Indwara y’amaso, indwara z’amaso zivyimba, n’indwara y’amaso y’amaso¶

Igipfunsi c'ijisho kivyimba ningoga, gitukura, giteye igomwe mu mwana canke umuntu akuze, canke igisebe, igisebe, canke indwara y'ibihaha/amenyo Iri hagati y'ikiraro c'izuru n'imfuruka z'akanwa ("Ikigobe c'akaga c'imbere mu maso"), gishobora gutera mu masaha makeyi kivuye ku ndwara y'urukoba yo hejuru (**preior septal)bittis canke n’indwara ikomeye cane ishobora gutuma umuntu abona neza kandi igatuma umuntu apfa (indwara y’ibihimba vy’irondoka canke y’ibihimba vy’irondoka) canke amaraso ashobora gutera indwara iri mu ntango y’ubwonko (thrombose septique cavernose sinus [CST]). Kubera ko igihimba c’ijisho c’umuntu (uruzitiro rw’amagufa) ari agasandugu gakomeye kandi kafunze gafatanye ata guca ku ruhande n’imitsi y’ubwonko n’imitsi idafise amavalve, ibivyimba canke ibivyimba biri inyuma y’imitsi y’amaso uruzitiro rw’amagufa bica bimenagura ningoga umutsi w’amaso, bica bitera umutsi w’amaso n’imitsi y’igihanga. Ukwemera ubwo nyene "6 Orbital Red Flags" (ububabare buva ku kwinyiganza kw'amaso, ijisho ry'umubiri rivyimba, kubona kabiri, kwinyiganza kw'amaso bibujijwe, ukubura ukuntu abona, canke ukuntu umunyeshure abona ibintu bidasanzwe) n'imiti yihutirwa yo mu bitaro iterwa mu mitsi y'amaso birakiza ukuntu umuntu abona n'ubuzima.

Ivyo ubikore ubu¶

1. Uceceke buhoro buhoro ibipfunsi vy’amaso vyimba (utafyonda ku ntugu y’ijisho ubwayo) hanyuma ukore igikorwa co gupima amaso y’inyuma y’igitanda c’intambwe 4:
2. Intambwe ya 1 (Ukwinyiganza kw'amaso n'ugusuzuma ububabare): Fata urutoke rwawe \(30\text{ centimeters}\) (\(12\text{ inches}\)) imbere y'isura y'umurwayi maze urunyiganyize buhoro buhoro mu buryo bwa "H" (ibubamfu, iburyo, hejuru, hasi). Mbega kwinyiganza ijisho bitera ububabare bukomeye bubabaza inyuma y’ijisho, canke ijisho ryavyimvye risubira inyuma canke rinanirwa kwinyiganza neza bituma umuntu abona kabiri?
3. Intambwe ya 2 (Proptosis / Bulging Check): Hagarara inyuma y’umurwayi yicaye, ushire umutwe inyuma gatoyi, urabe hasi hejuru y’uruhanga rwiwe ku bisusu vyose bibiri. Mbega igihimba c’ijisho c’ijisho ryafashwe kisohoka imbere cane kuruta ijisho rifise amagara meza (canke igihimba c’ijisho gisunikwa hasi kikaja hanze)?
4. Intambwe ya 3 (Igenzura ry’ubushobozi bwo kubona n’ibara ry’umutuku): Fuka ijisho rifise amagara meza maze usuzume nimba umurwayi ashobora gusoma neza amajambo mato mato. Fata ikintu gitukura cane (nk’igipfukisho c’icupa gitukura) imbere y’ijisho rifise amagara meza hanyuma ushire ijisho ry’umutuku: iyo ibara ry’umutuku risa n’iry’umutuku, ry’umuhondo, canke ry’umuhondo/ibara ry’umuhondo ("red desaturation")** mw’ijisho ry’umutuku, umutsi w’amaso uriko urafatwa.
5. Intambwe ya 4 (Isuzuma ry’ugukwiragira kw’amaso yo mu mpande zompi ko ata thrombose sinus caverneuse): Suzuma IJISHO RIRINDI (rihuye). Iyo ukuvyimba, ugutukura, igipfunsi c’ijisho gitemba, canke imitsi y’ijisho iremvye bitangura gukwiragira ku ijisho rya kabiri mu masaha 24 gushika kuri 48, biherekejwe n’ugufatwa n’umutwe canke umuriro mwinshi, uce wikeka ko ufise Cavernous Sinus Thrombosis ubwo nyene.
6. Genda ubwo nyene mu bitaro bivura indwara zihutirwa nimba hari ICYO COSE muri ivyo bimenyetso 6 vy’umutuku bizunguruka, canke nimba umurwayi ari umwana atarashika ku myaka 1, afise ubudahangarwa bw’umubiri, canke adashobora gufungura ijisho bihagije kugira ngo arisuzume. Hamagara 911 muri Leta Zunze Ubumwe za Amerika na Canada, 112 muri Leta Zunze Ubumwe za Amerika, Ubumwe bw’Uburaya bwose9 inomero z'ivyihutirwa.
7. **Ntukigere ufyonda, utera, utera icumu, canke utobora urushinge igisebe ico ari co cose, utere (furuncle), utere, canke ubwoya bwo mu zuru bwakuze imbere mu "Nkomoko y'akaga y'Isura." imitsi) mu sinus cavernous iri imbere mu gihanga. Gufyonda igisebe co mu maso bisunika imigera ya Staphylococcus aureus n’ibihimba vy’umubiri bitera amaraso bisubira inyuma bigana mu bwonko.
8. Guma umurwayi yicaye agororotse umutwe wiwe ushizwe hejuru ku \(30\text{ gushika kuri }45\text{ degrees}\) kandi umugumye ataco akora mu kanwa (NPO). Kwicara agororotse bigabanya umuvuduko w’imitsi n’uguhagarara kw’amazi imbere mu nzira y’amaraso n’imbere mu nzira y’amaraso. Guhagarika ivyo kurya n’ivyo kunywa kuko igisebe co mu gice c’imbere c’umubiri akenshi gisaba gufata amashusho y’ivyuma (CT) vyihutirwa be n’ugukura amazi mu gice c’umubiri (endoscopie sinus/orbital drainage) hakoreshejwe uburyo bwo gutera umuti w’ububabare rusangi.
9. NTUSHIRE amavuta ashushe ku gisebe gikekwa ko gifise ububabare bw’amaso bukomeye cane canke igisebe co mu maso gikomeje kwaguka vuba cane gifise umuriro mwinshi, kandi NTUSHIRE mu jisho imiti yo mu rugo idashobora gutera inda. Naho amavuta ashushe afasha ku ndwara yoroshe y’amaso (hordeolum), ububabare bw’amaso bukomeye cane busaba ububabare bw’amaso bukomeye cane. gutandukanya isuzuma rya CT/MRI.
10. Suzuma nimba hari ibintu bishobora gutuma umuntu arwara indwara y’ibiherere ku mubiri (Mucormycose): Iyo umurwayi afise indwara y’igisukari (DKA), indwara y’igisukari idashobora gucungera neza, ubukene bw’imitsi, ubuvuzi bw’imiti, canke ubuherutse gukoresha imiti myinshi y’ibicurane, agira ububabare mu maso/mu bihaha, ijisho ryavyimvye, na ibisebe vy’umubiri vy’umukara canke igisenge c’akanwa (palate), bamenyeshe ubwo nyene Mucormycose y’inzovu-y’ubwonko vyihutirwa mu bitaro.

