Amaraso ava mu gice c'inyuma n'indwara y'igice c'ijisho: Ijisho ry'urutare n'idirisha ry'inyuma¶

Retrobulbar hemorrhage (RBH) itera Orbital Compartment Syndrome (OCS) ni kimwe mu bibazo vyihutirwa vyihuta cane bishobora gutuma umuntu abona nabi mu buvuzi bwose: amaraso ava mu mutsi canke mu mitsi afashwe inyuma y’igihimba c’ijisho imbere mu gice c’ijisho gikomeye, gifise inkuta zine, ku buryo gishobora gutuma umuntu abona neza cane. nerve kandi igaca amaraso aja mu nzira y’amaso. Ivyo biterwa n’ugukomeretswa mu maso canke mu nzira y’amaso (igipfunsi, umupira w’amaguru, umufuko w’umuyaga, canke ukugwa), kubagwa igipfunsi co kwisiga (blepharoplasty), guhagarika amaso, kubagwa mu bihimba vy’amaso, canke gutera amaso kugira ngo amaso adatere, umukazo uriko uraduga imbere mu nzira y’amaso yugarijwe utuma igipfunsi c’ijisho kija imbere (streptotchels**right). (umubumbe ukomeye nk’urutare), utuma amaso adashobora gukora neza (ophthalmoplegia), kandi ugatuma umuntu agira Ikibazo c’amaso (RAPD) n’ukuntu umuntu abona neza. Nimba umuntu aherutse gukomeretswa n’amaso canke abazwe igipfukisho c’amaso, akagira ububabare bukomeye cane mu nzira y’amaso, ijisho ry’umubiri rivyimba, abona kabiri canke abona nabi, hamagara uwo mu karere iwanyu . inomero z'ivyihutirwa ubwo nyene. Mu gihe urindiriye gutwara abantu vyihutirwa, nusubiremwo ubuyobozi bujanye n’ivyo ku ibikomere vy'amaso muri rusangi n'ukwitaho umubumbe wacitse, Ugufunga kw'umutsi wo hagati w'amaso n'ugufatwa n'amaso, na Glaucome y'imfuruka y'agahomerabunwa n'ugutandukana kw'amaso.

Kubera ko utugingo ngengabuzima tw’umubiri w’umuntu dupfa ubudasiba, tudashobora gusubira inyuma inyuma y’iminota 60 gushika kuri 90 gusa (gushika ku minota 120)** y’ugufatanya kw’imitsi, gukiza amaso bivana no kumenya ubwo nyene ku ruhande rw’igitanda, kwicara umurwayi ahagaze ku 45 degrees, ntiwigere wemera ko umurwayi afuha izuru, no kumujana ku muganga w’ivyihutirwa canke w’amaso azoca akora Lateral Canthotomy and Inferior Cantholysis (LCIC), ata kurindira ko bamupima, kugira ngo arekure umuvuduko w’amaso.

