Hematoma ya Retrobulbar, Go Thunya ga Leitlho, le Bolwetse jwa Karolo ya Leitlho¶

Morago ga go itewa mo leitlhong, go itewa ka baseball kgotsa ka sekgono mo sefatlhegong, go wa, kgotsa go thulwa ke koloi, leitlho le le botlhoko thata, le le thata jaaka letlapa, le le tlhotlhoregang (proptosis) le le nang le pono e e wa ke boemo jwa tshoganyetso jwa karo jo bo tlhokang nako jo bo bidiwang **Orbital Compartment Syndrome (OCS) Ka gonne sokete ya leitlho la motho (modikologo) ke lebokoso le le gagametseng, le le nang le mabota a le manè la marapo le le bulegileng fela kwa pele, go dutla madi mo tshikeng e e kafa morago ga bolo ya leitlho go tlhatlosa ka bonako kgatelelo ya mo teng ga leitlho go feta kgatelelo ya tshika e e fa gare ya retina, go kgamela retina le tshika ya leitlho mo lobakeng lwa metsotso e le **2060 go ya go **1. Tota le fa go se na letlhotlhora la madi le le kwa morago, go robega ga fa fatshe go go tshesane ga marapo a leitlho (Orbital Blowout Fracture) go ka tshwara mesifa e e tsamaisang leitlho kwa godimo, ga tsosa reflex e e kotsi e e dirang gore pelo e nne bonya (oculocardiac reflex), kgotsa ga pateletsa mowa wa sinus gore motho a se ka a foka ka fa morago ga leitlho. Fa mongwe le mongwe yo o nang le kgobalo ya sefatlhego kgotsa ya leitlho a nna le leitlho le le buduleng, go latlhegelwa ke pono, go bona gabedi, go feroga sebete ka go itaya ga pelo ka bonya, kgotsa go utlwa botlhoko ga molomo o o kwa godimo le lerama, leletsa nomoro ya tshoganyetso ya lefelo la lona ka bonako ka dinomoro tsa tshoganyetso. Sekaseka diporothokholo tse di amanang le kgobalo mo dikgobalo tsa matlho le tlhokomelo ya tshoganyetso, dikgobalo tsa tlhogo le go roroma ga tlhogo, le selulaiti ya modikologo le go ruruga ga madi mo dinkong.

Dira se jaanong¶

1. Leletsa nomoro ya gago ya tshoganyetso ya selegae ka bonako (911 kwa United States le Canada, 112 go ralala Kopano ya Yuropa, 999 kwa United Kingdom) fa leitlho le le gobetseng le tlhotlhoregela kwa pele (proptosis), le ikutlwa le gagametse e bile le le thata jaaka letlapa ka fa tlase ga diphuka tsa matlho tse di rurugileng, le na le lesedi le le sa bonaleng sentle kgotsa le le nang le lesedi le le fifetseng mo go tlwaelegileng, e, kgotsa ga e kgone go ya kwa godimo kwantle ga botlhoko jo bo tseneletseng le go feroga sebete.
2. Nna molwetse a tlhamaletse (bonnye didikirii di le 45 go ya go di le 90) fa go sa belaelwe kgobalo ya mothapo wa lerapo la mokwatla. Go boloka tlhogo e tsholeditswe kwa godimo ga selekanyo sa pelo go dirisa maatlakgogedi go fokotsa kgatelelo ya go dutla madi mo ditshikeng le go pitlagana ga ditshika mo teng ga sokete ya leitlho, go fokotsa go kokoana ga hematrobulbar ya hematrooma.
3. Laela molwetse ka thata: "O SE KE WA FOKA NKO, o se ka wa ethimola o tswetse molomo, mme o se ka wa gagamala." Go robega ga go foka ga orbital go thuba lerapo le le sesane jaaka pampiri le le kgaoganyang leroba la leitlho le di-sinus tsa maxillary le ethmoid tse di tletseng mowa. Go foka nko go dira jaaka pompo ya mowa ya kgatelelo e e kwa godimo, go pateletsa mowa wa sinus go feta mo lephanyegong la go thubega ka tlhamalalo ka fa morago ga tlhogo ya leitlho (tension orbital emphysema), e e ka foufatsang leitlho ka bonako ka go gatelela mothapo wa leitlho.
4. Tlhola pono mo leitlhong le le gobetseng gone jaanong (o khurumetse leitlho le le sa gobelang) mme o boeletse go tlhola metsotso mengwe le mengwe e le 10. Dira gore motho a bale mogatiso, a bale gore o tshwere menwana e le kae, kgotsa a bolele gore a o kgona go bona motsamao wa diatla kgotsa lesedi. Fa botlhale jwa pono bo wela tlase go tswa mo go baleng ditlhaka go ya go bala menwana fela morago ga go itewa mo sefatlhegong, bolelela bathusi ba kalafi le ngaka ya phaposi ya maemo a tshoganyetso gore pono e simolotse go wela tlase ka motsotso o o tlhomameng gore ba dire Lateral Canthotomy and Cantholysis (LCC) ka bonako mo teng ga fensetere ya **ischemic ya metsotso e le 90.
5. Sireletsa leitlho ka thebe e e gagametseng, e e tlhomilweng (kgotsa botlase jwa kopi ya pampiri/foam e e bofilweng mo lerapo la phatla le lerapo la marama) ka kgatelelo ya ZERO mo tlhogong ya leitlho. Le ka motlha o se ke wa phuthela setlhako sa elastic ka thata go dikologa leitlho le le utlwileng botlhoko, mme le ka motlha o se ke wa tobetsa sephuthelwana sa aese ka tlhamalalo mo leitlhong; fa go na le keledi e e sa lemogiwang mo leboteng la bolo ya leitlho (kgobalo ya kgolokwe e e bulegileng) kgotsa hematoma ya retrobulbar, kgatelelo ya kwa ntle e tla tlhotlhora diteng tsa leitlho kwa ntle kgotsa e potlakise go tlhoka madi ga methapo ya leitlho.
6. Boloka molwetse a sa je sepe gotlhelele ka molomo (NPO) mme o alafe go feroga sebete kgotsa go kgwa ka bonako. Go kgwa le go kgwa go baka ditlhatlogo tse di bogale tsa kgatelelo ya ditshika le ya ditshika mo teng ga tlhogo le mo lesobeng la leitlho, go atolosa go dutla madi ga retrobulbar, mme balwetse ba ba nang le mesifa ya leitlho e e tshwaregileng ya hebartento compression kgotsa surtrobul paakanyo ya kamore.