Ijisho ryavyimvye n'akaga-inkomoko itatu y'indwara igiti c'ingingo¶

Koresha iki kigereranyo c’ubuvuzi kugira ngo utandukanye umururumba wo ku ruhu rw’amaso n’indwara y’ibihaha vy’amaso, thrombose cavernose sinus, n’indwara y’ibicurane vy’ibicurane.

flowchart TD
    Start["Ivyimba bikomeye, bitukura, canke bibabaza igipfunsi c'amaso<br/>canke indwara yo hagati mu maso mu mfuruka zitatu z'akaga"] --> OpenCheck{"Gucapura amaso mu bugwaneza:<br/>Suzuma uko amaso yinyiganza, ukuntu abona, n'aho ahagaze"}

    OpenCheck -->|"IBENDERA RYOSE RITUKURA RIRIHO:<br/>- Ububabare iyo umuntu ariko aranyiganyiga ijisho<br/>- Ijisho rishobora kwinyiganza bibujijwe canke Kubona kabiri<br/>- Igikoko c’ijisho kivyimba imbere (Proptosis) canke gisunikiwe hasi<br/>- Kubona bigabanutse, ibara ry’ijisho ry’umutuku ryayozwe cane<br/> umupira w'ijisho"| OrbitTrue["INYUMA Y'IGIHUGU (ORTITAL)<br/>canke IKIBUMBANO C'IGIHUGU:<br/>1. Genda mu bitaro vy’ivyihutirwa UBWO nyene<br/>2. Gumana wicaye ugororotse ku bushuhe bwa degre 30 gushika kuri 45<br/>3. Ntaco ubika mu kanwa (NPO) kugira ngo ukoreshe CT scan n'ugubagwa<br/>4. Bikeneye vuba antibiyotike + ENT/Amaso"]

    OrbitTrue --> CSTCheck{"Amaso Yose Yoba Aragira Ingingo,<br/>canke Umutwe Ukomeye / Ugusenyuka kw’Imitsi y’Umutwe<br/>(CN III, IV, V1/V2, VI) / Umuriro Utera cane?"}

