Dhiig-baxa Retrobulbar iyo Cilad-xumada Qaybta Orbital: Isha Proptotic-Hard iyo Daaqadda Canthotomy Lateral¶

Dhiigbaxa retrobulbar (RBH) ee keena ** Orbital Compartment Syndrome (OCS)** waa mid ka mid ah xaaladaha degdega ah ee ugu dhaqsaha badan aragga khatarta ah ee dhammaan daawooyinka: dhiig halbowle ah ama xidid xidid ah oo ku xanniban gadaashiisa kubbadda isha gudaha gudaha qallafsan, koofiyadda lafaha afar- gidaar ee daloolka isha (orbit) si degdeg ah u gooya xididdada indhaha si degdeg ah Waxaa kiciyay dhaawacyada wejiga ee aan muuqan ama orbital (feer, baseball, barkin shil, ama dhicis), qalliinka indho-furka qurxinta (blepharoplasty), xannibaadaha suuxinta retrobulbar, qalliinka sanka, ama daaweynta xinjirowga lidka ku ah, cadaadiska kor u kaca gudaha orbit-ka xiran ayaa hore u riixaya kubbadda isha (** proptosis *** ds) globe**), waxay curyaamisaa dhaq-dhaqaaqa indhaha (ophthalmoplegia), waxayna sababtaa Qaraabo Cilad Ardayga Afferent ah (RAPD) oo araggu si degdeg ah u yaraado. Haddii qof dhawaan dhaawac isha ah ama qalliin indho-shareer ah uu ku dhaco xanuun qoto dheer oo orbital ah, isha kacsan, laba aragga, ama aragga blur, wac degaankaaga nambarada degdega ah isla markiiba. Inta aad sugayso gaadiidka degdega ah, dib u eeg tilmaamaha la xidhiidha dhaawacyada guud ee indhaha iyo daryeelka globe ee dillaacay, Xiritaanka halbowlaha isha ee dhexe iyo istaroogga ishaiyo xagal ba'an-xiran glaucoma iyo goynta isha.

Sababtoo ah unugyada ganglion-ka ee bini'aadamka waxay la kulmaan dhimasho joogto ah, dhimasho ischaemic ah oo aan laga beddeli karin ka dib ** 60 ilaa 90 daqiiqo (ilaa 120 daqiiqo ugu badnaan)** cadaadiska xididdada dhiigga, badbaadinta aragga waxay ku xiran tahay aqoonsiga degdegga ah ee sariirta, u fadhiisata bukaanka si qumman 45 darajo. Samee sariir deg deg ah ** Lateral Canthotomy iyo Cantholysis Inferior (LCIC) ***, adoon sugin CT scan, si loo sii daayo cadaadiska xanniban.

