Retrobulbar Hematoma, Orbital Blowout Fracture, le Ocular Compartment Syndrome¶

Ka mor'a ho phunya leihlo, baseball kapa setsoe se otla sefahlehong, ho oa, kapa ho oa ha koloi, leihlo le bohloko haholo, le thata-thata, le phunyeletsang (proptosis ) le pono e oelang ke nako ea tšohanyetso ea ho buuoa e tsejoang e le ** Orbital Compartment Syndrome (OCS) ** ho tloha ** Retrobulbar Hematoma Hobane sokete mahlo a motho (orbit) ke lebokose le thata le nang le marako a mane le bulehileng feela ka pele, mali a tsng ka mor'a thaka ea leihlo a potlakela ho phahamisa khatello ea methapo e bohareng ea retina, e khama retina le mothapo oa optic nakong ea 60 ho isa ho metsotso e 120 **. Esita le ha ho se na lesela la mali la retrobulbar, ho robeha ha lesapo le tšesae la socket ea leihlo (* Orbital Blowout Fracture ) ho ka tšoasa mesifa e tsamaisang leihlo holimo, e leng se etsang hore ho be le pelo e kotsi e fokotsang pelo ( oculocardiac reflex **), kapa ho qobella moea oa sinus ka mor'a leihlo la mahlo haeba motho a phunya nko ea hae. Haeba mang kapa mang ea nang le leqeba sefahlehong kapa mahlo a e-ba le leihlo le tsoileng matsoho, ho lahleheloa ke pono, pono e habeli, ho nyekeloa ke pelo ho otlang butle, kapa ho tsieleha ha molomo o ka holimo le lerama, letsetsa nomoro ea hau ea tšohanyetso ea sebakeng sa heno hang-hang. dinomoro tsa tshohanyetso. Hlahloba liprothokholo tse amanang le trauma ka likotsi tsa mahlo le tlhokomelo ea tšohanyetso, maqeba a hlooho le ho ferekana, le orbital cellulitis le cavernous sinus thrombosis.

Etsa sena hona joale¶

1. ** Letsetsa nomoro ea hau ea ts'ohanyetso ea lehae hang-hang ** (911 United States le Canada, 112 ho pholletsa le European Union, 999 United Kingdom) haeba leihlo le lemetseng le ntse le tsoela pele (**proptosis **), le ikutloa le le thata ka tlas'a mahlo a ruruhileng, le na le pono e lerootho kapa e lefifi, le na le moithuti ea sa boneng ka mokhoa o tloaelehileng, ntle le ho fokotseha ha bohloko kapa ho sisinyeha ka mokhoa o tloaelehileng. ho nyekeloa ke pelo.
2. Lulisa mokuli a otlolohile (bonyane likhato tse 45 ho isa ho tse 90) haeba ho sa belaelloe hore ho na le kotsi ea lesapo la mokokotlo. Ho boloka hlooho e phahame ka holim'a boemo ba pelo ho sebelisa matla a khoheli ho theola khatello ea mali ea methapo le tšubuhlellano ea venous ka har'a sokete ea leihlo, ho liehisa ho bokellana ha retrobulbar hematoma.
3. Laela mokuli ka tieo: "U SE KE U BUUA NKO, u se ke ua thimola u koetse molomo, 'me u se ke ua ikhathatsa." Ho robeha ha orbital blowout ho pshatla lesapo le tšesaane la pampiri le arolang sokete ea leihlo ho maxillary a tletseng moea le lisinu tsa ethmoid. Ho phunya nko ho sebetsa joalo ka pompo ea moea e nang le khatello e phahameng, ho qobella moea oa sinus ho phunyeha ho robeha ka ho toba ka mor'a leihlo la leihlo (tension orbital emphysema), e ka foufatsang leihlo hang-hang ka ho hatella methapo ea optic.
4. Sheba pono ka leihlong le lemetseng hona joale (ho koahela leihlo le sa tsoa kotsi) 'me u phete cheke metsotso e meng le e meng e 10. E-re motho eo a bale se ngotsoeng, a bale hore na u tšoere menoana e mekae, kapa u bolele hore na o bona ho sisinyeha ha letsoho kapa khanya. Haeba pono ea pono e theoha ho tloha ho bala mangolo ho ea ho bala menoana feela ka mor'a ho otloa sefahlehong, bolella baoki ba thuso ea bongaka maemong a tšohanyetso le ngaka ea kamore ea tšohanyetso hore pono e nepahetseng ea motsotso e qala ho theoha e le hore ba etse bethe hang-hang ** Lateral Canthotomy and Cantholysis (LCC) ** ka har'a ** fensetere ea metsotso e 90 ea ischemic **.
5. Sireletsa leihlo ka thebe e thata, e koaletsoeng (kapa tlase ea kopi ea pampiri/ea foam e kentsoeng lesapong la phatla le lerameng) ka ZERO pressure on the eyeball. Le ka mohla u se ke ua thatela letlapa la rekere ka thata leihlong le tsietsing, 'me le ka mohla u se ke ua hatella pakete ea leqhoa ka ho toba leihlong le ruruhileng; haeba ho e-na le lekhalo le sa lemoheng leboteng la leihlo (** kotsi e bulehileng ea globe **) kapa hematoma ea retrobulbar, khatello ea ka ntle e tla hatella lintho tse ka hare ho leihlo kapa ho potlakisa optic nerve ischemia.
6. Ho boloka mokuli a se na letho ho hang ka molomo (NPO) le ho phekola ho nyekeloa ke pelo kapa ho hlatsa hang-hang. Ho hlatsa le ho khutlela morao ho baka li-spikes tse matla ka har'a venous le arterial pressure ka har'a hlooho le socket ea leihlo, ho atoloha ho tsoa mali a retrobulbar, le bakuli ba nang le mesifa ea mahlo e qabeletsoeng kapa retrobulbar hematomas hangata ba hloka ho senyeha ka potlako ha opereishene kapa ho lokisoa ha kamore ea ho buuoa.

