Orbital Cellulitis, Matenda Otupa Maso, ndi Cavernous Sinus Thrombosis¶

Kutupa kwachangu, kofiyira, diso lanthete mwa mwana kapena wamkulu, kapena chithupsa, pimple, kapena sinus/mano matenda Ali pakati pa mlatho wa mphuno ndi ngodya za pakamwa (the "Danger Triangle of the Face"), amatha kuchuluka pakangotha ​​maola ochepa kuchokera ku matenda akhungu (**preseptal kapena periorbital) kulowa mu cellulitis yozama * diso (postseptal kapena orbital cellulitis) kapena magazi omwe ali ndi kachilombo m'munsi mwa ubongo (septic cavernous sinus thrombosis [CST]). Chifukwa diso la diso la munthu (bony orbit **) ndi bosi lolimba, lotsekedwa lolumikizidwa mwachindunji ku ubongo wa cavernous venous sinuses ndi mitsempha yopanda valve, mafinya kapena kutupa kumbuyo kwa fibrous ** orbital septum ** mofulumira imaphwanya mitsempha ya optic, imapuwala minofu ya diso, ndikufalitsa mabakiteriya molunjika mu chigaza. Kuzindikira mwamsanga "6 Orbital Red Flags" (kupweteka kwa diso, diso lotukuka, masomphenya awiri, kutsekedwa kwa maso, kutaya masomphenya, kapena kusokonezeka kwa pupil reflex) ndi maantibayotiki ofulumira m'chipatala amapulumutsa masomphenya ndi moyo.

Chitani izi tsopano¶

1. Gawani pang'onopang'ono zikope zotupa (popanda kukanikiza diso lokha) ndikufufuza 4-Step Bedside Orbital Triage Check:
2. Khwerero 1 (Kuyenda kwa Diso & Kuwona Ululu): Gwirani chala chanu \(30\text{centimeters}\) (\(12\text{inches}\)) kutsogolo kwa nkhope ya wodwalayo ndikuchisuntha pang'onopang'ono mu ndondomeko ya "H" (kumanzere, kumanja, mmwamba, pansi). Kodi kusuntha diso kumayambitsa **kuwawa kozama kuseri kwa diso **, kapena diso lotupa **limakhala kumbuyo kapena kulephera kusuntha kwathunthu ** kupangitsa kuwona kawiri?
3. Khwerero 2 (Proptosis / Bulging Check): Imani molunjika kumbuyo kwa wodwala yemwe wakhala pansi, tembenuzirani mutu wawo kumbuyo pang'ono, ndipo yang'anani pansi pamphumi pawo pa nsidze zonse ziwiri. Kodi diso la diso lomwe lakhudzidwa ** limatuluka patsogolo ** kuposa diso lathanzi (kapena diso likukankhira pansi ndi kunja)?
4. Khwerero 3 (Kuwona Kuwoneka bwino & Kuwoneka Kwamtundu Wofiyira): Phimbani diso lathanzi ndikuwonetsetsa ngati wodwalayo amatha kuwerenga zilembo zazing'ono bwino. Gwirani chinthu chofiira kwambiri (monga kapu ya botolo lofiira) kutsogolo kwa diso lathanzi ndiyeno diso lotupa: ngati mtundu wofiira ukuwoneka ** wofiyira, lalanje, kapena bulauni / imvi ("red desaturation")** mu diso lotupa, ** mitsempha ya optic ikuphwanyidwa **.
5. Khwerero 4 (Kuwona Kufalikira Kwapawiri Kwa Cavernous Sinus Thrombosis): Yang'anani diso LINA (losiyana). Ngati kutupa, kufiira, kugwa kwa chikope, kapena kuwonongeka kwa minofu ya diso kumayamba kufalikira ku **diso lachiwiri mkati mwa maola 24 mpaka 48 **, limodzi ndi mutu waukulu kapena kutentha thupi, ganizirani Cavernous Sinus Thrombosis nthawi yomweyo.
6. Pitani ku dipatimenti yachipatala mwamsanga ngati Mbendera 6 Orbital Red ilipo, kapena ngati wodwala ali mwana wosakwanitsa chaka chimodzi, alibe chitetezo chokwanira, kapena sangathe kutsegula diso mokwanira kuti afufuze. Imbani 911 ku United States ndi Canada, 112 kudutsa European Union, 999 ku United Kingdom, kapena muwone zonse. manambala angozi.
7. Musamafinya, mphuno, mikondo, kapena kuboola pimple, wiritsani (furuncle), carbuncle, kapena tsitsi lamphuno lolowera mkati mwa "Danger Triangle of the Face." Makona atatu omwe amachokera ku ** mlatho wa mphuno kupita kumanzere ndi kumanja kwa kamwa** amakhetsa chammbuyo kudzera m'mitsempha yopanda valavu kulowa m'kati mwa *angular chigaza. Kufinya chithupsa cha nkhope kumakankhira mabakiteriya a Staphylococcus aureus ndi timadontho tating'onoting'ono tomwe timatsekera mmbuyo ku ubongo.
8. Ikani wodwala kukhala mowongoka mutu wake utakwezedwa pa \(30\mawu{mpaka}45\malemba{digrii}\) ndi kuwasunga Nothing by Mouth (NPO). Kukhala mowongoka kumachepetsa kuthamanga kwa venous ndi kuchulukana kwamadzimadzi mkati mwa orbit ndi cavernous sinus. Pewani chakudya ndi zakumwa chifukwa chiphuphu cha orbital subperiosteal nthawi zambiri chimafuna kujambulidwa kwadzidzidzi kwa CT ndi opaleshoni ya endoscopic sinus/orbital drainage pansi pa anesthesia wamba.
9. OSATI kukanikiza kotentha kwa munthu amene akuganiziridwa kuti orbital cellulitis kapena chiphuphu chakumaso chomwe chikuchulukirachulukira komanso kutentha kwambiri, ndipo OSATIKO mankhwala osabala m'maso. Ngakhale kukanikiza kotentha kumakhala kothandiza pakhungu laling'ono (hordeolum), orbital cellulitis yoopsa imafuna kutulutsa mwachangu maantibayotiki a m'mitsempha ndi CT.
10. Yang'anani zifukwa zomwe zimayambitsa mafangasi (Mucormycosis): Ngati wodwala matenda adiabetic ketoacidosis (DKA), matenda a shuga osayendetsedwa bwino, neutropenia, chemotherapy, kapena kugwiritsa ntchito mankhwala a corticosteroid aposachedwa kwambiri amayamba kuwawa kumaso, kutupa kwa diso, ndi zotupa zakuda kapena zotupa pakamwa pamphuno. (m'kamwa), lengezani zadzidzidzi zadzidzidzi za Rhino-Orbital-Cerebral Mucormycosis pachipatala.