Hadda samee tan¶

1. ** Wac nambarka deg-degga ah ee degaankaaga ama u tag qaybta gargaarka degdegga ah ee isbitaalka kuugu dhow. nambarada degdega ah. Si cad ugu sheeg soo diraha ama kalkaalisada kala soocida xaaladaha degdega ah: "Lacag laga shakisan yahay dhiigbaxa retrobulbar hemorrhage / orbital part syndrome syndrome: dhaawac dhawaanahan indhaha ah (ama qalliinka indhaha daboolka) oo leh barar, indho adag iyo arag beel, waxay u baahan tahay depression degdeg ah oo sariirta ah 60 ilaa 90 daqiiqo."
2. **Bukaanka u fadhiiso si toos ah xagal 45-degree ilaa 90-degree ah oo deji oo deji. Si toos ah u fadhiisashada waxay isticmaashaa cuf-jiidad si ay hoos ugu dhigto cadaadiska halbowlaha iyo xididdada dhiigga ee madaxa iyo wareegga, hoos u dhigista dhiig-baxa retrobulbar iyo hoos u dhigista cadaadiska intraocular.
3. ** Weligaa ha marin daboolka isha oo dhagan, faashad cadaadiska, ama baraf baraf ah oo si toos ah ugu cadaadinaya kubbadda isha. Cadaadiska isha ama ku xidhid suufka faashad ee daboolka indhaha waxay dib ugu riixdaa kubbadda isha koofiyadda dhiigga ka buuxo, isla markiiba waxay burburisaa halbowlaha dhexe ee indhaha. Haddii aad u baahan tahay inaad ilaaliso isha inta lagu jiro gaadiidka, ku dheji ** bir ama caag ah gaashaanka isha Fox** (ama gunta koob warqad ah) si cidhifkeedu u dul istaago oo keliya ** lafta birta iyo dhabanka**, waligaa ha taaban caalamka.
4. (Valsalva) Bukaanka u sheeg in aanu waligii sanka afuufin, ku hindhisin af xidhan, si xoog leh u qufac, foorarsan, ama cadaadis (Valsalva) Sanka oo la afuufo waxay qarxisaa hawo cadaadis sare leh oo ka timaadda daloolka sanka si toos ah iyada oo loo marayo jabka ilaa godka isha (** kacsanaanta orbital emphysema**), halka qufaca, mataga, ama cadaadis saaraya cadaadiska xididdada orbital waxayna deddejisaa dhiigbaxa halbowlaha isha gadaashiisa.
5. Haddii bukaanku mar kaliya lagu sameeyay qalitaan indho-shareer ah (blepharoplasty) oo leh tolmo maqaarka dibadda ah ama cajalad haysta dhaymo, u dig dhakhtarka qalliinka oo toos u aad qolka gargaarka degdegga ah. Cisbitaalka ama rugta caafimaadka, isla markiiba sii daynta dhaymada faashad dibadeed oo adag iyo furitaanka tolmada nabarrada dambe waxay kaa caawin kartaa soo saarista dhiig aan muuqan ka hor inta aan kanthotomy buuxan.
6. **Bukaanka si adag afka uga ilaali (wax la cuno ama la cabbo) oo keen liiska dhammaan daawooyinka dhiiga khafiifiya isla markiiba.

Geedka go'aanka: kala soocida dhaawacyada orbital, protosis, iyo Orbital Compartment Syndrome¶

flowchart TD
    Start["Dhaawaca Wajiga ee Indhaha, Qalliinka Indhaha (Blepharoplasty), Qalitaanka Sinus, ama Block Retrobulbar"] --> CheckOCS{"Fiiri 5ta Calaamadood ee Wadnaha ee Cudurka Orbital Compartment Syndrome: 1. Proptosis (Bulging Eye) 2. Rock-Hard Globe / Indhaha daboolka dhagan 3. aragga oo hoos u dhaca"}

    CheckOCS -->|"HAA: Proptosis + Kacsan Globe + Aragga Luminta ama RAPD"| Emergency["ARAGTIDA DEGDEGGA AH EE QAYBTA ORBITAAL SYNDROME (60 ilaa 90 Daqiiqo Daaqadda Xididka Ischemia ee Ilmaha): Wac 911/112/999"]

    CheckOCS -->|"MAYA: Hubi Calaamadaha Globe Dilay ee Furan"| OpenGlobe{"Ilmo ilmada/ardayga ugu sarreeya, qol hore oo fidsan, unug madaw oo iris ah oo soo baxay, ama 360-degree chemosis dhiig leh oo il jilicsan leh?"}

    OpenGlobe -->|"HAA"| Ruptured["Dilaaca Globe Furan ee La Tuhman yahay: Cajalad adag oo Fox ah oo ka koraysa cidhifka lafta KALIYA, cadaadis eber ah oo isha saaran, ka hortagga xanuunka, hagaajinta qolka qalliinka degdega ah"]

    OpenGlobe -->|"MAYA: aragga caadiga ah, daboolka indhaha oo jilicsan, ardayda caadiga ah, dhaqdhaqaaqa indhaha oo aan hagaagsanayn"| Fracture["Qiimee jabniinka Orbital Blowout Fracture ama Hyphema: Si toosan u fadhiiso, AAN sanka afuufin, dhakhtarka indhaha oo degdeg ah & qiimaynta CT"]

    Emergency --> FirstAid["1. Si toos ah ugu fadhiiso 45-90 darajo; Si Adag ma laha Indhuhu, Ma jiro Cadaadis ku Saabsan Globe, iyo Ma jiro Sanka oo la garaaco ama maroojinayo"]

    FirstAid --> NoCT["2. Ha ka daahin CT Scan: Cilad-baadhista sariirta ee kiliinikada ayaa tilmaamaysa niyad jab degdeg ah haddii aragga la dhimo ama IOP> 40 mmHg"]