    CSTCheck -->|"EGO: Gukwiragira kw’ijisho rihuye n’irindi mu masaha 24-48,<br/>amaso akonje, uruhanga/itama ry’umubiri, meningismus,<br/>canke bitangurirwa n’ibivyimba vyo mu mazuru/mu maso canke sphenoid sinusitis"| CST["INTWARO Y'IBIMENYETSO VY'IBIMENYETSO (CST):<br/>1. Hamagara 911 / 112 / 999 Ubwo nyene<br/>2. Ivyihutirwa vyo mu mutwe bishobora gutera ubuzima<br/>3. Ikeneye stat IV Vancomycine + Ceftriaxone + Metronidazole,<br/> MRV/CTV igipimo c'ubwonko, n'imiti igabanya amaraso"]

    CSTCheck -->|"Indwara y’isukari (DKA), Neutropenia,<br/>canke Uguhagarika ubudahangarwa bw’umubiri + Eschar yirabura mu zuru/mu kanwa<br/>canke ugucika intege mu maso"| Mucor["MUCORMYCOSE YO MU GIHUGU:<br/>Gukuraho ivyiyumviro biva mu bwonko + IV Liposomal Amphotericine B"]

    OpenCheck -->|"NTA BENDERA RITUKURA RIZERUKA:<br/>- Ata kubabara, amaso yuzuye agenda neza mu nzira zose<br/>- Kubona neza 20/20 & ibara ry’umutuku ryiza<br/>- Nta gukura kw’amaso; sclera yera isa n'iyisanzwe<br/>- Kuvyimba bigarukira cane ku ruhu rw'inyuma rw'igipfukisho c'amaso"| PreseptalCheck{"Ni igiki catumye<br/>Igipfunsi co hanze kivyimba?"}

    PreseptalCheck -->|"Umuriro, igipfukisho c'ijisho gitukura gishushe,<br/>urumo rw'ibikoko, gukorora, canke sinusitis"| Preseptal["CELLULITIS PREPTAL (PERIORBITAL):<br/>Isuzuma ry’ubuvuzi ryihutirwa ry’umunsi umwe ku bijanye n’imiti yo mu kanwa<br/>(canke imiti yo mu kanwa iyo umwana < 1 yr canke akaze)<br/>Gukurikirana buri masaha 4 ku bijanye n’amabendera atukura yo mu kanwa"]

    PreseptalCheck -->|"Agakoko gatoyi gameze nk’ibisebe ku<br/>ku ruhande rw’amaso (Stye) canke igiti c’umukara gikomeye kitababaza<br/>imbere mu gipfukisho (Chalazion), nta muriro"| Stye["HORDEOLUM (STYE) CANKE CHALAZION:<br/>Shirako umuti usukuye ushushe iminota 10-15 4x ku musi;<br/>Ntukigere ufyonda canke upfunyariza igipfunsi c'amaso"]

Urubibi rw’umubiri: Kubera iki igice c’ijisho ari co gikingira umuriro¶

Kugira ngo utahure igituma amaso abiri yavyimvye asa n’ayo nyene iyo ari hirya no hino mu cumba ashobora kugira ingaruka zitandukanye rwose, utegerezwa gutahura urupapuro rworoshe kandi rukomeye rw’imitsi y’amaso yitwa orbital septum:

1. Igipande c’amaso: Igipande c’amaso gifatanya n’uruzitiro rw’amagufa y’uruzitiro rw’amaso (igice c’amaso) kigashika mu bipande vyo hejuru n’ivyo hasi vy’amaso. Ikora nk’intambamyi y’umubiri (firewall) itandukanya urukoba rwo hejuru n’urukoba rwo munsi y’urukoba rw’ibipfunsi (ikibanza c’imbere y’ijisho) n’umwobo w’amagufa uri harehare kandi ukingiye inyuma y’igihimba c’ijisho (ikibanza c’inyuma canke c’inyuma y’ijisho).
2. Preseptal (Periorbital) Cellulitis (Imbere y'uruhome rw'umuriro): Iyo udukoko turumye ku gipfukisho c'ijisho, igikomere kiri hafi y'igipfunsi, canke igihimba c'ijisho gipfutse (stye) kigatera urukoba imbere y'igipfukisho c'ijisho, ibipfunsi vy'amaso birashobora gusenyuka cane hafi gufunga), ariko igihimba c’ijisho, imitsi y’ijisho, n’umutsi w’amaso wicaye inyuma y’igice c’ijisho ntibikozweko na gato kandi ntibivyimba.
3. Indwara y’inyuma y’uruzitiro (Inyuma y’uruhome rw’umuriro): Ni gute imigera ishika inyuma y’uruzitiro rw’uruzitiro iyo akenshi idatera ibipfunsi igororotse ivuye ku ruhu? Ibice birenga 85 gushika kuri 90 kw'ijana vy'abantu barwara indwara y'ibihimba vy'irondoka biva ku ndwara y'ibihimba vy'irondoka iri hafi, cane cane indwara y'ibihimba vy'irondoka.
4. Uruhome rw’imbere rw’uruzitiro rw’ijisho rutandukanya inzira y’amaso n’ingingo z’umuyaga zitwa etmoïde** ni igipande c’igufa gitoya nk’impapuro citwa lamina papyracea (mu rurimi rw’ikirundi “igipande gitoya nk’igipapuro”), kikaba kiri munsi ya **\(0.5\text{ milimetero}\) na ho (foramina) ku mitsi n’imitsi idafise amavalve.
5. Iyo indwara y’umusonga canke y’imbere y’umubiri yiyongera umukazo, ibivyimba n’imigera (Imigera y’amahaha, Staphylococcus aureus [harimwo na MRSA], umugwi w’imigera y’amahaha, Haemophilus influenzae, canke anaerolybeak bica mu bihimba vy’umubiri bitagira umwuka) inzira y’umubiri, igatuma haba igisebe c’inzira y’umubiri kiri munsi y’amagufa canke cellulite y’inzira y’umubiri ikwiragiye.
6. Odontogenic (Dental) Orbital Cellulitis: Igisebe c’imizi y’iryinyo ryo hejuru canke ry’imbwa kitavuwe gishobora gusenyuka kija hejuru kikaja mu nzira y’amaso, kigaca hasi mu nzira y’amaso kikaja mu nzira y’amaso.