Setlhare sa tshwetso: Go tlhaola kgobalo e e bogale ya mo tikologong ya leitlho, proptosis, le dithubego tsa go thunya¶

flowchart TD
    Start["Kgobalo e e Botlhofo mo Leitlhong, Lerama, kgotsa Phatleng (Go Itlhaba, Bolo, go Wa, kgotsa go Thula)"] --> GlobeCheck{"Kgato 1: Kgaola go Thubega ga Lefatshe le le Bulegileng (Lerothodi la keledi/leitlho le le kwa godimo, thishu e ntsho ya iris e e tlhagelelang, go tswa ga leitlho le le nang le madi ka didikirii di le 360, kgotsa leitlho le le tswang mowa)?"}

    GlobeCheck -->|"EE: Go Belaelwa Go Thubega ga Kgolokwe e e Bulegileng"| OpenGlobe["POROTOKOLO YA GLOBE E e BULILWENG: 1. Kgatelelo ya LEFELA mo leitlhong; O SE KE wa tlhola kgatelelo ya mo teng ga leitlho (tonometry). 2. Theipi e e gagametseng ya leitlho la Fox kgotsa kopi ya pampiri mo godimo ga rim ya marapo. 3. Leletsa 911 / 112 / 999 go bona paakanyo ya tshoganyetso ya karo e nnye ya matlho, dibolayamegare tsa IV, le dibolayamegare tsa go tshologa."]

    GlobeCheck -->|"NNYAA: Lebota la Globe le Bonaga le sa Senyega"| OCSCheck{"Kgato 2: Go Tlhatlhoba Bolwetse jwa Letlhokwa la Leitlho (Retrobulbar Hematoma): Leitlho le le tlhotlhoregang le le botlhoko (proptosis), dikhurumelo tse di gagametseng jaaka letlapa, pono e e wa, kgotsa leitlho le le bonya (RAPD)?"}

    OCSCheck -->|"EE: Hematoma ya Retrobulbar / Bolwetse jwa Karolo ya Matlho"| Canthotomy["TSHOGANYETSO YA KARO YA METSOTSO E 90: 1. Leletsa 911 / 112 / 999 Ka bonako; nna o tlhamaletse ka didikirii di le 45-90. 2. Tlhagisa Ngaka ya ER fa e goroga: E tlhoka go dira Canthotomy & Cantholysis ya mo thoko ga bolao ka bonako PELE ga CT Scan. 3. Fana ka IV Mannitol / Asetazolamide / Methylprednisolone jaaka borogo."]

