Orbital Cellulitis, Tšoaetso ea Mahlo a Ruruhileng, le Cavernous Sinus Thrombosis¶

Leihlo le ruruhileng ka potlako, le khubelu, le bonolo ho ngoana kapa motho e moholo, kapa ho ruruha, lekhopho, kapa tšoaetso ea sinus/meno E lutseng lipakeng tsa borokho ba nko le likhutlong tsa molomo (the "Danger Triangle of the Face"), e ka eketseha ka mor'a lihora tse seng kae ho tloha ts'oaetso ea letlalo e kaholimo (**preseptal kapa periorbital) ho kena liseleng tse tebileng tsa pono * thaka ea leihlo (postseptal kapa orbital cellulitis) kapa lesela la mali le tšoaelitsoeng botlaaseng ba boko (septic cavernous sinus thrombosis [CST]). Hobane sekoti sa mahlo a motho (the bony orbit) ke lebokose le thata, le koetsoeng le kopantsoeng ka ho toba le li-venous sinuses tsa boko ka methapo e se nang valve, boladu kapa ho ruruha ka mor'a fibrous orbital septum ** kaotlako e pshatla methapo ea optic, e holofatsa mesifa ea mahlo, 'me e jala libaktheria ka har'a lehata. Kamohelo ea hang-hang "6 Orbital Red Flags" (bohloko bo tsamaisanang le mahlo, mahlo a kobehileng, pono e habeli, ho sisinyeha ha mahlo, ho lahleheloa ke pono, kapa pupil reflex e sa tloaelehang) le lithibela-mafu tse potlakileng tsa sepetlele tse kenang methapong li boloka pono le bophelo.

Etsa sena hona joale¶

1. Arola mahlo a ruruhileng ka bonolo (ntle le ho tobetsa thaka ea leihlo) 'me u etse Tlhahlobo ea Mehato e 4 ea Bedside Orbital Triage:
2. Mohato oa 1 (Ho sisinyeha ha Mahlo le ho Hlahloba Bohloko): Tšoara monoana oa hau \(30\text{ centimeters}\) (\(12\text{ inches}\)) ka pel'a sefahleho sa mokuli 'me ue tsamaise butle ka mokhoa oa "H" (ka ho le letšehali, ka ho le letona, holimo, tlase). Na ho tsamaisa leihlo ho baka **bohloko bo tebileng bo otlang ka mor'a leihlo **, kapa na leihlo le ruruhileng ** le salla morao kapa le hlōleha ho tsamaea ka botlalo ** ho baka pono e habeli?
3. Mohato oa 2 (Proptosis / Bulging Check): Ema ka ho toba ka mor'a mokuli ea lutseng, u lebise hlooho hanyenyane morao, 'me u shebe liphatleng tsa bona ka ho toba lintšing ka bobeli. Na cornea ea leihlo le amehileng ** e tsoela pele ho ea pele ** ho feta leihlo le phetseng hantle (kapa na leihlo la leihlo le sutumelletsoa tlase le ka ntle)?
4. Mohato oa 3 (Tlhahlobo ea Pono ea Boiketlo le Bofubelu ba ho Tlatseha ha Mmala): Koahela leihlo le phetseng hantle 'me u hlahlobe hore na mokuli a ka bala mongolo o monyane ka ho hlaka. Tšoara ntho e khubelu e khanyang (joaloka sekoahelo sa botlolo e khubelu) ka pel'a leihlo le phetseng hantle 'me joale leihlo le ruruhileng: haeba' mala o mofubelu o shebahala ** o felile, oa lamunu, kapa o sootho / o moputsoa ("red desaturation")** ka leihlong le ruruhileng, ** optic nerve e ntse e hatelloa **.
5. Mohato oa 4 (Tlhahlobo ea Ho Hasoa ha Li-Bilateral bakeng sa Cavernous Sinus Thrombosis): Sheba leihlo la Le leng (le fapaneng). Haeba ho ruruha, bofubelu, mahlo a kolobileng, kapa ho holofala ha mesifa ea mahlo ho qala ho ata ho ** leihlo la bobeli nakong ea lihora tse 24 ho isa ho tse 48 **, ho tsamaea le hlooho e bohloko kapa feberu, motho ea belaellang **Cavernous Sinus Thrombosis ** hang-hang.
6. Eya hang-hang lekaleng la maemo a tšohanyetso sepetlele haeba E MONG LE EFE ea 6 Orbital Red Flags e le teng, kapa haeba mokuli e le ngoana ea ka tlaase ho selemo se le seng, a sa khone ho itšireletsa mafung, kapa a sa khone ho bula leihlo ka ho lekaneng hore a le hlahlobe. Letsetsa 911 United States le Canada, 112 ho pholletsa le European Union, 999 United Kingdom, kapa u bone tsohle. dinomoro tsa tshohanyetso.
7. Le ka mohla u se ke ua petetsa, pop, lerumo, kapa ua phunya pimple leha e le efe, belisa (furuncle), carbuncle, kapa moriri oa nko o kenang ka hare ho "Kotsi Triangle ea Sefahleho." Trietharo e tlohang ** borokho ba nko ho ea likhutlong tse ka ho le letšehali le tse ka ho le letona tsa molomo ** e phalla ka ho toba ka morao ka methapo e se nang valve ho ea ka har'a lithapo tse se nang valve ho ea ka har'a lithapo tse se nang valve. lehata. Ho pepeta hlahala sefahlehong ho sutumelletsa libaktheria tsa Staphylococcus aureus le maqeba a manyane a septic morao ho ea bokong.
8. Boloka hore mokuli a lule a otlolohile hlooho ea hae e phahamisitsoe ho \(30\text{ho }45\text{degree}\)' me u ba boloke Nothing by Mouth (NPO). Ho lula o otlolohile ho fokotsa khatello ea venous le tšubuhlellano ea mokelikeli ka har'a orbit le cavernous sinus. Qoba lijo le lino hobane leqeba la orbital subperiosteal hangata le hloka litšoantšo tsa tšohanyetso tsa CT le drainage ea endoscopic sinus/orbital tlas'a anesthesia e akaretsang.
9. *U SE KE UA kenya litlhare tsa lapeng tse sa hlabang ka leihlong. Le hoja li-compresses tse futhumetseng li thusa bakeng sa stye e nyenyane ea mahlo (hordeolum), cellulitis e matla ea orbital e hloka lithibela-mafu tse pharalletseng le ho hlakoloa ka potlako ka har'a MRI.
10. Sheba mabaka a kotsi a fungal (Mucormycosis): Haeba mokuli ea nang le diabetes ketoacidosis (DKA), lefu la tsoekere le sa laoleheng hantle, neutropenia, chemotherapy, kapa tšebeliso ea morao-rao ea tekanyo e phahameng ea corticosteroid a ka ba le bohloko ba sefahleho / sinus, leihlo le ruruhileng, le ** makhopho a mats'oafo kapa marotholi a mats'oafo ka har'a nose. (mahalapa)**, phatlalatsa boemo ba tšohanyetso ba Rhino-Orbital-Cerebral Mucormycosis nakong ea tlhahlobo ea sepetlele.