    NoCT --> LCIC["3. Kanthotomy Lateral Sariirta Degdegga ah & Cantholysis Inferior (LCIC) + IV Mannitol / Acetazolamide / Corticosteroids-Qiyaas Sare"]

Pathophysiology: waa maxay sababta orbit-ka lafaha uu u dhaqmo sida cunto kariye cadaadis xiran¶

Si aad u fahamto sababta malqacad dhiig ah oo isha gadaasheeda ah ay qofka ku indho tiri karto hal saac gudaheed iyadoo isha madaw ee dhabanka ku taal aanay waxba u dhimayn, waa inaad eegtaa anatomy ee ** daloolka orbital** iyo orbital septum:

               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. ** Sanduuq yar oo 30-militir ah oo lafaha ah:** Godka isha bini'aadamku waa Ahraamta afar- gidaar ah oo lafo adag ah (saqaf, sagxadda, darbiga dhexe, iyo gidaarka dambe) kaas oo gadaal u sii durkaya ilaa cidhif dhuuban halkaasoo neerfaha indhaha uu ka galo madaxa. Guud ahaan mugga wareegga qofka weyni waa 30 millilitir (qiyaastii 2 qaado), oo horeba loogu soo xidhay si adag kubbadda isha (7 mL), neerfaha indhaha, lix muruq oo ka baxsan, neerfaha, iyo dufanka retrobulbar.
2. ** Albaabka hore ee qufulan (Orbital Septum iyo Canthal Tendons):** Sababtoo ah afarta darbi ee lafaha ma balaarin karaan dibadda, dariiqa kaliya ee cadaadiska kor u kaca ee gudaha godka isha si uu uga baxsado waa ** hore ** adigoo riixaya kubbadda isha godka (** proptosis**). Si kastaba ha ahaatee, furitaanka hore ee wareegga wareegga waxaa lagu shaabadeeyey xaashi adag oo adag oo loo yaqaan ** orbital septum ** oo si adag ugu xidha gudaha iyo dibadda ee lafaha lafaha ee ** dhexdhexaadinta iyo lateral canthal tendons ** (kaas oo ku dhejinaya daboolka sare iyo hoose ee indhaha sida xargaha gitaarka ee ku yaala xagga hore ee isha).
3. ** Dhiig-baxa Preseptal vs. Postseptal (Retrobulbar) Dhiigbax:**
4. Hematoma Preseptal (Sifudud "Isha Madow"): Dhiiggu wuxuu ku urursadaa * hore* ee septum orbital gudaha maqaarka dabacsan ee daboolka indhaha iyo dhabanka. Xataa marka daboolka indhuhu si weyn u bararaan guduudan, kubbadda isha hoosteeda waxay ahaanaysaa mid jilicsan, meel caadi ah, oo gebi ahaanba ammaan ah.
5. ** Dhiig-baxa ka dambeeya / dib-u-dhaqaajinta (Orbital Compartment Syndrome):** Dhiiggu wuxuu ururiyaa * gadaasha* septum-ka orbital gudaha koontada 30 mL ee la shaabadeeyey (badanaa laga soo jeexjeexay ** halbowlaha infraorbital, hore ama gadaale ethmoidal artery, ama xididka indhaha). Marka kubbadda isha hore loo sii riixo dhawr milimitir oo keliya, xuubka canthal-ka ee dambe wuxuu gaaraa xadka laastikada wuxuuna xiraa daboolka indhaha si adag uga soo horjeeda adduunka.
6. Sababta IOP> 40 mmHg Indhaha ka Indhoobo: Mar haddii daboolka indhuhu aanay hore u fidi karin, millilitir kasta oo dhiig ah oo isha ka dambeeya waxa ay toogtaan intraorbital iyo ** cadaadiska intraocular (IOP)** laga bilaabo kiisa caadiga ah 10 ilaa 21 mmHg* ilaa 40, 60, ama H. Marka cadaadiska orbital ka bato cadaadiska dhiigkarka ee ** xididdada ciliary dhabarka ee gaaban ** (kaas oo quudiya madaxa neerfaha indhaha) iyo ** halbowlaha isha dhexe ** (taas oo quudisa xuubka isha gudaha), socodka dhiigga ee isha iyo neerfaha indhaha ayaa si buuxda u joogsada, taasoo keenta ** ischemic optic neuropathy *** iyo ** xirmidda halbowlaha retinal ee dhexe (.