    OCSCheck -->|"NNYAA: Pono e e Tlwaelegileng, Modikologo o o Bonolo, Ga go na Proptosis"| MuscleTrapCheck{"Kgato 3: Tlhola Metsamao ya Matlho a a Kwa Ntle ga Matlho (Leba Kwa Godimo, Kwa Tlase, Mo Molemeng, Mo Mojeng): A Go Leba Kwa Godimo go thibetswe ka pono e e gabedi, KGOTSA go tsamaya le go feroga sebete, go kgwa, le go itaya ga pelo ka bonya (<60 bpm)?"}

    MuscleTrapCheck -->|"EE: Go Leba Kwa Godimo go go Thibetsweng + Bradycardia/Go feroga sebete (Bogolo jang mo Ngwanang/Mosha yo o nang le 'Leitlho le Lesweu')"| Trapdoor["GO ROBEGA GA FATSHE GA TRAPDOOR ORBITAL KA GO TSHWARA GA MESIFA: 1. CT Scan ya Orbital ya Lefapha la Maemo a Tshoganyetso JAANONG. 2. Ela tlhoko ECG go bona gore a go na le Oculocardiac Reflex (go tlhoka go tlhomama ga pelo/go thibega ga pelo). 3. E tlhoka go gololwa ka bonako ka karo mo diureng di le 24 go ya go di le 48 go thibela go bola ga mesifa go ya go ile."]

    MuscleTrapCheck -->|"GA GO na go tshwarwa ke mesifa kgotsa go thubega ga pelo"| SimpleBlowout["BELAELANG GO ROBEGA GO FOKA GA ORBITAL GO go SA RAROGANENG (Leitlho le le nweleng / enophthalmos, marama a a tlhotlhoregang/molomo o o kwa godimo, kgotsa crepitus): 1. GA GO FOKE nko ka botlalo dibeke di le 4 go ya go di le 6. 2. Lefapha la Maemo a Tshoganyetso la Potlako CT ya Di-Orbits go sekaseka bogolo jwa go robega le di-sinus."]

Pathofisioloji: Kafa leroba la leitlho le nnang seapei sa kgatelelo e e bolayang ka gone¶

1. Popego e e gagametseng ya mmele wa modikologo wa marapo le ditshika tsa canthal¶

Gore o tlhaloganye gore ke ka ntlha yang fa kokoanyo e nnye ya madi kgotsa mowa o o kafa morago ga leitlho o baka bofofu ka bonako jaana, akanya ka tsela e metšhini e motho a dikologang ka yone: - Mabota a le Mane a a Gagametseng a Marapo: Sokete ya leitlho ke piramiti e e bopegileng jaaka pere, e e nang le matlhakore a le manè e e nang le palogare ya bolumu ya ka fa gare ya dimililitara di le 30 fela (\(30\text{ mL}\)), e e tswaletsweng kwa godimo (lerapo la kwa pele / marulelo a a dikologang), kwa ntle (lerapo la zygomatic /bit kgotsa la sphenoid). fatshe), le ka hare (marapo a etmoid le a lacrimal / lebota le bohareng). - Lebati la Kwa Pele le le Tswaletsweng: Go kgabaganya phatlha e e kwa pele ya piramiti, bolo ya leitlho (kgolokwe) le mafura a a dikologang di tshwarwa ka thata mo teng ga sokete ke letlhare le le thata la tlhale (septum e e dikologang) mme di tlhomamisiwa jaaka mogala wa katara mo direming tsa marapo ke canthal ya bogareng crura e e kwa tlase le e e kwa godimo). - Sebopego sa go Ikobela Kgatelelo ya Bolumu: Ka tlwaelo, kgatelelo ya go ikhutsa mo teng ga leitlho le mo teng ga leitlho (IOP) ke Dimilimitara di le 10 go ya go di le 20 tsa mercury (\(\text{mmHg}\)). Ka gonne mabota a marapo a sa kgone go atologela kwa ntle mme mosifa wa canthal o o kafa thoko o thibela bolo ya leitlho go tsamaela kwa pele go feta dimilimitara di le mmalwa, modikologo o ka kgona go amogela fela dimililitara di ka nna 4 go ya go di le 5 tsa seeledi se se oketsegileng pele ga go tlhokafala gotlhe ga dithishu. - Fa tshika e e thubegileng ya infraorbital, tshika ya ethmoidal e e kwa pele kgotsa e e kwa morago, kgotsa lekala la tshika ya matlho e tswa madi a a fetang dimililitara di le 5 mo khounung ya mesifa ya retrobulbar (kgotsa morago ga gore mowa wa sinus o patelediwe go tsena ka fa tlase ga kgatelelo), kgatelelo ya mo teng ga leitlho e tlhatlogela kwa godimo go tsamaya le mmHg.