Igereranyo ryuzuye ry'ibibazo 5 vy'amaso yavyimvye cane¶

Koresha iyi mbonerahamwe y’ubuvuzi kugira ngo utandukanye ibisebe vy’amaso bitagira akamaro, indwara y’amaso y’imbere, indwara y’amaso y’imbere, indwara y’amaso y’imbere, n’indwara y’amaso:

"Ikigo c'akaga c'inkomoko itatu yo mu maso" n'indwara y'amaraso y'ibihaha (CST)¶

Kubera iki inkomoko itatu kuva ku kiraro c’izuru gushika ku mfuruka z’akanwa idafise imitsi y’amaraso .¶

Iyo ushushanije inkomoko y'inkomoko mu maso hawe insonga iri hejuru ku kiraro c'izuru ryawe (hagati y'ibisusu vyawe) n'imfuruka zibiri zo hasi ku mfuruka z'ibubamfu n'iz'iburyo z'akanwa kawe (harimwo izuru ryawe ryose, uruzitiro rw'izuru, umunwa wo hejuru, n'amenyo yo hejuru y'akanwa kawe), uba ufise amenyo yo hejuru yo hagati), uba ufise amenyo yo hejuru y'inkomoko). izwi kw’izina rya Inkomoko y’Urupfu).

Hafi mu mitsi yose y’umubiri w’umuntu, imitsi y’inzira imwe irabuza amaraso gusubira inyuma. Ariko rero, imitsi yo hagati mu maso n’iyo mu nzira (umutsi wo mu maso, umutsi wo mu mfuruka, n’imitsi yo hejuru n’iyo hasi y’amaso) nta mitsi ikora y’inzira imwe (canke ireka amaraso atemba mu nzira zibiri bivanye n’umuvuduko): 1. Mu bisanzwe, amaraso ava ku kiraro c’izuru no ku munwa wo hejuru aramanuka aciye mu mutsi wo mu maso aja mu mutsi wo mu mutwe wo mu ijosi wo mu mutima. 2. Ariko rero, umutsi w’imfuruka uri mu mfuruka y’imbere y’ijisho uhuza ata guca ku ruhande n’umutsi w’amaso wo hejuru**, uwo mutsi ugenda ugororotse ugasubira inyuma uciye mu nzira y’ijisho, ukaja mu murongo w’inzira y’ijisho wo hejuru ukaja mu cavernous sinus iri imbere mu ntango y’igihanga. 3. Iyo umuntu afise indwara y’urukoba iterwa n’imigera imbere muri iyo mfuruka itatu (kenshi na kenshi igisebe co mu zuru [igisebe co mu zuru kivuye ku gukura ubwoya bwo mu zuru canke gutoragura izuru], igisebe c’izuru canke igisebe co ku zuru canke ku munwa wo hejuru, **igisebe c’izuru canke igisebe c’izuru gikomeye cane,**upper too,**thmoid sinusitis and) irayifyonda canke irayitera, umuvuduko munini w’ubuhinga uhatira imigera n’amaraso yanduye gusubira inyuma (gusubira inyuma) biciye mu mitsi y’amaso idafise amavalve bikaja mu nzira y’amaso.

Imbere mu bwonko bw’umuntu: Ibarabara ry’amasanganzira ry’abantu benshi kuruta ayandi yose mu bwonko bw’umuntu¶

Ivyiyumviro vy’imitsi ni ivyumba bibiri vy’imitsi vyuzuye amaraso bimeze nk’ibiponji, vyicaye ku ruhande rw’ibubamfu n’urw’iburyo rw’igihimba c’umubiri (sella turcica) hagati y’igihimba c’igihanga, bifatanye bica ku murongo wo hagati n’ibivyimba vy’imitsi**.