Ivyo ubikore ubu¶

1. Hamagara inomero y’ivyihutirwa yo mu karere kawe canke ugende ku bitaro vy’ivyihutirwa biri hafi ubwo nyene. Hamagara 911 muri Leta Zunze Ubumwe za Amerika na Canada, 112 mu bihugu vyose vy’Ubumwe bw’Uburayi, 999 mu Bwongereza, 000 muri Australiya, canke urabe urutonde rwacu rw’ibintu vyihutirwa inomero z'ivyihutirwa. Bwira neza uwurungika canke umuforoma w'ivyihutirwa: "Ukwikeka ko afise amaraso ava mu gice c'inyuma c'amaso: ububabare bw'ijisho buherutse (canke kubagwa igipfukisho c'ijisho) n'ijisho ry'amaso rikomeye, rikomeye nk'urutare n'ukubura amaso, bikeneye gukurwako ububabare bwo mu gitanda mu minota 60 90."
2. Icara umurwayi ahagaze mu mfuruka ya degre 45 gushika kuri degre 90 maze umugumye atuje. Ntukigere uryamira umurwayi akekwa ko afise amaraso y’inyuma y’umubiri ku mugongo. Kwicara ugororotse bikoresha ububasha bw’isi kugira ngo bigabanye umuvuduko w’amazi wo mu mitsi n’imitsi imbere mu mutwe no mu nzira y’amaso, bikaba bigabanya amaraso ava mu gice c’inyuma c’amaso kandi bikagabanya gatoyi umuvuduko wo mu maso.
3. NTUKIGERE ushirako igitambaro c’amaso gikomeye, umugozi w’umukazo, canke igipande c’urubura gikandagira ku ntugu y’ijisho. Mu ndwara y’igice c’ijisho, umukazo wo mu gice c’ijisho uramaze kuduga cane uva ku 10 gushika ku 20 mmHg urengeye 40 gushika ku 80 mmHg. Gukanda kw’ijisho canke gufata igitambaro co gupfuka ijisho ku bipfunsi vy’ijisho bica bisunika igihimba c’ijisho kigasubira inyuma mu gice c’ijisho cuzuye amaraso, bigatuma ubwo nyene umutsi wo hagati w’ijisho usenyuka. Niba ukeneye gukingira ijisho mu gihe co gutwara, ushireko igikingirizo c’ijisho c’icuma canke c’ipulasitike ca Fox (canke hasi mu gikombe c’impapuro) kugira ngo uruhande rwaco rube ku igufa ry’igihanga n’iry’itama gusa, ntukigere ukora ku mubumbe.
4. Itegeka umurwayi KUTAZOKWIGEZE afuha izuru, gusesa amaraso afise akanwa kafunze, gukorora cane, gupfukama, canke gukomeretsa (Valsalva). Igikomere c’inzira y’amaso gicapura kenshi uruhome rwo hagati canke hasi rw’ijisho ry’amaso ry’uruzitiro rw’amaso ruri ku ruhande rw’amaso n’amaso y’amaso. Gufuha mu zuru bitera umuyaga w’umuvuduko munini uva mu mfuruka y’izuru ugororotse unyura mu mfuruka y’ijisho (tension orbital emphysema), mu gihe gukorora, gukorora canke gutera umuvuduko mwinshi bitera umuvuduko munini w’imitsi y’ijisho kandi bigatuma amaraso ava mu mitsi y’ijisho yihuta.
5. Nimba umurwayi aherutse kubagwa igipfunsi c’amaso (blepharoplasty) afise imidodo y’urukoba yo hanze canke umugozi ufashe igipfukisho, umenyeshe umuganga maze ugende ugororotse mu cumba c’ubuvuzi bw’ivyihutirwa. Inyuma y’ugubagwa kw’amaso akenshi gutera mu masaha ya mbere **3 gushika ku masaha 24, canke ukuduga kw’umuvuduko w’amaraso uko epinephrine iri mu miti yo gutera ububabare yo mu karere igenda irahera). Mu bitaro canke mu kigo c’ubuvuzi, guca urekura imigozi y’inyuma ikomeye no gufungura imirongo y’ibikomere yo mu ruhande birashobora gutuma amaraso yo hejuru asohoka imbere y’uko umuntu akora canthotomie yuzuye.
6. Guma umurwayi ataco arya canke anywa) kandi uzane urutonde rw’imiti yose igabanya amaraso. Ntumuhe aspirine, ibuprofen, canke imiti y’inyongera y’imiti igabanya amaraso (apixaban, rivaroxaban, warfarin, clopidogrel), nk’imiti igabanya amaraso mu gihe c’ivyago. tranexamic acid) kandi bishobora gusaba ko umuntu abagwa ubwo nyene.

Igiti c'ingingo: gutoranya ihungabana ry'umubiri, proptosis, n'indwara y'umubiri¶

flowchart TD
    Start["Igikomere c’ijisho/mu maso, kubagwa igipfukisho c’amaso (Blepharoplasty), kubagwa amaso, canke guhagarika amaso"] --> CheckOCS{"Suzuma ibimenyetso 5 vy’ingenzi vy’indwara y’amaso: 1. Proptosis (Ijisho rivyimba) 2. Ijisho rikomeye nk’urutare / Ibipfunsi bikomeye 3. Ukubona bigabanutse 4. Ijisho ry’umuyaga 5. Inenge y’amaso (RAPD)?"}

    CheckOCS -->|"EGO: Proptose + Umubumbe w’Igihugu + Gutakaza Iyerekwa canke RAPD"| Emergency["INDWARA Y'IBIMENYETSO VY'IBIMENYETSO BITERA AKAGA (Idirisha ry'Iminota 60 gushika ku 90): Hamagara 911 / 112 / 999"]

    CheckOCS -->|"OYA: Suzuma Ibimenyetso vy'Umubumbe Ufunguye"| OpenGlobe{"Amarira/umunyeshure afise isonga, icumba c’imbere gisanzwe, igihimba c’ijisho c’umwirabura gisohotse, canke chemosis y’amaraso y’ibipimo 360 n’ijisho ryoroshe?"}

    OpenGlobe -->|"EGO"| Ruptured["Bikekwa ko Open Globe Rupture: Igipande gikomeye c'ingabo y'umugabo ku ruhande rw'amagufa GUSA, nta gitutu gikomeye ku jisho, imiti igabanya ububabare, gusanura vyihuse icumba co kubagiramwo"]

    OpenGlobe -->|"OYA: Ukubona neza, ibipfukamiro vy’amaso vyoroshe, amaso asanzwe, inyigisho z’amaso zidakomeretse"| Fracture["Gusuzuma ku bijanye n’uguca ibice kw’amaso canke Hyphema: Icara uhagaze, NTUVUGE izuru, ushire umutima ku bitaro vy’amaso n’isuzuma rya CT"]

    Emergency --> FirstAid["1. Icara Ugororotse ku Degre 45-90; NTA gupfuka amaso, NTA gutera umukazo ku mubiri, no gufuha canke gutera umukazo mu zuru"]