2. Go kgangwa ga ditshika (Bolwetse jwa Karolo ya Matlho)¶

Fela jaaka bolwetse jo bo botlhoko jwa karolo mo leotong le le thubegileng kgotsa mo letsogong la pele (bona kgobalo ya go thubaganngwa le bolwetse jwa phaposi), fa kgatelelo e e mo teng ga karolo e e tswalegileng ya orbital e feta kgatelelo ya go tshelwa ga madi mo ditshikaneng tse dinnye tse di fepang leitlho le tshika ya leitlho: 1. Go phutlhama ga go tswa ga madi mo ditshikaneng (\(>25\text{ go ya go }30\text{ mmHg}\)): Mothapo o o mo gare wa retina o o nang le mabota a masesane le ditshika tsa vortex di pitlaganngwa di tswalega pele, di tshwara madi a ditshika mo teng ga leitlho mme di dira gore go pitlagana go nne maswe le go feta. 2. Ischemia e Khutshwane ya Ciliary le Vasa Nervorum (\(>35\text{ go ya go }45\text{ mmHg}\)): Ditshika tse dinnye tse di fepang tlhogo ya mothapo wa leitlho wa kwa pele le mothapo wa leitlho wa retrobulbar di a phutlhama, mme seno se baka bolwetse jwa methapo ya leitlho jwa ischemic. 3. Go Thibana ga Tshika ya Bogare ya Retina (\(>60\text{ go ya go }80\text{ mmHg}\)): Fa kgatelelo ya madi e e dikologang le e e mo teng ga leitlho e atamela kgatelelo ya madi ya tshika ya diastolic, tshika ya retina e e fa gare e emisa go elela ka nako ya diastole (e bonala mo ophthalmoscope e tswalela fa fatshe ka botlalo jaaka tshika e e thunyang). 4. Lefensetere la go Falola la Metsotso e le 60 go ya go e le 120: Dithutopatlisiso tsa diphologolo tse di tshelang le tsa go utlwisa botlhoko mo kalafing di tlhomamisa gore fa go tlhoka madi go go feletseng ga retina le methapo ya leitlho go simolola mo Bolwetseng jwa Orbital Compartment Syndrome, **go fokotsa kgatelelo ya madi ka karo go go dirwang mo metsotsong e le 60 go ya go e le 90 go busetsa pono e e tlwaelegileng, e e fetang 8 go fokotsa kgatelelo ya madi go go diegang go feta metsotso e le 120 go ya go e le 240 (diura di le 2 go ya go di le 4) gantsi go tlogela molwetse a foufetse ruri mo leitlhong leo.

3. Bomekheniki jwa go Thubega ga Orbital (Kgopolo ya Haeteroliki kgatlhanong le ya go Koba)¶

Ke ka ntlha yang fa fa fatshe kgotsa lebota le le kafa teng la leitlho le phanyega fa rim e e bokete ya marapo e e dikologileng karolo e e kwa ntle ya leitlho yone e sa thubege? - Mokgwa wa Haeteroliki: Fa selo se se kgolokwe se se fetang disentimetara di le 5 (disentimetara di le 2) ka bophara (jaaka seatla, baseball, bolo ya kirikete, kgotsa bolo ya thenese) se itaya karolo e e kwa pele ya leitlho, se kgoromeletsa bolo ya leitlho kwa morago mo khounung ya dimililitara di le 30 ya mafura a a sa gateleleng a a dikologang. Lekhubu leo la kgatelelo ya haeteroliki ka tshoganyetso le thunya kwa ntle kgatlhanong le mabota otlhe a mane a marapo mme le thunya marapo a mabedi a masesane thata a "safety-valve" mo legatleng: 1. Bodilo jwa Orbital jwa Morago-Bogare (Borulelo jwa Maxillary Sinus): Ke fela 0.5 milimeters e e bokima, e e koafaditsweng go ya pele ke khuti le kanale e e tshotseng mothapo wa infraorbital (\(V_2\)). 2. Lebota la Modikologo wa Bogare (Lamina Papyracea ya Sinus ya Ethmoid): Le ranotswe ka tlhamalalo jaaka "llaga e e tshesane jaaka pampiri" (e le bokima jwa dimilimitara di le 0.2 go ya go 0.4 fela**). - Mokgwa wa go Bofa: Go itaya ka tlhamalalo mo rim e e kwa tlase e e kitlaneng ya modikologo (ntlha ya lerapo la marama) go fetisa lekhubu la go tshoga la motšhini kwa morago le le bofang fa fatshe go go tshesane ga modikologo ka tlhamalalo ka fa morago ga lone kwantle ga go thuba bolo ya leitlho ka boyone.