Sefate sa qeto: Teko ea ts'oaetso e mpe ea periorbital, proptosis, le ho robeha ha moea¶

flowchart TD
    Start["Tlhekefetso e Blunt ho Leihlo, Lerama, kapa Phatleng (Punch, Ball, Fall, kapa Crash)"] --> GlobeCheck{"Mohato oa 1: Rule Out Open Globe Rupture (Lerutoana la Teardrop/pealed, tissue e lefifi ea iris e hlahelletseng, 360-degree bloody conjunctival ballooning, kapa leihlo le theohileng)?"}

    GlobeCheck -->|"EE: Ho belaelloang hore Open Globe Rupture"| OpenGlobe["OPEN GLOBE PROTOCOL: 1. ZERO pressure on eye; U SE KE UA hlahloba khatello ea intraocular (tonometry). 2. Theipi e thata ea thebe ea mahlo a Fox kapa senoelo sa pampiri holim'a moqomo oa masapo. 3. Letsetsa 911 / 112 / 999 bakeng sa tokiso ea tšohanyetso ea ophthalmology ea microsurgical, lithibela-mafu tsa IV, & antiemetics."]

    GlobeCheck -->|"HLOKO: Globe Wall e Bonahala e le Ntle"| OCSCheck{"Mohato oa 2: Screen for Orbital Compartment Syndrome (Retrobulbar Hematoma): Leihlo le bohloko le kobehileng (proptosis), likhurumetso tse thata tsa majoe, pono e oelang, kapa ngoana ea botsoa (RAPD)?"}

    OCSCheck -->|"EE: Retrobulbar Hematoma / Ocular Compartment Syndrome"| Canthotomy["TŠEBELETSO EA HO BUA EA METSOTSO E 90: 1. Bitsa 911 / 112 / 999 Hang-hang; lula u otlolohile likhato tse 45-90. 2. Tlhokomeliso Ngaka ea ER ha e fihla: E Hloka HAMANG KAMELA Bedside Lateral Canthotomy & Cantholysis PELE CT Scan. 3. Fana ka IV Mannitol / Acetazolamide / Methylprednisolone e le borokho."]

    OCSCheck -->|"NO: Pono e Tloaelehileng, Orbit e Bonolo, Ha ho Proptosis"| MuscleTrapCheck{"Mohato oa 3: Lekola Metsamao ea Mahlo a Extraocular (Sheba Holimo, Tlase, Ka ho Le letšehali, ka ho le letona): Na ho Sheba holimo ho thibetsoe ka pono e habeli, KAPA e tsamaisana le ho nyekeloa ke pelo, ho hlatsa, le ho otla ha pelo butle (<60 bpm)?"}

    MuscleTrapCheck -->|"YES: Ho Thibela Ho Sheba Holimo + Bradycardia/Nausea (Haholo-holo ho Ngoana/Mocha ea nang le 'Leihlo le Lesoeu')"| Trapdoor["TRAPDOOR ORBITAL FLOOR FRACTURE E KHOTSOANG MOSIPA: 1. Lefapha la Tšohanyetso Orbital CT Scan HONA JOALE. 2. Hlahloba ECG bakeng sa Oculocardiac Reflex (vagal bradycardia / heart block). 3. E hloka ho lokolloa ka potlako ho buuoa ka hare ho 24 ho lihora tsa 48 ho thibela necrosis ea mesifa e sa feleng."]

