Retrobulbar Hematoma, Jabka Orbital Blowout Syndrome, iyo Qaybta Indhaha¶

Ka dib marka isha la feero, kubbadda koleyga ama xusulka ayaa wejiga ku dhufanaya, dhicitaan, ama shil baabuur, xanuun aad u xanuun badan, dhagxaan adag, indho bararsan (proptosis) oo leh aragga hoos u dhaca waa xaalad degdeg ah oo qalliin oo waqti-dhiman ah oo loo yaqaan ** Orbital Compartment Syndrome (OCS)** oo ka timid ** Retrobulbar Hematoma. Sababtoo ah godka isha bini'aadamka (orbit) waa mid adag, sanduuqa lafaha afar-dibi ah ayaa ka furan oo keliya xagga hore, dhiigbaxa halbowlaha ah ee ka dambeeya kubbadda isha wuxuu si degdeg ah u kiciyaa cadaadiska intraorbital ee ka sarreeya cadaadiska halbowlaha isha dhexe, oo ceejinaya isha iyo neerfaha indhaha gudaha ** 60 illaa 120 daqiiqo . Xataa marka aanu jirin xinjiro dhiig oo retrobulbar ah, jabka sagxada lafaha khafiifka ah ee godka isha ( Orbital Blowout Fracture**) waxay dabin kartaa muruqa isha kor u qaadaya, taasoo kicinaysa falcelinta wadnaha gaabisa ee khatarta ah (** oculocardiac reflex**), ama ku khasbo hawada sinus gadaasheeda kubbadda isha haddii qofku sanka afuufo. Haddii qof kasta oo dhaawac ka soo gaadhay wejiga ama isha uu ku dhaco isha dillaacsan, lumis aragga, aragga labanlaaban, lallabbo leh garaaca wadnaha oo gaabis ah, ama kabuubyo xagga faruuryaha iyo dhabanka sare, wac lambarka degdegga ah ee degaankaaga isla markiiba nambarada degdega ah. Dib u eegis ku saabsan borotokoolka dhaawacyada ee la xiriira dhaawacyada indhaha iyo daryeelka degdegga ah, dhaawacyo madaxa iyo miyir beelkaiyo Cellulitis orbital iyo xinjirowga sanka ee godka.

Hadda samee tan¶

1. Isla markiiba wac nambarka deg-degga ah ee degaankaaga *** (911 gudaha Mareykanka iyo Kanada, 112 guud ahaan Midowga Yurub, 999 gudaha Boqortooyada Ingiriiska) haddii isha dhaawacan ay horay u soo baxayso (proptosis), uu dareemo cidhiidhi iyo dhagax adag hoostiisa daboolka bararsan, leh arag guduudan ama madow, leeyahay arday aan si caadi ah u kicin karin xanuun la'aanteed oo aan kor u kicin karin. lalabo.
2. ** Bukaanka u fadhiiso si toos ah (ugu yaraan 45 ilaa 90 darajo) haddii aan la tuhunsanayn dhaawaca laf dhabarta.** Inaad madaxa kor u qaaddo heerka wadnaha waxay isticmaashaa cuf-jiidad si ay hoos ugu dhigto cadaadiska dhiigga halbowlaha iyo ciriiriga xididada gudaha godka isha, hoos u dhigista dhismaha hematoma retrobulbar.
3. ** Si adag u amar bukaanka: "SANKAAGA HA BURIN, ha hindhisin adigoo afkaaga xidhan, hana is adkayn." Sanka oo la afuufo wuxuu u dhaqmaa sida bamka hawada cadaadiska sare leh, taasoo ku qasbeysa hawada sinus ee dillaaca jabka tooska ah ee ka dambeeya kubbadda isha (** kacsanaanta orbital emphysema ***), taasoo isla markiiba indhaha ka saari karta iyadoo la cadaadiyo dareemayaasha aragga.
4. Ka eeg aragga isha dhaawacantay hadda (daboosha isha aan dhaawacmin) oo ku celi jeegga 10kii daqiiqoba mar. Qofku ha akhriyo daabac, xisaabi inta farood ee aad kor u qaadayso, ama sheeg inay arki karaan dhaqdhaqaaqa gacanta ama iftiinka. Haddi aragga aragga uu hoos uga dhaco akhrinta xarfaha ilaa tirinta faraha oo kaliya ka dib dharbaaxo wejiga ah, u sheeg kalkaaliyayaasha caafimaadka iyo takhtarka qolka degdega ah daqiiqadda saxda ah ee aragga bilaabay inuu hoos u dhaco si ay u sameeyaan sariir degdeg ah ** Lateral Canthotomy iyo Cantholysis (LCC) ** gudaha ** 90-daqiiqo daaqad ischemic **.
5. **Isha ku ilaali gaashaan adag, oo daboolan (ama hoose ee warqad/koob xumbo ah oo lagu dhejiyay lafta daanka iyo dhabanka) cadaadiska ZERO ee kubbadda isha. Haddii ay jirto jeex aan la ogaanin oo ku taal gidaarka kubbadda isha (dhaawaca caalamiga ah ee furan) ama hematoma retrobulbar, cadaadiska dibadda ayaa soo tuujin doona waxa isha ku jira ama wuxuu dardar gelinayaa ischemia neerfaha indhaha.
6. **Bukaanka waxba afka ha ku haynin (NPO) oo dawee lallabada ama matagga isla markiiba