Papiso e e tseneletseng ya maemo a tshoganyetso a le 4 a a masisi a morago ga go utlwa botlhoko¶

Kaedi e e feletseng ya kalafi ya maemo a tshoganyetso a le 4 a go utlwa botlhoko mo tikologong¶

1. Hematoma ya Retrobulbar le go Kgaola Madi mo Letlhakoreng la Bolao le go Kgaola Madi (LCC)¶

Ke ka ntlha yang fa balwetse ba ba nang le hematoma ya retrobulbar ba sa ntse ba latlhegelwa ke pono mo dikokelong tsa segompieno? Lebaka la #1 ke go leta CT scan ya orbital kgotsa go leta go lekanya kgatelelo ya mo teng ga leitlho ka Tono-Pen pele ga go sega tendon ya canthal e e kwa thoko. - Tlhatlhobo ya Kalafi kwa Bolaong (Ga go Tlhokege CT): Fa molwetse yo o utlwileng botlhoko (kgotsa molwetse yo o sa tswang go dirwa blepharoplasty ya leitlho, karo ya dinko, kgotsa boloko ya go bolaya bogatsu ya retrobulbar) a tlhagelela ka "4 Ps of Orbital Compartment Syndrome": 1. Botlhoko (botlhoko jo bo tseneletseng, jo bo tseneletseng jwa orbital). 2. Proptosis (go tlhotlhorega kwa pele ga kgolokwe ka kganetso e e thata jaaka letlapa go boela morago ka bonolo ga dijithale mo godimo ga dikhurumelo tse di tswetsweng). 3. Go sa tlwaelega ga leitlho (go sa tlwaelega ga leitlho la afferent [RAPD] mo tekong ya lebone le le akgegang, kgotsa leitlho le le atolositsweng le le bonya). 4. Pono e e Bokoa / e e Fokotsegang (kgotsa go palelwa ke go sekaseka pono mo molwetse yo o tsentsweng leitlho la kgobalo yo o nang le leitlho la proptotic le le thata jaaka letlapa le le nang le RAPD kgotsa Kgatelelo ya mo Leitlhong \(>40\text{ mmHg}\)). - Kafa Go Kgaola Leitlho mo Letlhakoreng le go Kgaola Leitlho ka fa Tlase go Bolokang Leitlho ka gone mo Metsotsong e le 2: - Mo lefelong la go tsosolosa la Lefapha la Maemo a Tshoganyetso, ngaka e tlhaba dimililitara di le 1 go ya go di le 2 tsa lidocaine e e nang le epinephrine mo sekhutlong se se kwa thoko sa diphuka tsa matlho (canthus e e kafa thoko), e e tshwara ka ditlelampe go kgabaganya canthus e e kafa thoko metsotswana e le 30 ka hemostata go thubaganya ditshika tsa madi tse di nang le cucentriss1. (go kgaola kanthotomi). - Ke Eng fa Canthotomy e le nosi e sa lekane: Go sega fela letlalo mo sekhutlong sa leitlho go fokotsa fela kgatelelo ya orbital ka dimilimitara di le mmalwa tsa mercury. Morago ga moo ngaka e tshwanetse go goga letlhokwa le le kwa tlase go tswa mo tlhogong ya leitlho, e utlwe ka dintlha tsa sekere go bona inferior crus ya tendon ya canthal e e kwa thoko e e gagametseng, e e tshwanang le mogala wa katara, mme e kgaole tendon eo gotlhelele (inferior cantholysis). - Ka nako ya fa crus e e kwa tlase e kgaolwa, letlhokwa le le kwa tlase le wela gotlhelele le sa tlhomama, bolo ya leitlho e ya kwa pele ka dimilimitara di le 4 go ya go di le 6 go fokotsa sebaka sa retrobulbar, kgatelelo ya intraorbital e wela tlase ka 20 go ya go 40 mmHg mo metsotswaneng e se kae, mme madi a tshika a itlhaganelela kwa morago mo tshikeng le mo retin ya methapo e e fa gare.