Sababaha caadiga ah ee dhiig-baxa retrobulbar iyo wareegga kacsanaanta¶

Halka tamar-sare ee dhaawaca ba'an ay tahay sababta #1 ee waaxyaha xaaladaha degdegga ah, dhowr qalliin, caafimaad, iyo xaalado degdeg ah oo sanka ayaa soo saara xanuunka qaybta Orbital Compartment Syndrome oo isku mid ah:

Aqoonsiga Qaybta Orbital Syndrome vs. "Isha madow" aan waxyeello lahayn¶

Sababtoo ah ku dhawaad bukaan kasta oo dhaawac weji ah ayaa bararay, daboolay daboolka indhaha, kuwa ag taagan iyo dhakhaatiirta caafimaadka waa inay yaqaanaan sida loo kala saaro mid aan fiicneyn Isha madow ee preseptal ** iyo arag halis ah ** dhiigbaxa retrobulbar iyo ** globe dillaacsan

Miiska isbarbardhigga sariirta: Preseptal Black Eye vs. Dhiig-baxa Retrobulbar vs. Furfurka Globe¶

Sida loo hubiyo Proptosis iyo Cilad Ardayga Afferent (RAPD) gudaha 30 ilbiriqsi¶

1. In "Isha-Shimbiraha" ee foodda foodda innagu eegi in ay ka hortag ah: Istaag si toos ah gadaashiisa ama ka korreeya madaxa bukaanka fadhiya, oo gadhka u janjeeri in yar kor, oo si toos ah hoos hoos in ay foodda in ay ku dul sunnayaasha labada dhabannada. Indhaha madow ee fudud, kaliya maqaarka jilicsan ee maqaarka ayaa ka soo baxa. Gudaha retrobulbar hemorrhage, waxaad arki doontaa xubbada dhabta ah ee xubbada isha ee ay saamaysay ** horay u soo baxaysa dhowr milimitir oo dhaaftay cirifka cawska** marka loo eego isha aan dhaawacmin.
2. ** Tijaabada Dheefta Cas ee (Calaamadda ugu horreysa ee Cadaadiska Dareemaha Optic):** Ku qabo shay cas oo dhalaalaya (sida koofiyadda dhalada cas ama dawada degdegga ah) ee isha wanaagsan ee bukaanka hortiisa, ka dibna isha dhaawacantay horteeda. Kahor inta uusan bukaanku lumin awoodda akhrinta xarfaha, neerfaha indhaha ee ischaemic wuxuu lumiyaa awoodda uu ku dareemo casaan dhalaalaya: bukaanku wuxuu soo sheegi doonaa in koofiyadda cas ay u egtahay "mid ba'ay, liimi ah, bunni, ama cawl" isha dhaawacantay.
3. ** Tijaabada Tooshshka Lulida ee RAPD (Ardayga Marcus Gunn):** Xataa haddii bukaanku miyir daboolan yahay, dhuuban yahay, ama aad u bararayo inuu akhriyo jaantuska isha, ** Tijaabada Tooshka Lulshada** waxay isla markiiba kuu sheegaysaa haddii neerfaha aragu dhimanayo:
4. Dabool nalka qolka oo ku iftiimi isha ** aan dhaawacmin (wanaagsan) 3 ilbiriqsi: ardayga wanaagsan iyo ardayga dhaawacan ayaa si adag u cidhiidhya (jawaab la isku raacay).
5. Si degdeg ah u lulaya laydhka biriijka sanka oo si toos ah isha ugu haya indhaha dhaawacantay:sababta oo ah dareemaha indhaha ee burburay ee isha dhaawacantay uma gudbin karaan ishaarka iftiinka maskaxda, maskaxdu waxay u malaynaysaa in qolku mugdi galay RAPD togan oo kacsan, isha prototic waa calaamad buuxda oo loogu talagalay Canthotomy Lateral iyo Cantholysis.

Habka deg-degga ah ee isbitaalka: Kanthotomy-ka dambe iyo Kantholysis Inferior (LCIC)¶

Marka uu bukaan yimaado waaxda xaaladaha degdega ah ee qaba Orbital Compartment Syndrome, dhakhtarka degdega ah ama dhakhtarka indhaha waxa uu sameeyaa hab sariireed 2-daqiiqo ah oo loo yaqaan Lateral Canthotomy and Inferior Cantholysis (LCIC).

