Retrobulbar Hematoma, Orbital Blowout Fracture, and Ocular Compartment Syndrome¶

Mgbe ọkpọchara anya, baseball ma ọ bụ ikpere aka na-eti ihu, ọdịda, ma ọ bụ ihe mberede ụgbọ ala, nnukwu ihe mgbu, nkume siri ike, anya na-egbuke egbuke (proptosis) na-adaba n'ọhụhụhụhụhụhụhụhụhụhụhụhụhụhụ anya bụ oge mberede mberede ịwa ahụ nke a maara dị ka ** Orbital Compartment Syndrome (OCS)** sitere na ** Retrobulbar Hematoma . N'ihi na oghere anya mmadụ (orbit) bụ nke siri ike, igbe ọkpụkpụ nwere mgbidi anọ na-emeghe naanị n'ihu, ọbara ọgbụgba n'azụ bọọlụ anya na-agba ọsọ ngwa ngwa n'elu nrụgide nke akwara retina Central, na-akpagbu retina na akwara optic n'ime nkeji 60 ruo 120 . Ọbụlagodi mgbe ọ nweghị mkpụkọ ọbara retrobulbar dị, mgbaji nke ọkpụkpụ dị mkpa nke oghere anya ( Orbital Blowout Fracture) nwere ike ọnyà akwara na-ebuli anya elu, na-akpalite reflex na-egbu egbu nke obi dị ize ndụ ( oculocardiac reflex**), ma ọ bụ na-amanye ikuku sinus n'azụ bọọlụ anya ma ọ bụrụ na onye ahụ afụ ya imi. Ọ bụrụ na onye ọ bụla nwere mmerụ ihu ma ọ bụ anya na-etolite anya na-agba agba, ịhụhụ ọhụụ, ọhụhụ abụọ, ọgbụgbọ na-eji nwayọ nwayọ, ma ọ bụ egbugbere ọnụ elu na ntì, kpọọ nọmba mberede mpaghara gị ozugbo site na. nọmba mberede. Nyochaa ụkpụrụ trauma metụtara na mmerụ anya na nlekọta mberede, isi mmerụ ahụ na mgbakasị ahụ, na orbital cellulitis na cavernous sinus thrombosis.

Mee nke a ugbu a¶

1. ** Kpọọ nọmba mberede mpaghara gị ozugbo *** (911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom) ma ọ bụrụ na anya merụrụ ahụ na-aga n'ihu (proptosis), na-enwe mmetụta nke siri ike na nkume siri ike n'okpuru nku anya fụrụ akpụ, nwere ọhụụ na-agba agba ma ọ bụ na-agba ọchịchịrị, nwere nwa akwụkwọ nke na-adịghị enwu ọkụ ma ọ bụrụ na ọ na-enweghị ike ịla n'iyi ma ọ bụrụ na ọ na-agbake n'oge ọ bụla. ọgbụgbọ.
2. ** Nọdụ ala onye ọrịa kwụ ọtọ (opekata mpe ogo 45 ruo 90) ma ọ bụrụ na a naghị enyo mmerụ ahụ ọkpụkpụ azụ.** Idobe isi elu karịa ọkwa nke obi na-eji ike ndọda belata ọbara ọgbụgba na akwara venous n'ime oghere anya, na-ebelata mmepụta nke hematoma retrobulbar.
3. ** Nye onye nrịanrịa iwu nke ọma: "Afụla imi gị, emechila ọnụ gị uzere, emelakwa nsogbu."** Ọkpụkpụ nke orbital na-agbaji ọkpụkpụ dị nro nke na-ekewa oghere anya na ikuku maxillary na ethmoid sinuses. Ịfụ imi na-arụ ọrụ dị ka mgbapụta ikuku dị elu, na-amanye ikuku sinus site na mgbawa mgbawa ozugbo n'azụ bọọlụ anya (** nchekasị orbital emphysema ***), nke nwere ike kpuo ìsì ozugbo site na ịpịkọta akwara optic.
4. Leba anya n'ọhụụ dị n'anya merụrụ ahụ ugbu a (na-ekpuchi anya na-emerụghị ahụ) ma megharịa nlele ahụ kwa nkeji iri ọ bụla. Mee ka onye ahụ gụọ ebipụta, gụọ mkpịsị aka ole ị na-ebuli elu, ma ọ bụ kwuo ma ọ nwere ike ịhụ mmegharị aka ma ọ bụ ọkụ. Ọ bụrụ na anya anya na-adaba site n'ịgụ akwụkwọ ozi na-agụta naanị mkpịsị aka mgbe a kụsịrị ihu, gwa ndị ọrụ ahụike na ndị dọkịta na-ahụ maka ụlọ mberede ahụ kpọmkwem nkeji ọhụụ malitere ịdaba ka ha mee n'akụkụ akwa ụra ozugbo ** Lateral Canthotomy na Cantholysis (LCC)** n'ime ** 90 nkeji ischemic window **.
5. ** Chekwaa anya na ọta siri ike (ma ọ bụ ala mpempe akwụkwọ/ụfụfụ nke e debere n'ọkpụkpụ brow na cheekbone) na nrụgide ZERO na nku anya. Ọ bụrụ na a na-ahụtaghị anya mmiri na mgbidi anya (** meghere globe mmerụ ahụ **) ma ọ bụ hematoma retrobulbar, nrụgide dị n'èzí ga-ewepụ ihe dị n'ime anya ma ọ bụ mee ngwa ngwa ischemia akwara optic.
6. ** Debe onye ọrịa kpam kpam ihe ọ bụla site n'ọnụ (NPO) ma na-agwọ ọgbụgbọ ma ọ bụ vomiting ozugbo.** Ọgbụgbọ na retching na-eme ka spikes na-eme ihe ike na venous na arterial pressure n'ime isi na anya anya, na-agbasa ọbara ọgbụgba retrobulbar, na ndị ọrịa nwere akwara anya ma ọ bụ retrobulbar hematomas na-achọkarị nkwụsịtụ ịwa ahụ ngwa ngwa ma ọ bụ nrụzi ụlọ ọrụ.