Geedka go'aanka: Kala soocida dhaawacyada ba'an ee xubinta taranka, protosis, iyo jabka dillaaca¶

flowchart TD
    Start["Dhaawaca Isha, dhabannada, ama foodda ka soo gaadha"] --> GlobeCheck{"Talaabada 1: Meesha Ka Baxa Dildilaaca Globe Furan (Ardayga ilmada/Ardayga ugu sarreeya, unug madow oo iris ah oo soo baxaya, buufin 360-degree dhiig leh oo isku xiran, ama isha dillaacsan)?"}

    GlobeCheck -->|"HAA: Waxaa la tuhunsan yahay inuu dillaacay Globe Open"| OpenGlobe["PROTOCOL GLOBE FURAN: 1. Cadaadiska ZERO ee isha; Ha hubin cadaadiska intraocular (tonometry). 2. Cajalad adag ku dheji gaashaanka indhaha Fox ama koob warqad ah oo ku dul yaal cidhifka lafta. 3. Wac 911/112/999 si aad u hagaajiso qalliinka indhaha ee degdega ah, antibiyootiga IV, & antiemetics."]

    GlobeCheck -->|"MAYA: gidaarka Globe ayaa si toos ah u soo muuqda"| OCSCheck{"Talaabada 2: Screen for Orbital Partment Syndrome (Retrobulbar Hematoma): Isha oo xanuunaysa (proptosis), dabool adag oo adag, aragga oo dhacaya, ama arday caajis ah (RAPD)?"}

    OCSCheck -->|"HAA: Retrobulbar Hematoma / Indhaha Indhaha"| Canthotomy["90-daqiiqo Gurmad Qalliin ah: 1. Wac 911/112/999 Isla markiiba; fadhiiso toosan 45-90 darajo. 2. Dhaqtarka digniinta ER marka uu yimaado: Wuxuu u baahan yahay sariir deg deg ah Kanthotomy & Kantholysis KA HOR CT Scan. 3. Sii IV Mannitol / Acetazolamide / Methylprednisolone sida buundada."]

    OCSCheck -->|"MAYA: Aragga Caadiga ah, Orbit Jilicsan, Ma jiro Kahortag"| MuscleTrapCheck{"Talaabada 3: Hubi Dhaqdhaqaaqa Indhaha ee Ka Baxsan (Fiiri kor, Hoos, Bidix, Midig): Miyuu aragga sare ku xaddidan yahay laba aragga, AMA ay weheliso lallabbo, matag, iyo garaaca wadnaha oo gaabis ah (<60 bpm)?"}

    MuscleTrapCheck -->|"HAA: eegno kor u xaddidan + Bradycardia/Labo (Gaar ahaan Ilmaha/Dhallinyarada leh 'Isha Cad')"| Trapdoor["JAB JABAN SABAQA ORBITAL ORBITAL: 1. Waaxda Gurmadka Degdegga ah ee Orbital CT Scan hadda. 2. La soco ECG si aad u hesho Reflex Oculocardiac (vagal bradycardia/wadne block). 3. Wuxuu u baahan yahay qaliin degdeg ah oo lagu sii daayo 24 ilaa 48 saacadood gudahood si looga hortago necrosis muruqa joogtada ah."]

    MuscleTrapCheck -->|"MAYA ku dheggan muruqa ama Bradycardia"| SimpleBlowout["SHARCIYADA AAN LAGU QABAN JABIN FARXUMA FUMAYSIGA AH (Isha oo go'day / enophthalmos, dhaban kabuubyo ah/bishimaha sare, ama ceermiska): 2. Waaxda Degdegga ah ee Degdegga ah ee CT of Orbits si loo qiimeeyo xajmiga jabka iyo sinuska."]