    FirstAid --> NoCT["2. NTUCEREZWE GUKORA CT SCAN: Gupima umuntu ku buriri bisaba ko umuntu ahita akuraho ububabare iyo abona bigabanutse canke iyo IOP > 40 mmHg"]

    NoCT --> LCIC["3. Guca igitanda vyihutirwa no gukuraho igihimba c'irondoka (LCIC) + IV Mannitol / Acetazolamide / Imiti myinshi"]

Pathophysiology: kuki inzira y'amagufa yigenza nk'igitekerezo c'umuriro gikingijwe¶

Kugira ngo utahure igituma akayiko k’icayi k’amaraso ari inyuma y’ijisho gashobora guhuma umuntu mw’isaha imwe mu gihe ijisho ryirabura ryinshi riri ku matama ritagira akamaro, utegerezwa kuraba ubuhinga bw’umubiri w’umwobo w’ijisho n’uw’igice c’ijisho:

               SUPERIOR ORBITAL WALL (Rigid Frontal Bone Roof)
          +-------------------------------------------------------+
          |                     BONY ORBITAL CONE                 |
          |  Total Volume = ONLY 30 mL (2 Tablespoons)            |
          |                                                       |
          |    [ RETROBULBAR FAT & MUSCLES ]                      |======\
          |    * RUPTURED INFRAORBITAL OR   *                     |OPTIC  |
          |    * ETHMOIDAL ARTERY BLEEDING  * ===> +------------+ |NERVE  |
          |    * (High Pressure > 50 mmHg)  *      |  EYEBALL   | |(CN II)|
          |                                        |  (Pushed   | | & CRA |
          |  Medial & Lateral Bony Walls           |  Forward)  | |Crushed|
          +----------------------------------------+------------+ +======/
               INFERIOR ORBITAL WALL (Rigid Maxillary Floor)         |
                                                   ^                 |
                                                   |                 |
                        ANTERIOR DOOR BLOCKED BY:  |                 v
                     1. Fibrous Orbital Septum     |         LATERAL CANTHAL
                     2. Medial & Lateral Canthal   |         TENDON (Anchors
                        Tendons (Tethers Eyelids   |         eyelids tight to
                        Tightly to Bone)           |         the bony rim)

1. Agasandugu gatoyi k’amagufa k’imililitiro 30, katagira aho gahera: Igipfukisho c’ijisho ry’umuntu ni piramide y’inkuta zine y’amagufa akomeye (igisenge, hasi, uruhome rwo hagati, n’uruhome rwo mu ruhande) igaca inyuma ikaja ku mpera ndende aho umutsi w’amaso winjira mu gihanga. Igitigiri cose c’inzira y’amaso y’umuntu akuze ni militiro 30 gusa (nk’ibiyiko 2), kikaba caramaze gupakirwa neza n’igihimba c’ijisho (7 mL), umutsi w’amaso, imitsi itandatu iri hanze y’amaso, imitsi, n’ibinure vy’inyuma.
2. Urugi rw’imbere rwugarijwe (Orbital Septum na Canthal Tendons): Kubera ko inkuta zine z’amagufa zidashobora kwaguka zija hanze, uburyo bumwe rudende bwo kuduga umuvuduko uri imbere mu gitereko c’ijisho kugira ngo umuntu ahunge ni imbere mu gusunika igihimba c’ijisho kikava mu gitereko (proptose). Ariko rero, urufunguruzo rw’imbere rw’inzira y’amaso rukingirwa n’igipande gikomeye c’urudodo citwa orbital septum kandi kigafatanywa cane n’amagufa y’imbere n’inyuma n’imitsi y’amaso yo hagati n’iyo mu ruhande** (iyifata amaso yo hejuru n’ayo hasi nk’imitsi y’amaso y’igitari).
3. Amaraso ava imbere y'igihimba c'irondoka n'inyuma y'igihimba c'irondoka (Retrobulbar):
4. Preseptal Hematoma (Simple "Black Eye"): Amaraso akoranira imbere y'igice c'inyuma c'urukoba rw'amaso n'itama. Naho ibipfunsi vy’amaso vyoba vyimba cane bifise ibara ry’umuyugubwe, igihimba c’ijisho kiri musi kiguma ari ikiyoroshe, kikaba kiri mu kibanza gisanzwe kandi kikaba kidatekanye rwose.
5. Ugusohoka amaraso inyuma y’uruzitiro / inyuma y’uruzitiro (Syndrome de l’orbital compartment): Amaraso akoranira inyuma y’uruzitiro rw’uruzitiro imbere mu gice c’amagufa c’imiliyoni 30 gipfutse (kenshi ava mu mutsi w’amagufa uwutaburutse, umutsi w’imbere canke w’inyuma w’uruzitiro, veinth, canke o). Iyo igihimba c’ijisho gisunikiwe imbere milimetero nkeyi gusa, umutsi w’inyuma w’ijisho urashika ku rugero rwawo rwo gukomera maze ugafunga ibipfunsi vy’ijisho nk’ingoma ku mubumbe.
6. Igitero c’imitsi (Igituma IOP > 40 mmHg Ihuma Ijisho): Igihe ibipfunsi vy’amaso bitagishobora gutambuka imbere, mililitiro yose y’amaraso yongewe inyuma y’ijisho irasa mu nzira y’amaso kandi umuvuduko w’amaso (IOP) ukava ku rugero rwawo rusanzwe H20 gushika kuri 650. 100+ milimetero. Iyo umuvuduko w’inzira y’amaso urenze umuvuduko w’amaraso w’imitsi migufi y’inyuma y’amaso (igaburira umutwe w’umutsi w’amaso) n’umutsi w’amaso wo hagati** (ugaburira umutsi w’amaso wo hagati), amaraso aja mu nzira y’amaso n’umutsi w’amaso arahagarara burundu, bikaba bituma **imitsi y’amaso **ischemic and central neuropathy . (IKIGANIRO).