Leihlo le ruruhileng le kotsi-triangle tšoaetso ea triage sefate sa qeto¶

Sebelisa pampiri ena ea kliniki ho khetholla ho ruruha ha mahlo ho tloha botebong ba orbital cellulitis, cavernous sinus thrombosis, le fungal mucormycosis e hlaselang.

flowchart TD
    Start["Ho Ruruhile ho Holimo, ho Khubelu, kapa Leihlo le Bohloko <br/>kapa Tšoaetso ea Bohareng ba Sefahleho ho Kotsi Triangle"] --> OpenCheck{"Arola Mahlo ka Bonolo:<br/>Sheba Motsamao oa Mahlo, Pono, le Boemo"}

    OpenCheck -->|"LEFALA LE MANG LE MANG ORBITAL RED FLAG PRESENT:<br/>- Ho opelwa ha o tsamaisa leihlo<br/>- Motsamao wa mahlo o thibetsweng kapa Pono e Habedi<br/>- Lehlo le lebile pele (Proptosis) kapa le theohele tlase<br/>- Ho fokotseha ha pono, mmala o mofubedu o hlatswitsweng, kapa RAPD<br/>- Leihlo le thata haholo ho sheba leihlo"| OrbitTrue["POSTSEPTAL (ORBITAL) CELLULITIS<br/>kapa SUBPERIOSTEAL ABSCESS:<br/>1. E-ea Lefapheng la Tšohanyetso la Sepetlele HANG-HANG<br/>2. Lula u otlolohile ho likhato tse 30 ho isa ho tse 45<br/>3. Keep Nothing by Mouth (NPO) bakeng sa CT scan & operation <br/>4. E hloka hang-hang lithibela-mafu tsa IV + ENT/Ophthalmology"]

    OrbitTrue --> CSTCheck{"Na Mahlo ka Bobeli aa Kena,<br/>kapa Hlooho e Tebileng / Cranial Nerve Palsy<br/>(CN III, IV, V1/V2, VI) / High Spiking Fever?"}