Waa maxay sababta maqaarka loo gooyo oo keliya ("Canthotomy") kuma filna: anatomy ee Cantholysis¶

Luul qalliin oo halis ah oo lagu barto dawo kasta oo degdeg ah iyo degenaanshiyaha dhaawacyada ayaa ah faraqa u dhexeeya Tallaabada 1 (Lateral Canthotomy) iyo Tallaabada 2 (Kantholysis Inferior):

                     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.)

• Sababta Talaabada 1aad (Canthotomy) kaligeed u fashilantay qaaxo).
• Sababta Talaabada 2-aad (Cantholysis Inferior) waa tillaabada badbaadinta aragga: U soo jiidida daboolka hoose ee isha oo xoog leh waxay daaha ka qaadaysaa taut, faleebo cad oo cad oo si sax ah u dareemaya ** xarig gitaar si adag loo hagaajiyay** marka lagu dhufto talooyinka maqas iris-gaaban. Jeexitaanka seedaha hoose (** cantholysis liidata**) waxay si buuxda u xirtaa daboolka hoose ee isha, taas oo u oggolaanaysa in kubbadda isha ay hore u socoto 4 ilaa 6 millimitir, sii daynaysa dhiigga ku xayiran ee retrobulbar, oo isla markiiba hoos u dhigaya cadaadiska intraocular by 30 ilaa 50+ mmHg.

Tilmaamaha bukaan-socodyada iyo socodka-shaqaynta cusbitaalka ee tallaabo-tallaabo ee LCIC¶

1. Calaamado buuxda (Isla markiiba ku samee Sariirta dhinaceeda CT ka hor):
2. Taariikhda dhaawaca orbital, qalliinka indhaha daboolka, ama xannibaadda retrobulbar PLUS protosis/globe kacsan ** lagu daray mid kasta oo ka mid ah:**
   • Aragga oo yaraada,
   • Ciladda Ardayga ee Qaraabada Afferent Togan (RAPD), AMA
   • Cadaadiska Intraocular (IOP) ** 40 mmHg**.
3. Tallaabo-Tallaabo Farsamada Sariirta Dhinaceeda (Waxaa Sameeyay Dhaqtar):
4. ** U diyaargarowga & suuxinta:** Ku nadiifi geeska kore ee isha povidone-iodine indhaha oo ku dur 1 ilaa 2 mL oo 1% ama 2% lidocaine 1:100,000 epinephrine si toos ah u gali canthus lateral iyadoo ujeedadeedu tahay cidhifka lafta dambe (weligeed u leexan).
5. Devascularize (Clamp): Ku dheji hemostat toosan oo toosan oo dhan canthus-ka dambe ilaa dariiqa hoose ilaa cirifka lafta lateral orbital 30 ilaa 60 ilbiriqsi si aad u burburiso xididada dhiiga una abuurto wado aan dhiig ku daadan.
6. Tallaabada 1-aad - Kanthotomy-da danbe: Isticmaalka maqasyada cirridka ee afka qallafsan ama Stevens tenotomy maqas, si toosan u jar xariiqda la jajabiyey ee cidhifka isha ** 1 ilaa 2 sentimitir dhinaceeda** ilaa cidhifka orbital ee lafaha.
7. Tallaabada 2-Cantholysis-hooseeya: Ku qabso cidhifka dibadda ee isha hoose oo xoog ilko leh oo si adag u jiid xagga hore iyo kor xagga saqafka (ka fog kubbada isha). Isticmaal caarada maqasyada xiran si aad u xabagto ("strum") fibros cidhiidhi ah ** jilibka hoose ee jilibka canthal ee lateral *** ku dheji daboolka hoose ee lafta, tilmaan caarada maqaska xagga hoose / ka fog adduunka, oo jar seedaha gebi ahaanba ilaa isha hoose ay si buuxda u dabacsan tahay oo caajis tahay.
8. ** Dib u hubi IOP & Aragga Isla markiiba:** Dib u cabbir cadaadiska intracular 2 ilaa 5 daqiiqo gudahood. Haddii IOP sii jirto > 40 mmHg, u gudub Tallaabada 3 (Superior Cantholysis) adigoo jaraya qolofta sare ee seedda canthal lateral ee ka hooseysa isha kore.
9. ** Xusuusin Bogsiinta Quruxda ee Bukaanka:** U xaqiiji bukaanka iyo qoyska in jeexitaanka kanthotomy ee dambe uu si fiican u bogsado oo si fudud loo tolay dhakhtarka qalliinka oculoplastic 3 ilaa 5 maalmood ka dib marka dhammaan bararka orbital uu xalliyo, oo aan ka tagin wax nabar muuqda.