Mtengo wa chisankho wotupa wamaso ndi ngozi zitatu¶

Gwiritsani ntchito tchati chachipatalachi kuti musiyanitse kutupa kwa zikope kuchokera kukuya kwa orbital cellulitis, cavernous sinus thrombosis, ndi fungal mucormycosis.

flowchart TD
    Start["Kutupa Kwambiri, Kufiyira, Kapena Kupweteka kwa Chikope"] --> OpenCheck{"Pang'onopang'ono Gawani Zikope:<br/>Yang'anani Mayendedwe a Maso, Masomphenya, & Kaimidwe"}

    OpenCheck -->|"ILIYONSE ORBITAL RED FLAG PRESENT:<br/>- Kupweteka mukasuntha diso<br/>- Kuyenda kwa diso kosalekeza kapena Kuwona Pawiri<br/>- Mpira wa diso ukutukuka kutsogolo (Proptosis) kapena kukankhira pansi<br/>- Kusawona bwino, kufiyira kotsukidwa, kapena RAPD<br/>- Chikope chotchinga kwambiri kuti chifufuze"| OrbitTrue["POSTSEPTAL (ORBITAL) CELLULITIS<br/>kapena SUBPERIOSTEAL ABSCESS:<br/>1. Pitani ku Chipatala cha Emergency Department NTHAWI YOMWEYO<br/>2. Khalani mowongoka pa madigiri 30 mpaka 45<br/>3. Musasunge Chilichonse mwa Mouth (NPO) pa CT scan & opaleshoni <br/>4. Amafunikira maantibayotiki a IV + ENT/Ophthalmology"]

    OrbitTrue --> CSTCheck{"Kodi Maso Onse Awiri Akukhudzidwa,<br/>kapena Kupweteka Kwambiri kwa Mutu / Cranial Nerve Palsy <br/>(CN III, IV, V1/V2, VI) / High Spiking Fever?"}