    CSTCheck -->|"EE: E atametse ho leihlo le fapaneng ka hare ho 24-48h, <br/>li-eyeballs tse leqhoa, phatleng / lerameng, meningismus, <br/>kapa pele ho lethopa la nko / sefahleho kapa sphenoid sinusitis"| CST["SEPTIC CAVERNOUS SINUS THROMBOSIS (CST):<br/>1. Letsetsa 911/112/999 Hanghang<br/>2. Boemo ba Tšohanyetso ba Intracranial e Kotsing<br/>3. E hloka stat IV Vancomycin + Ceftriaxone + Metronidazole,<br/> MRV/CTV boko venogram, le IV anticoagulation"]

    CSTCheck -->|"Diabetes Ketoacidosis (DKA), Neutropenia,<br/>kapa Immunosuppression + Black Eschar Nkong/Mahalapeng<br/>kapa Ho Shoa ha Sefahleho"| Mucor["RHINO-ORBITAL-CEREBRAL MUCORMYCOSIS:<br/>Tlhahiso ea Hang-hang ea Opereishene + IV Liposomal Amphotericin B"]

    OpenCheck -->|"HA HO ORBITAL FUDUDU LIFALA:<br/>- Ho se utloe bohloko, ho sisinyeha ha mahlo ka hohle-hohle <br/>- Pono e tlwaelehileng ya 20/20 & ho tlala ha mmala o mokgubedu <br/>- Ha ho thaka ya leihlo; sclera e tšoeu e shebahala e tloaelehile<br/>- Ho ruruha ho fella ka letlalo la ka ntle la mahlo"| PreseptalCheck{"Ke Eng e Bakileng ho Ruruha ha Kantle<br/>Leihlo?"}

    PreseptalCheck -->|"Feberu, leihlo le lefubelu le mofuthu,<br/>ho longoa ke kokoanyana, mongoapo, kapa sinusitis"| Preseptal["PRESEPTAL (PERIORBITAL) CELLULITIS:<br/>Tlhahlobo e potlakileng ea bongaka ea letsatsi le le leng bakeng sa lithibela-mafu tse nooang<br/>(kapa lithibela-mafu tsa IV haeba ngoana a le ka tlase ho selemo kapa boima)<br/>Sheba lihora tse ling le tse ling tse 4 bakeng sa Orbital Red Flags"]

    PreseptalCheck -->|"Leqhutsu le lenyenyane le kang lekhopho ka ho le letona<br/>eyelash margin (Stye) kapa pea e tiileng e se nang bohloko<br/>ka hare ho sekhurumetso (Chalazion), ha ho feberu"| Stye["HORDEOLUM (STYE) KAPA CHALAZION:<br/> Kenya kopo e hlwekileng e futhumetseng ka compress 10-15 mets 4x letsatsi le letsatsi;<br/>Le ka mohla o se ke wa petetsa kapa wa pepesa leqhutsu la dintshi"]

Moeli oa Anatomical: Hobaneng Orbital Septum e le firewall ea leihlo¶

Ho utloisisa hore na ke hobane'ng ha lintši tse peli tse ruruhileng tse shebahalang li batla li tšoana ho tloha ka phaposing kaofela li ka ba le liphetho tse fapaneng ka ho felletseng, u tlameha ho utloisisa letlapa le lesesaane le thata la khoka e bitsoang orbital septum:

1. The Orbital Septum: The orbital septum e hokela haufi le lerapo le chitja la sokete ea leihlo (orbital rim) ebe e fetela karolong e ka holimo le e ka tlaase ea tarsal ea lintši. E sebetsa e le ** tšitiso ea 'mele ea anatomical (firewall) ** ho arola letlalo le ka holimo le ka tlas'a letlalo la mahlo a mahlo (**sebaka sa preseptal ) ho tloha sebakeng se tebileng, se koaletsoeng ka mor'a leihlo la leihlo ( sebaka sa postseptal kapa orbital **).
2. Preseptal (Periorbital) Cellulitis (Ka Pele ho Lebota la Mollo): Ha kokoanyana e loma ka leihlong, mongoapo o haufi le ntši, kapa lesela le koetsoeng la lintši (stye) le tšoaetsa letlalo ka pel'a septum ea orbital, letlalo le hlephileng la lintshi le ka ruruha (empa ka nako e 'ngoe le koala lets'oao), mesifa ea mahlo, le methapo ea mahlo e lutseng ka mor'a septum ha e amehe ka ho feletseng ebile ha e chese **.
3. Postseptal (Orbital) Cellulitis (Ka morao ho Firewall): Libaktheria li fihla joang ka mor'a septum ea orbital haeba hangata li sa phunye ka ho toba ho tsoa letlalong? Ho feta karolo ea 85 ho isa ho 90 lekholong ea linyeoe tsa orbital cellulitis li hasana ka kotloloho ho tsoa ho tšoaetso e haufi ea sinus ea paranasal, haholo-holo ethmoid sinus.
4. Lerako le ka hare la sekoti sa leihlo le arohanyang potoloho ho tloha ethmoid air cell ke pampiri e tšesaane ea lesapo le bitsoang lamina papyracea (ka ho toba "papyrus-thin layer"), e ka tlaase ho \(0.5\text{ millimeters}\) (\(0.02\text{inches}\)) bakeng sa methapo ea tlhaho ea timina le methapo ea tlhaho.
5. Ha ethmoid e matla ea baktheria kapa sinusitis e ka pele e haha ​​khatello, boladu le baktheria (Streptococcus pneumoniae, Staphylococcus aureus [ho akarelletsa le MRSA], Streptococcus anginosus group, Haemophilus influenzae, kapa ho phunyeletsa ka ho toba pampiring kapa anaerobes ka har'a lamina-anaerobes) ho etsa sekoti sa orbital e ka tlas'a periosteal kapa ho hasana orbital cellulitis.
6. Odontogenic (Dental) Orbital Cellulitis: Leqeba le ka holimo la molar kapa leino la canine le sa phekoloeng le ka hohola ho ea holimo ho maxillary sinus le ho feta fatše ho orbit ho ea soketeng ea leihlo.

Papiso e felletseng ea maemo a 5 a hlobaetsang a ruruhileng¶

Sebelisa tafole ena ea litleleniki ho khetholla maqeba a mahlo a kotsi, preseptal cellulitis, orbital cellulitis, cavernous sinus thrombosis, le allergic angioedema:

"Triatharo e Kotsi ea Sefahleho" le Septic Cavernous Sinus Thrombosis (CST)¶

Ke hobane'ng ha khutlotharo e tsoang borokho ba nko ho ea likhutlong tsa molomo ha e na li-valve tsa venous¶

Haeba u hula khutlotharo sefahlehong sa hau ka ** ntlha e kaholimo borokhong ba nko ea hau ** (pakeng tsa lintši tsa hau) le ** likhutlo tse peli tse tlase ka letsohong le letšehali le likhutlong tse ka ho le letona tsa molomo oa hau ** (ho kenyeletsoa nko eohle ea hau, sebaka sa nko, molomo o ka holimo, le meno a ka holimo), u entse 'mapa oa "Kotsi ea Sefahleho" e tsejoang ka hore ke "Kotsi Triangle ea Sefahleho"* (Tal Triangle ea Sefahleho)*

Hoo e batlang e le methapong eohle ea 'mele oa motho, li-valve ** li thibela mali ho phalla morao. Leha ho le joalo, methapo ea bohareng ba sefahleho le orbit (** mothapo oa sefahleho, mothapo oa angular, le methapo ea mahlo e phahameng le e tlaase ) ** ha e na li-valve tse sebetsang ka tsela e le 'ngoe ** (kapa li lumella ho phalla ha mali ka mahlakoreng a mabeli ho itšetlehile ka khatello): 1. Ka tloaelo, mali a tsoang borokhong ba nko le molomo o ka holimo a theohela tlaase ka mothapo oa sefahleho ho ea mothapong oa ka hare oa jugular molaleng. 2. Leha ho le joalo, angular vein e k'honeng e ka hare ea leihlo e hokahana ka ho toba ** le mothapo o phahameng oa mahlo , o tsamaeang ka ho toba morao ka mokotleng oa mahlo 'me o feta phatlong e phahameng ea orbital ** ho kena ** cavernous sinus ** ka hare ho setsi sa lehata. 3. Haeba motho a e-ba le tšoaetso ea letlalo la baktheria ka har'a khutlo-tharo ena (haholo-holo furuncle ea nko [ho bela ka har'a nko ho tloha ho hlotha moriri oa nko kapa ho phunya nko], ho tsoa ha makhopho a makhopho kapa ho bela nkong kapa molomong o ka holimo, acute sphenoid kapa ethmoid sinusitis kapa leino le ka pele pops it, khatello e phahameng ea mochine e qobella libaktheria le li-clots tsa mali tse nang le tšoaetso ** khutlela morao (ka morao) ** ka methapo ea mahlo e se nang valve ka ho toba ka har'a sinus ea cavernous.

Ka hare ho Cavernous Sinus: Tsela e nang le batho ba bangata ka ho fetisisa bokong ba motho¶

Cavernous sinuses ke liphaposi tse peli tsa venous tse nang le spongy, tse tletseng mali tse lutseng ka lehlakoreng le letšehali le ka ho le letona la tšoelesa ea pituitary (sella turcica) bohareng ba lehata, tse hokahaneng ho pholletsa le midline ka intercavernous sinuses.