Osisi mkpebi: Ntule nke trauma periorbital na-adịghị ahụkebe, protosis, na mgbaji ọkpụkpụ.¶

flowchart TD
    Start["Ahụhụ na-adịghị ahụkebe na anya, ntì, ma ọ bụ ọkpọiso (nkụkụ, bọọlụ, ọdịda, ma ọ bụ okuku)"] --> GlobeCheck{"Kwụpụ 1: Kwụsị Mepee Mgbawa Globe (ụmụ akwụkwọ anya mmiri/oke elu, anụ ahụ gbara ọchịchịrị na-apụta, balloon conjunctival ọbara 360-degree, ma ọ bụ anya gbajiri agbaji)?"}

    GlobeCheck -->|"EE: A na-enyo enyo na-emepe emepe Globe"| OpenGlobe["Oghere GLOBE PROTOCOL: 1. ZERO pressure on eye; Elelela mgbali intraocular (tonometry). 2. Teepu isiike Fox anya ọta ma ọ bụ akwụkwọ iko n'elu ọkpụkpụ rim. 3. Kpọọ 911/112/999 maka nrụzi microsurgical ophthalmology mberede, ọgwụ nje IV, & antiemetics."]

    GlobeCheck -->|"Mba: Mgbidi Globe na-apụta na ọ dịghị"| OCSCheck{"Kwụpụ 2: Ihuenyo maka Ọrịa Orbital Compartment Syndrome (Retrobulbar Hematoma): Anya na-egbu mgbu na-egbu mgbu (proptosis), mkpuchi siri ike siri ike, ọhụụ dara ada, ma ọ bụ nwa akwụkwọ ume ume (RAPD)?"}

    OCSCheck -->|"EE: Retrobulbar Hematoma / Ocular Compartment Syndrome"| Canthotomy["90-MINUTE Ịwa Ahụ Mberede: 1. Kpọọ 911 / 112 / 999 ozugbo; Nọdụ ala 45-90 degrees. 2. Dọkịta Alert ER na mbata: Achọrọ ozugbo Bedside Lateral Canthotomy & Cantholysis TUPU CT nyocha. 3. Nye IV Mannitol / Acetazolamide / Methylprednisolone dị ka akwa mmiri."]

    OCSCheck -->|"Mba: Ọhụụ nkịtị, Orbit dị nro, Enweghị Proptosis"| MuscleTrapCheck{"Kwụpụ 3: Lelee mmegharị anya pụrụ iche (Lee elu, ala, aka ekpe, aka nri): A na-amachibido nlele elu na ọhụụ abụọ, ma ọ bụ ọgbụgbọ, ọgbụgbọ, na ọnụ ọgụgụ obi nwayọ (<60 bpm)?"}

    MuscleTrapCheck -->|"EE: Mgbochi anya elu + Bradycardia/Ọgbụgbọ (Ọkachasị na nwata/Teen nwere 'Anya ọcha')"| Trapdoor["ỌJỤRỤ ỤLỌ ORBITAL NDỊ NA-ECHICHE NDỊ MMADỤ AHỤ: 1. Ngalaba Mberede Orbital CT Scan UGBUA. 2. Nyochaa ECG maka Oculocardiac Reflex (vagal bradycardia/block heart). 3. Na-achọ ntọhapụ ịwa ahụ ngwa ngwa n'ime awa 24 ruo 48 iji gbochie necrosis muscle na-adịgide adịgide."]

    MuscleTrapCheck -->|"Ọnweghị ntinye akwara ma ọ bụ Bradycardia"| SimpleBlowout["SUSPECT UNCOMPLICATED ORBITAL BLOWOUT FRACTURE (Sunken eye / enophthalmos, numb cheek/upper lip, or crepitus): 1. Strictly NO nose blowing for 4 to 6 weeks. 2. Ngalaba Mberede ngwa ngwa CT nke Orbits iji nyochaa nha mgbawa na sinuses."]