    CSTCheck -->|"INDE: Kufalikira kwa diso losiyana mkati mwa 24-48h, <br/>miyendo yamaso oundana, dzanzi pamphumi/tsaya, meningismus,<br/>kapena kutsogozedwa ndi mphuno/nkhope chithupsa kapena sphenoid sinusitis"| CST["SEPTIC CAVERNOUS SINUS THROMBOSIS (CST):<br/>1. Imbani 911/112/999 Nthawi yomweyo<br/>2. Ngozi Yadzidzidzi Yowopsa Yam'mimba <br/>3. Ikufunika stat IV Vancomycin + Ceftriaxone + Metronidazole,<br/> MRV/CTV brain venogram, ndi IV anticoagulation"]

    CSTCheck -->|"Matenda a shuga a Ketoacidosis (DKA), Neutropenia,<br/>kapena Immunosuppression + Black Eschar mu Mphuno/M'kamwa"| Mucor["RHINO-ORBITAL-CEREBRAL MUCORMYCOSIS:<br/>Kuwonongeka Mwamsanga Mwamsanga + IV Liposomal Amphotericin B"]

    OpenCheck -->|"NO ORBITAL RED FLAGES:<br/>- Kusawawa, kusuntha kwamaso kosalala kumbali zonse<br/>- Kuwona kwabwinobwino kwa 20/20 & kukhathamira kwamtundu wofiyira wofiyira<br/>- Palibe kuphulika kwa diso; white sclera imawoneka bwino<br/>- Kutupa kumangokhala pakhungu lakunja"| PreseptalCheck{"Nchiyani Chinayambitsa Kutupa kwa Kunja<br/>Chikope?"}

    PreseptalCheck -->|"Kutentha thupi, chikope chofiyira chofunda,<br/>kulumidwa ndi kachilombo posachedwa, kukanda, kapena sinusitis"| Preseptal["PRESEPTAL (PERIORBITAL) CELLULITIS:<br/>Kuwunika kwachipatala kwanthawi yomweyo kwa maantibayotiki amkamwa<br/>(kapena maantibayotiki a IV ngati mwana wazaka 1 kapena kukhwima)<br/>Yang'anirani maola 4 aliwonse pa Orbital Red Flags iliyonse"]

    PreseptalCheck -->|"Kaphuphu kakang'ono ngati pimple pa<br/>pamphepete mwa kope (Stye) kapena nandolo wosamva kupweteka<br/>mkati mwa chivindikiro (Chalazion), osatentha thupi"| Stye["HORDEOLUM (STYE) KAPENA CHALAZION:<br/>Pakani kotentha koyera kwa mphindi 10-15 4x tsiku lililonse;<br/>Osafinya kapena kutulutsa chotupa cha chikope"]

Malire a Anatomical: Chifukwa chiyani Orbital Septum ndi chiwombankhanga chamaso¶

Kuti mumvetse chifukwa chake zikope ziwiri zotupa zomwe zimawoneka ngati zofanana kuchokera kuchipinda chonsecho zitha kukhala ndi zotulukapo zosiyana, muyenera kumvetsetsa tsamba lopyapyala lolimba la minofu yolumikizana yotchedwa orbital septum:

1. The Orbital Septum: The orbital septum imamangirira m'mphepete mwa fupa la diso (**orbital rim ) ndikupita kumtunda ndi kumunsi kwa mabala a tarsal a zikope. Zimakhala ngati ** chotchinga chotchinga chamoto (firewall) ** kulekanitsa khungu lapamwamba ndi minofu yaing'ono yazikope ( danga la preseptal **) kuchokera kukuya, kutsekeka kwa mafupa kumbuyo kwa diso (**the postseptal kapena orbital space **).
2. Preseptal (Periorbital) Cellulitis (Kutsogolo kwa Chiwombankhanga): Tizilombo tikaluma pachikope, kukanda pafupi ndi nsidze, kapena kutsekeka kwa nsidze (stye) kumakhudza khungu *kutsogolo kwa septum ya orbital, khungu lotayirira la zikope limatha kutupa (koma nthawi zina kutsekeka), minyewa yamaso, ndi minyewa yamaso yomwe imakhala kuseri kwa septum imakhala yosakhudzidwa kwathunthu komanso yosapsa **.
3. Postseptal (Orbital) Cellulitis (Kuseri kwa Firewall): Kodi mabakiteriya amafika bwanji kuseri kwa septum ya orbital ngati nthawi zambiri samenya molunjika kuchokera pakhungu? Kupitilira 85 mpaka 90 peresenti ya matenda a orbital cellulitis amafalikira kuchokera ku kachilombo koyambitsa matenda a paranasal sinus, makamaka ethmoid sinus.
4. Khoma lamkati la socket ya diso lomwe limalekanitsa kanjira kuchokera ku ethmoid air cell ndi mbale yopyapyala ya pepala yotchedwa lamina papyracea (kwenikweni "gumbwa-thin layer"), yomwe ili yosakwana \(0.5\text{ millimeters}\) (\(0.02\text{ mainchesi}\)) minyewa yopanda minyewa.
5. Pamene pachimake bakiteriya ethmoid kapena frontal sinusitis amamanga kuthamanga, mafinya ndi mabakiteriya (**Streptococcus pneumoniae **, Staphylococcus aureus [kuphatikizapo MRSA], Streptococcus anginosus gulu, Haemophilus influenzae, kapena kuthyola papepala kapena laminaapyrace papepala) kupanga subperiosteal orbil abscess ** kapena kufalitsa orbital cellulitis.
6. Odontogenic (Mano) Orbital Cellulitis: Chiphuphu cham'mwamba cham'mwamba kapena cham'mimba chomwe sichinachiritsidwe chingathe kulowera m'mwamba kupita ku maxillary sinus ndi kupyola pansi pa kanjira kamene kamalowa mkati mwa diso.