Kwiruka ataco bimaze hagati y’amaraso y’imitsi ari imbere mu nzira y’amaraso, canke yinjijwe mu ruhome rwayo rw’inyuma, ni ibihimba bihambaye cane ata handi mu mubiri bica imbere mu mutsi: - Imbere mu nzira y'amaraso y'umubiri: - Umutsi w’imbere w’umutima (umutsi mukuru ugaburira ubwonko) n’umutsi w’impuhwe uwukikuje. - Umutsi w’umutwe VI (Abducens Nerve): Umutsi ugenzura umutsi w’inyuma (utuma umutsi w’ijisho uja hanze uja ku gutwi). Kubera ko umutsi w’umutwe VI ureremba widegemvya imbere hagati y’igihimba c’umubiri c’imbere aho kurindwa mu ruhome rw’inyuma, ukudashobora guhindukiza ijisho hanze (lateral gaze palsy) hafi y’igihe cose ni ikimenyetso ca mbere CANE c’imitsi y’umubiri c’umubiri w’umuntu afise indwara y’ibihimba vy’umubiri. - Ishizwe mu ruhome rw’inyuma rw’umubiri w’umuntu (kuva hejuru gushika hasi): - Umutsi w’umutwe III (Oculomoteur Nerve): Uduza igihimba co hejuru c’ijisho (levator palpebrae), ugafunga igihimba c’ijisho, ugatuma ijisho rigenda imbere, hejuru no hasi. - Umutsi w’umutwe IV (Umutsi w’umutwe): Utuma ijisho rijana hasi n’imbere. - Umutsi w’umutwe V1 (Igice c’amaso c’umutsi w’umutwe w’amaso): Inyiyumvo y’ugutahura ku ruhanga, ku gipfukisho co hejuru, ku zuru, no ku ruhu rw’ijisho. - Umutsi w’umutwe V2 (Igice c’umutsi w’umutwe w’imbere): Inyiyumvo y’ugutahura ku matama, ku munwa wo hejuru, no ku menyo yo hejuru.

Igihe ca kera c'indwara y'amaraso y'ibihaha¶

1. Prodrome (Imisi ya 1 gushika ku ya 5): Umurwayi afise igisebe kibabaje imbere mu zuru canke ku munwa wo hejuru (kenshi aherutse gufyonda), indwara y’ibihaha ikaze cane, canke indwara y’ibihaha, iherekejwe n’ugutera ububabare bukomeye **umutwe ukaze inyuma y’ijisho rimwe canke mu mutwe
2. Uguhagarara kw’ijisho n’uguhagarara kw’imitsi y’umutwe (Amasaha): Nk’uko thrombus septique ipfuka igihimba ca mbere c’ijisho, amaraso y’imitsi ava mu jisho ntashobora gusohoka. Igipfukisho c’ijisho kiravyimba kikafunga, umweru w’ijisho ugasohoka (chemose), igihimba c’ijisho kigaca kivyimba kija imbere (proptose), Umutsi w’ijisho VI ukaba ubanza kunanirwa (ijisho rihindukira gatoyi imbere ntirishobora kuraba hanze), rikurikirwa ningoga n’imitsi y’ijisho (droping III na IV] umunyeshure agira ubunebwe, n’ijisho ryakonje rwose) hamwe n’ugucika intege canke guturika kw’ibipimo n’inshinge mu ruhanga no ku matama (Cranial Nerves V1/V2).
3. Ugukwiragira mu mpande zibiri mu bihimba vy’umubiri (Mu masaha 24 gushika kuri 48): Kubera ko ibihimba vy’umubiri vy’ibubamfu n’ivy’iburyo bifatanye bica ku murongo wo hagati n’imirongo y’ibihimba vy’umubiri idafise amavalve, iyo septic clot ikwiragizwa mu bihimba vy’umubiri bihuye n’ivyo bihimba vy’umubiri. Igihe ukuvyimba kw’ijisho ku ruhande rumwe n’ugusenyuka kw’imitsi y’ijisho bigaragara bukwi na bukwi mw’ijisho rya KABIRI, ni ikimenyetso ca kera c’indwara ya Cavernous Sinus Thrombosis (ikiyitandukanya n’indwara y’amaso yoroshe, iguma mw’ijisho rimwe).
4. Indwara y'umutwe n'indwara y'umutwe: Umuriro mwinshi cane (\(39.5^\uruzitiro rw'uruzitiro" (\)39.5^\uruzitiro rw'uruzitiro{C}\uruzitiro{ ku }41^\uruzitiro\uruzitiro{C}$ [\(103^\uruzitiro\uruzitiro{F}\uruzitiro{kugeza kuri }106^\uruzitiro\uruzitiro), ri, vo, fu\)] gufatwa n’intandara, canke gufatwa n’indwara y’umutima (kuva ku gutera umutsi w’imbere mu mutwe/thrombose).