Pathophysiology: Otu oghere anya na-esi aghọ osi nri na-egbu egbu¶

1. Anatomi siri ike nke ọkpụkpụ orbit na akwara canthal¶

Iji ghọta ihe kpatara ntakịrị mkpokọta ọbara ma ọ bụ ikuku dị n'azụ anya na-akpata kpu ìsì ngwa ngwa, tụlee usoro nhazi nke orbit mmadụ: - ** Mgbidi ọkpụkpụ anọ siri ike: *** oghere anya bụ ụdị ube, pyramid nwere akụkụ anọ nwere nkezi olu dị n'ime naanị ** 30 milliliters ($ 30\text{mL}\()**, nke etinyere n'elu (ọkpụkpụ n'ihu / orbital), n'èzí (zygomatic na sphenoid ọkpụkpụ / mpụta), mgbidi na ala (ma ọ bụ ala ọkpụkpụ) / mgbidi etiti). - ** Ọnụ ụzọ n'ihu nke edochiri: *** N'akụkụ oghere ihu nke pyramid ahụ, a na-ejide bọọlụ anya (globe) na abụba orbital n'ime oghere site na mpempe akwụkwọ siri ike (** orbital septum**) wee gbanye ya dị ka eriri guitar n'akụkụ ọkpụkpụ site na ** medial canthal tendon ma ọ bụ ** n'akụkụ akụkụ ya. crura**). - ** Usoro nrube isi nke nrụgide:** Na-adịkarị, izu ike intraorbital na nrụgide intraocular (IOP) bụ **10 ruo 20 millimeters nke mercury (\)\text{mmHg}$)**. N'ihi na mgbidi ọkpụkpụ enweghị ike ịgbasa n'èzí na akwara canthal dị n'akụkụ na-egbochi nku anya ịkwaga ihe karịrị milimita ole na ole n'ihu, orbit nwere ike ịnweta naanị ihe dịka ** 4 ruo 5 milliliters ** nke mgbakwunye mmiri tupu ike agwụchaa anụ ahụ niile. - Ozugbo agbawara ** akwara infraorbital, akwara ethmoidal azụ ma ọ bụ azụ, ma ọ bụ alaka akwara ophthalmic ** na-agbapụta ihe karịrị milliliters 5 n'ime cone muscle retrobulbar (ma ọ bụ mgbe a na-amanye ikuku sinus n'okpuru nrụgide), nrụgide intraorbital na-agbago n'akụkụ akụkụ ihe na-emepe emepe na ** 8 mm H.

2. The vaskụla strangulation cascade (Ocular Compartment Syndrome)¶

Dị ka nnukwu ọrịa akụkụ akụkụ n'ụkwụ ma ọ bụ n'ihu gbajiri agbaji (lee mmerụ ahụ na akụkụ syndromes), mgbe nrụgide dị n'ime oghere orbital gbachiri emechi karịrị nrụgide perfusion nke obere akwara na-enye anya na akwara optic: 1. ** Mpụpụ Ọpụpụ venous (\(> 25\text{ga }30\text{mmHg}\)):** A na-ebu ụzọ mechie vein retinal vein nke dị gịrịgịrị na veins vortex, na-adọta ọbara venous n'ime anya wee na-akawanye njọ. 2. ** Short Posterior Ciliary and Vasa Nervorum Ischemia (\(> 35\text{to }45\text{mmHg}\)):** Obere obere ụgbọ mmiri na-enye isi irighiri akwara ihu na retrobulbar optic akwara ndakpọ, na-akpata ischemic optic neuropathy. 3. ** Central retinal artery Occlusion (\(> 60\text{to }80\text{mmHg}\)):** Mgbe orbital na intraocular mgbali na-abịaru nso diastolic ọbara mgbali, Central retinal artery na-akwụsị na-eru n'oge diastole (anya na ophthalmoscope dị ka a pulsating Central retinal artery) wee mechie kpamkpam. 4. ** Ohere ịlanahụ nke nkeji 60 ruo 120:** Ihe ọmụmụ izizi na ụlọ ọgwụ na-egosi na ozugbo ischemia retinal na optic akwara zuru ezu na-amalite na ọrịa Orbital Compartment Syndrome, ** ịwa ahụ nke a na-eme n'ime nkeji 60 ruo 90 na-eweghachi ọhụụ nkịtị ma ọ bụ nso-nkịtị n'ihe karịrị pasenti 85 nke ndị ọrịa nwere nkụda mmụọ. nkeji (awa 2 ruo 4)** na-ahapụ onye ọrịa ugboro ugboro ka ọ kpuo ìsì n'anya ahụ.