Pathophysiology: Sida godka isha uu u noqdo kariyaha cadaadiska dilaaga ah¶

1. Anatomy adag ee wareegga lafaha iyo seedaha canthal¶

Si aad u fahamto sababta ururin yar oo dhiig ama hawo ah oo isha gadaasheeda ah ay u keento indho la'aan si degdeg ah, tixgeli naqshadda farsamada ee wareegga bini'aadamka: - ** Afar darbi oo Lafo Adag:** Indhuhu waa pear-qaabeeya, Ahraamta afar-gees ah leh celcelis ahaan mugga gudaha ah oo keliya 30 millilitir (\(30\text{mL}\)), oo ku xiran xagga sare (lafaha hore / orbital), bannaanka (zygomatic iyo sphenoid lafaha / lateral), gidaarka iyo hoose (lafaha hoose) / gidaarka dhexe). - ** Albaabka Hore ee La Xidhay:** Dhanka furitaanka hore ee Ahraamta, kubbadda isha (globe) iyo dufanka orbital waxa si adag loogu hayaa godka dhexdiisa xaashi adag oo fibro ah (** the orbital septum**) oo waxay ku xidhan tahay sida xadhig gitaar ah oo ku xidha cidhifyada lafaha ee ** dhexda dhexe ama seedaha kanthal-ka sare. crura**). - ** Qalooca u Hogaansanaanta Cadaadiska:** Caadiyan, nasashada cadaadiska intraorbital iyo intraocular (IOP) waa 10 ilaa 20 milimitir oo meerkuri ah (\(\text{mmHg}\)). Sababtoo ah darbiyada lafaha ma balaadhi karaan bannaanka, xuubka canthal-ka dambena wuxuu ka hortagayaa in kubbadda isha ay horay u socoto wax ka badan dhowr milimitir, orbit-ku wuxuu qaadi karaa kaliya qiyaastii ** 4 ilaa 5 millilitir ** dareere dheeri ah ka hor inta aan dhammaan cufnaanta unugyadu dhammaan. - Marka uu dillaaco ** halbowlaha infraorbital, halbowlaha hore ama dambe ee ethmoidal, ama laanta halbowlaha indhaha** ayaa ku dhiig baxa in ka badan 5 millilitir oo ah koofiyadda muruqa retrobulbar (ama ka dib marka hawada sinus lagu khasbo cadaadiska), cadaadiska intraorbital ayaa cirka isku shareeray**0,60mmH

2. Cascade ceejinta xididdada dhiigga (Ocular Compartment Syndrome)¶

Sida xanuunka qaybta ba'an ee lugta hoose ama cududda oo jajaban (eeg burburka dhaawaca iyo cilladda qaybta), marka cadaadiska gudaha qolka orbital ee kuxiran uu ka bato cadaadiska dhiig karka ee xididada yaryar ee quudiya isha iyo neerfaha indhaha: 1. ** Dhiigbaxa Xididada oo Burburay (\(>25\text{ to }30\text{mmHg}\)):** Xididada isha ee dhexe ee dhuuban iyo xididada vortex-ka ayaa marka hore la xidhaa, dhiiga xididada isha ku haya oo ka sii dara ciriiriga. 2. ** Ciliary Dambe Gaaban iyo Vasa Nervorum Ischemia (\(> 35' qoraal { to } 45\text { mmHg}\)):** Maro-mareenada yaryar ee quudiya madaxa neerfaha aragga iyo retrobulbar neerfaha indhaha oo burbura, taasoo keenta ischemic optic neuropathy. 3. Xidhmada Halbowlaha Ilmaha Dhexe (\(> 60\qoraalka ilaa }80\qoraal {mmHg}\)): Marka cadaadiska orbital iyo intraocular u soo dhawaado cadaadiska dhiigga ee halbowlaha diastolic, halbowlaha indhaha ee dhexe wuxuu joogsadaa qulqulka inta lagu jiro diastole (oo lagu arki karo indhaha sida garaaca xididdada dhexe ee indhaha) ka dibna gebi ahaanba. 4. ** Daaqadda badbaadada ee 60-ilaa-120-daqiiqo:** Daraasaadka dhaawacyada aasaasiga ah iyo kuwa kiliinikada waxay caddeeyeen in marka ay dhammaato ischemia isha iyo neerfaha indhaha ay ka bilaabato Orbital Compartment Syndrome,* Daqiiqado (2 ilaa 4 saacadood)** si joogto ah ayay bukaanku si joogto ah uga indho la'yihiin ishaas.