Gushiramwo indwara zifata mu nzira: Uburyo bwo gushikiriza indwara bwa Chandler¶

Mu gisata c’ubuvuzi bw’ibihe vyihutirwa, abaganga b’amaso n’abaganga b’amatwi (ENT surgeons) bakoresha Chandler Classification ku bipimo vya CT vy’imitsi y’umubiri n’ivy’imitsi y’umubiri kugira ngo bamenye nimba umurwayi akeneye imiti y’ubuvuzi yonyene canke kubagwa mu cumba co kubagiramwo vyihutirwa:

Ivyihutirwa bidasanzwe: Indwara y’ibiherere ku mubiri (Mucormycose y’ibiherere ku mubiri)¶

Naho 98 kw’ijana vy’indwara y’ibihimba vy’irondoka mu bana n’abakuze bafise amagara meza iterwa n’imigera, indwara y’ibiherere ku mubiri yica, ishobora gusenyura ningoga yitwa Mucormycose y’ibihimba vy’irondoka y’inzoka (iterwa n’ibikoko vyo mu bwoko bwa Mucorales, nka Rhizopus, Acorsive) . abarwayi bari mu kaga gakomeye: - Ni nde ari mu kaga: Abarwayi bo muri indwara y'igisukari (DKA) (aho isukari nyinshi mu maraso n’amaraso afise aside bitanga ivyuma vy’ubuntu bigaburira ibiherere ku mubiri Mucorales), indwara y’igisukari idacunzwe neza, indwara mbi z’amaraso/neutropenia, abaronka ingingo canke uburozi bw’amagufa, ubuvuzi bwa deferoxamine iron-chelation therapy, canke ubuvuzi bwa corticosteroid buherutse gukoreshwa. - Uko Mucormycose isenya utugingo ngengabuzima (Angioinvasion): Bitandukanye n’imigera itera ibisebe vy’umutuku bishushe, Mucorales hyphae z’ibiherere ku mubiri zitera zica mu bihome vy’imitsi, zikayifunga zigafunga amaraso yose. Ivyo bituma urupfu rw’imitsi y’umubiri (infarction) rwihuta, bigatuma imitsi yanduye ihinduka umweru yapfuye hanyuma igahinduka yirabura nk’amakara (eschar necrotique). - Uko womenya ko ata ndwara ya Mucormycose iri iruhande y’igitanda: Niba umurwayi w’igisukari canke afise ubumuga bwo kurwanya indwara afise ububabare bwo mu bihaha, mu maso hacitse intege, canke ijisho ryavyimvye/ryagabanutse, ushire itara ry’umuco imbere mu mazuru yompi (uravye igice c’amazuru n’igice c’amazuru) no ku ft as palate and the moth as palate) urukoba rw’igipfukisho c’amaso. Igikoko cose c’umwirabura, igisebe c’umutuku/umwirabura, canke igisebe c’umuhondo ku rurimi canke imbere mu zuru ni ikintu gikomeye co kubagwa gisaba ko umuntu ahita akurwamwo ivyuma vy’umubiri mu cumba co kubagiramwo, hanyuma akamutera umuti witwa Amphotericin B mu masaha makeyi.

Ukwitwararika neza utuvungukira dutoduto tw'amaso (Styes & Chalazia) n'amategeko y'umutekano y'inkomoko y'akaga¶

Kugira ngo utunenge dutoduto two mu maso ntituzokwigere tugira ibintu vyihutirwa vyo mu nzira canke mu mutwe, ukurikize aya mategeko akomeye yerekeye isuku n’ubutabazi bwa mbere:

1. Uko wovura neza indwara y’amaso (Hordeolum) idakomeye muhira¶

Niba ufise akagingo ngengabuzima gatoyi kandi gatukura gatoyi kari mu ntango y’igipfukisho c’ijisho (external hordeolum / stye) canke imbere mu gipfukisho c’ijisho (hordeolum y’imbere) gafise zero Orbital Red Flags (ukwinyiganza kw’ijisho gusanzwe ata kubabara, ukubona gusanzwe, nta muriro, nta gukwiragira kw’ijisho ryose): - Ushireko amavuta asukuye, asusurutse (atasha) mu minota 10 gushika kuri 15, incuro 4 ku musi. Ubushuhe buyoroshe burashongera amavuta y’ibishashara (meibum) apfutse igihimba c’irondoka kugira ngo kivemwo ubwaco. - Wose neza ibiganza n’amazi n’isabune imbere n’inyuma yo gukora hafi y’ijisho, kandi ureke kwambara amavuta yo kwisiga amaso canke ama lens gushika iyo stye ivuyeho (jugunya inkoni za kera zanduye za mascara maze ushiremwo imigera canke usubirize ama lens). - NTUKIGERE ufyonda, upfunyaritse canke utera umugozi n’urushinge: Gufyonda bica bicagura akagingo ngengabuzima gatoyi k’igihimba c’irondoka kigasubira inyuma mu mitsi y’imbere n’iy’inyuma.