2. Go Robega ga Lebati la "Matlho a Masweu" la Bana le Tsibogo e e Bolayang ya Oculocardiac¶

Mo baneng, mo basheng le mo bagolong ba ba botlana ba ba ka fa tlase ga dingwaga di le 20, marapo a fa fatshe ga orbital a na le collagen e ntsi e e elastic mme ga a ise a thubege jaaka lerapo la bagolo: - Fa ngwana a itewa mo leitlhong ke bolo, sekgono, kgotsa lengole, fa fatshe go go tshesane ga modikologo go obegela kwa tlase jaaka sekgomaretsi sa greenstick, mafura a modikologo le mosifa o o kwa tlase wa rectus (o o nnang ka tlhamalalo mo fatshe) di hernia ka nakwana go feta mo lephanyegong, mme lerapo le le elastic le tlhotlhorega jaaka le le tshwarang mesifa e e kwa tlase ya rectus ka thata mo ditlhaeng tsa yone. - Ke Eng fa e sa Tlhotlhomisiwe ka Phogo e le Go Thunya: Ka gonne marapo a bana a a elastic a boela morago ka phepafalo kwantle ga go thubega, gantsi go batlile go nna le leitlho le lentsho le le senang sepe, go dutla madi ga leitlho le le kwa tlase ga leitlho, le "leitlho le lesweu" le le lebegang le tlwaelegile gotlhelele ka fa ntle. Le fa go ntse jalo, fa moshipa o o tshwarwang o o kwa tlase wa rectus o otlollolwa, o ntsha letshwao le le tseneletseng la go tlhotlheletsa go ya kwa godimo ga karolo ya matlho ya mothapo wa trigeminal (Mothapo wa Tlhogo V) go ya kwa kutu ya boboko, o o thuntshiwang ka tlhamalalo go ya kwa tlase mo mothapong wa vagus (Mothapo wa Tlhogo X) go ya kwa pelong le mo mpeng le Oculocar As (Oculocar As). - **ThConcussion Trap: Ka ntlha ya fngwana a kgwa kgapetsakgapetsa, a lebega a le mosetlha e bile a mofufutso, a utlwa a tsewa ke sedidi/a robetse, e bile a opiwa ke tlhogo ka leitlho le le lebegang le tlwaelegile kwa ntle, badiri ba maemo a tshoganyetso gantsi ba tlhatlhoba ngwana ka tsela e e sa siamang ka kgobalo ya tlhogo kgotsa go thunya ga tlhogo** mme o otare ya boboko e e fosang modikologo o o kwa tlase. - Kafa o ka e Bona Ka Ponako: Tlhola go itaya ga pelo ga ngwana (gantsi gle bonya thata ka dibetso di le 35 go ​​ya go di le 55 ka motsotso**, ka dibetso tsa go tshaba tse di konang kgotsa ditlhako tsa go tshwara ga sinus) mme kope ngwana go latela monwana wa gago mme a lebe ka tamalalo GODIMO go ya kwa siling. Fa leitlho le le gobetseng le sa kgone go dikologa go ya kwa godimo go feta mola o o fa gare mme go leba kwa godimo go tsosa lekhubu la go feroga sebete, botlhoko jwa leitlho, le go wela tlase ga go itaya ga pelo mo monithara wa pelo, ngwana o na le go robega ga modikologo wa lebati le le tshwaregileng go go tlhokang go gololwa ka bonako mo lobakeng lwa diura di le 24 go ya go di le 48 tsa mesifa (Go tshwaragana ga mesifa ya leitlho ga Volkmann).

3. Go tlhotlhorega ga Mothapo wa Infraorbital (\(V_2\)): Motlhala o o Fitlhegileng wa go Thubega ga Bodilo jwa Modikologo¶

O ka bona jang kwa lefelong la kotsi gore a leitlho le lentsho le le rurugileng ke lebadi fela la dithishu tse di boleta ("shiner") kgotsa ke marapo a a ka fa tlase go thunya ga fa fatshe ga orbital? - Tabosa monwana wa gago ka botlhofo go kgabaganya lerama le le kwa tlase la molema le la moja la motho, letlhakore la nko, molomo o o kwa godimo, mme o mmotse gore a meno a gagwe a a kwa godimo a kwa pele a ikutlwa a le "logong" kgotsa a tlhotlhorega (jaaka morago ga go thuntshiwa ka Novocain ya meno). - Mothapo wa infraorbital (kala la karolo ya maxillary ya mothapo wa trigeminal, \(V_2\)) o tsamaya ka tlhamalalo mo thaneleng e e tshesane ya marapo e e tshwanang le pampiri mo teng ga fa fatshe ga sokete ya leitlho pele o tswa o ya kwa lerameng go tlamela ka maikutlo mo menong a a fa gare le a a kwa godimo a sefatlhego. - Fa go itewa mo leitlhong go baka go utlwa botlhoko kgotsa go tlhotlhorega ga diphini le dinalete mo molomong o o kwa godimo, marinini/meno a a kwa godimo, le lerama mo letlhakoreng le le lengwe, go thubega ga go thunya ga fa fatshe ga orbital ka kanale ya infraorbital go teng go fitlha go supiwa ka tsela e sele ka CT scan ya orbital.

4. Orbital Emphysema: Ke Eng fa go Budula Nko go Fetola Go Thubega go go Bonolo go nna Tsela ya Mowa e e Yang kwa Modikologong¶