3. Farsamoyaqaannada Jabka Orbital Blowout Fracture (Hydraulic vs. Aragtida Buckling)¶

Waa maxay sababta sagxada ama gidaarka gudaha ee godka isha uu dillaaco iyadoo cirifka lafaha ka cuslaa ee ku wareegsan isha dibaddeeda aanu jabin? - ** Farsamada Haydarooliga:** Marka shay wareegsan oo ka weyn 5 sentimitir (2 inji) dhexroor (sida feedh, baseball, kubbadda cricket, ama kubbadda teniska) uu ku dhufto dhinaca hore ee isha, waxay dib ugu riixdaa kubbadda isha 30-millitir koorta dufan orbital ah oo aan la fahmi karin. Mawjadda cadaadiska haydarooliga ee degdega ah ayaa dibadda uga qaraxday dhammaan afarta darbi ee lafaha oo waxay qarxisay labadii lafo ee "nabad-gelyada" ugu khafiifsan ee madaxa: 1. ** Dabaqa Dabada-Medial Orbital (Saqafka Maxillary Sinus):** Kaliya ** 0.5 milimitir qaro weyn , oo ay sii wiiqantay jeexdin iyo kanaalka sidda ** dareemaha infraorbital ($ V_2$). 2. Darbiga Dhexdhexaadka ah ee Orbital (Lamina Papyracea of ​​the Ethmoid Sinus): Si macno ahaan loo tarjumay sida "Lakabka khafiifka ah" (kaliya 0.2 ilaa 0.4 millimitir qaro weyn). - ** Farsamaynta Qalabaynta:* Dharbaaxo toos ah oo ku dhacda cidhifka orbital ee hoose (cidhifka dhabannada) waxa ay gudbisaa mawjadda shoogga farsamaysan oo gadaal u celinaysa kaas oo si toos ah u xidha sagxada orbital-ka dhuuban ee gadaashiisa iyada oo aan dillaacin kubbadda isha lafteeda.

Isbarbardhigga dhammaystiran ee 4-ta xaaladood ee degdegga ah ee daba-galka ah ee orbital¶

Tilmaame caafimaad oo faahfaahsan oo ku wajahan 4ta degdega ah ee dhaawacyada orbital¶

1. Retrobulbar Hematoma iyo Kanthotomy Lateral Sariirta & Kantholysis (LCC)¶

Waa maxay sababta bukaanada qaba hematoma retrobulbar ay wali u waayaan aragooda cisbitaalada casriga ah? Sababta #1 waa ** sugitaanka baarista CT orbital ama sugitaanka in lagu cabbiro cadaadiska intracular ee Tono-Pen ka hor inta aan la jarin jilibka canthal lateral . - ** Cilad-baadhista Kiliiniga ee Sariirta (Lama baahna CT): Haddii bukaan-socod (ama bukaan dhawaan lagu sameeyay blepharoplasty daboolka indhaha, qalliinka sanka, ama xannibaadda suuxdinta retrobulbar) uu keeno "4 Ps of Orbital Compartment Syndrome": 1. Xanuun *** (xanuun daran oo daran oo orbital ah). 2. Proptosis (soo-baxa hore ee adduunka oo leh iska caabin dhagax adag oo dib-u-soo-celin dhijitaal ah oo dabacsan oo dabool xiran). 3. Ardayga oo aan caadi ahayn (Cillad arday ah oo afferent ah [RAPD] oo ku taal tijaabada lulitaanka-tooshka, ama arday gaabis ah oo fidsan). 4. ** Aragga Liidata / Hoos U Dhaca (ama awood la'aanta in lagu qiimeeyo aragga bukaan-socod gudaha ah oo leh isha dhagax adag oo leh RAPD ama Cadaadis Intraocular ah \(>40\text{mmHg}\)). - Sidee Canthotomy-ka dambe iyo Kantholysis-ka Hoose u Badbaadiyaa Isha 2 Daqiiqo gudahood: - Qeybta dib u soo nooleynta ee Waaxda Degdegga ah, dhakhtarku wuxuu ku duraa 1 ilaa 2 millilitir oo lidocaine ah oo leh epinephrine geesaha dambe ee indhaha daboolka (* canthus lateral ), isku dhejinta gudaha canthus lateral ee 30 ilbiriqsi oo leh hemostat si uu u burburiyo xididdada dhiigga, oo wuxuu sameeyaa 1 sentimitir oo gooyaa googooyo leh iris () - Waa maxay sababta Kanthotomy Kaligeed aysan ugu filnayn: Kaliya goynta maqaarka ee cidhifka isha waxay hoos u dhigtaa cadaadiska orbital dhowr milimitir oo meerkuri ah. Dhaqtarku waa inuu dabadeed ka soo qaadaa daboolka isha hoose ee kubbadda isha, dareemaa caarada maqasyada si ay u cidhiidhi gasho, xarig gitaar u eg ** qolof hoose ee seediga lateral ee canthal , oo si buuxda u gooyaa seedaha ( cantholysis hoose). - Isla marka qolofka hoose la gooyo, daboolka isha hoose ayaa si buuxda u furfuran, kubbadda isha ayaa hore u socotaa 4 ilaa 6 milimitir si ay u demiso booska retrobulbar, cadaadiska intraorbital ayaa hoos u dhacaya 20 ilaa 40 mmHg ilbidhiqsiyo gudahood, dhiiga halbowlaha ayaa dib ugu soo yaacay halbowlaha dhexe ee isha iyo neerfaha indhaha.