    MuscleTrapCheck -->|"Ha ho na mesifa e kenang kapa bradycardia"| SimpleBlowout["TSOELA PELE HO TŠOANYEHA HO TS'OA KE MORPO (Leihlo le kolobileng / enophthalmos, lerama le robehileng/molomo o ka holimo, kapa crepitus): 1. Ha ho na nko e butsoang bakeng sa libeke tse 4 ho isa ho tse 6. 2. Lefapha la Tšohanyetso la CT of Orbits ho lekola boholo ba fracture le sinus."]

Pathophysiology: Kamoo sokete ea mahlo e fetohang seiphepelo se bolaeang sa khatello¶

1. Sebōpeho se thata sa sebopeho sa masapo le li-canthal tendon¶

Ho utloisisa hore na ke hobane'ng ha pokello e nyenyane ea mali kapa moea o ka mor'a leihlo e baka bofofu ka potlako hakana, nahana ka moralo oa mochine oa potoloho ea motho: - Mabota a Mane a Rigid Bony: Sekoti sa mahlo ke piramite e bōpehileng joaloka pere, e mahlakoreng a mane e nang le molumo o ka hare o ka hare oa 30 milliliters feela (\(30\text{ mL}\)), e koaletsoeng ka holimo (lesapo le ka pele / marulelo a orbital), ka ntle (zygomatic le sphenoid masapo / lateral lerako le ka tlaase), lerako le ka tlaase (ka hare) marapo / lebota le bohareng). - Monyako o Tiisitsoeng o ka Pele: Ka nqane ho phallo e ka pele ea piramite, thaka ea leihlo (globe) le mafura a orbital li ts'oaroe ka thata ka har'a sokete ka letlapa le thata la fibrous (the orbital septum) 'me le tšehelitsoe joalo ka thapo ea katara ho lirimo tsa masapo ka ** medial canthal tendon** le tendon** le canthal tendon *** le canthal superior crura**). - Volume-Pressure Compliance Curve: Ka tlwaelo, kgatello ya intraorbital le intraocular (IOP) e phomolang ke 10 ho 20 millimeters ya mercury (\(\text{mmHg}\)). Hobane marako a marapo a ke ke a atoloha ka ntle 'me lateral canthal tendon e thibela leihlo la leihlo hore le se ke la tsamaea ho feta limilimithara tse seng kae ho ea pele, orbit e ka amohela feela **4 ho 5 milliliters ** ea mokelikeli o eketsehileng pele lithane tsohle tsa lesela li felile. - Hang ha mothapo o robehile infraorbital artery, anterior or posterior ethmoidal artery, or ophthalmic artery branch e tsoa mali a fetang 5 milliliters ka har'a khoune ea mesifa ea retrobulbar (kapa ka mor'a hore moea oa sinus o kene tlas'a khatello), khatello ea intraorbital e phahama ka lehlakoreng la exponential ho 60 mm * 40, org *

2. The vascular strangulation cascade (Ocular Compartment Syndrome)¶

Joalo ka "acute compartment syndrome" leoto le tlase le robehileng kapa forearm (bona ho senya kotsi le compartment syndrome), ha khatello e ka hare ho karolo e koetsoeng ea orbital e feta khatello ea mali ea methapo e menyenyane e fepang leihlo le mothapo oa optic: 1. Venous Outflow Collapse (\(>25\text{ to }30\text{ mmHg}\)): Mothapo o mosesaane o bohareng oa retina le methapo ea vortex e koaleha pele, e koale mali a venous ka har'a leihlo 'me tšubuhlellano e mpefala. 2. Short Posterior Ciliary and Vasa Nervorum Ischemia (\(>35\text{ ho }45\text{ mmHg}\)): Metsoana e menyenyane e fepang hlooho ea methapo ea kutlo e ka pele le methapo ea kutlo ea retrobulbar optic, e baka ischemic optic neuropathy. 3. Central Retinal Artery Occlusion (\(>60\text{ to }80\text{ mmHg}\)): Ha khatello ea orbital le intraocular e atamela diastolic arterial blood pressure, mothapo o bohareng oa retina o emisa ho phalla nakong ea diastole (e bonahalang ho ophthalmoscope e le pulsating central retinal e koala ka ho feletseng). 4. ** The 60-to-120-Minute Survival Window: ** Liphuputso tsa khale le tsa kliniki tse sithabetsang li tiisa hore hang ha retinal le optic nerve ischemia e qala ho Orbital Compartment Syndrome, ** ho senyeha ha opereishene ho etsoang nakong ea 60 ho metsotso ea 90 ho tsosolosa pono e tloaelehileng kapa e haufi le e tloaelehileng ho feta karolo ea 85 lekholong ea bakuli ** (0 ho lieha ho feta metsotso e 2 ho feta metsotso e 2 ho ea ho 2 decompression) lihora)** hangata e siea mokuli a foufetse ka ho sa feleng leihlong leo.

