances, and visual impairments, are not only prevalent in PD patients but may also precede the onset of typical motor symptoms. Historically overlooked due to masking by other clinical features, these ocular manifestations contribute to the deterioration of patients' quality of life. This review systematically examines PD-related ocular abnormalities across three key domains: First, eyelid dysfunction manifests as reduced blink frequency, with 61.1% of PD patients reporting dry eye symptoms, further exacerbating their life quality impairment. Second, oculomotor disturbances are characterized by staircase-pattern square-wave jerks, convergence insufficiency, and increased error rates in antisaccade tasks, with prolonged antisaccade latency serving as a predictive marker for freezing of gait. Third, visual dysfunction encompasses diminished visual acuity, dyschromatopsia, impaired contrast sensitivity, and visual hallucinations. Imaging studies reveal structural alterations such as retinal ganglion cell layer thinning and reduced retinal microvascular density, which correlate with visual deficits and hold promise as potential biomarkers. The establishment of a neuro-ophthalmological collaborative framework not only facilitates early PD diagnosis and prognostic assessment but also enhances clinicians' comprehensive understanding of disease mechanisms. Such an approach provides an objective foundation for optimizing future therapeutic strategies.
目的：探讨中心性晕轮状视网膜脉络膜萎缩不同病变阶段的眼底影像学特征。方法：回顾分析中心性晕轮状视网膜脉络膜萎缩患者眼部检查及眼底荧光血管造影(fundus fluorescein angiography，FFA)检查，分析不同病变阶段荧光素眼底血管造影的影像学特征，总结该病发展转归的临床规律。结果：I期：眼底彩色照相：黄斑区轻度色素紊乱，可累及或未累及中心凹。FFA示：中心凹附近高荧光，RPE和脉络膜毛细血管的萎缩面积及程度尚不足以透见下方粗大的脉络膜血管。II期：眼底可见一类圆形的低色素区域，荧光造影可见与眼底彩照对应的高荧光区，随造影过程延长可见萎缩区荧光素渗漏。III期：黄斑区萎缩灶外围边界模糊，其中可见一部分边界清晰、稳定的完全萎缩灶。FFA：萎缩灶内边界清晰的部分视网膜色素上皮细胞(retinal pigment epithelium，RPE)及脉络膜完全萎缩，周边在造影晚期可见未完全萎缩的脉络膜毛细血管渗漏区域。IV期：黄斑区边界清晰的视网膜脉络膜萎缩灶，黄斑中心凹累及。FFA可见与眼底像相对应的脉络膜萎缩灶，其中可透见粗大的脉络膜血管。周围部分未见活动性荧光素渗漏，病变稳定。结论：荧光素眼底血管造影能反映的脉络膜萎缩程度是不同阶段病变阶段的主要指标。
Objective: To investigate the imaging features of fundus fluorescein angiography in central areolar choroidal dystrophy at different stages. Methods: Ocular examination and fundus fluorescein angiography were carried out, imaging features of fundus ffuorescein angiography were retrospectively analyzed. Results: Stage I: fundus photography showed mild macular pigment disorders, which was involved with the fovea. Fundus fluorescein angiography (FFA): high fluorescence was close to the fovea, the area and the extent of RPE and choroidal capillaries atrophy were insufffcient to see through the thick choroidal vessels beneath. Stage II: fundus showed a round of low pigment area, fluorescein angiography showed high fluorescence corresponding region, with the angiography procedure the ffuorescein leakage could be observed. Stage III: boundaries of macular atrophy lesions were unclear which showed part of a clear boundary, stable completely atrophy lesions. FFA: part of retinal pigment epithelium (RPE) and choroidal uncompletely atrophy surrounded was visible, in the late of angiography choroidal atrophy capillary leakage could be seen. Stage IV: boundary of macular retinal choroidal atrophy was clear, foveal involvement. FFA: choroidal atrophy lesions were clear which could be seen through the thick choroidal vessels. Fluorescein leakage disappeared and the disease was stable. Conclusion: The extend of choroidal atrophy in fundus ffuorescein angiography is an important indictor reflecting the progression of different stages.