2. Ilmaha "White-Eid" ee dabinka jaban iyo falcelinta wadnaha ee dilaaga ah¶

Carruurta, dhalinyarada, iyo dhalinyarada da'doodu ka yar tahay 20 jir, lafaha sagxada orbital waxay qani ku yihiin kolajka laastikada oo aan weli u jajabin sida lafaha qaangaarka: - Marka ilmaha isha ay kaga dhufato kubbad, xusul ama jilib, sagxada orbital ee khafiifka ah waxay hoos u soo foorartaa sida xiniinyaha cagaarka ah, baruurta orbital iyo ** muruqa malawadka hoose ** (kaas oo si toos ah u fadhiya sagxada) herniate waqti yar iyada oo loo marayo dildilaaca, iyo lafaha jilicsan ** waxay si toos ah ugu soo noqotaa meel sidii muruqa gu'gu raran yahay ee dib u celinaya daanka. - Sababta si khaldan loogu garto miyir-beelka: Sababtoo ah lafaha jilicsan ee carruurta ayaa si nadiif ah dib ugu soo noqda iyaga oo aan jebin, waxaa jira ku dhawaad ​​eber indho madow, eber dhiig-baxa hoostiisa, iyo "Isha cad" oo si caadi ah u eeg dibadda. Si kastaba ha ahaatee, marka muruqa dabada hoose ee qanjidhada ah la kala bixiyo, waxay dabka saartaa calaamadda afferent ee ** qaybta indhaha ee neerfaha trigeminal (Cranial Nerve V) ilaa jirridda maskaxda, taas oo si toos ah hoos ugu dhacda ** dareemaha xididka (Cranial Nerve X)** ilaa wadnaha iyo caloosha (** The Oculocardiac Reflex Reflex. - Dabinka miyir-qabka: Sababtoo ah ilmuhu si isdaba joog ah ayuu matagaya, u muuqdaa cirro iyo dhidid, dareema dawakhaad/hurdo, oo uu leeyahay madax-xanuun isha caadiga ah ee dibadda ah, shaqaalaha gargaarka degdegga ah ayaa had iyo jeer si khaldan u baara ilmaha dhaawac madaxa ama miyir beelka oo dalbo CT-ga maskaxda oo seega wareegga hoose. - Sida Isla Markiiba Loo Arko Haddii isha dhaawacantay aysan kor u soo wareegi karin khadka dhexe oo ay kor u fiiriso waxay kicisaa lallabo, xanuun isha, iyo garaaca garaaca wadnaha ee kormeeraha wadnaha, cunuga wuxuu leeyahay ** dabin dabin ah oo jaban orbital una baahan qaliin degdeg ah 24 ilaa 48 saacadood ka hor inta uusan muruqa qanjaruufo la kulmin xanuunka ischemic necrosis ee joogtada ah.

3. Dareemaha Infraorbital (\(V_2\)) Kabuubyo: Dareenka Qarsoon ee jabka Dabaqa Orbital¶

Sideed ku ogaan kartaa goobta shilku ka dhacay in isha madow ee barartay ay tahay nabar jilicsan oo unug jilicsan ("shiner") ama lafo hoose ** sagxada orbital jab jaban**? - Fartaada si khafiif ah ugu toosi qofka bidix iyo dhabankiisa hoose ee midig, dhinaca sanka, faruuryaha sare, oo weydii haddii ilkahooda hore ee hore ay dareemayaan "qoryo" ama kabuubyo ** (sida tallaalka Novocain ka dib). - ** Dareemaha infraorbital *** (laan ka mid ah qaybta maxillary ee neerfaha trigeminal, $ V_2$) waxay si toos ah u dhex martaa tunnel-ka lafaha dhuuban ee gudaha sagxadda isha isha ka hor inta uusan ka bixin dhabanka si uu u siiyo dareenka wejiga dhexe iyo ilkaha sare. - Haddii jug isha ku dhacdaa ay keento ** kabuubyo ama biinanka-iyo cirbadaha bishimaha sare, ciridka sare/ilkaha, iyo dhabanka isla dhinac ah, ** sagxada orbital afuuf jaban** dhex mara kanaalka infraorbital ayaa jira ilaa si kale loo caddeeyo CT scan orbital.