3. Mekhanics ea Orbital Blowout Fracture (Hydraulic vs. Buckling Theory)¶

Ke hobane'ng ha fatše kapa lebota le ka hare la socket ea leihlo le petsoha ha lesapo le boima ho feta le pota-potileng ka ntle ho leihlo le lula le sa robeha? - The Hydraulic Mechanism: Ha ntho e chitja e kholo ho feta lisenthimithara tse 5 (2 inches) ka bophara (joalo ka feisi, baseball, bolo ea krikete, kapa bolo ea tenese) e otla ka pele ho leihlo, e sutumelletsa thaka ea leihlo morao ka har'a kholune ea limililithara tse 30 ea mafura a sa tsitsang a orbital. Leqhubu leo la tšohanyetso la hydraulic pressure le phatloha ka ntle khahlanong le marako a mane a marapo 'me le ntša masapo a mabeli a masesaane a "safety-valve" a lehata: 1. The Posterior-Medial Orbital Floor (Roof of the Maxillary Sinus): Feela **0.5 millimeters botenya **, e fokolisitsoeng ho feta ke groove le kanale e jereng infraorbital nerve (\(V_2\)). 2. Lebota la Medial Orbital (Lamina Papyracea of ​​the Ethmoid Sinus): Ha e fetoleloa ka ho toba e le "pampiri-tšesaane lera" (feela 0.2 ho 0.4 millimeters tenya **). - The Buckling Mechanism: Ho otla ka kotloloho rim e teteaneng e tlase ea orbital (cheekbone edge) ho fetisetsa leqhubu le ts'oanelang ho ea morao le hohelang mokato o mosesane oa orbital ka morao ho lona ntle le ho phatloha thaka ea leihlo.

Papiso e felletseng ea maemo a tšohanyetso a 4 a acute post-traumatic orbital¶

Tataiso e qaqileng ea kliniki ho maemo a tšohanyetso a 4 a orbital trauma¶

1. Retrobulbar Hematoma le Bedside Lateral Canthotomy & Cantholysis (LCC)¶

Ke hobane'ng ha bakuli ba nang le retrobulbar hematoma ba ntse ba lahleheloa ke pono ea bona lipetlele tsa kajeno? Lebaka la # 1 ke ** ho emela CT scan ea orbital kapa ho emela ho lekanya khatello ea intraocular ka Tono-Pen pele u khaola lateral canthal tendon . - Tlhahlobo ea Kliniki Bophakong (Ha ho CT e Hlokehang): Haeba mokuli ea tšoenyehileng (kapa mokuli ea sa tsoa etsoa eyelid blepharoplasty, sinus opereishene, kapa retrobulbar anesthetic block) a hlahisa "4 Ps of Orbital Compartment Syndrome": 1. Bohloko (bohloko bo tebileng, bo tebileng ba orbital). 2. Proptosis (ho hatela pele ho lefats'e ka khanyetso e thata ea lejoe ho khutlisetsoa morao ha dijithale holim'a likhurumetso tse koetsoeng). 3. Ho se tloaelehe ha moithuti (bofokoli bo bong bo fapaneng ba pupillary [RAPD] tekong ea lebone le ntseng le sisinyeha, kapa ngoana ea botsoa ea atolositsoeng). 4. Pono e Fosahetseng / e Fokolang (kapa ho se khone ho lekola pono ho mokuli ea intubated ea nang le leihlo le thata la proptotic le RAPD kapa Intraocular Pressure \(>40\text{ mmHg}\)). - Kamoo Lateral Canthotomy le Inferior Cantholysis e Boloka Leihlo ka Metsotso e 2: - Lefapheng la Emergency resuscitation bay, ngaka e kenya 1 ho 2 milliliters ea lidocaine e nang le epinephrine ka har'a sekhutlo sa lateral sa mahlo a mahlo (lateral canthus **), e phunyeletsa ka ōko ho canthus bakeng sa metsotsoana ea 30 ka hemostat ho senya methapo ea mali, 'me e etsa 1-centimeter e nang le scisthomy horizo . - **Hobaneng Canthotomy Alone e sa Leke: Ho seha feela letlalo hukung ea leihlo ho theola khatello ea orbital ka limilimithara tse seng kae tsa mercury. Joale ngaka e tlameha ho hula leihlo le ka tlaase ho tloha leihlo la leihlo, e utloe ka malebela a lisekere bakeng sa setaele se thata, sa katara-joaloka ** crus e tlaase ea lateral canthal tendon , 'me e phunye tendon eo ka ho feletseng ( inferior cantholysis **). - Ka nako eo crus e tlaase e khaotsoeng, leihlo le ka tlaase le oela ka ho feletseng, leihlo la leihlo le fetela pele ho limilimithara tse 4 ho isa ho tse 6 ho fokotsa sebaka sa retrobulbar, khatello ea intraorbital e theoha ka ** 20 ho 40 mmHg ka metsotsoana **, 'me mali a methapo ea mali a khutlela ka har'a mothapo o bohareng oa retina le methapo ea optic.