Fa lebota le le fa gare (lamina papyracea) kgotsa fa fatshe ga modikologo go thubega, mafura a a senang megare a sokete ya leitlho jaanong a buisana ka tlhamalalo le dinko tsa nko tsa etmoid kgotsa tsa maxillary tse di tletseng mowa: - Fa motho a hema ka tsela e e tlwaelegileng, kgatelelo ya mowa mo teng ga nko e kwa tlase. - Le fa go ntse jalo, go budulela nko ka maatla go dira gore go nne le dikgatelelo tsa mo nkong tsa 60 go ya go di feta 100 mmHg (tse di lekanang le go budulela thaere ya koloi). - Go thunya goo ga mowa o o senang megare wa sinus le mamina go thunya ka go phatloga ga lerapo go tsena mo diphukeng tsa matlho (go baka go phatloga ga diphuka tsa matlho ka tshoganyetso ka maikutlo a go phatloga ga "Rice Krispies" subcutaneous crepitus ka fa tlase ga menwana ya gago) le ka fa morago ga tlhogo ya leitlho. - Fa letlhabaphefo la legogo la sinus kgotsa mafura a orbital le dira jaaka ball-valve (go letlelela mowa go tsena ka nako ya go foka ka nko mme le o tshwara gore o se ka wa kgona go boela mo sinus), kgetsi ya mowa e e tshwaregileng e gatelela tshika e e fa gare ya retina le mothapo wa leitlho (Go tlhoka go foufala ga tshoganyetso), go baka gore kgetsana ya mowa ya retrobulbar. - Mo godimo ga moo, go pateletsa dibakateria tse di kgotletsweng tsa dinko go tsena mo mafureng a a senang megare a a dikologang go dira gore go nne le kotsi e kgolo ya gore motho a se ka a kgona go bona sentle selulaiti ya modikologo le go ruruga ga madi mo dinkong, ke ka moo balwetse ba ba nang le dithubego tsa orbital tse di tlhaeletsanang le sinus ba thibelwang go foka nko, go thuma mo metsing, kgotsa go tshameka diletswa tsa phefo dibeke di le 4 go ya go di le 6.

Ka metlha kgaphela kwa thoko go thubega ga Kgolokwe e e Bulegileng ka nako e le nngwe pele ga o ama leitlho¶

Nako le nako fa seatla, baseball, pellet ya BB, khokho ya lebotlolo, kgotsa galase e e thubegileng di itaya leitlho, maatla a a thubang marapo a a dikologang le one a ka thuba lebota la bolo ya leitlho ka bolone (Open Globe Rupture). Pele ga o letla ope go tobetsa mo diphukeng tsa matlho kgotsa go tlhola tsitsipano ya orbital, tlhatlhoba leitlho ka matlho go bona Matshwao a le Thataro a go Thubega ga Kgolokwe e e Bulegileng: 1. "Lerothodi la Keledi" kgotsa Moithuti yo o Tlhotlhegileng: Moithuti ga a tlhole a le kgolokwe; e gogelwa mo sebopegong sa keledi e e motsu e e supang kwa sekhutlong sa cornea kgotsa sclera koo lebota la bolo ya leitlho le neng la thunya gone mme iris ya thiba leroba. 2. Go tlhotlhorega ga leitlho ka madi ka didikirii di le 360 ​​(Bullous Hemorrhagic Chemosis): Lera le le phepa le le mo godimo ga bosweu jwa leitlho le rurugile go nna lesale le lekima, le le nang le madi, le le tshwanang le jeli le le dikologileng lethapo la leitlho gotlhelele, le fitlha go thubega ga leitlho ka fa tlase. 3. Pigment e e Borokwa jo bo Fifetseng kgotsa e Ntsho (Uveal Prolapse) e e Tswang mo Bosweung jwa Leitlho: Le ka motlha o se leke go phimola "lebala le le leswe" le lentsho le le fifetseng kgotsa le le borokwa mo sclera morago ga go utlwa botlhoko; ke iris ya molwetse kgotsa mmele wa ciliary o o tlhagelelang ka sclera e e thubegileng. 4. Phaposi e e Boteng ka Tsela e e sa Tlwaelegang kgotsa e e seng Boteng/e e Sephaphathi kwa Pele (kgotsa Hyphema): Sebaka se se kafa morago ga lethapo la leitlho se tletse ka madi a a tlhatlaganeng (hyphema, bona dikgobalo tsa matlho) kgotsa o lebega a phutlhame fa a bapisiwa le leitlho le lengwe. 5. Go ntsha Jelly e e Phepa (Vitreous Humor) mo godimo ga leitlho. 6. Go Latlhegelwa ke Pono e e Masisi ka Leitlho le le Bonolo, le le Lebegang le Tswile Moya.

Fa go na le letshwao lepe la go thubega ga kgolokwe e e bulegileng, **emisa go dirisa mmele ka bonako, theipa thebe e e gagametseng ya Fox kgotsa botlase jwa kopi ya pampiri mo godimo ga phatla e e nang le marapo le lerapo la marama o sa ama leitlho, boloka molwetse a eme sentle e bile a ritibetse, mme o letsetse 911 / 119 / 9.