Kuyerekeza kwathunthu kwa 5 zovuta zotupa zamaso¶

Gwiritsani ntchito tebulo lachipatalali kuti musiyanitse zilonda zapakhungu, preseptal cellulitis, orbital cellulitis, cavernous sinus thrombosis, ndi matupi angioedema:

"Ngozi ya Triangle ya Nkhope" ndi Septic Cavernous Sinus Thrombosis (CST)¶

Chifukwa makona atatu kuchokera pa mlatho wa mphuno mpaka kumakona a pakamwa alibe mavavu a venous¶

Ngati mujambula makona atatu kumaso anu ndi ** pamwamba pa mlatho wa mphuno yanu ** (pakati pa nsidze zanu) ndi ** ngodya ziwiri zapansi kumanzere ndi kumanja kwa pakamwa panu ** (kuphatikizapo mphuno yanu yonse, mphuno yamphuno, mlomo wapamwamba, ndi mano apakati), mwajambula "Ngozi Yowopsa ya Nkhope" (Tal Triangle of the Face)* (Tal Triangle of the Face)* (Tal)

Pafupifupi m'mitsempha yonse ya m'thupi la munthu, zopindika za njira imodzi mavavu amalepheretsa magazi kuyenda chammbuyo. Komabe, mitsempha yapakati pa nkhope ndi orbit (** mtsempha wa nkhope, mtsempha wa angular, ndi mitsempha yapamwamba ndi yotsika ya ophthalmic ) ** ilibe ma valve ogwira ntchito a njira imodzi ** (kapena kulola kuti magazi aziyenda mozungulira malinga ndi kukakamizidwa): 1. Nthawi zambiri, magazi ochokera pamlatho wa mphuno ndi mlomo wapamwamba amatsikira pansi kudzera mumtsempha wa nkhope kulowa mkati mwa mtsempha wamkati m'khosi. 2. Komabe, ** mtsempha wa angular ** womwe uli mkati mwa ngodya ya diso umagwirizanitsa mwachindunji ndi ** mtsempha wapamwamba wa ophthalmic , womwe umayenda molunjika kumbuyo kudzera muzitsulo zamaso ndikudutsa ** kupsompsona kwapamwamba kwa orbital ** mu ** cavernous sinus ** mkati mwa chigaza. 3. Ngati munthu atenga matenda a pakhungu la bakiteriya mkati mwa makona atatuwa (kawirikawiri matumbo amphuno [kuwira mkati mwa mphuno chifukwa chozula tsitsi la m'mphuno kapena kutola mphuno], phuphuphuphu kapena zilonda pamphuno kapena kumtunda, acute sphenoid kapena ethmoid sinusitis kutsogola, kapena mphuno) pops it, kuthamanga kwa mawotchi kukakamiza mabakiteriya ndi magazi omwe ali ndi kachilombo ** kubwereranso (kumbuyo)* kudzera mu mitsempha ya ophthalmic yopanda valve yopita ku cavernous sinus.

Mkati mwa Cavernous Sinus: Njira zodzaza kwambiri muubongo wamunthu¶

Ma Cavernous sinuses ndi zipinda ziwiri za venous, zodzaza ndi magazi zomwe zimakhala kumanzere ndi kumanja kwa chithokomiro cha pituitary (sella turcica) pakatikati pa chigaza cha chigaza, cholumikizidwa pakati pa mzere wapakati ndi ** intercavernous sinuses **.