2. Uko wofata igisebe, igisebe (furuncle), canke umushatsi ukuze mu mfuruka zitatu z’akaga¶

• Ntukigere ukura canke gukuraho ubwoya bwo mu zuru (ubwoya bwo mu zuru) ukoresheje amapinze: Gukuraho ubwoya bwo mu zuru bica bifungura umutsi w’ubwoya uri imbere mu gice c’izuru gifise imigera myinshi (aho 30 kw’ijana vy’abantu mu bisanzwe bitwara Staphylococcus aureus #no furcle), bikaba bituma habaho ubwoya bwo mu zuru. Indwara y’amaraso. Imisi yose kata ubwoya bwo mu zuru ata nkomanzi ukoresheje umukasi w’umutwe uzunguruka canke n’umuyagankuba uzunguruka.
• Iyo habonetse igisebe canke igisebe kibabaje ku zuru, imbere mu zuru, canke ku munwa wo hejuru: Ntukigere ugifyonda canke ngo ugipfuke. Ushireko umuti usukuye kandi ushushe. Iyo igisebe kibabaje kiri imbere mu zuru canke ku kiraro c’izuru gica gitukura (cellulitis), ububabare butera, kivyimba kija mu mfuruka y’imbere y’ijisho, canke umuriro, genda ku muganga uwo musi nyene kugira ngo akureho imiti igabanya ubukana bw’indwara (n’amavuta yo mupirocin yo mu zuru iyo akubwiwe).

Inyandiko nyayo yo guhanahana amakuru kuri 911 / 112 / 999 n'ugutoranya abarwayi¶

Kubera ko amavuriro y'ubuvuzi bwihutirwa n'ivyumba vy'ugutegerezwa vyihutirwa akenshi vyiyumvira ko ijisho ryivyimvye ari "ijisho ry'ibara ry'agahama (conjunctivitis)" canke ururimi rw'ibikoko, koresha aya majambo nyayo y'ubuvuzi mu gutoranya:

• Ku bikekwa ko ari indwara y'ibihimba vy'irondoka:

  "Ndi mu gutoranya umurwayi w'imyaka [Imyaka] afise ibivyimba bikomeye vy'amaso PLUS Orbital Cellulitis red flags: umurwayi afise [ububabare bukomeye iyo yinyiganza ijisho / kwinyiganza kw'ijisho bibujijwe n'ukubona kabiri / ukuvyimba kw'imbere kw'igihimba c'ijisho / ukugabanya ibara ry'amaso gukurikira / gutahura []]. Twaragumye umurwayi ataco akora mu kanwa (NPO) kandi yicaye agororotse, kandi turakeneye gusuzumwa n’umuganga vyihutirwa, imiti igabanya ubukana bw’indwara, n’ugupima CT kugira ngo ntihagire igisebe kiri munsi y’amagufa."

• Ku muntu akekwa ko afise indwara y'amaraso (CST):

  "Emergency triage: uyu murwayi yari afise [ikivyimba co hagati mu maso / indwara y'amazuru / indwara y'ibihaha] ubu afise umutwe ukomeye cane, umuriro mwinshi, [igipfunsi c'ijisho kigwa / kudashobora gukura ijisho hanze], n'ibivyimba ubu biriko birakwiragira ku gice ca kabiri c'ijisho ry'inyuma n'iry'inyuma ry'ijisho (rihuye n'ivyo). guca mu cumba c'ubuvuzi bw'ivyihutirwa, gupima amaraso, gupima imiti irwanya indwara zitandukanye, no gupima imitsi y'amaraso mu buryo bwihutirwa."

Ibibazo bikunda kubazwa¶

Ni ubuhe buryo bwihuta bwo kumenya itandukaniro riri hagati y’indwara y’ibihimba vy’irondoka (preseptal) idakomeye cane n’indwara y’ibihimba vy’irondoka (postseptal) iteye akaga?¶

Fata neza amaso yavyimvye maze usabe uwo muntu akurikire urutoke rwawe amaso yiwe ari ibubamfu cane, iburyo cane, hejuru no hasi. Mu ndwara y’amaso y’imbere y’amaso (preseptal cellulitis) yoroshe, iyo ndwara iba gusa mu ruhu rw’inyuma rw’ijisho, rero guhindura igihimba c’ijisho biraryoha 100 kw’ijana kandi ntibibabaza iyo umuntu abona neza; mu ndwara y’amaso y’akaga, iyo ndwara iba iri inyuma cane y’uruhome rw’umuriro rw’amaso, ni co gituma kwinyiganza igihimba c’ijisho bitera ububabare bukomeye, kwinyiganza bike, kubona kabiri canke ijisho ry’imbere rivyuka.

Ni gute indwara y’amaso y’umwana ihinduka indwara y’amaso y’ibivyimba vyihutirwa mw’ijoro rimwe?¶

Uruhome rw’imbere rw’igihimba c’ijisho rutandukanya ijisho n’igihimba c’umubiri citwa ethmoïde kiri imbere mu zuru ni igufa ry’urupapuro ryitwa lamina papyracea, rikaba rifise uburebure butarenga igice ca milimetero kandi rikaba ritobowe n’utugingo ngengabuzima dutoduto tw’amaraso. Mu bana no mu bakiri bato, indwara y’amaso yitwa ethmoïde acute bacterial isunika bitagoranye ibisebe biciye muri iryo gufa ry’umubiri ryinshi bikaja mu gitereko c’ijisho, bigatuma haba igisebe co munsi y’amaso gica ku mitsi y’amaso no ku mutsi w’amaso mu masaha makeyi.