2. Ho robeha ha Trapdoor ea Bana "White-Eyed" le Lethal Oculocardiac Reflex¶

Ho bana, bacha le batho ba baholo ba ka tlase ho lilemo tse 20, masapo a orbital floor a ruile ka collagen e otlolohileng mme ha a so sotlehe joalo ka lesapo la batho ba baholo: - Ha ngoana a otloa ka leihlong ke bolo, setsoe, kapa lengole, mokato o mosesaane oa orbital o kobehela tlase joalo ka hinge ea greenstick, mafura a orbital le inferior rectus muscle (o lutseng fatše ka kotloloho) o akheha nakoana ka lebaka la ho phatloha, 'me lesapo le rekere ** le tsubella ho khutlela sebakeng joalo ka lesapo le kentsoeng ka har'a mosifa le kentsoeng ka thata. mehlahare. - Lebaka Leo ka Lona le Lemohuoang Phoso e le Leferefere: Hobane marapo a rekere a bana a khoehla hantle ntle le ho pshatleha, hangata ho na le leihlo le letšo le batlang le le lefela, ho tsoa mali a tsoang subconjunctival, le "leihlo le lesoeu" le shebahalang le tloaelehile ka ntle. Leha ho le joalo, ha mesifa ea "pinched inferior rectus" e otlolohile, e chesa pontšo e matla e fapaneng ho fihlela ** karohano ea mahlo ea methapo ea trigeminal (Cranial Nerve V) ** ho ea bokong ba boko, e chesang ka ho toba ho theosa le methapo ea vagus (Cranial Nerve X) ** ho ea pelong le ka mpeng (* * The Oculoner Reflex) * Reflex * The Oculoner Reflex . - The Concussion Trap: Kaha ngoana o hlatsa khafetsa, o shebahala a le mosehla a bile a fufuleloa, o ikutloa a tsekela/o robala, 'me o na le hlooho e opang ka leihlo le shebahalang hantle ka ntle, basebetsi ba tšohanyetso ba atisa ho hlahloba ngoana hampe ka ho lemala hloohong kapa moferefere le ho laela CT ea boko e lahleheloang ke orbit e tlase. - Tsela ea ho E Bona Hang-hang: Sheba** ho otla ha pelo** ea ngoana (hangata e lieha haholo 35 ho ea ho 55 ho otla ka motsotso, ka li-junctional beats kapa li-spikes tsa ho tšoara sinus) 'me ** kopa ngoana hore a latele monoana oa hao 'me a shebe ka ho toba HOLIMO HOLIMO **. Haeba leihlo le lemetseng le sa khone ho potoloha holimo ho feta moeli oa bohareng 'me le shebile holimo le baka leqhubu la ho nyekeloa ke pelo, bohloko ba mahlo, le ho theoha ha sekhahla sesupong sa pelo, ngoana o na le **entrapped trapdoor orbital fracture ** e hlokang ho lokolloa ka potlako ka hare ho ** 24 ho lihora tsa 48 ** pele mesifa e pinched e utloa bohloko bo sa feleng ba mesifa ea ischemann (Voiceman contract necrosis).

3. Infraorbital Nerve (\(V_2\)) Bohatsu: Leseli le Patehileng la Ho robeha ha Orbital Floor¶

U ka tseba joang sebakeng sa kotsi hore na leihlo le letšo le ruruhileng e mpa e le leqeba la 'mele o bonolo ("shiner") kapa lesapo le ka tlaase e leng ho robeha ha lesapo la orbital floor? - Mathisa monoana oa hau habobebe lerameng le ka tlase le letšehali le le letona la motho, lehlakoreng la nko, molomo o ka holimo, 'me u ba botse hore na meno a bona a ka pele a ka "lehong" kapa a le botsoa** (joaloka ka mor'a ho thunngoa ha Novocain ea meno). - The **infraorbital nerve ** (kalakala ea karohano ea maxillary ea methapo ea trigeminal, $ V_2 $) e matha ka ho toba ka kotopo ea masapo e tšesaane ea pampiri ka hare ho mokatong oa sekoti sa leihlo pele e tsoa lerameng ho fana ka maikutlo ho bohareng ba meno le meno a ka holimo. - Haeba ho otla leihlo ho baka ** bohatsu kapa lithapo le linale molomong o ka holimo, marenene a ka holimo / meno, le lerama ka lehlakoreng le le leng **, ho robeha ha "orbital floor blowout fracture ** ka infraorbital canal ho ba teng ho fihlela ho pakoa ka tsela e 'ngoe ka orbital CT scan.