Kuthamanga * molunjika pakati pa magazi a venous mkati mwa cavernous sinus, kapena oikidwa mu khoma lake lakunja, ndi zinthu zofunika kwambiri zomwe palibe paliponse m'thupi zomwe zimadutsa mkati mwa mtsempha: - Mkati mwa kuwala kwa cavernous sinus: - Mtsempha wamkati wa Carotid (mtsempha waukulu womwe umadyetsa ubongo) ndi plexus yake yachifundo yozungulira. - Cranial Nerve VI (Abducens Nerve): Mitsempha yomwe imayendetsa lateral rectus muscle (yomwe imayendetsa diso kunja kukhutu). Chifukwa Cranial Nerve VI imayandama momasuka mkati mwa cavernous sinus m'malo motetezedwa ku khoma lakunja, **kulephera kuyang'ana kunja (kuwonongeka kwapang'onopang'ono kwapang'onopang'ono) pafupifupi nthawi zonse ndi CHOYAMBA CHOYAMBA chizindikiro cha mitsempha ya Cavernous Sinus Thrombosis **. - Zophatikizidwa mukhoma lakumbuyo la cavernous sinus (kuyambira pamwamba mpaka pansi): - Cranial Nerve III (Oculomotor Nerve): Imakweza chikope chakumtunda (levator palpebrae), imamanga mwana, ndikulowetsa diso mkati, mmwamba, ndi pansi. - Cranial Nerve IV (Trochlear Nerve): Imayendetsa diso pansi ndi mkati. - Cranial Nerve V1 (Ophthalmic Division of Trigeminal Nerve): Kumverera kwapamphumi, kumtunda kwa chikope, mphuno, ndi cornea. - Cranial Nerve V2 (Maxillary division of Trigeminal Nerve): Zomverera pamasaya, milomo yakumtunda, ndi mano akumtunda.

Zolemba zakale za Septic Cavernous Sinus Thrombosis¶

1. Prodrome (Masiku 1 mpaka 5): Wodwala amakhala ndi chithupsa chowawa mkati mwa mphuno kapena pamlomo wapamwamba (kawirikawiri wofinyidwa posachedwapa), sphenoid/ethmoid sinusitis yoopsa, kapena orbital cellulitis, yomwe ikutsatiridwa ndi kuwonjezereka **kupweteka kwamutu kumbuyo kwa diso limodzi kapena pamphumi ** komwe sikumayankha mankhwala opweteka.
2. Unilateral Orbital Congestion & Cranial Nerve Palsies (Maola): Monga momwe septic thrombus imatsekera mphuno yoyamba ya cavernous, magazi a venous kuchokera m'diso sangathe kukhetsa. Chikope chimakula kutseka, mabuloni oyera a diso kunja (** chemosis ), diso limatuluka kutsogolo (proptosis), ndipo ** Cranial Nerve VI imalephera poyamba ** (diso limatembenukira mkati pang'ono ndipo silingayang'ane kunja), mwamsanga kutsatiridwa ndi ** Cranial Mitsempha III ndi IV (kugwetsa upper eyelid, eyelid, eyelid). mboni ya diso yowuma) kuphatikiza ** dzanzi kapena mapini-ndi-singano zoyaka pamphumi ndi patsaya** (Cranial Nerves V1/V2).
3. Kufalikira Pamapawo Awiri Pamapawo Awiri (Mkati mwa Maola 24 mpaka 48): Chifukwa ming'oma yakumanzere ndi yakumanja imalumikizidwa pakatikati ndi njira zopanda ma valve, magaziwo amafalikira ku kutsutsana ndi mphanga mkati mwa maola 24 mpaka 48. **Pamene kutupa kwa diso limodzi ndi kupunduka kwa minofu ya diso kumawonekera mwadzidzidzi mu diso LACHIWIRI, ndilo chizindikiro cha Cavernous Sinus Thrombosis ** (kusiyanitsa ndi cellulitis yosavuta ya orbital, yomwe imakhala m'diso limodzi).
4. Intracranial Sepsis & Meningitis: Kutentha kwambiri kwa "picket-fence" (\(39.5^\circ\text{C}\text{ to }41^\circ\text{C}\) [\(103^\circ\text{F}\text{ to }106^\circ\text{F}\), kusokoneza, kusokoneza, kusokoneza, kapena sitiroko (kuchokera mkati carotid mtsempha wamagazi spasm/thrombosis).