Mbega vy'ukuri birateye akaga gutera igisebe canke gukura ubwoya imbere mu zuru mu "Danger Triangle of the Face"?¶

Egome, imitsi isohora iyo mfuruka itatu iva ku kiraro c’izuru ija mu mfuruka z’akanwa irahuza ata guca ku ruhande inyuma biciye mu nzira y’amaso biciye mu mitsi y’amaso yo hejuru n’iyo hasi idafise amavalve ikaja mu nzira y’amaso iri mu ntango y’ubwonko. Kubera ko iyo mitsi idafise amavalve y’inzira imwe yo guhagarika gusubira inyuma, gufyonda igivyimba canke umushatsi wanduye imbere mu zuru canke ku munwa wo hejuru birashobora gutuma imigera n’ibihimba vy’umubiri vyanduye bisubira inyuma mu gihanga, bikaba bituma umuntu arwara indwara y’umusonga yitwa septic cavernous sinus thrombosis.

Ni kuki kugerageza ingene ibara ry'umutuku risa ("red desaturation") ari ikigeragezo gihambaye cane mw'ijisho ryavyimvye?¶

Intsinga z’imitsi ziri mu mutsi w’amaso zituma umuntu abona ibara ry’umutuku ry’agahama ni zo zishobora gushikirwa cane n’umukazo w’ubuhinga n’ugucika intege kw’amaraso. Imbere y’uko igisebe canke ukuvyimba kw’ijisho bihuma burundu, gufatanya umutsi w’amaso bituma ikintu gitukura cane (nk’igipfukisho c’icupa gitukura) kigaragara nk’aho cazimiye, kimeze nk’igipfukisho c’umuhondo, canke nk’igitukura c’umuhondo iyo kibonwa n’ijisho ryafashwe n’ijisho rigereranijwe n’ijisho rifise amagara meza, ivyo bikaba bimenyesha abaganga ko bikeneye gukorwa vyihuse.

Amasoko yasuzumwe¶

• Ishure ry’ubuvuzi bw’amaso ryo muri Amerika (AAO, Leta Zunze Ubumwe za Amerika): Ingingo ngenderwako z’ubuvuzi n’Ivyiyumviro vya EyeWiki ku ndwara y’amaso y’imbere y’amaso, indwara y’amaso y’amaso (Itsinda rya Chandler ry’Imigwi I gushika ku V), n’Indwara y’Amaso y’Imitsi y’Imitsi.
• Ishirahamwe ry’ingwara zandukira ryo muri Amerika (IDSA, Leta Zunze Ubumwe za Amerika): Ingingo ngenderwako zo gupima no gufasha indwara z’urukoba n’iz’ibihimba vy’umubiri na Ingingo ngenderwako z’ubuvuzi ku ndwara y’urukoba n’imigera y’urukoba mu bana n’abakuze (orbital na intracranial).
• Ikigo c’Igihugu c’Ubuzima n’Ukwitwararika (NICE, Ubwongereza) n’Ishure ry’Abaganga b’Amaso (RCOphth, Ubwongereza): Indwara y’amaso (Acute): Indwara y’amaso n’iy’amaso Ivyiyumviro vy’ugurungikwa mu bitaro vyihutirwa (NG79).
• Ishure ry’ubuvuzi bw’abana ryo muri Amerika (AAP, Leta Zunze Ubumwe za Amerika): Ugufasha indwara y’ibihaha n’indwara y’ibihaha y’ibihaha mu barwayi b’abana.
• Ishirahamwe ry’Uburayi ry’Ivy’Ubuvuzi bw’Imigera (ECMM) n’Ishirahamwe ry’Ivyigwa ku Micoses (MSG ERC): Ingingo ngenderwako y’Isi Yose yerekeye Gupima no Gucungera Indwara y’Imigera (Ivyiyumviro vyihutirwa vy’Indwara y’Imigera y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi y’Imitsi.

Inyobora zifitaniye isano¶

• Gutakaza amaso bukwi na bukwi, gutandukana kw'amaso, n'indwara y'amaso y'ibara ry'agahama
• Ibikomerekezo vy'amaso: guturika n'imiti, gukomeretswa kwinjira mu maso, n'ugukomeretswa kw'amaso
• Indwara y’ibihimba vy’umubiri (indwara y’ibihimba vy’umubiri) n’indwara y’ibihimba vy’umubiri (cellulite) bifise amabendera atukura
• Sepsis n'ukwemera ivy'uguhungabana
• Indwara y'igisukari yitwa ketoacidose (DKA) n'indwara y'isukari nyinshi mu mubiri