Impamvu zisanzwe z'amaraso ava mu gice c'inyuma c'umubiri n'inzira y'umubabaro¶

Naho uguhungabana kw’inguvu nyinshi ari co kintu ca mbere mu bigo vy’ubuvuzi vyihutirwa, ubuvuzi bwinshi bw’ivyihutirwa bwo kubaga, ubuvuzi, n’ubuvuzi bw’ibihaha butera indwara isa n’iyo Orbital Compartment Syndrome:

Kumenya indwara y'igice c'umubiri n'"ijisho ryirabura" ritagira akamaro.¶

Kubera ko hafi umurwayi wese afise ibikomere vyo mu maso afise ibipfunsi vy’amaso bivyimvye, bikomeretse, abamubona n’abaganga bategerezwa kumenya gutandukanya ijisho ryirabura ry’imbere y’igihimba c’umubiri ryiza n’ijisho ry’inyuma ry’igihimba c’irondoka ry’inyuma ry’ijisho ry’inyuma ry’ijisho ry’inyuma ry’ijisho ry’imbere ry’igihimba c’irondoka ry’inyuma ry’ijisho ry’imbere ry’ijisho ry’imbere ry’ijisho ry’imbere y’igihimba c’irondoka.

Imeza yo kugereranya iruhande y’igitanda: Ijisho ryirabura ry’imbere y’igitanda n’Ijisho ryirabura ry’inyuma n’Ijisho ry’Ijisho ry’Ijisho¶

Uko womenya ko ata Proptose n’akaga k’amaso (RAPD) mu masegonda 30¶

1. Uruhanga rw'"Ijisho ry'Inyoni" Gusuzuma ko ata Proptose: Hagarara inyuma canke hejuru y'umutwe w'umurwayi yicaye, ushire ikibuno ciwe hejuru gatoyi, hanyuma urabe hasi ugororotse hejuru y'uruhanga rwawe ujabutse ibipfunsi vyiwe ku magufa yompi y'amatama. Mu jisho ryirabura ryoroshe, urukoba rworoshe rwonyene ni rwo rusohoka. Mu retrobulbar hemorrhage, uzobona igihimba c’ijisho nyaco c’ijisho ryafashwe gisohotse imbere milimetero nyinshi kirenze umurongo w’ijisho ugereranyije n’ijisho ritakomeretse.
2. Ikigeragezo c’Ukutukura (Ikimenyetso ca mbere c’Ugufatanya kw’Imitsi y’Amaso): Fata ikintu gitukura cane (nk’igipfukisho c’icupa gitukura canke igipfukisho c’imiti y’ivyihutirwa) imbere y’ijisho ryiza ry’umurwayi, hanyuma imbere y’ijisho ryakomeretse. Imbere y'uko umurwayi atakaza ubushobozi bwo gusoma amajambo, umutsi w'amaso ugira ubumuga bwo mu mutwe uratakaza ubushobozi bwo kubona umutuku ukeye: umurwayi azotanga raporo ko igipfukisho c'umutuku kimeze nk'"icazimiye, cayozwe n'umutuku, c'inzobe, canke c'imvi" mw'ijisho ryakomeretse.
3. Ikigeragezo c’Itara Rizunguruka ku ndwara ya RAPD (Umunyeshure wa Marcus Gunn): Naho umurwayi yoba ataco azi, afise intubation, canke yavyimvye cane ku buryo adashobora gusoma igicapo c’amaso, Igerageza ry’Itara Rizunguruka rica rikubwira ubwo nyene nimba umutsi w’amaso uriko urapfa:
4. Zima amatara yo mu cumba maze umurikishe itara ry’ikaramu mu ijisho ritakomeretse (ryiza) mu masegonda 3: umunyeshure mwiza n’umunyeshure yakomeretse bompi barafatanya cane (inyishu y’ukwemeranya).
5. Niwihutire gutera umuco w’umuco ujabutse ikiraro c’izuru ushike mu jisho ryakomeretse: kubera ko umutsi w’amaso wajanjaguwe uri mw’ijisho ryakomeretse udashobora gutanga ikimenyetso c’umuco mu bwonko, ubwonko bwiyumvira ko icumba cacitse umwijima, kandi **abanyeshure bompi bagaca bafunguka (pan light of **am right be.) RAPD nziza mu jisho ry’umubabaro, ry’umubiri ni ikimenyetso c’ukuri c’uko umuntu yoca akora Canthotomie Latérale na Cantholyse.