Kukhazikika kwa Matenda a Orbital: The Chandler Classification System¶

Mu dipatimenti yodzidzimutsa, ophthalmologists ndi otolaryngologists (ENT surgeons) amagwiritsa ntchito ** Chandler Classification ** pazitsulo zowonjezera za CT za orbits ndi sinuses kuti adziwe ngati wodwala akufunikira maantibayotiki achipatala yekha kapena opaleshoni yachipatala mwadzidzidzi:

Mwadzidzidzi Wapadera: Fungal Sinusitis (Rhino-Orbital-Cerebral Mucormycosis)¶

Ngakhale 98 peresenti ya orbital cellulitis mwa ana athanzi ndi akuluakulu ndi bakiteriya, yakupha, yowononga mwamsanga fungal mwadzidzidzi yotchedwa ** Rhino-Orbital-Cerebral Mucormycosis ** (yomwe imayambitsidwa ndi nkhungu za dongosolo la Mucorales, monga Rhizopus kapena Mucor, kapena kuukira kwapadera): - Ndani ali pachiwopsezo: Odwala ku matenda a shuga a ketoacidosis (DKA) (kumene shuga wambiri wamwazi ndi asidi amatulutsa ayironi yaulere yomwe imadyetsa Mucorales mafangasi), matenda a shuga osayendetsedwa bwino, matenda a hematologic malignancies/neutropenia, otengera chiwalo kapena mafupa, chithandizo cha deferoxamine iron-chelation, kapena chithandizo chaposachedwa kwambiri cha corticosteroid. - Mmene Mucormycosis amawonongera minofu (Angioinvasion): Mosiyana ndi mabakiteriya omwe amayambitsa mafinya ofiira ofunda, Mucorales fungal hyphae amalowerera mwachindunji m'makoma a mitsempha , kutsekeka ndikutseka magazi onse. Izi zimayambitsa kufa msanga kwa minofu ya ischemic (infarction) ndikusintha minofu yomwe ili ndi kachilombo yoyera yakufa kenako yakuda yamalasha (necrotic eschar). - Mmene mungadziwire matenda a Mucormycosis pafupi ndi bedi: Ngati wodwala matenda a shuga kapena olephera chitetezo chamthupi ali ndi ululu wa sinus, dzanzi la nkhope, kapena diso lotupa / logwa, walani tochi mkati mwa mphuno (kuyang'ana ku septum yamphuno ndi turbinates) ndi denga la pakamwa ndi pakamwa. **Kutumphuka kulikonse kwakuda, zilonda zofiirira/zakuda, kapena chigamba cha dzanzi mkamwa kapena mkati mwa mphuno ndizochitika zadzidzidzi zomwe zimafuna kuti achotsedwe msanga m'chipinda chopangira opaleshoni ndikulowetsa liposomal Amphotericin B m'msempha pasanathe maola angapo.

Chisamaliro chotetezeka ku zikope zazing'ono (Styes & Chalazia) motsutsana ndi malamulo a chitetezo cha Danger Triangle¶

Kuti mupewe zipsera zazing'ono kumaso kuti zisakhale zoopsa za orbital kapena intracranial, tsatirani malamulo awa a ukhondo ndi chithandizo choyamba:

1. Momwe mungasamalire bwino Eyelid Sye (Hordeolum) kunyumba¶

Ngati muli ndi kaphuphu kakang'ono kofiira m'munsi mwa nsidze (external hordeolum / stye) kapena mkati mwa chikope (internal hordeolum) ndi zero Orbital Red Flags (kusuntha kwamaso kosapweteka, kuwona kwabwinobwino, kutentha thupi, kusafalikira pachivundikiro chonse): - Pakani zopakani zoyera, zotentha (osati zowotcha) kwa 10 mpaka mphindi 15, kanayi pa tsiku. Kutentha pang'ono kumasungunula mafuta okhuthala (meibum) omwe amamangirira chithokomiro kotero kuti amakhetsa okha. - Sambani m'manja bwino ndi sopo ndi madzi musanagwire kapena kukhudza pafupi ndi diso, ndipo siyani kudzola zopakapaka m'maso kapena magalasi olumikizirana mpaka khosi litatheratu (tayani ndodo zakale za mascara zomwe zaipitsidwa ndikuphera tizilombo kapena kusintha magalasi olumikizana nawo). - OSAFINYA, kutsina, kapena kupyoza stye ndi singano: Kufinya kumang'amba kapisozi kakang'ono ka gland kobwerera m'mbuyo mu mitsempha ya preseptal ndi orbital.