Isku-xidhaha caafimaadka (waxaa loo istcimaalaa LCIC, marna beddelka jarista seedaha)¶

Markaad u diyaargaroobayso LCIC sariirta dhinaceeda ama isla markiiba, dhakhaatiirta degdega ah waxay maamulaan daawaynta daawaynta xididada si ay u yareeyaan mugga vitreous, u xakameeyaan wax soo saarka aqueous aqueous, una yareeyaan bararka dareemayaasha indhaha: - Mannitol faleebo: 1 to 2 g/kg IV waxaa lagu shubay in ka badan 30 daqiiqo (wakiil hyperosmotic oo dheecaan ka soo saara isha iyo wareega). - ** Acetazolamide (Diamox): 500 mg IV bolus (carbonic anhydrase inhibitor oo joojiya wax soo saarka dareeraha aqueous ee isha). - ** Dhibcaha hoos u dhigista IOP-ka maadada ah:** Timolol 0.5% iyo dhibcaha brimonidine (iska ilaali haddii globe furan laga shakiyo). - ** Qiyaasta sare ee Corticosteroids ee xididka:** Methylprednisolone (250 mg to 1,000 mg IV) ama dexamethasone si loo yareeyo caabuqa neuropathy indhaha. - ** Dib-u-noqoshada xinjirowga lidka ku ah & Antiemetics:** Ondansetron-ka-xididka si looga hortago matagga cadaadiska xididdada, xakamaynta cadaadiska dhiigga, iyo dib-u-noqoshada isla markiiba warfarin, apixaban, ama rivaroxaban.

Lambarada degdega ah ee gobolka iyo borotokoolka wakaalada¶

Dhiigbaxa la tuhunsan yahay ee retrobulbar ama xanuunka qaybta orbital waa Qaybta 1/Mudnaanta 1aad ee indhaha iyo xaaladaha degdega ah ee dhaawacyada oo leh daaqad adag oo albaab-ilaa-la-jaro ah oo 60-ilaa-90-daqiiqo ah:

• Mareykanka iyo Kanada: garaac 911 si aad ugu qaado meesha kuugu dhow Heerka 1 ama Heerka 2 Xarunta Dhaawaca ama Waaxda Gurmadka Degdega ah ee Cisbitaalka (waligaa ha tagin xafiiska indhaha ama xarunta daryeelka degdega ah). Waxaa maamula ** Akademiyada Indhaha ee Maraykanka (AAO)** iyo ** Kulliyadda Maraykanka ee Dhakhaatiirta Qalliinka ATLS (Taageerada Nolosha Sare ee Dhawaaqa)** borotokoolka dhaawacyada, kaas oo ku amraya kantoomiyada sariirta dhinaceeda ee qaybta dhaawaca ee uu takhtarka degdegga ahi iskaanka CT ka hor.
• United Kingdom: garaac 999 ama aad isla markiiba cisbitaal weyn Waaxda Gurmadka (A&E). Sida hoos timaada ** Royal College of Emergency Medicine (RCEM)** iyo ** Royal College of Ophthalmologists** Heerarka dhaawacyada, Diiwangeliyayaasha Daawada Degdegga ah iyo La-taliyayaasha ayaa loo tababaray oo loo tababaray si ay u fuliyaan sariirta dhinaca Lateral Canthotomy iyo Cantholysis iyada oo aan la sugin wicitaanka imaatinka dhakhtarka indhaha.
• Midowga Yurub: Wac 112. Lagu maareeyay soo noolaynta dhaawacyada Yurub iyo borotokoolka degdegga ah ee indhaha.
• Australia iyo New Zealand: Wac 000 gudaha Australia ama 111 gudaha New Zealand. Lagu maareeyo ** Kulliyadda Australiyaanka ee Daawada Degdegga ah (ACEM)** iyo RANZCO tilmaamaha dhaawacyada degdega ah ee orbital.
• Hindiya iyo Aasiya-Pacific:** garaac 112 (ama 108 gudaha Hindiya), 995 gudaha Singapore, 119 gudaha Japan iyo Kuuriyada Koonfureed, ama 999 gudaha Malaysia iyo Hong Kong. U gudub isbitaalka weyn ee dhaawacyada ama qaybta degdegga ah ee isbitaalka indhaha.