3. Mechanics nke Orbital Blowout Fracture (Hydraulic vs. Buckling Theory)¶

Kedu ihe kpatara ala ma ọ bụ mgbidi dị n'ime oghere anya ji agbawa ebe ọkpụkpụ dị arọ dị n'akụkụ mpụta anya na-agbajighị? - ** Usoro hydraulic:** Mgbe ihe dị okirikiri karịrị 5 centimeters (2 sentimita) na dayameta (dị ka ọkpọ, baseball, cricket ball, ma ọ bụ bọọlụ tenis) kụrụ n'ihu anya, ọ na-atụgharị anya bọọlụ azụ n'ime cone 30-milliter nke abụba orbital na-enweghị mgbagha. Igwe nrụgide hydraulic na mberede ahụ gbawara n'èzí megide mgbidi ọkpụkpụ anọ niile wee gbapụ ọkpụkpụ "valve" dị gịrịgịrị n'ime okpokoro isi: 1. ** Ulo elu Orbital Posterior-Medial (Roof of the Maxillary Sinus):** Naanị ** 0.5 millimeters gbara ọkpụrụkpụ**, na-esiwanye ike site na uzo na ọwa mmiri na-ebu ** akwara infraorbital ($ V_2$). 2. ** The Medial Orbital Wall (Lamina Papyracea of ​​the Ethmoid Sinus): Asụgharị n'ụzọ nkịtị dị ka " oyi akwa mpempe akwụkwọ " (naanị ** 0.2 ruo 0.4 millimeters gbara ọkpụrụkpụ**). - ** Usoro ihe eji eme ihe:** Ogbugbu ozugbo na oke oke orbital dị ala (ọnụ cheekbone) na-ebunye igwe nrụgharị azụ azụ nke na-ejide ala orbital dị mkpa ozugbo n'azụ ya na-agbajighị bọọlụ anya n'onwe ya.

Ntụle zuru oke nke 4 nnukwu ihe mberede orbital post-traumatic¶

Ntuziaka ụlọ ọgwụ zuru oke maka ihe mberede 4 orbital trauma¶

1. Retrobulbar Hematoma na Bedside Lateral Canthotomy & Cantholysis (LCC)¶

Kedu ihe kpatara ndị ọrịa nwere hematoma retrobulbar ji ka na-ahụ ụzọ n'ụlọ ọgwụ ọgbara ọhụrụ? Ihe kpatara #1 bụ ** na-echere nyocha CT orbital ma ọ bụ na-echere iji Tono-Pen tụọ nrụgide intraocular tupu ibelata akwara canthal mpụta . - ** Nchọpụta ụlọ ọgwụ n'akụkụ ihe ndina (Ọ dịghị CT achọrọ): Ọ bụrụ na onye ọrịa trauma (ma ọ bụ onye ọrịa nke emere nkuchi anya blepharoplasty n'oge na-adịbeghị anya, ịwa ahụ sinus, ma ọ bụ ngọngọ anestetiiki retrobulbar) na-egosi "4 Ps of Orbital Compartment Syndrome": 1. ** Mgbu *** (oke mgbu orbital na-egbu mgbu). 2. ** Proptosis *** (mgbawa n'ihu nke ụwa nwere oke nguzogide siri ike na retropulsion dijitalụ dị nro na mkpuchi mechiri emechi). 3. Ahụhụ nke ụmụ akwụkwọ (nrụrụ nwa akwụkwọ na-adịghị ahụkebe [RAPD] n'ule ọkụ ọkụ ọkụ, ma ọ bụ nwa akwụkwọ gbajiri ume ume). 4. ** Ọhụụ dara ogbenye / na-agbadata ** (ma ọ bụ enweghị ike ịlele ọhụụ na onye ọrịa nwere trauma nke nwere anya prototic siri ike nke nwere RAPD ma ọ bụ nrụgide intraocular \(>40 ederede{mmHg}\)). - ** Kedu ka Canthotomy dị n'akụkụ na Cantholysis dị ala si echekwa anya n'ime nkeji abụọ:* - N'ime ebe a na-emeghachi ihe mberede, dọkịta ahụ na-agbanye 1 ruo 2 milliliters lidocaine na epinephrine n'akụkụ nkuku nku anya (** mpụta canthus ), na-agbanye n'akụkụ canthus dị n'akụkụ maka 30 sekọnd na hemostat iji gwepịa arịa ọbara, na-eme ka 1-centimeter horizontalthos na iriors () - Ihe kpatara na naanị Canthotomy ezughị: Naanị ịcha akpụkpọ ahụ n'akụkụ nkuku anya na-agbadata nrụgide orbital site na milimita ole na ole nke mercury. Dọkịta ahụ ga-ewepụrịrị nkuchianaya ala n'anya bọọlụ, nwee mmetụta na ntụmadị mkpa maka ike siri ike, eriri guitar dị ka ** obere crus nke akwara canthal mpụta**, wee snip akwara ahụ kpamkpam (** cantholysis dị ala**). - Oge a na-egbutu crus dị ala, nkuchianya nke ala na-adaba kpamkpam, bọọlụ anya na-aga n'ihu 4 ruo 6 millimeters iji mebie oghere retrobulbar, nrụgide intraorbital na-agbada site na ** 20 ruo 40 mmHg n'ime sekọnd **, ọbara akwara na-agbaghachikwa azụ n'ime akwara retina Central na akwara anya.