2. Momwe mungachitire ndi pimple, wiritsani (furuncle), kapena tsitsi lomwe lalowa mu Danger Triangle.¶

• Osazula kapena kutulutsa m'mphuno vibrissae (tsitsi la mphuno) ndi zomangira: Kuzula ng'anjo za tsitsi la mphuno kumatsegula chitseko chakuya chamkati mwa mphuno yodzaza ndi mabakiteriya (momwe 30 peresenti ya anthu mwachibadwa amanyamula Staphylococcus aureus), kupanga choyambitsa #1 cha mphuno zamphuno ndi Cathrombosis. Nthawi zonse cheka tsitsi la mphuno mosamala ndi lumo lozungulira lozungulira kapena chodulira chamagetsi.
• Ngati chithupsa chowawa kapena chiphuphu chikaonekera pamphuno, m'mphuno, kapena m'kamwa kumtunda: Osachifinya kapena kuchitulutsa. Ntchito woyera ofunda compress. Ngati mphuno yowawa mkati mwa mphuno kapena pa mlatho wa mphuno ikuyamba kufalikira kufiira (** cellulitis **), kupweteka kwapakhosi, kutupa mkati mwa ngodya ya diso, kapena kutentha thupi, onani dokotala tsiku lomwelo ** kuti mupeze mankhwala opha tizilombo (ndi intranasal mupirocin mafuta ngati atalamulidwa).

Zolemba zenizeni za 911/112/999 ndi kuyeserera kuchipatala¶

Chifukwa chakuti zipatala zokhala ndi anthu otanganidwa kwambiri komanso zipinda zodikirira mwadzidzidzi nthawi zambiri amaganiza kuti diso lotupa ndi "diso la pinki (conjunctivitis)" kapena kulumidwa ndi kachilomboka, gwiritsani ntchito mawu awa:

• Kwa Oganiziridwa kuti Postseptal (Orbital) Cellulitis:

  "Ndili ndi wodwala wazaka [Zaka] yemwe akutupa kwambiri m'zikope PLUS Orbital Cellulitis zizindikiro zofiira: wodwalayo amakhala ndi [kupweteka kwakukulu pamene akusuntha diso / kusayenda kwa diso ndi masomphenya awiri / kutsogolo kuphulika kwa diso / kuchepa kwa masomphenya kapena kutsukidwa kwa mtundu wofiira] kutsatira [matenda a sinus. woongoka, ndipo amafunikira kuunika kwadzidzidzi kwa dokotala, maantibayotiki a stat IV, ndi CT scan ya orbital kuti aletse abscess ya subperiosteal."

• Kwa Oganiziridwa Kuti Cavernous Sinus Thrombosis (CST):

  "Emergency triage: wodwala uyu anali ndi [pakati pa nkhope zotupa / matenda a m'mphuno / mphuno] ndipo tsopano ali ndi mutu waukulu wa retro-orbital, kutentha thupi kwambiri, [kugwa kwa chikope / kulephera kusuntha diso kunja], ndi kutupa komwe tsopano kukufalikira ku diso laCHIWIRI (losiyana). maantibayotiki ambiri, komanso kuwunika kwadzidzidzi kwa CT/MR."

Mafunso omwe amafunsidwa pafupipafupi¶

Kodi njira yachangu kwambiri yodziwira kusiyana kotani pakati pa mild periorbital (preseptal) cellulitis ndi orbital (postseptal) cellulitis yowopsa ndi iti?¶

Gwirani pang'onopang'ono zikope zotupa ndikutsegula ndipo funsani munthuyo kuti atsatire chala chanu ndi maso kumanzere, kumanja, mmwamba, ndi pansi. Mu wofatsa preseptal cellulitis, matenda ali kokha kunja chikope khungu, kotero kusuntha diso ndi 100 peresenti yosalala ndi zopweteka ndi masomphenya abwinobwino; mu orbital cellulitis yowopsa, matendawa amakhala kuseri kwa socket firewall, kotero kusuntha kwa diso kumayambitsa kupweteka kwambiri, kusuntha pang'ono, kuwona pawiri, kapena kuyang'ana kutsogolo.