4. Orbital Emphysema: Ke Hobane'ng ha ho Bulua Nko ho Fetola Leqhetsoana le Bonolo ho ba Tsela ea Moea ho ea ho Orbit¶

Ha lebota le bohareng (lamina papyracea) kapa fatše la orbit fractures, mafura a sa hloekang a sokete ea mahlo joale a buisana ka ho toba le ethmoid kapa maxillary nasal sinuses e tletseng moea: - Tlas'a phefumoloho e tloaelehileng, khatello ea moea ka har'a nko e tlase. - Leha ho le joalo, ho butsoela nko ka matla ho hlahisa likhatello tsa intranasal tsa 60 ho feta 100 mmHg (ho lekana le ho kenya moea oa lebili la koloi). - Ho phatloha hoo ha moea o sa hloekang oa sinus le mucus ho phunyeletsa lesapo ho phunyeletsa lintši (ho baka ho phatloha ha lintši ka tšohanyetso ka ho lla **"Rice Krispies" subcutaneous crepitus ** maikutlo a tlas'a menoana ea hau) le ka mor'a leihlo la leihlo. - Haeba leqhubu la sinus mucosa kapa mafura a orbital le sebetsa e le ball-valve (ho lumella moea hore o kene nakong ea ho bululela nko empa oa e tšoasa e le hore e se ke ea phonyoha hape ka har'a sinus), mokotla oa moea o koaletsoeng o hatella methapo e bohareng ea retinal le methapo ea optic (Tension Orbital Emphysema), e bakang bofofu bo matla bo hlokang ho fokotseha ha bulb ea tšohanyetso. - Ho feta moo, ho qobella libaktheria tsa nasal sinus tse silafetseng ho kena mafura a sterile a orbital ho baka kotsi e kholo ea ho ba le pono orbital cellulitis le cavernous sinus thrombosis, ke ka lebaka leo bakuli ba nang le maqeba a sinus-communicating orbital fractures ba thibeloa ho butsoela nko, scuba diving, kapa ho bapala liletsa tsa moea bakeng sa **4 libeke tse 6 **.

Kamehla thibela ho phatloha ha Open Globe ka nako e le 'ngoe pele u ama leihlo¶

Nako le nako ha feisi, baseball, BB pellet, bottle cork, kapa khalase e pshatlehileng e otla leihlo, matla a robehang masapo a orbital a ka boela a phatlola lebota la leihlo ka bolona (Open Globe Rupture). Pele u lumella mang kapa mang ho tobetsa lintšing tsa mahlo kapa ho sheba tsitsipano ea orbital, hlahloba leihlo ka mahlo bakeng sa Matšoao a Tšeletseng a Phahamo e Butsoeng ea Globe: 1. Morutwana wa "Teardrop" kapa Peaked Pupil: Morutwana ha a sa le chitja; e huleloa ka har'a sebopeho se nchocho sa teardrop se lebileng nqa sekhutlong sa cornea kapa sclera moo lerako la leihlo le phatlohileng 'me iris e thibile lesoba. 2. 360-Degree Bloody Ballooning of the Conjunctiva (Bullous Hemorrhagic Chemosis): Lera le hlakileng holim'a bosoeu ba leihlo le ruruhile ho ba selikalikoe se teteaneng, se nang le mali, se kang jelly se pota-potileng cornea ka ho feletseng, se patehileng ho phunyeha ha scleral ka tlase. 3. Lefifi le Lefifi kapa Pigment e Letšo (Uveal Prolapse) E Itšoarellang ka Bosoeu ba Leihlo: Le ka mohla u se ke ua leka ho hlakola "lebala" le lefifi le letšo kapa le sootho holim'a sclera ka mor'a ts'oaetso; ke iris ea mokuli kapa 'mele oa ciliary o hlahelletseng ka har'a sclera e phatlohileng. 4. Kamore e ka Holimo e Tebileng kapa e sa tebang ka mokhoa o sa tloaelehang (kapa Hyphema): Sebaka se ka morao ho cornea se tletse mali a nang le lera (hyphema, bona likotsi tsa mahlo) kapa e shebahalang e putlame ha e bapisoa le leihlo le leng. 5. ** Extrusion of Clear Jelly (Vitreous Humor)** holim'a leihlo. 6. Tahlehelo e Tebileng ea Pono ka Leihlo le Bonolo, le Chebahaneng le Sehatsetsi.

Haeba lets'oao lefe kapa lefe la ho phatloha ha globe le le teng, ** emisa ho qhekella hang-hang, tobetsa thebe ea Fox e thata kapa tlase ea kopi ea pampiri holim'a phatla e nang le masapo le lerameng le se nang letho mahlong, boloka mokuli a tsepame a khobile matšoafo, 'me u letse 911 / 112 / 999**.