2. Ọrịa ụmụaka "White-Eyed" ọnyà ọnyà na mgbawa nke Oculocardiac Reflex na-egbu egbu.¶

N'ime ụmụaka, ndị nọ n'afọ iri na ụma, na ndị na-eto eto na-erubeghị afọ 20, ọkpụkpụ nke ala orbital bara ụba na collagen na-agbanwe ma ọ ka na-agbaji dị ka ọkpụkpụ okenye: - Mgbe bọọlụ, ikpere, ma ọ bụ ikpere na-akụ nwata ahụ n'anya, ala orbital dị mkpa na-ehulata ala dị ka ihe mgbakwasị ụkwụ greenstick, abụba orbital na anụ ahụ dị ala ** (nke na-anọdụ n'ala ozugbo n'ala) herniate nwa oge site na mgbape, na ọkpụkpụ na-agbanwe agbanwe ** na-agbadata ozugbo n'ime ebe dị ka mmiri na-ebunye ọnyà na ọnyà ya. agba. - Ihe kpatara eji achọpụta ya dị ka mgbakasị ahụ: N'ihi na ọkpụkpụ na-agbanwe ụmụaka na-adaghachi azụ nke ọma na-akụjisịghị, ** a na-enwekarị anya ojii efu, ọbara ọgbụgba subconjunctival efu, yana "anya ọcha" na-ele anya nke ọma n'èzí . Otú ọ dị, mgbe a na-agbatị ahụ ike nke dị ala nke dị ala, ọ na-eme ka mgbaàmà na-egbuke egbuke na-eme ka ** nkewa ophthalmic nke akwara trigeminal (Cranial Nerve V) na ụbụrụ ụbụrụ, nke na-agba ọkụ ozugbo na ** vagus nerve (Cranial Nerve X) na obi na afo (* The Oculocardiac / Aflex Reflex). - Ọnyà mgbakasị ahụ: N'ihi na nwatakịrị ahụ na-agbọ agbọ ugboro ugboro, na-achakwa ọcha na ọsụsọ na-agba ya, na-enwe isi ọwụwa/ụra, na-enwekwa isi ọwụwa na anya na-ele anya n'èzí, ndị ọrụ mberede na-achọpụtakarị nwa ahụ nwere mmerụ ahụ isi ma ọ bụ mgbakasị ahụ ma tụọ CT ụbụrụ ụbụrụ nke na-efunahụ orbit dị ala. - ** Otu esi amata ya ozugbo:** Lelee ọnụ ọgụgụ obi nwata ahụ ** (na-adịkarị nwayọ na ** 35 ruo 55 iti kwa nkeji **, yana mgbanarị mgbanarị ma ọ bụ njide nhịahụ) na ** rịọ nwa ahụ ka ọ soro mkpịsị aka gị wee lelie anya elu n'elu ụlọ. Ọ bụrụ na anya merụrụ ahụ enweghị ike ibugharị n'elu gafee etiti etiti wee na-ele anya elu na-akpalite ọgbụgbọ, mgbu anya, na mbelata nke akwara obi, nwatakịrị ahụ nwere mgbaji mgbaji agbaji n'ụzọ ọnyà ** chọrọ ntọhapụ ịwa ahụ ngwa ngwa n'ime awa 24 ruo 48 ** tupu uru ahụ a na-ahụ anya na-ata ahụhụ na-adịgide adịgide nke muscle ischemic eyecrosis (Volk necrosis).

3. Nerve Infraorbital (\(V_2\)) Ọnwụ: Ihe ngosi zoro ezo na mgbaji n'ala Orbital¶

Kedu otu ị ga-esi mara n'ebe ihe mberede mere ma anya ojii fụrụ akpụ bụ naanị ọnya anụ ahụ dị nro ("shiner") ma ọ bụ ọkpụkpụ dị n'okpuru ** orbital floor blowout fracture**? - Gbaa mkpịsị aka gị obere ihe n'ofe ** aka ekpe na aka nri onye ahụ, akụkụ imi imi, egbugbere ọnụ elu, jụọ ha ma ezé ihu ha dị elu na-eche "osisi" ma ọ bụ ọgbụgbọ *** (dị ka mgbe a gbasịrị eze Novocain). - The ** infraorbital nerve *** (alaka nke ngalaba maxillary nke akwara trigeminal, $ V_2$) na-agba ọsọ ozugbo site na oghere ọkpụkpụ dị obere n'ime ala nke oghere anya tupu ọ pụta na ntì iji nye mmetụta n'etiti ihu na ezé elu. - Ọ bụrụ na ntigbu n'anya na-akpata ** ọnụọgụ ma ọ bụ ntụtụ-na-a ga-adị na egbugbere ọnụ elu, chịngọm elu/ezé, na ntì n'otu akụkụ **, mgbaji mgbaji n'ala nke orbital ** site na ọwa mmiri infraorbital dị ruo mgbe achọpụtara na ọ bụghị site na nyocha CT orbital.