4. Emphysema Orbital: Waa maxay sababta Sanku u garaaca uu jab fudud ugu beddelo marin hawo-mareenka¶

Marka gidaarka dhexe (lamina papyracea) ama sagxada orbit-ka dillaaca, dufanka nadiifka ah ee godka isha hadda wuxuu si toos ah ula xiriiraa hawada ka buuxsantay ethmoid ama maxillary sanka sanka: - Neefsashada caadiga ah, cadaadiska hawada ee sanka ayaa hooseeya. - Si kastaba ha ahaatee, ** sanka oo si xoog leh loo afuufo waxa ay dhalisaa cadaadis sanka gudihisa oo ah 60 ilaa in ka badan 100 mmHg** (oo u dhiganta in la buufiyo taayirka baabuurka). - Qaraxaas hawada sinuska ah ee aan nadiifka ahayn iyo xabku waxay ka soo boodaan dildilaaca lafta ee daboolka indhaha (taasoo keenta buufin degdeg ah oo ku dhaca daboolka indhaha oo dillaacsan "Rice Krispies" crepitus subcutaneous dareenka farahaaga hoostiisa) iyo gadaashiisa kubbadda isha. - Haddii xuubka xuubka sinuska ama dufanka orbital uu u dhaqmo sida ball-valve (hawo soo gelisa xilliga sanka la afuufayo balse ku dabinayo si aysan dib ugu soo laaban sinuska), jeebka hawada ee xiran wuxuu cadaadiyaa halbowlaha indhaha ee dhexe iyo neerfaha indhaha (** Orbital Emphysema**), taasoo keenta indho-la'aan degdeg ah oo u baahan dib-u-kicinta irbadda jeebka. - Intaa waxaa dheer, in bakteeriyada sanka sanka ee wasakhaysan lagu qasbo baruurta orbital-ka ee nadiifka ah waxay abuurtaa khatar sare oo aragga halis gelinaysa Cellulitis orbital iyo xinjirowga sanka ee godka, taas oo ah sababta bukaanada qaba jabka orbital-ka ee sinus-ku-xidhiidha laga mamnuuco inay sanka ka afuubaan, quusitaanka, ama ciyaaraan qalabka dabaysha muddo 4 ilaa 6 toddobaad ah.

Had iyo jeer meesha ka saar dildilaaca Globe Open ka hor intaadan isha taaban¶

Mar kasta oo feedh, baseball, BB pellet, guf dhalada, ama muraayad jabay ay isha ku dhufato, xoogga jaba lafaha orbital waxa kale oo ay qarxi kartaa gidaarka kubbadda isha lafteeda (** Furfurka Globe**). Kahor intaadan qofna u oggolaan inuu ku cadaadiyo daboolka indhaha ama hubin xiisadda orbital, si muuqaal ah u eeg isha Lix calaamadood oo dillaacsan Globe Furan: 1. Ardayga ilmada ah ama ugu sarreeya: Ardaygu ma wareego; waxa la jiidayaa qaab ilmood oo fiiqan oo tilmaamaya geesta cornea ama sclera halkaas oo gidaarka kubbadda isha uu ka dillaacay iyo iris-ku-xidhay daloolka. 2. ** 360-Degree Ballooning Bloody of the Conjunctiva (Bullous Hemorrhagic Chemosis):** Xuubka cad ee ka sarreeya cadka isha waxa uu bararsan yahay giraan qaro weyn, dhiig leh, jelly oo kale ah oo gebi ahaanba ku wareegsan isha, qarinaya dillaaca scleral ee hoostiisa. 3. Mawrow Madow ama Midab Madow (Uveal Prolapse) Oo Ka Soo Baxaya Cadaanka Isha: Weligaa ha isku dayin inaad tirtirto "meel wasakh" madow ama bunni ah oo ku taal sclearada ka dib; waa iris-ka bukaanka ama jirka ciliary-ga ee ka soo baxa sclera dillaacay. 4. ** Qolka hore ee aan caadiga ahayn ee qoto dheer ama aan gacmeedka ahayn (ama Hyphema):** Meesha ka dambaysa xudunta isha waxa ka buuxa dhiig lakab ah (hyphema, eeg dhaawacyada isha) ama u muuqda mid dumay marka loo eego isha kale. 5. Ka-baxa Jelly Cad (Vitreous Humor) oogada isha. 6. ** lumis aragga daran oo leh il jilicsan oo jilicsan.

Haddii calaamad kasta oo ka mid ah dillaaca globe-ka furan yahay ay jirto, ** jooji dhammaan khalkhalgelinta jirka isla markiiba, ku dheji gaashaanka Fox ee adag ama gunta koob warqad ah oo ku dul yaal ciirta lafta iyo dhabanka iyada oo aan la taaban isha, bukaanka u dhig mid toosan oo deji, oo wac 911/112/999**.