Ho matha ka ho toba bohareng ba mali a venous ka har'a sinus ea cavernous, kapa a kentsoeng leboteng la lona le ka ntle, ke likarolo tsa bohlokoa tseo ho seng kae kapa kae 'meleng tse fetang ka har'a mothapo: - Ka har'a lumen ea cavernous sinus: - Internal Carotid Artery (mothapo o ka sehloohong o fepang boko) le plexus ea eona e potolohileng methapo ea kutlo e nang le kutloelo-bohloko. - Cranial Nerve VI (Abducens Nerve): Mothapo o laolang lateral rectus mesifa (e tsamaisang thaka ea leihlo ka ntle ho ea tsebeng). Hobane Cranial Nerve VI e phaphamala ka bolokolohi ka har'a setsi sa cavernous sinus ho e-na le ho sireletsoa leboteng le ka ntle, **ho se khone ho lebisa leihlo ka ntle (lateral look palsy) hoo e ka bang kamehla ke letšoao la VERY FIRST methapo ea methapo ea Cavernous Sinus Thrombosis **. - E kentsoeng leboteng la lateral la cavernous sinus (ho tloha holimo ho ea tlase): - Cranial Nerve III (Oculomotor Nerve): E phahamisa leihlo le ka holimo (levator palpebrae), e tlamella thaka, ebe e isa leihlo ka hare, holimo le tlaase. - Cranial Nerve IV (Trochlear Nerve): E isa leihlo tlase le ka hare. - Cranial Nerve V1 (Ophthalmic Division of Trigeminal Nerve): Maikutlo a kutlo phatleng, mahlo a ka holimo, nko le cornea. - Cranial Nerve V2 (Maxillary Division of Trigeminal Nerve): Maikutlo a kutlo lerameng, molomong o ka holimo, le meno a ka holimo.

Nako ea khale ea Septic Cavernous Sinus Thrombosis¶

1. Prodrome (Matsatsi a 1 ho isa ho a 5): Mokuli o na le lethopa le bohloko ka har’a nko kapa molomong o ka holimo (hangata e sa tsoa petetsoa), sphenoid/ethmoid sinusitis e matla, kapa orbital cellulitis, e tsamaeang le ho mpefala hlooho e bohloko ka mor’a leihlo le leng kapa phatleng e sa arabeleng ho libolaea-bohloko.
2. Unilateral Orbital Congestion & Cranial Nerve Palsies (Lihora): Ha septic thrombus e koala sinus ea pele ea cavernous, mali a venous a tsoang ka leihlong ha a khone ho tsoa. Eyelid e ruruha ho koaloa, libalune tse tšoeu tsa leihlo li tsoa (chemosis), thaka ea leihlo e tsoela pele (proptosis), 'me ** Cranial Nerve VI e hlōleha pele ** (leihlo le retelehela ka hare hanyenyane 'me ha le khone ho sheba ka ntle), ka potlako e lateloa ke ** Cranial Nerves III le IV** (drooping upper eyelid, aishpilated ka ho feletseng. Leihlo le hoammeng) mmoho ho tsieleha kapa ho tjhesa diphini le dinale phatleng le lerameng (Cranial Nerves V1/V2).
3. Ho Nama Likarolo Ka Bobeli Ho Fetisisa Li-Intercavernous Sinuses (Ka Lihora tse 24 ho isa ho tse 48): Hobane libe tsa lehaheng tse ka ho le letšehali le le letona li hokahane ho theosa le bohareng ka likanale tse se nang li-valve intercavernous, lesela la septic le hasana ho mabapaneng a cavernous sinus nakong ea lihora tse 24 ho isa ho tse 48. **Ha ho ruruha ha leihlo le le leng le ho holofala ha mesifa ea mahlo ho hlaha ka tšohanyetso ka leihlong la BOBELI, ke letšoao la khale la Cavernous Sinus Thrombosis ** (e khethollang ho cellulitis e bonolo ea orbital, e lulang ka leihlong le le leng).
4. Intracranial Sepsis & Meningitis: Matšoao a phahameng a "picket-fence" a spiking (\(39.5^\circ\text{C}\text{ho }41^\circ\text{C}\) [\(103^\circ\text{F}\text{ to }106^\circ\text{F}\), pherekano, pherekano), kapa stroke (ho tloha ka hare ho methapo ea carotid spasm / thrombosis).