4. Orbital Emphysema: Ihe kpatara na ịfụ imi na-atụgharị mgbaji dị mfe ka ọ bụrụ ụgbọ elu gaa na Orbit.¶

Mgbe mgbidi nke etiti (* lamina papyracea*) ma ọ bụ ala nke mgbaji orbit, abụba na-adịghị mma nke oghere anya na-ekwurịta okwu ozugbo na ikuku jupụtara ** ethmoid ma ọ bụ maxillary nasal sinuses **: - N'okpuru iku ume nkịtị, nrụgide ikuku n'ime imi dị ala. - Agbanyeghị, ** ịfụ imi n'ike na-ebute nrụgide intranasal nke 60 ruo ihe karịrị 100 mmHg ** (nke dabara na ịgbanye taya ụgbọ ala). - Mgbawa ahụ nke ikuku na-adịghị ọcha na imi na-esi na ọkpụkpụ gbawara n'ime nku anya (na-akpata balloon mberede nke nku anya ya na mgbawa "Rice Krispies" subcutaneous crepitus mmetụta n'okpuru mkpịsị aka gị) na n'azụ nku anya. - Ọ bụrụ na mpịachi nke sinus mucosa ma ọ bụ orbital abụba na-eme dị ka ball-valve ** (ikwe ka ikuku banye n'oge imi na-afụ ma ọnyà ya ka ọ ghara ịlanarị azụ n'ime sinus), akpa ikuku ahụ tọrọ atọ na-ejikọta akwara etiti retinal na akwara optic ( Tension Orbital Emphysema ), na-eme ka kru ìsì nke na-achọ mkpatụ ikuku ikuku. - Na mgbakwunye, ịmanye nje bacteria sinus nasal emetọọ n'ime abụba orbital na-adịghị mma na-emepụta nnukwu ihe egwu egwu egwu orbital cellulitis na cavernous sinus thrombosis, nke mere na a na-egbochi ndị ọrịa nwere mgbawa orbital na-akpakọrịta sinus ịfụ imi ha, ịkwọ mmiri mmiri, ma ọ bụ ịkpọ ngwa ikuku maka izu 4 ruo 6 **.

Wepụ mgbe niile mgbawa Open Globe tupu emetụ anya¶

Mgbe ọ bụla ọkpọ, baseball, BB pellet, bottle cork, ma ọ bụ iko gbajiri agbaji kụtara anya, ike nke na-agbaji ọkpụkpụ orbital nwekwara ike ịgbawa mgbidi nke anya bọọlụ n'onwe ya (Open Globe Rupture). Tupu ikwe ka onye ọ bụla pịa na nkuchianaya ma ọ bụ lelee esemokwu orbital, lelee anya anya maka ** Ihe ịrịba ama isii nke mgbawa Globe mepere emepe : 1. ** Nwa akwụkwọ "anya mmiri" ma ọ bụ ọnụ ọgụgụ dị elu: ** Nwa akwụkwọ anaghịzi agba gburugburu; a na-adọba ya n'ụdị anya mmiri tụrụ atụ nke na-atụ aka n'akụkụ nkuku nke cornea ma ọ bụ sclera ebe mgbidi bọọlụ anya gbawara na iris gbachie oghere ahụ. 2. ** 360-Degree Bloody Ballooning of the Conjunctiva (Bullous Hemorrhagic Chemosis): Akpụkpọ ahụ doro anya na-acha ọcha nke anya na-aza aza n'ime mgbanaka siri ike, ọbara ọbara, jelii yiri mgbanaka gbara ya gburugburu gburugburu cornea, na-ezobe mgbawa scleral n'okpuru. 3. ** Agba aja aja ma ọ bụ Black Pigment (Uveal Prolapse) Na-arapara na Ọcha nke Anya: ** Agbalịla ihichapụ "ebe unyi" ojii ma ọ bụ aja aja gbara ọchịchịrị na sclera mgbe trauma gasịrị; ọ bụ iris onye ọrịa ma ọ bụ ahụ ciliary na-apụta site na sclera gbawara agbawa. 4. ** Ụlọ dị omimi ma ọ bụ na-emighị emi / Flat Anterior Chamber (ma ọ bụ Hyphema):** Oghere dị n'azụ cornea jupụtara na ọbara nwere akwa akwa (hyphema, lee. mmerụ anya) ma ọ bụ anya dara ada tụnyere anya nke ọzọ. 5. ** Extrusion nke Clear jelii (Vitreous Humor)** n'elu anya. 6. ** Ọhụụ siri ike na anya dị nro, nke na-ele anya nke ọma.**

Ọ bụrụ na ihe ịrịba ama ọ bụla nke mgbawa ụwa mepere emepe dị, ** kwụsị ịhịa aka n'ahụ ozugbo, kpachie ọta Fox siri ike ma ọ bụ n'okpuru iko akwụkwọ n'elu brow na cheekbone na-enweghị kọntaktị na anya, mee ka onye ọrịa kwụ ọtọ ma dị jụụ, kpọọ 911/112/999**.