Su'aalaha soo noqnoqda¶

Sideen ku garan karaa farqiga u dhexeeya isha madow ee caadiga ah iyo dhiigbaxa retrobulbar?¶

Indhaha madow ee caadiga ah (hematoma preseptal), dhiiggu wuxuu si dhib la'aan ah ugu fadhiyaa maqaarka dabacsan ee hore ee indhaha: xitaa haddii daboolka indhaha ay u muuqdaan guduud iyo barar, waxay dareemaan jilicsanaan, kubbadda isha waxay ku fadhidaa qoto dheer oo caadi ah, dhaqdhaqaaqa indhaha waa caadi, aragguna waa cad yahay markaad si tartiib ah kor ugu qaaddo daboolka. Dhiig-baxa retrobulbar-ka, dhiiggu waxa uu ku xayiran yahay kubbadda isha ee gudaha godka lafaha, isaga oo u riixaya kubbadda isha si muuqata hore (proptosis), oo ku fidinaya daboolka indhaha si adag lafta si aan loo furi karin, dhaqdhaqaaqa indhaha oo qaboojiya, oo keena xanuun qoto dheer iyo aragti yar.

Waa maxay sababta daaqadda 60-ilaa-90-daqiiqo ay aad muhiim ugu tahay qaybta Orbital Syndrome?¶

retina waa kordhinta unugyada maskaxda oo leh isticmaalka ugu sarreeya ee ogsijiinta garaam kasta unug kasta oo jidhka bini'aadamka ah. Marka uu dhiigbaxa gudaha godka isha ee adag ee 30-milliter ah uu kaxeeyo cadaadiska ka sarreeya 40 ilaa 50 mmHg, waxay xirtaa halbowlaha indhaha ee dhexe iyo halbowlayaasha yaryar ee quudinta dareemaha indhaha. Tijaabada iyo daraasadaha caafimaadku waxay muujinayaan in 60 ilaa 90 daqiiqo ka dib (iyo ku dhawaad ​​caalami ahaan ka baxsan 120 daqiiqo) ee ischemia dhamaystiran ee isha, unugyada ganglion ee retina waxay u dhintaan si joogto ah, taasoo keentay indho la'aan aan laga soo kaban karin haddii aan la gooyn seedaha kanaalka dambe ee waqtiga.

Maxay takhaatiirtu u sugi la'yihiin CT scan ka hor inta aan la samayn kanthotomy lateral?¶

Orbital Compartment Syndrome waxa lagu ogaadaa kiliinikada sariirta dhinaceeda in ka yar laba daqiiqo iyada oo la hubinayo proptosis, globe adag oo adag, iyo aragga oo yaraada ama cillad arday ah (RAPD). U qaadida bukaanka qolka shucaaca, helitaanka CT-ga wajiga, iyo sugitaanka dib-u-dhiska sawirka waxay si joogto ah u isticmaashaa 30 ilaa 60 daqiiqo 90-daqiiqo ee daaqada badbaadada isha. Goynta xuubka canthal-ka dambe ee sariirta dhinaceeda waxay ku qaadataa laba daqiiqo suuxinta maxalliga ah, isla markiiba waxay soo celisaa socodka dhiigga isha, waxayna u oggolaanaysaa bukaanku inuu si badbaado leh u maro CT scan ka dib.

Maxaa la iiga mamnuucay inaan sanka afuufo ka dib markii isha laygu dhuftay?¶

Saamaynta indho-beelka ah ee isha waxay had iyo jeer dildillaacdaa darbiga dhexe ee aadka u dhuuban (lamina papyracea) ama sagxada godka isha, kaas oo la wadaaga gidaarka ethmoid-ka ka buuxo iyo sanka sanka ee maxillary. Markaad sanka afuufto, cadaadiska gudaha marinnada sankaaga ayaa kor u kacaya 80 ilaa 100 mmHg, oo hawada ku qarxinaya dildilaaca lafaha si toos ah gadaashiisa kubbadda ishaada. Sababtoo ah unugyadu waxay u dhaqmaan sida waalka daboolka hal-jid ah, hawadu waxay ku xayiran tahay isha gadaasheeda (xanuunka orbital emphysema) waxayna u burburisaa neerfaha aragga sida xinjir dhiig.