Staging of Orbital Infections: The Chandler Classification System¶

Lefapheng la maemo a tšohanyetso, litsebi tsa mahlo le li-otolaryngologists (ENT surgeons) li sebelisa ** Chandler Classification ** ho hlahloba CT e ntlafalitsoeng ea li-orbits le sinus ho fumana hore na mokuli o hloka lithibela-mafu tsa bongaka a le mong kapa opereishene ea tšohanyetso ea kamoreng:

Boemo ba Tšohanyetso bo Khethehileng: Fungal Sinusitis e Hlaselang (Rhino-Orbital-Cerebral Mucormycosis)¶

Leha liperesente tse 98 tsa orbital cellulitis ho bana ba phetseng hantle le batho ba baholo ke baktheria, kotsi e bolaeang, e senyang ka potlako tšohanyetso ea fungal e bitsoang Rhino-Orbital-Cerebral Mucormycosis ** (e bakoang ke hlobo ea taelo Mucorales, joalo ka Rhizopus kapa Mucor, kapa litlhaselo tse phahameng tsa Asper): - Ke mang ea kotsing: Bakuli ba lefu la tsoekere ketoacidosis (DKA) (moo tsoekere e phahameng ea mali le asiti e tsoang maling a ntšang tšepe ea mahala e fepang Mucorales fungus), lefu la tsoekere le sa laoleheng hantle, malignancies/neutropenia, ba amohelang ho fetisoa ha 'mele oa setho kapa masapo, phekolo ea deferoxamine iron-chelation, kapa phekolo ea morao tjena ea corticosteroid e phahameng haholo. - Kamoo Mucormycosis e senyang lisele tsa 'mele (Angioinvasion): Ho fapana le libaktheria tse bakang boladu bo bofubelu bo futhumetseng, Mucorales fungal hyphae e hlasela ka ho toba maboteng a methapo ea mali **, ea a koala leo khaola phallo eohle ea mali. Sena se baka ka potlako ischemic tissue death (infarction)** le ho fetola thishu e ng le tšoaetso e shoeleng e soeufetse ebe e ntšo leshala (necrotieschar). - **Mhoa oa ho hlahloba Mucormycosis haufi le bethe: Haeba mokuli ea nang le lefu a tsoekere kapa ea haelloang ke mele a e-na le mahlaba a sinus, ho tsieleha sefahlehong, kapa leihlo le ruruhileng/le thekeselang, khantša lebone ka hare ho linkong** ka bobeli (ho sheba septum ea nko le li-turbinates) le marulelong a letlalo la molomo le thata, le bonolo joaloka nko **Lekhapetla lefe kapa lefe le letšo la necrotic, seso se pherese e lefifi/e ntšo, kapa lekhalo le lerootho mahalapeng kapa ka har'a nko ke boemo ba tšohantso bo hlokang ho senyeha hang-hang ka phaposing ea ho buoa le ho intravenous liposomal Amphotericin B ka mor'a lihora tse seng kae.

Tlhokomelo e bolokehileng bakeng sa likotlo tse nyane tsa mahlo (Styes & Chalazia) vs. Melao ea ts'ireletso ea Danger Triangle¶

Ho thibela matheba a manyane sefahlehong hore a se ke a fetoha maemo a tšohanyetso a orbital kapa intracranial, latela melao ena e tiileng ea bohloeki le thuso ea pele:

1. Mokhoa oa ho tšoara ka mokhoa o sireletsehileng Eyelid Sye e sa rarahanang (Hordeolum) lapeng¶

Haeba u e-na le lekhopho le lenyenyane le bofubelu botlaaseng ba leihlo (external hordeolum / stye) kapa ka hare ho leihlo (internal hordeolum) le zero Orbital Red Flags (motsamao o tloaelehileng oa mahlo o se nang bohloko, pono e tloaelehileng, ha ho feberu, ha ho na sekoahelo se pota-potileng): - ** Kenya li-compress tse hloekileng, tse futhumetseng (eseng scalding) ** bakeng sa **metsotso e 10 ho isa ho e 15, makhetlo a 4 ka letsatsi . Mofuthu o bonolo o qhibilihisa oli e teteaneng ea boka (meibum) e koalang tšoelesa hore e tsoe ka tlhaho ka boeona. - Hlapa matsoho hantle ka sesepa le metsi pele le ka mor'a ho tšoara haufi le leihlo, 'me u khaotse ho itlotsa ka litlolo tsa mahlo kapa lilense tsa ho kopana ho fihlela stye e felile ka ho feletseng (lahlela masela a khale a silafetseng a mascara 'me u bolaee likokoana-hloko kapa u nkele lilense tsa ho kopana). - ** LE KA mohla u se ke ua petetsa, ho penya, kapa ho petsola stye ka nale: Ho petetsa ho phunya khepisi e nyane ea tšoelesa ka morao ho methapo ea pele le ea orbital.