Linomoro tsa libaka tsa tšohanyetso le liprothokholo tsa mekhatlo¶

• United States le Canada: Letsetsa 911 bakeng sa lipalangoang tsa hang-hang ho ea Level I kapa Level II Trauma Center e nang le 24/7 Emergency Medicine le Ophthalmology / Oculoplastic Surgery. Tlas'a ** American College of Emergency Physicians (ACEP) **, ** Advanced Trauma Life Support (ATLS) **, le ** American Academy of Ophthalmology (AAO) ** tataiso, lingaka tsa tšohanyetso li koetlisitsoe le ho fuoa mangolo a ho etsa bethe hang-hang ** Lateral Canthotomy le Cantholysis (LCC) ** pele ho CT Imaging Syndrome.
• United Kingdom: Letsetsa 999 (kapa 112). Tlas'a ** Royal College of Emergency Medicine (RCEM) ** le ** Royal College of Ophthalmologists (RCOphth) ** tataiso ea ho sithabela maikutlo, ho tsoa mali ho retrobulbar ka tahlehelo ea pono ho khetholloa e le ts'ohanyetso ea hang-hang ea ho senyeha ha opereishene e etsoang Kamoreng ea Tsohanyetso ea Lefapha la Tšohanyetso pele ho fetisoa ha radiology.
• European Union: Letsetsa 112. Latela ** European Resuscitation Council (ERC) ** le litsela tsa naha tsa maxillofacial / ophthalmic trauma bakeng sa ho senyeha ha orbital hang-hang le maxillofacial CT angiography.
• Australia le New Zealand: Letsetsa 000 Australia kapa 111 New Zealand. Latela RANZCO (Royal Australian le New Zealand College of Ophthalmologists) le ANZCOR tataiso ea ho sithabela ha mahlo.
• India le Asia-Pacific: Letsetsa 112 India, 119 Japane le Korea Boroa, kapa 995 Singapore. Kopa lipalangoang tse tobileng ho ea sepetlele sa boemo bo phahameng ba mahlomola se nang le litšoantšo tsa CT, meriana ea tšohanyetso ea moea / bokhoni ba ho buoa, le ho fana ka tšireletso ea ophthalmology.

Bona dinomoro tsa tshohanyetso bakeng sa linomoro tsohle tsa machaba tsa thomello ea tšohanyetso.

Lipotso tse botsoang khafetsa¶

Ke hobane'ng ha ke sa khone ho beha pakete ea leqhoa ka ho toba leihlong le letšo le ruruhileng hang ka mor'a ho otla ka thata?¶

Ho fihlela ngaka e hlahloba leihlo la mahlo 'me e tiisa hore lerako la lefats'e le tsitsitse ebile ha ho na retrobulbar hematoma, ho beha boima ba leqhoa kapa ho hatella compress e batang ka ho toba holim'a leihlo ho kotsi. Haeba ho na le ho phatloha ho patiloeng ha scleral (globe e bulehileng), boima ba leqhoa bo ka phunyeletsa lense ea ka hare le jelly ea vitreous ka ntle ho leihlo; haeba ho na le retrobulbar hematoma, khatello ea ka ntle e eketsa khatello e seng e ntse e le kotsi e khamang methapo ea optic. Kamehla sireletsa leihlo holim'a rim e nang le masapo ho e-na le hoo.

Hobaneng ha leihlo la ka le ile la tsoa joalo ka bolo ea kolofo hang ha ke letsa nko ka mor'a ho otloa sefahlehong?¶

Lesapo le arolang bokahare le botlaaseng ba sokete ea leihlo la hau ho tloha linkong tsa nko le botenya bo ka tlase ho halofo ea millimeter 'me hangata le petsoha nakong ea leqeba le lerootho la sefahleho le ha bokantle ba sefahleho sa hau bo shebahala bo le botle. Ha u phunya nko ea hao ho butsoela nko, u hlahisa khatello ea moea e fetang 60 ho ea ho 100 mmHg ka har'a mekotla ea hau ea nko, e phatlollang moea oa sinus le libaktheria hantle ka har'a lesapo leo le phunyeletsang mahlo a hao le ka mor'a leihlo la leihlo la hau (** orbital emphysema**); haeba pono e lerootho kapa leihlo le utloa le le thata ka mor'a ho butsoela nko, e-ea phaposing ea maemo a tšohanyetso hang-hang.

Ke hobane'ng ha ngoana ea hlatsa ka ho otla ha pelo butle ka mor'a hore a otloe mahlong a atisa ho hlokomeloa hampe ka ho ferekana kelellong?¶

Bana ba na le masapo a fatše a tenyetsehang a phatlohileng ha a ts'oaroa 'me a koaleha ka morao joalo ka lemati la trap le laetsoeng la selemo, a pitla mosifa oa leihlo o tlase ntle le ho siea leihlo le letšo ka ntle. Ho otlolla mesifa ea mahlo e koaletsoeng ho hlohlelletsa trigeminal-vagal **oculocardiac reflex**, e bakang ho nyekeloa ke pelo ho matla, ho hlatsa, letlalo le lerootho, ho fokola le ho otla ha pelo butle ka mokhoa o kotsi (bradycardia). Kamehla u botse ngoana ofe kapa ofe ea nang le bothata ba sefahleho ho sheba ka ho toba siling; haeba leihlo le leng le sa khone ho nyoloha, ke ho robeha ha orbital, eseng feela ho ferekana.