Lambarada degdega ah ee gobolka iyo borotokoolka wakaalada¶

• Mareykanka iyo Kanada: Wac 911 si aad degdeg ugu aado Heerka I ama Heerka II Xarunta Dhaawaca oo leh 24/7 Dawaynta Degdega ah iyo Indhaha/Awoodaha Qalliinka Oculoplastic. Sida hoos timaada ** American College of Emergency Physicians (ACEP)**, Taageerada Nolosha Sare ee Dhaawaca Nolosha (ATLS), iyo Akadamiyadda Maraykanka ee Ophthalmology (AAO) tilmaamaha, takhaatiirta degdega ah ayaa loo tababaray oo la aqoonsan yahay si ay u qabtaan sariir degdeg ah ** Lateral Canthotomy iyo Cantholysis (LCC)
• United Kingdom: garaac 999 (ama 112). Sida hoos timaada Royal College of Emergency Medicine (RCEM) iyo Royal College of Ophthalmologists (RCOphth) tilmaamaha dhaawacyada, dhiig-baxa retrobulbar ee leh luminta aragga waxaa loo kala saaraa xaalad degdeg ah oo qalliin oo qallafsan oo lagu sameeyo Qolka Dib-u-nooleynta Waaxda Degdegga ah kahor wareejinta shucaaca.
• Midowga Yurub: Wac 112. Raac ** Golaha Dib-u-soo-nooleynta Yurub (ERC)** iyo dariiqyada dhaawacyada indhaha ee maxillofacial/ophthalmic ee loogu talagalay depression degdeg ah orbital iyo maxillofacial CT angiography.
• Australia iyo New Zealand: Wac 000 gudaha Australia ama 111 gudaha New Zealand. Raac RANZCO (Kolejka Dhakhaatiirta Indhaha ee Royal Australia iyo New Zealand) iyo ANZCOR tilmaamaha dhaawacyada indhaha.
• Hindiya iyo Aasiya-Pacific:** Wac 112 gudaha Hindiya, 119 gudaha Japan iyo Kuuriyada Koonfureed, ama 995 gudaha Singapore. Codso gaadiid toos ah oo aad geyso cisbitaalka dhaawacyada heer jaamacadeed oo ku qalabaysan sawirka CT, dawada degdega ah ee hawo-mareenka/awoodaha qaliinka, iyo caymiska indhaha.

Eeg nambarada degdega ah dhamaan lambarada dirista degdega ah ee caalamiga ah.

Su'aalaha soo noqnoqda¶

Waa maxay sababta aan baraf baraf ah si toos ah ugu dhejin karin isha madow ee barara isla markiiba garaacid adag ka dib?¶

Ilaa uu dhakhtarku baaro kubbadda isha oo uu ka xaqiijiyo in gidaarka adduunku uu sax yahay oo aanu jirin hematoma retrobulbar, dhigista miisaanka baraf baraf ama cadaadin qabow si toos ah isha daboolkeeda waa khatar. Haddii uu jiro dillaac qarsoon oo scleral ah (globe furan), miisaanka xirmada barafka ayaa ka tuujin kara muraayadda gudaha iyo jelly vitreous isha; Haddii uu jiro hematoma retrobulbar, cadaadiska dibadda wuxuu ku darayaa cadaadiska khatarta ah ee ceejinaya dareemayaasha indhaha. Had iyo jeer isha ku ilaali cidhifka lafta beddelkeeda.

Maxay ishaydu ugu soo baxday sida kubbadda Golf-ka markii aan sanka afuufay ka dib markii aan wejiga ka dhacay?¶

Lafaha kala sooca gudaha iyo hoose ee godka ishaada iyo sanka sankaagu waa dhumuc ka yar nus millimitir waxayna si joogta ah dildillaacdaa inta lagu jiro dhaawaca wejiga ee aan muuqan xitaa marka bannaanka wejigaagu u muuqdo mid fiican. Markaad sanka isku qabato si aad sankaaga u garaacdo, waxaad dhalisa in ka badan 60 ilaa 100 mmHg oo cadaadis hawo ah gudaha marinnada sankaaga, kaas oo ku qarxiya hawada sinuska iyo bakteeriyada isla markaa lafahaas dilaaca indhahaaga iyo gadaashiisa kubbadda isha (** orbital emphysema**); Haddi aragu rogmo ama ishu dareemto cidhiidhi ka dib markaad sanka kaa afuufto, isla markiiba u tag qolka gargaarka degdega ah.

Waa maxay sababta ilmaha matagaya garaaca wadnaha oo gaabis ah ka dib markii uu isha ku dhufto inta badan si khaldan loo ogaado miyir-beelka?¶

Carruurtu waxay leeyihiin lafo sagxadda orbital ah oo dabacsan kuwaas oo dillaaca marka ay saameeyaan oo dib u soo xiraan sida dabin guga ku raran, oo qanjaruufo muruqa isha malawadka ee hoose iyada oo aan in badan isha madow kaga tagin dibadda. Kala bixinta muruqa isha ee xayiran waxa ay kicisaa trigeminal-vagal **oculocardiac reflex**, kaas oo sababa lallabbo daran, matag, maqaarka oo cirro, caajisnimo, iyo garaaca wadnaha oo gaabis ah (bradycardia). Had iyo jeer weydii ilmo kasta oo qaba dhaawaca wejiga inuu si toos ah u eego saqafka; Haddii il keliya aanay kor u qaadi karin, waa jab orbital ah oo xidhan, ee ma aha miyir beel keliya.