2. Mokhoa oa ho sebetsana le pimple, belisa (furuncle), kapa moriri o melang sebakeng sa Danger Triangle.¶

• Le ka mohla u se ke ua phunya kapa ho ntša li-nasal vibrissae (moriri oa nko) ka li-tweezers: Ho phunya moriri oa nko ho bula moriri o tebileng ka har'a sebaka sa nko se nang le baktheria (moo ka tlhaho liperesente tse 30 tsa batho ba jarang Staphylococcus aureus), ho theha #1 trigger for nasal furuncles le Cavernous Thrombosis. Ka linako tsohle feta moriri oa nko ka mokhoa o sireletsehileng ka sekere se chitja se pota-potiloeng kapa mochini o fokotsang motlakase oa rotary.
• Haeba lethopa le bohloko le hlaha nkong, ka har'a nko, kapa molomong o ka holimo: Le ka mohla u se ke ua e petetsa kapa ua e phaphatha. Sebelisa compress e hloekileng e futhumetseng. Haeba leqhubu le bohloko ka har'a nko kapa borokhong ba nko le hlahisa bofubelu bo jalang (**cellulitis **), bohloko bo otlang pelo, ho ruruha ho ea karolong e ka hare ea leihlo, kapa feberu, bona ngaka ** letsatsing lona leo ** bakeng sa lithibela-mafu tsa tsamaiso (le intranasal mupirocin setlolo haeba ho laetsoe).

Mongolo o nepahetseng oa puisano bakeng sa 911/112/999 le tlhahlobo ea sepetlele¶

Hobane litleliniki tsa tlhokomelo e potlakileng le likamore tsa ho leta maemong a tšohanyetso hangata li nka hore leihlo le ruruhileng ke "leihlo le lepinki (conjunctivitis)" kapa ho longoa ke kokoanyana, sebelisa mantsoe ana a kliniki nakong ea tlhahlobo:

• Bakeng sa Cellulitis e belaelloang ea Postseptal (Orbital):

  "Ke "triage" le mokuli ea lilemo li [Amo] ea nang le ho ruruha ha mahlo a hlobaetsang PLUS Orbital Cellulitis e khubelu lifolakha tse khubelu: mokuli o na le [bohloko bo tebileng ha a sisinya leihlo / ho sisinyeha ha leihlo le nang le pono e habeli / ho ruruha ha leihlo / ho fokotseha ha pono kapa ho hlatsuoa ha 'mala o mofubelu] ka mor'a [sinus infections. e lokile, 'me e hloka tlhahlobo ea hang-hang ea ngaka, lithibela-mafu tsa stat IV, le CT scan e fapaneng ea orbital ho thibela lesapo la subperiosteal."

• Bakeng sa Ho belaelloang hore Cavernous Sinus Thrombosis (CST):

  "Tlhaloso ea maemo a tšohanyetso: mokuli enoa o ne a e-na le [lehlaseli bohareng ba sefahleho / tšoaetso ea nko / tšoaetso ea sinus] 'me hona joale o na le hlooho e matla ea retro-orbital, feberu e matla, [leihlo le kolobileng / ho se khone ho tsamaisa leihlo ka ntle], le ho ruruha hoo hona joale ho atang ho ea leihlo la BOBELI (le fapaneng). lithibela-mafu tse pharalletseng, le tlhahlobo ea tšohanyetso ea CT/MR.”

Lipotso tse botsoang khafetsa¶

Ke tsela efe e potlakileng ea ho tseba phapang lipakeng tsa periorbital (preseptal) cellulitis le kotsi ea orbital (postseptal) cellulitis?¶

Ka bonolo tšoara mahlo a ruruhileng a bulehile 'me u kope motho hore a latele monoana oa hae ka mahlo ho ea ka ho le letšehali, hole ka ho le letona, holimo le tlase. Ka cellulitis e bonolo ea preseptal, tšoaetso e ka har'a letlalo la mahlo a ka ntle, kahoo ho tsamaisa leihlo ke karolo ea 100 lekholong e boreleli ebile ha e na bohloko ka pono e tloaelehileng; ho cellulitis e kotsi ea orbital, tšoaetso e tebile ka mor'a lesira la socket ea leihlo, kahoo ho tsamaisa thaka ea leihlo ho baka bohloko bo tebileng bo opang, ho sisinyeha ho fokolang, pono e habeli, kapa leihlo le shebileng pele.