Na Lateral Canthotomy le Cantholysis li siea lebali le senyang ka ho sa feleng hukung ea leihlo?¶

Che; a lateral canthotomy le inferior cantholysis ke sekotoana se senyenyane, se hloekileng sa 1-centimeter karolong e ka ntle ea tlhaho ea leihlo moo lingaka tsa oculoplastic tsa cosmetic li etsang maqeba khafetsa. Hang ha ho ruruha ha retrobulbar ho rarolla ka matsatsi a 'maloa, ngaka ea mahlo kapa ngaka e buoang ea polasetiki e ka kopanya lesela le sekhutlo sa leihlo le ka morao ka leqeba le sa bonahaleng, athe ho hloleha ho khaola ka mor'a metsotso e 90 ho baka bofofu bo sa feleng, bo ke keng ba etsolloa.

Na ho robeha hohle ha orbital blowout ho hloka opereishene ho kenya poleiti ka mokoting oa mahlo?¶

Che; ho feta halofo ea batho ba baholo ba fola ka mokhoa o sireletsehileng ntle le ho buuoa. Lingaka tsa mahlo le lingaka tse buoang tsa maxillofacial li sebetsa feela Hang-hang (ka hare ho lihora tse 24 ho isa ho tse 48) haeba mesifa ea mahlo e ts'oaroa ka mokhoa o ts'oanelang e bakang reflex ea oculocardiac kapa pono e sa rarolloeng habeli, kapa Subacutely (ka matsatsi a 7 ho isa ho a 14 hang ha ho ruruha ho theoha) haeba ho robeha ho koahetse ho feta karolo ea 50 lekholong, ho baka liphesente tse fetang 50 kapa ho baloa habeli. thaka ya leihlo ho tebela morao (**enophthalmos**) ka ho feta 2 millimeters.

A na nka fofa ka sefofane kapa ke qoela ka scuba ka ho robeha ho sa phekoleheng ha orbital blowout?¶

Lifofane le litsebi tsa mahlo ka kakaretso li eletsa ho ema ho fihlela ho robeha ha orbital ka puisano ea sinus kapa moea oa orbital (pneumo-orbit) e hlahlobiloe le ho hloekisoa (hangata libeke tse 1 ho isa ho tse 2 bakeng sa lifofane tsa khoebo haeba moea oa retrobulbar o le teng, hobane moea o qabeletsoeng ka har'a sokete ea leihlo o hola ka 25 ho ea ho 30 lekholong ho ea ka liphesente tse 25 ho isa ho tse 30 ho ea ho bophahamo ba methapo ea mothapo). Ho qoela ka Scuba ho thibetsoe ka thata ho fihlela pholiso e felletseng ea masapo (libeke tse 4 ho isa ho tse 8), kaha maske a petetsa le sinus barotrauma e ka baka koluoa ​​​​ea mali ea orbital kapa emphysema.

Litataiso tse amanang¶

• Likotsi tsa mahlo le tlhokomelo ea tšohanyetso
• Ntho e tsoang kantle ho mahlo, cornea abrasion, le welding flash
• Maqeba a hlooho le ho ferekana kelellong
• Orbital cellulitis, cavernous sinus thrombosis, le tšoaetso ea sefahleho ea khutlotharo e kotsi

Mehloli le tataiso ea semmuso¶

• ** Komiti ea American College of Surgeons (ACS, United States) Komiti ea Tlhekefetso: ** * Advanced Trauma Life Support (ATLS) Bukana ea Thuto ea Seithuti * ( Ocular Trauma and Emergency Orbital Compartment Syndrome / Lateral Canthotomy le Cantholysis protocols).
• American Academy of Ophthalmology (AAO, United States): EyeWiki le Clinical Statements on Management of Orbital Blowout Fractures, Pediatric White-Eyed Trapdoor Fractures, le Retrobulbar Hemorrhage.
• Royal College of Emergency Medicine (RCEM) le Royal College of Ophthalmologists (RCOphth, United Kingdom): Taelo e Molemohali ea Boikoetliso: Traumatic Orbital Compartment Syndrome le Emergency Lateral Canthotomy le Cantholysis.
• ** Koleji ea Amerika ea Lingaka tsa Tšohanyetso (ACEP, United States): ** Mekhoa ea Meriana ea Meriana ea Emergency Medicine: Acute Management of Ocular and Maxillofacial Trauma.
• Royal Australian le New Zealand College of Ophthalmologists (RANZCO): Litaelo tsa Clinical for Acute Ophthalmic Trauma le Open Globe Protection.