Kanthotomy-ka dambe iyo Kantholysis-ka miyay ka tagaan nabar aan kala go 'lahayn oo joogto ah oo ku yaal geesta isha daboolka?¶

Maya; Kanthotomy-ka dambe ee sariirta iyo kantholysis-ka hoose waa mid yar, nadiif ah 1 senti mitir oo shinni ah oo ka soo baxa dusha dabiiciga ah ee daboolka indhaha halkaas oo dhakhaatiirta qalliinka isqurxintu ay si joogto ah u sameeyaan jeexid. Marka bararka retrobulbar uu xaliyo dhowr maalmood, dhakhtarka indhaha ama dhakhtarka qalliinka caaga ah ayaa si fudud u tolli kara seedaha iyo geesta isha daboolka oo ay weheliyaan nabar aan la arki karin, halka ay ku guuldareystaan ​​inay gooyaan 90 daqiiqo gudahood waxay keenaysaa indho la'aan joogto ah, oo aan laga noqon karin.

Dhammaan jab-jabka orbital-ka waxay u baahan yihiin qalliin si saxan loogu dhejiyo godka isha?¶

Maya; in ka badan kala badh ka mid ah dadka qaangaarka ah ee dabaqa orbital ah iyo jabka dilaaca gidaarka dhexe ayaa si badbaado leh u bogsada qalliin la'aan. Dhakhaatiirta indhaha iyo dhakhaatiirta qalliinka maxillofacial kaliya waxay shaqeeyaan isla markiiba (24 ilaa 48 saacadood gudahood) haddii muruqa isha uu si farsamaysan u xayiran yahay taasoo keenaysa reflex oculocardiac ama aan xallin laba aragga, ama si hoose (7 ilaa 14 maalmood gudahood marka bararku hoos u dhaco) haddii jabku daboolo in ka badan 50 boqolkiiba ama laba laabashada indhaha ayaa sababa akhriska kubbada ee joogtada ah. dib u quuso (** enophthalmos**) in ka badan 2 milimitir.

Ma ku duuli karaa diyaarad ama ma ku duuli karaa quuska iyadoo aan la daweyn jabin orbital ah?¶

Diyaaradaha iyo dhakhaatiirta indhaha guud ahaan waxay ku talinayaan in la sugo ilaa jabka orbital leh isgaarsiinta sinus ama hawada orbital (pneumo-orbit) la qiimeeyay oo la nadiifiyay (sida caadiga ah 1 ilaa 2 toddobaad ee duulimaadyada qolalka ganacsiga haddii hawada retrobulbar ay jirto, sababtoo ah hawada ku xayiran gudaha godka isha waxay ku fidsan tahay 25 ilaa 30 boqolkiiba dhererka qolka fadhiga sida waafaqsan sharciga wiilka). Quusitaanka scuba si adag ayaa loo mamnuucay ilaa laga bogsado lafaha buuxa (4 ilaa 8 toddobaad), maadaama maaskarada la cadaadiyo iyo sinus barotrauma ay sababi karaan dhiigbax orbital ah oo musiibo ah ama emphysema.

Tilmaamaha la xidhiidha¶

• Dhaawaca indhaha iyo daryeelka degdega ah
• Isha shay qalaad, naaxinta xudunta, iyo tooshka alxanka
• Dhaawac madaxa iyo miyir beelka
• Cellulitis Orbital, xinjirowga sanka ee godka, iyo caabuqyada wejiga saddexagalka khatarta ah

Ilaha iyo hanuuninta rasmiga ah¶

• Kuliyada Dhakhaatiirta Maraykanka ee Dhakhaatiirta (ACS, United States) ee Gudida Dhaawaca: Taageerada Nolosha Dhaawaca Sarreysa (ATLS) Buugga Koorsada Ardayga
• ** Akademiyada Indhaha ee Maraykanka (AAO, Maraykanka):** EyeWiki iyo Bayaanada Kiliinikada ee Maareynta Jajabka Orbital Blowout, Jajabka Dabinka Indhaha ee Carruurtu, iyo Dhiig-baxa Dib-u-Celinta.
• ** Royal College of Emergency Medicine (RCEM) iyo Royal College of Ophthalmologists (RCOphth, United Kingdom):** Hagaha Dhaqanka ugu Fiican: Xanuunka Qaybta Orbital Syndrome iyo Kanthotomy Dambe ee Degdega ah iyo Kantholysis.
• ** College of American Emergency Physicians (ACEP, United States):** Nidaamka Kiliinikada ee Daawada Degdegga ah: Maareynta Ba'an ee Dhaawaca Indhaha iyo Maxillofacial.
• Royal Australian iyo New Zealand College of Ophthalmologists (RANZCO): Xeerarka Caafimaadka ee Dhaawaca Indhaha ee Ba'an iyo Ilaalinta Globe Furan.