Tšoaetso ea ethmoid sinus ho ngoana e fetoha boemo ba tšohanyetso bo ruruhileng ba mahlo ka bosiu bo le bong joang?¶

Lerako le ka hare la lesotho la leihlo le arolang leihlo ho ethmoid sinus ka har'a nko ke lesapo le tšesaane la pampiri le bitsoang lamina papyracea, le botenya bo ka tlase ho halofo ea millimeter 'me le phunyeletsoa ke methapo e menyenyane ea mali. Ho bana le bacha, baktheria e matla ea ethmoid sinusitis e sutumelletsa boladu habonolo ka lesapong lena le tšesaane ho kena ka har'a sokete ea leihlo, ho etsa hore ho be le lesapo la mokokotlo le hatellang mesifa ea leihlo le mothapo oa optic ka mor'a lihora tse ngata.

Na ho hlile ho kotsi ho hlahisa pimple kapa ho phunya moriri ka har'a nko "Kotsi Triangle ea Sefahleho"?¶

E, methapo e ntšang khutlo-tharo ho tloha borokhong ba nko ho ea likhutlong tsa molomo e hokahana ka ho toba ka soketeng ea leihlo ka methapo ea mahlo e se nang valve e phahameng le e ka tlaase ho sinus ea lehaheng e karolong e ka tlaase ea boko. Hobane methapo ena e haelloa ke li-valve tsa tsela e le 'ngoe tse emisang ho phalla ho khutlela morao, ho pepeta lethopa kapa follicle ea moriri e tšoaelitsoeng ka har'a nko kapa molomong o ka holimo ho ka qobella libaktheria le maqeba a tšoaelitsoeng ho khutlela morao ka har'a lehata, ho baka lefu le bolaeang la cavernous sinus thrombosis.

Ke hobane'ng ha ho hlahloba hore na 'mala o mofubelu o khanyang hakae ("red desaturation") ke teko ea bohlokoa hakaale ka leihlo le ruruhileng?¶

Methapo ea methapo e ka hare ho methapo ea optic e fetisang maikutlo a 'mala o mofubelu o khanyang ke eona e amehang ka ho fetisisa khatellong ea mechine le ischemia. Nako e telele pele sethopo sa orbital kapa ho ruruha ho foufatsa leihlo ka ho feletseng, ho hatella methapo ea optic ho etsa hore ntho e khubelu e khanyang (joaloka sekoahelo sa botlolo se khubelu) se shebahale se felile, se hlatsoitsoe sa lamunu, kapa se sootho se bohlooho ha se talingoa ka leihlo le amehileng ha se bapisoa le leihlo le phetseng hantle, ho lemosa lingaka hore ho buuoa ka tšohanyetso ho hlokahala hang-hang ho boloka pono.

Mehloli e hlahlobiloe¶

• American Academy of Ophthalmology (AAO, United States): Clinical Guidelines and EyeWiki Consensus on Preseptal Cellulitis, Orbital Cellulitis (Chandler Classification Groups I to V), le Septic Cavernous Sinus Thrombosis.
• Mokhatlo oa Mafu a tšoaetsanoang oa Amerika (IDSA, United States): Itloaetse Tataiso bakeng sa Tlhahlobo le Tsamaiso ea Mafu a Letlalo le a Soft Tissue le Tlhahiso ea Kliniki bakeng sa Acute Bacterial Rhinosinusitis ho Bana le Batho ba Baholo (mathata a orbital le a intracranial).
• Setsi sa Sechaba sa Bophelo bo Botle le Tlhokomelo e Ntle (NICE, United Kingdom) le Royal College of Ophthalmologists (RCOphth, United Kingdom): Sinusitis (Acute): Periorbital le Orbital Cellulitis Emergency Referral Criteria (NG79).
• American Academy of Pediatrics (AAP, United States): Taolo ea Acute Sinusitis le Periorbital/Orbital Cellulitis ho Bakuli ba Bana.
• European Confederation of Medical Mycology (ECMM) le Mycoses Study Group (MSG ERC): Global Guideline for the Diagnosis and Management of Mucormycosis (Rhino-Orbital-Cerebral Mucormycosis) kananelo ea tšohanyetso le tsamaiso ea ho buoa/liposomal Amphotericin B).

Litataiso tse amanang¶

• Ho lahleheloa ke pono ka tšohanyetso, retinal detachment, le acute angle-closure glaucoma
• Likotsi tsa mahlo: ho chesoa ke lik'hemik'hale, ts'oaetso e phunyeletsang, le hyphema
• Necrotizing fasciitis (tšoaetso e jang nama) le lifolakha tse khubelu tsa cellulitis
• Ho lemoha sepsis le septic shock
• Lefu la tsoekere ketoacidosis (DKA) le boemo ba hyperosmolar hyperglycemic