Uburyo bwo gufasha mu bitaro: Guca igihimba c'irondoka co mu ruhande n'uguca igihimba c'irondoka co hasi (LCIC)¶

Iyo umurwayi ashitse mu bitaro vy’ibiza afise indwara y’ibihaha, umuganga w’ibiza canke umuganga w’amaso akora igikorwa c’iminota 2 co kumuvura iruhande y’igitanda citwa Lateral Canthotomy and Inferior Cantholysis (LCIC).

Kubera iki guca urukoba gusa ("Canthotomy") BITAHAGIJE: ubuhinga bwo gukata urukoba rwa Cantholyse .¶

Ibara ry’agaciro ry’ugubaga ryigishwa mu buvuzi bwose bw’ivyihutirwa n’ubuvuzi bw’ihungabana ni itandukaniro riri hagati ya Intambwe ya 1 (Canthotomie Latérale) na Intambwe ya 2 (Cantholyse Inférieure):

                     OUTER CORNER OF THE EYE (LATERAL CANTHUS)

     [Upper Eyelid Tarsal Plate]
                  \
                   \   Superior Crus of Lateral Canthal Tendon
                    \  (Cut in Step 3 ONLY if IOP stays > 40 mmHg)
                     \
    (CORNEA)          +=======> [LATERAL CANTHOTOMY INCISION]
                     /          (Step 1: 1-2 cm skin cut to bony rim)
                    /
                   /   *** INFERIOR CRUS OF LATERAL CANTHAL TENDON ***
                  /    (Step 2: MUST Strum & Snip This "Guitar String"
     [Lower Eyelid]     Tendon to Release the Lower Eyelid & Drop IOP.)

• Kubera iki Intambwe ya 1 (Canthotomy) yonyene idashobora: Guca urukoba mu mfuruka y’inyuma y’ijisho (canthotomy y’inyuma) bigabanya gusa umuvuduko w’ijisho n’ibice nka 10 gushika kuri 14 mmHg kubera ko igihimba c’inyuma c’ijisho gifise uburemere bwimbitse igufa ry’inyuma ry’umubiri (tubercule de Whitnall).
• Kubera iki Intambwe ya 2 (Inferior Cantholysis) ari yo ntambwe ikiza amaso: Gukwega igipfukisho co hasi imbere n’ivyuma vy’amaso bigaragaza umugozi w’umweru ukomeye kandi w’insinga wumva neza na neza nk’umurongo wa gitari utunganijwe neza** iyo uvuzwe n’imitwe y’umukasi w’amaso udakomeye. Guca uwo mutsi wo hasi (inferior cantholysis) bica bifungura burundu igipfukisho co hasi, bikaba bituma igihimba c’ijisho gishobora gutera imbere milimetero 4 gushika ku 6, kikarekura amaraso y’inyuma y’ijisho yafunzwe, maze ubwo nyene umuvuduko wo mu jisho ugabanuka 30 gushika kuri 50+ mmHg.