Dhiigbaxa retrobulbar ma dhici karaa ka dib qalliinka indho-sharafeedka qurxinta (blepharoplasty)?¶

Haa Dhiig-baxa retrobulbar waa dhibaatada ugu cabsida badan ee aragga khatarta ah ee blepharoplasty ee daboolka indhaha ee la isku qurxiyo, oo dhaca inta badan 3 ilaa 24 saacadood ee ugu horreeya qalliinka ka dib marka epinephrine suuxinta maxalliga ah ay xirto ama haddii bukaanku qufaco, matag, foorarsado, ama cadaadis. Haddii aad isku aragto xanuun qoto dheer oo degdeg ah oo hal il ah, barar degdeg ah oo isha horay u sii riixaya, ama aragga qallafsan ka dib qalliinka daboolka isha, wac 911 iyo dhakhtarkaaga isla markiiba si faashado iyo tolmo adag la sii daayo oo kanthotomy lagu sameeyo.

Kanthotomy lateral si joogto ah ma u beddelaa isha ama ma dhaawacdaa kubbadda isha?¶

Maya. Kanthotomy lateral iyo cantholysis ma gooyaan kubbadda isha innaba; waxay ka dhigaysa 1-ilaa-2-centimitir jeex toosan geesta sare ee daboolka indhaha waxayna gooysaa seedaha fiibka ah ee yar yar ee ku xidha daboolka isha hoose ee lafta. Marka dhiigbaxa orbital iyo bararka ay xalliyaan 3 ilaa 5 maalmood, dhakhtarka indhaha ama dhakhtarka qalliinka indhaha ayaa si fudud u tolaya seedaha iyo geeska kore ee isha oo dib u soo celiyaan maqaarka cagtu tuke ee dabiiciga ah, taasoo ka tagaysa nabar aan la arki karin iyagoo badbaadinaya aragga bukaanka.

Ilaha iyo hanuuninta rasmiga ah¶

• ** Akademiyada Indhaha ee Maraykanka (AAO, Maraykanka):** * Tilmaamaha Dhaqanka EyeWiki & Clinical: Syndrome Compartment Syndrome, Dhiig-baxa Dib-u-dhiska, iyo Kanthotomy Lateral iyo Cantholysis*.
• Kulliyadda Dhakhaatiirta Qalliinka Mareykanka (ACS, Mareykanka): Taageerada Nolosha Dhaawaca Hormarsan (ATLS) Buugga Koorsada Ardayga
• Royal College of Emergency Medicine (RCEM) & Royal College of Ophthalmologists (United Kingdom): *Hagaha Dhaqanka ugu Fiican: Maareynta Xanuunada Orbital Partment Syndrome (OCS) ee Waaxda Gurmadka.
• ** Lima V iyo al. (Journal of Oral and Maxillofacial Surgery) & Hayreh SS (Cilmi Baadhista Isha Tijaabada ah):** Ischemia-da isha iyo Wakhtiga Dulqaadka ee Shayga ilaa Dhexdhexaadiyaha Xididka Xididka Xun ee Ba'an (90-ilaa-100-Daaqadda Daaqadda).
• Xiriirka Caalamiga ah ee Ururada Laanqeyrta Cas iyo Bisha Cas (IFRC): * Gargaarka Degdegga ah ee Caalamiga ah, Dib-u-nooleynta, iyo Tilmaamaha Waxbarashada: Dhaawaca Indhaha iyo Difaaca Difaaca*.

Tilmaamaha la xidhiidha¶

• Dhaawaca indhaha, globe dillaacay, iyo isha kiimikaad oo gubta
• Xiritaanka halbowlaha isha ee dhexe, istaroogga isha, iyo arteritis unug weyn
• glaucoma xagal-xiran oo ba'an iyo lumitaanka aragga ee isha
• Isha shay qalaad, naaxinta xudunta, iyo tooshka alxanka
• Auricular hematoma, hematoma septal sanka, iyo dhaawac wajiga ah