Nọmba mberede mpaghara na ụkpụrụ ụlọ ọrụ¶

• United States na Canada: Kpọọ 911 maka ibuga ngwa ngwa gaa na Ọkwa I ma ọ bụ Ọkwa II Trauma Center nwere ọgwụ mberede 24/7 na Ophthalmology / Oculoplastic Surgery ike. N'okpuru ** American College of Emergency Physicians (ACEP) , ** Advanced Trauma Life Support (ATLS), na ** American Academy of Ophthalmology (AAO) ** ntuziaka, a zụrụ ndị dọkịta mberede na nzere ka ha rụọ n'akụkụ ụra ozugbo ** Lateral Canthotomy na Cantholysis (LCC)* tupu CT imaging maka Orbital Combital.
• United Kingdom: Kpọọ 999 (ma ọ bụ 112). N'okpuru ** Royal College of Medical Emergency (RCEM)*** na Royal College of Ophthalmologists (RCOphth) trauma ụkpụrụ, retrobulbar hemorrhage with visual loss bụ nkewa dị ka ihe mberede ịwa ahụ ozugbo emere n'ime Ụlọ Mweghachi nke Ngalaba Mberede tupu nnyefe redio.
• European Union: Kpọọ 112. Soro ** European Resuscitation Council (ERC)** na ụzọ trauma maxillofacial/ophthalmic nke mba maka mgbakasị orbital ozugbo na maxillofacial CT angiography.
• Australia na New Zealand: Kpọọ 000 na Australia ma ọ bụ 111 na New Zealand. Soro RANZCO (Royal Australian na New Zealand College of Ophthalmologists) na ANZCOR ntụzịaka trauma anya.
• India na Asia-Pacific: Kpọọ 112 na India, 119 na Japan na South Korea, ma ọ bụ 995 na Singapore. Rịọ mbugharị ozugbo gaa n'ụlọ ọgwụ trauma dị elu nwere onyonyo CT, ụzọ ikuku/ikike ịwa ahụ ọgwụ mberede na mkpuchi anya.

Lee nọmba mberede maka nọmba izipu ihe mberede mba ụwa niile.

Ajụjụ a na-ajụkarị¶

Kedu ihe kpatara na enweghị m ike itinye mkpọ ice ozugbo na anya ojii fụrụ akpụ ozugbo m nwesịrị ihe siri ike?¶

Ruo mgbe dọkịta na-enyocha bọọlụ anya wee gosi na mgbidi nke ụwa adịghị emebi emebi na enweghị hematoma retrobulbar, itinye ibu nke mkpọ ice ma ọ bụ ịpị mkpakọ oyi ozugbo na nkuchianaya dị ize ndụ. Ọ bụrụ na e nwere mgbawa scleral zoro ezo (oghe ụwa), ịdị arọ nke mkpọ ice nwere ike ịpịnye oghere dị n'ime na jelii vitreous n'anya; Ọ bụrụ na enwere hematoma retrobulbar, nrụgide dị n'èzí na-agbakwunye na nrụgide dị ize ndụ na-akpagbu irighiri akwara anya. Chebe anya mgbe niile n'elu ọnụ ọkpụkpụ kama.

Kedu ihe kpatara anya m ji gbapụta dị ka bọọlụ gọlfụ ozugbo m furu imi m mgbe a kụrụ ya ihu?¶

Ọkpụkpụ nke kewapụrụ ime na ala oghere anya gị na sinuses imi gị erughị ọkara millimita oke na-agbajikwa ugboro ugboro n'oge mmerụ ihu na-adịghị mma ọbụlagodi mgbe mpụta ihu gị dị mma. Mgbe ị na-atụnye imi gị ka ịfụ imi gị, ị na-ebute nrụgide ikuku karịrị 60 ruo 100 mmHg n'ime akụkụ imi gị, nke na-agbawa ikuku sinus na nje bacteria kpọmkwem site na ọkpụkpụ ahụ gbawara n'ime nku anya gị na n'azụ anya gị (** orbital emphysema ***); ọ bụrụ na ọhụụ na-agba agba ma ọ bụ na anya na-adị ike mgbe ịfụsịrị imi gị, gaa na ụlọ mberede ozugbo.

Kedu ihe kpatara na nwata na-agbọ agbọ na-eji nwayọọ nwayọọ na-akụ ya na anya ya na-emekarị ka ọ na-aghọtahie ya?¶

Ụmụaka nwere ọkpụkpụ ala orbital na-agbanwe agbanwe nke na-emeghe na mmetụta ma na-emechi azụ azụ dị ka ụzọ ọnyà mmiri jupụtara, na-akụda akwara anya ike dị ala na-ahapụghị ọtụtụ anya ojii n'èzí. Mgbatị ahụ akwara anya tọrọ atọ na-akpali trigeminal-vagal **oculocardiac reflex**, nke na-ebute ọgbụgbọ, ọgbụgbọ, akpụkpọ ahụ na-acha uhie uhie, ike ọgwụgwụ, na ọnụma obi na-adị ngwa ngwa (bradycardia). Gwa nwata ọ bụla nwere mmerụ ihu ka ọ na-elegide anya n'uko ụlọ; ọ bụrụ na otu anya enweghị ike ibuli elu, ọ bụ mgbaji agbaji agbaji agbaji agbaji, ọ bụghị naanị mkparị.