Ibimenyetso vy'ubuvuzi n'intambwe ku yindi y'ibikorwa vy'ibitaro vya LCIC¶

1. Ibimenyetso vy'ukuri (Ukore ubwo nyene iruhande y'igitanda imbere y'uko ukora CT):
2. Amateka y’ugukomeretswa n’umubiri, kubagwa igipfunsi c’amaso, canke guhagarika amaso PLUS proptosis/tense globe PLUS UMUNTU WOSE muri:
   • Kugabanya ubushobozi bwo kubona,
   • Inenge nziza y'amaso (RAPD), CANKE
   • Umuvuduko wo mu maso (IOP) > 40 mmHg.
3. Intambwe ku yindi ubuhinga bwo gutera iruhande y'igitanda (bukorwa n'umuganga):
4. Gutegura no gutera ububabare: Sukura imfuruka y’inyuma y’ijisho n’imiti y’amaso yitwa povidone-iodine hanyuma ushiremwo 1 gushika kuri 2 mL ya 1% canke 2% ya lidocaine n’imiti 1:100.000 ya epinephrine uyishire mu gice c’inyuma c’ijisho (igufa ry’inyuma ry’ijisho).
5. Devascularize (Clamp): Fata hemostat igororotse mu buryo buringaniye ku ruhande rw’umubiri gushika ku ruhande rw’umubiri rw’amagufa mu masegonda 30 gushika kuri 60 kugira ngo ujanjagure imitsi y’amaraso maze ureme inzira idafise amaraso.
6. Intambwe ya 1 - Guca igihimba c’ijisho mu ruhande: Ukoresheje iris canke umukasi wa Stevens tenotomy, kata mu buryo buringaniye ku murongo ujanjaguritse kuva ku mfuruka y’inyuma y’ijisho 1 gushika kuri 2 sentimetero mu ruhande gushika ku ruhande rw’amagufa.
7. Intambwe ya 2 - Inferior Cantholysis: Fata uruhande rw’inyuma rw’igipfukisho co hasi n’ibikoresho vy’amenyo maze urukwegere neza imbere no hejuru werekeza ku gisenge (kure y’igipfukisho c’ijisho). Koresha isonga ry'umukasi ryugarijwe kugira ngo ukoreshe ("strum") inferior crus y'umutsi w'amaso wo mu ruhande ushize igipfukisho co hasi ku igufa, werekane isonga ry'umukasi hasi/kure y'umubumbe, hanyuma uce umutsi wose gushika igipfukisho co hasi gipfutse maze kiguye burundu.
8. Subira gusuzuma IOP & Vision Ubwo nyene: Subira gupima umuvuduko wo mu maso mu minota 2 gushika kuri 5. Iyo IOP iguma > 40 mmHg, genda ku Intambwe ya 3 (Superior Cantholysis) mu guca igihimba co hejuru c’umutsi w’amaso wo mu ruhande munsi y’igipfukisho co hejuru.
9. Iciyumviro co gukiza abarwayi: Remesha umurwayi n’umuryango ko igice c’inyuma c’amaso gikira neza cane kandi gishobora kudogwa bitagoranye n’umuganga w’amaso haciye imisi 3 canke 5 iyo ibivyimba vyose vyo mu nzira y’amaso bimaze gukira, nta nkovu iboneka isigaye.

Ivyuma vy’ubuvuzi (Bikoreshwa iruhande ya LCIC, ntivyigera bisubirira guca umutsi)¶

Igihe bariko barategura LCIC iruhande y’igitanda canke ubwo nyene inyuma y’aho, abaganga b’ibihe vyihutirwa baratanga ubuvuzi bwo mu mitsi kugira ngo bagabanye umubare w’amaso, bagabanye ivyimburwa vy’amazi, bongere bagabanye ukuvyimba kw’imitsi y’amaso: - Mannitol yo mu mutsi: 1 to 2 g/kg IV iterwa mu minota irenga 30 (ikintu gitera amazi menshi mu jisho no mu nzira y’ijisho). - Imiti yo mu mutsi (Diamox): 500 mg IV bolus (umuti ugabanya amazi y’amazi asohoka mw’ijisho). - Amatotsi agabanya IOP: Amatotsi ya Timolol 0.5% na brimonidine (wirinde iyo umuntu akeka ko afise umubumbe wuguruye). - Imiti myinshi iterwa mu mutsi: Methylprednisolone (250 mg to 1,000 mg IV) canke dexamethasone kugira ngo ugabanye umururumba w’imitsi y’amaso iterwa n’ihungabana. - Imiti igabanya amaraso n’imiti igabanya ububabare: Ondansetron iterwa mu mutsi kugira ngo umuntu ntaruke gutera imbere mu muvuduko w’amaraso, gucungera umuvuduko w’amaraso, no guhindura ubwo nyene warfarin, apixaban, canke rivaroxaban.

Inomero z'ivyihutirwa zo mu karere n'amategeko y'ibigo¶

Ivyiyumviro vy’ugusohoka kw’amaraso mu nyuma canke indwara y’ibihimba vy’umubiri ni Iciciro ca mbere / Ivy’imbere 1 vy’ubuvuzi bw’amaso n’ivyihutirwa vy’ihungabana bifise idirisha ry’iminota 60 gushika kuri 90 ry’umuryango wo gukuraho ububabare:

• Leta Zunze Ubumwe za Amerika na Canada: Hamagara 911 kugira ngo utware Ikigo c’Ihungabana c’Urwego rwa 1 canke 2 canke Igisata c’Ibitaro vy’Ivyihutirwa kiri hafi (ntiwigere uja mu biro vy’umuganga w’amaso canke mu kigo c’ubuvuzi bwihutirwa). Igenzurwa na Ishure ry’Abaganga b’Amaso ryo muri Amerika (AAO) na Ishure ry’Abaganga b’Amerika ATLS (Advanced Trauma Life Support) amategeko agenga ivy’ihungabana, ategeka ko umuganga w’ivyihutirwa akora igihimba c’umubiri c’inyuma y’igitanda imbere y’uko akora CT scanning.
• Ubwongereza: Hamagara 999 canke ugende ubwo nyene mu bitaro bikomeye Igisata c'Ivyihutirwa (A&E). Mu Ishure ry’Ubwami ry’Ubuvuzi bw’Ivyihutirwa (RCEM) n’iry’Ishure ry’Ubwami ry’Abaganga b’Amaso**, Abanyamabanga b’Ishure ry’Ubuvuzi bw’Ivyihutirwa n’Abajanama baramenyerezwa kandi bafise uburenganzira bwo gukora ubuvuzi bw’amaso buva ku buriri ata kurindira ko abaganga b’amaso baza.
• Ubumwe bw'Uburaya: Hamagara 112. Icungiwe hakurikijwe amategeko y’i Buraya yo gusubiza ubuzima mu mubiri n’ubuvuzi bw’amaso bwihutirwa.
• Ostraliya na Nouvelle-Zélande: Hamagara kuri 000 muri Australiya canke 111 muri Nouvelle-Zélande. Irongowe hakurikijwe Ishure ryisumbuye ry’ubuvuzi bw’ibihe vyihutirwa ryo muri Australiya (ACEM) na RANZCO amabwirizwa yerekeye ihungabana ry’umubiri.
• Ubuhindi na Aziya-Pasifike: Hamagara 112 (canke 108 mu Buhindi), 995 muri Singapore, 119 mu Buyapani na Koreya y’Epfo, canke 999 muri Maleziya na Hong Kong. Bandanya mu bitaro bikomeye vy’abakomeretse canke mu bitaro vy’amaso vy’ivyihutirwa.

Ibibazo bikunda kubazwa¶

Nomenya gute itandukaniro riri hagati y’ijisho ryirabura risanzwe n’amaraso ava mu gice c’inyuma?¶

Mu jisho ryirabura risanzwe (preseptal hematoma), amaraso yicara ataco akora mu ruhu rworoshe imbere y’ibipfunsi: naho ibipfunsi vyoba bisa n’ibitukura kandi bivyimba, bimeze nk’ibiyoroshe, igihimba c’ijisho cicara mu burebure busanzwe, ukunyiganyiga kw’amaso ni ibisanzwe, kandi ukubona kuratomoye neza iyo udugije igipfukisho mu bugwaneza. Mu gusohoka kw’amaraso mu gice c’inyuma c’ijisho, amaraso arafatwa inyuma y’igihimba c’ijisho imbere mu gipfukisho c’amagufa, agasunika igihimba c’ijisho kigaragara imbere (proptose), agaca arambura ibipfunsi vy’amaso bikomeye nk’urutare ku igufa kugira ngo ntibishobore gufunguka, bigatuma amaso adashobora kwinyiganza, kandi agatuma umuntu abona neza cane kandi akabona nabi.

Ni kubera iki idirisha ry’iminota 60 gushika ku 90 ari ngirakamaro cane mu ndwara y’ibihimba vy’umubiri?¶

Retina ni igice c’umubiri w’ubwonko gikoresha umwuka mwinshi cane kuri garama y’umubiri wose wo mu mubiri w’umuntu. Iyo amaraso ava mu gice c’ijisho c’amagufa gikomeye c’imililitiro 30, atuma umuvuduko uri hejuru ya milimetero 40 gushika kuri 50, aca afunga umutsi wo hagati w’amaso be n’ututsi dutoduto tw’amaso tugaburira umutsi w’amaso. Ivyigwa vy’igerageza n’ivy’ubuvuzi vyerekana ko inyuma y’iminota 60 gushika ku 90 (kandi hafi kw’isi yose irenga iminota 120) y’ugucika intege kw’amaraso y’umubiri, utugingo ngengabuzima tw’umubiri dupfa ubudasiba, ivyo bikaba bituma umuntu agira ubuhumyi budashobora gusubira inyuma kiretse iyo umutsi w’inyuma w’umubiri uciwe mu gihe.

Ni kuki abaganga badakwiye kurindira ko bakora CT scan imbere y’uko bakora canthotomie latérale?¶

Indwara y’ibihimba vy’umubiri (Orbital Compartment Syndrome) isuzumwa mu buryo bw’ubuvuzi iyo umuntu ari iruhande y’igitanda mu minota itarenga ibiri mu kugenzura ko ata n’umwe afise proptose, ko afise umubiri ukomeye nk’urutare, kandi ko atabona neza canke ko afise akaga k’amaso (RAPD). Gutwara umurwayi mu cumba c’abaganga, gufata igipimo co mu maso, no kurindira ko basubira kwubaka ishusho, bifata iminota 30 gushika ku 60 y’iminota 90 y’idirisha ry’ubuzima ry’amaso. Guca umutsi w’inyuma w’igitanda ku ruhande rw’igitanda bifata iminota ibiri umuntu akoresheje umuti wo kumunezereza, bica bituma amaraso asubira mu nzira y’amaso, kandi bikaba bituma umurwayi ashobora gukorwako CT scan ata nkomanzi inyuma y’aho.