Kodi matenda a ethmoid sinus mwa mwana amasanduka bwanji kutupa kwa diso mwadzidzidzi?¶

Khoma lamkati la socket ya diso lomwe limalekanitsa diso ndi ethmoid sinus mkati mwa mphuno ndi fupa lopyapyala la pepala lotchedwa lamina papyracea, lomwe ndi lokhuthala lochepera theka la millimita ndipo limabooledwa ndi timitsempha ting'onoting'ono ta magazi. Ana ndi achinyamata, pachimake bakiteriya ethmoid sinusitis mosavuta amakankhira mafinya kudzera fupa woonda mu zitsulo diso, kupanga subperiosteal orbital abscess kuti akanikiza pa diso minofu ndi optic mitsempha mkati maola.

Kodi ndizowopsa kutulutsa pimple kapena kubudula tsitsi mkati mwa mphuno mu "Danger Triangle of the Face"?¶

Inde, mitsempha yotulutsa katatu kuchokera pamlatho wa mphuno kupita kumakona a m'kamwa imalumikizana cham'mbuyo kudzera muzitsulo zamaso kudzera mu mitsempha ya ophthalmic yopanda valavu yopita ku cavernous sinus kumunsi kwa ubongo. Chifukwa minyewayi ilibe mavavu anjira imodzi kuti asiye kuyenda mobwerera m'mbuyo, kufinya chithupsa kapena tsinde la tsitsi lomwe lili ndi kachilombo mkati mwa mphuno kapena kumtunda kungathe kukakamiza mabakiteriya ndi kutsekeka kwa kachilombo mmbuyo mu chigaza, kumayambitsa matenda a septic cavernous sinus thrombosis.

Nchifukwa chiyani kuyesa momwe mtundu wofiira umawonekera ("red desaturation") ndiyeso lofunika kwambiri mu diso lotupa?¶

Mitsempha ya m'mitsempha yomwe ili mkati mwa mitsempha ya optic yomwe imafalitsa malingaliro a mtundu wofiira kwambiri ndi yomwe imakhudzidwa kwambiri ndi kuthamanga kwa makina ndi ischemia. Kale kwambiri chiphuphu cha orbital chisanatsekeretu maso, kukanikiza mitsempha ya optic kumapangitsa chinthu chofiira chowala (monga kapu ya botolo yofiira) kuti iwoneke yazimiririka, yotsukidwa lalanje, kapena bulauni-imvi pamene ikuwoneka ndi diso lokhudzidwa poyerekeza ndi diso lathanzi, kuchenjeza madokotala kuti opaleshoni yadzidzidzi ikufunika mwamsanga kuti apulumuke.

Magwero afufuzidwa¶

• American Academy of Ophthalmology (AAO, United States): Clinical Guidelines and EyeWiki Consensus on Preseptal Cellulitis, Orbital Cellulitis (Chandler Classification Groups I to V), and Septic Cavernous Sinus Thrombosis.
• Infectious Diseases Society of America (IDSA, United States): Malangizo Othandizira Kuzindikira ndi Kuwongolera Matenda a Khungu ndi Ofewa ndi Chitsogozo Chachipatala cha Acute Bacterial Rhinosinusitis mu Ana ndi Akuluakulu (zovuta za orbital ndi intracranial).
• National Institute for Health and Care Excellence (NICE, United Kingdom) ndi Royal College of Ophthalmologists (RCOphth, United Kingdom): Sinusitis (Acute): Periorbital and Orbital Cellulitis Emergency Referral Criteria (NG79).
• American Academy of Pediatrics (AAP, United States): Management of Acute Sinusitis and Periorbital/Orbital Cellulitis in Pediatric Patients.
• European Confederation of Medical Mycology (ECMM) ndi Mycoses Study Group (MSG ERC): Global Guideline for the Diagnosis and Management of Mucormycosis (Rhino-Orbital-Cerebral Mucormycosis kuzindikira mwadzidzidzi ndi opaleshoni/liposomal Amphotericin B management).

Maupangiri ogwirizana¶

• Kutaya masomphenya mwadzidzidzi, kuwonongeka kwa retina, ndi glaucoma yotseka kwambiri
• Kuvulala kwamaso: kutentha kwa mankhwala, kuvulala kolowera, ndi hyphema
• Necrotizing fasciitis (matenda odya nyama) ndi mbendera zofiira za cellulitis
• Kuzindikira kwa sepsis ndi septic shock
• Matenda a shuga a ketoacidosis (DKA) ndi hyperosmolar hyperglycemic state