Canthotomy Lateral na Cantholysis ọ na-ahapụ ọnya na-emebi emebi na akuku nkuchianaya?¶

Mba; Canthotomy dị n'akụkụ akwa na cantholysis dị ala bụ obere snip 1 centimita dị ọcha na mpụta eke nkuchianaya ebe ndị dọkịta na-awa oculoplastic ịchọ mma na-eme mbepụ. Ozugbo ọzịza retrobulbar kwụsịrị ruo ọtụtụ ụbọchị, onye na-ahụ maka anya ma ọ bụ dọkịta na-awa rọba nwere ike ijikọ akaị na akụkụ nke nkuchianaya ahụ n'ụzọ dị mfe yana ọnya a na-adịghị ahụ anya, ebe ịghara ime ịkpụ ahụ n'ime nkeji 90 na-akpata kpuru ìsì na-adịgide adịgide.

Ọgbajie mgbaji niile nke orbital ọ na-achọ ịwa ahụ iji tinye efere na oghere anya?¶

Mba; Ihe karịrị ọkara nke ndị toro eto orbital na mgbaji gbajiri mgbidi etiti na-agwọ nke ọma na-enweghị ịwa ahụ. Ndị dọkịta na-ahụ maka anya na ndị dọkịta na-awa maxillofacial na-arụ ọrụ ozugbo (n'ime awa 24 ruo 48) ma ọ bụrụ na anụ ahụ anya na-ejide onwe ya na-eme ka ọkpụkpụ oculocardiac reflex ma ọ bụ na-edozi ọhụụ abụọ, ma ọ bụ subacutely (n'ime ụbọchị 7 ruo 14 ozugbo ọzịza na-agbada) ma ọ bụrụ na mgbaji na-ekpuchi ihe karịrị pasent 50 nke elu anya ma ọ bụ na-eme ka ọkpụkpụ anya na-aga n'ihu. sikwa azụ azụ (**enophthalmos**) ihe karịrị milimita 2.

Enwere m ike ịfe n'ụgbọelu ma ọ bụ jiri mgbaji gbajiri agbaji agbaji agbaji agbaji agbaji agbaji agbaji agbaji agbaji?¶

Ụgbọ elu na ophthalmologists n'ozuzu ndụmọdụ na-echere ruo mgbe orbital mgbawa na sinus nkwurịta okwu ma ọ bụ orbital ikuku (pneumo-orbit) e enyochala na kpochapụ (nke a 1 ka 2 izu maka azụmahịa ụlọ ụgbọ elu ma ọ bụrụ na retrobulbar ikuku dị ugbu a, n'ihi na tọrọ atọ ikuku n'ime anya anya gbasaa site 25 ka 30 percent na ụlọ elu dị ka, nwa okoro optik). Amachibidoro mmiri mmiri mmiri ruo mgbe ọgwụgwọ ọkpụkpụ zuru oke (izu anọ ruo asatọ), n'ihi na nkpuchi nkpuchi na sinus barotrauma nwere ike ịkpata ọgba aghara orbital hemorrhage ma ọ bụ emphysema.

Ntuziaka emetụtara¶

• Ahụhụ anya na nlekọta mberede
• Anya ihe mba ọzọ, abrasion corneal, na ọkụ ịgbado ọkụ
• mmerụ ahụ na mgbakasị isi
• Orbital cellulitis, cavernous sinus thrombosis, na ihe ize ndụ ihu triangle

Isi mmalite na nduzi ọchịchị¶

• ** Kọmiti American College of Surgeons (ACS, United States) kọmitii na trauma:** * Advanced Trauma Life Support (ATLS) Akwụkwọ ntuziaka ụmụ akwụkwọ* (Ocular Trauma and Emergency Orbital Compartment Syndrome / Lateral Canthotomy na Cantholysis protocols).
• ** American Academy of Ophthalmology (AAO, United States):** * Nkwupụta EyeWiki na Clinical na njikwa nke mgbawa Orbital Blowout Fractures, Pediatric White-Eyed Trapdoor Fractures, na Retrobulbar Hemorrhage*.
• ** Royal College of Medical Emergency (RCEM) na Royal College of Ophthalmologists (RCOphth, United Kingdom): *** Ntuziaka Omume Kasị Mma: Ọrịa Orbital Compartment Syndrome na Emergency Lateral Canthotomy na Cantholysis *.
• ** American College of Emergency Physicians (ACEP, United States):** * Usoro ọgwụgwọ na ọgwụ mberede: Njikwa oke nke anya na Maxillofacial Trauma*.
• ** Royal Australian na New Zealand College of Ophthalmologists (RANZCO): *** Ntuziaka nlekọta ahụike maka nnukwu ọnyà anya na Nchedo Globe.