Ni kuki mbujijwe gufuha izuru maze gukubitwa mu jisho?¶

Iyo umuntu akubise ijisho, kenshi bica bimenagura uruhome rwo hagati (lamina papyracea) canke hasi mu gitereko c’ijisho, ivyo bikaba bisangiye uruhome n’ibihimba vy’izuru vyawe vyuzuye umwuka. Iyo upfutse izuru ryawe, umukazo uri mu bihimba vy’izuru ryawe uraduga ukarenga 80 gushika kuri 100 mmHg, ugatera umuyaga uciye mu mfuruka y’igufa ugororotse inyuma y’igihimba c’ijisho ryawe. Kubera ko iyo nyama yoroshe ikora nk’umutsi w’ijisho ugenda mu nzira imwe, umuyaga urafata inyuma y’ijisho (tension orbital emphysème) maze ugamenagura umutsi wawe w’amaso nk’uko nyene amaraso afata.

Mbega amaraso yo mu nyuma y’amaso yoba ashobora kuva inyuma yo kubagwa amaso (blepharoplastie)?¶

Egome. Retrobulbar hemorrhage ni ikibazo giteye ubwoba cane gitera ubwoba amaso y’ugutera amaso yo hejuru canke yo hasi, kikaba gishika kenshi mu masaha 3 gushika kuri 24 ya mbere inyuma yo kubagwa iyo epinephrine y’aho hantu ipfuye canke iyo umurwayi akorora, arutse canke apfukamye,. Niwagira ububabare bukomeye butunguranye mw’ijisho rimwe, ukuvyimba kwihuta gusunika ijisho imbere, canke ukubona nabi inyuma yo kubagwa igipfukisho c’amaso, hamagara 911 n’umuganga wawe abaze ubwo nyene kugira ngo imigozi n’imidodo bikomeye bishobore kurekurwa maze bakore canthotomie.

Mbega iyo umuntu akoresheje igihimba c’ijisho co mu ruhande (latéral canthotomie) vyoba bituma ijisho rimera nabi ubudasiba canke ryonona igihimba c’ijisho?¶

Oya, guca igihimba c’ijisho n’igihimba c’ijisho co mu ruhande ntibica igihimba c’ijisho na gato; ikora igice c’amaso kiringaniye c’uburebure bwa santimetero 1 gushika kuri 2 ku mfuruka y’inyuma y’ibipfunsi vy’amaso maze igaca akatsi gatoyi k’insinga gafatanya igipfunsi co hasi n’igufa. Igihe amaraso n’ukuvyimba vyo mu nzira y’amaso bimaze guhera mu misi 3 canke 5, umuganga w’amaso canke umuganga w’amaso aradoda gusa umutsi n’imfuruka y’inyuma y’amaso asubira hamwe mu mfuruka y’urukoba rw’ikirenge c’igikona, agasiga inkovu idashobora kuboneka mu gihe ariko arakiza umurwayi.

Amasoko n'ubuyobozi buzwi¶

• Ishure ry’ubuvuzi bw’amaso ryo muri Amerika (AAO, Leta Zunze Ubumwe za Amerika): EyeWiki & Amabwirizwa y’ubuvuzi: Indwara y’ibihimba vy’amaso, amaraso ava mu gice c’amaso, n’uguca amaso mu ruhande n’uguca amaso mu ruhande.
• Ishure ryisumbuye ry’abaganga babaga ryo muri Amerika (ACS, Leta Zunze Ubumwe za Amerika): Igitabo c’amashure y’abanyeshure bafashwa mu buzima bw’abashikiwe n’ihungabana (ATLS) (Ivyerekeye ihungabana ry’amaso n’amasezerano yo gukuraho ububabare bw’amaso).
• Ishure ryisumbuye ry’ubuvuzi bw’ibihe vyihutirwa (RCEM) & Ishure ryisumbuye ry’abaganga b’amaso (Ubwongereza): Ingingo ngenderwako nziza: Gucungera indwara y’ibihe vy’amaso (OCS) mu gisata c’ubuvuzi bw’amaso.
• Lima V n’abandi. (Ikinyamakuru c'ubuvuzi bwo mu kanwa no mu maso) & Hayreh SS (Ubushakashatsi bw'amaso bw'igerageza): Ischemie y'amaso n'igihe co kwihanganira umutsi w'amaso wo hagati (Idirisha ry'iminota 90 gushika ku 100).
• Ishirahamwe mpuzamakungu ry’umusaraba utukura n’ukwezi gutukura (IFRC): Ingingo ngenderwako mpuzamakungu zijanye n’ubutabazi bwa mbere, gusubiza ubuzima mu buzima, n’uburezi: Gukomeretsa amaso no kwikingira.

Inyobora zifitaniye isano¶

• Ibikomere vy'amaso, umubumbe wacitse, n'amaso yaturiwe n'imiti
• Ugufunga kw'umutsi wo hagati w'amaso, indwara y'amaso, n'indwara y'umutsi w'ingingo nini
• Glaucome y'imfuruka y'agahomerabunwa n'ugutakaza amaso
• Ijisho ry'ikintu c'amahanga, gushaza kw'ijisho, n'umuco wo gusudira
• Hematoma yo mu matwi, hematoma yo mu mazuru, n’ugukomeretswa mu maso