Dinomoro tsa maemo a tshoganyetso tsa kgaolo le diporothokholo tsa boemedi¶

• United States le Canada: Letsa 911 go bona dipalangwa tsa ka bonako kwa Setheong sa Dikgobalo tsa Maemo I kgotsa Maemo II se se nang le bokgoni jwa Kalafi ya Tshoganyetso le Karo ya Matlho / Karo ya Matlho 24/7. Ka fa tlase ga dikaelo tsa Kholetšhe ya Amerika ya Dingaka tsa Maemo a Tshoganyetso (ACEP), Tshegetso ya Botshelo ya Dikgobalo Tse di Tsweletseng (ATLS), le Sekolo sa Matlho sa Amerika (AAO), dingaka tsa maemo a tshoganyetso di katisiwa le go newa tetla ya go dira ditshwantsho tsa ka bonako tsa fa thoko ga bolao tsa **Lateral Canthotomy le) CCT Canthosis Bolwetse jwa Lefelo la Orbital.
• Bogosi jo bo Kopaneng: Letsa 999 (kgotsa 112). Ka fa tlase ga dikaelo tsa Kholetšhe ya Bogosi ya Kalafi ya Maemo a Tshoganyetso (RCEM) le Kholetšhe ya Bogosi ya Dingaka tsa Matlho (RCOphth) tsa go utlwa botlhoko, go dutla madi ga retrobulbar ka go latlhegelwa ke pono go tlhaolwa jaaka tshoganyetso ya go fokotsa kgatelelo ya maikutlo ka bonako e e dirwang mo Phaposing ya go Tsosolosa ya Lefapha la Maemo a Tshoganyetso pele ga phetiso ya radioloji.
• Kopano ya Yuropa: Letsa 112. Latela Lekgotla la Yuropa la go Tsosolosa (ERC) le ditsela tsa bosetšhaba tsa kgobalo ya sefatlhego/matlho go bona go fokotsa kgatelelo ya modikologo ka bonako le angiography ya CT ya sefatlhego.
• Australia le New Zealand: Letsa 000 kwa Australia kgotsa 111 kwa New Zealand. Latela RANZCO (Kholetšhe ya Bogosi ya Australia le New Zealand ya Dingaka tsa Matlho) le ANZCOR dikaelo tsa go utlwa botlhoko mo matlhong.
• India le Asia-Pacific: Letsa 112 kwa India, 119 kwa Japane le Korea Borwa, kgotsa 995 kwa Singapore. Kopa dipalangwa tse di tlhamaletseng kwa bookelong jwa maemo a a kwa godimo jwa batho ba ba utlwileng botlhoko jo bo nang le ditshwantsho tsa CT, bokgoni jwa kalafi ya tshoganyetso jwa tsela ya mowa/karo, le tshireletso ya matlho.

Bona dinomoro tsa tshoganyetso bakeng sa dinomoro tsohle tsa thomelo ya tshohanyetso tsa matjhaba.

Dipotso tse di bodiwang kgapetsakgapetsa¶

Ke eng ke sa kgone go tsenya ice pack ka tlhamalalo mo leitlhong le lentsho le le rurugileng fela fa ke sena go itewa thata?¶

Go fitlha ngaka e tlhatlhoba tlhogo ya leitlho mme e tlhomamisa gore lebota la kgolokwe ga le a senyega e bile ga go na retrobulbar hematoma, go baya bokete jwa sephuthelwana sa aese kana go gatelela sedirisiwa se se tsididi ka tlhamalalo mo letlhogong la leitlho go kotsi. Fa go na le go thubega ga scleral go go fitlhegileng (globe e e bulegileng), bokete jwa sephuthelwana sa aese bo ka tlhotlhora lense ya ka fa gare le jeli ya vitreous go tswa mo leitlhong; fa go na le hematoma ya retrobulbar, kgatelelo e e tswang kwa ntle e oketsa kgatelelo e e setseng e le kotsi e e kgaolang tshika ya leitlho. Ka metlha sireletsa leitlho mo godimo ga rim ya marapo boemong jwa seo.

Ke eng fa leitlho la me le ne la tlhotlhorega jaaka bolo ya kolofo ka nako ya fa ke ne ke futswela nko morago ga go itewa mo sefatlhegong?¶

Lerapo le le kgaoganyang bokagare le botlase jwa leroba la leitlho la gago le di-sinus tsa gago tsa nko le bokima jo bo kwa tlase ga halofo ya milimitara mme le phanyega gangwe le gape fa o utlwile botlhoko thata mo sefatlhegong le fa bokafantle jwa sefatlhego sa gago bo lebega bo siame. Fa o tshwaratshwara dinko tsa gago go foka nko ya gago, o ntsha kgatelelo ya mowa e e fetang 60 go ya go 100 mmHg mo teng ga ditsela tsa gago tsa dinko, e e thunyang mowa wa sinus le dibakateria thwii ka mophanyego oo wa lerapo go tsena mo diphukeng tsa gago le ka fa morago ga tlhogo ya gago ya leitlho (**orbital emphysema**); fa pono e sa bonale sentle kgotsa leitlho le utlwa le gagametse morago ga go budulela nko, ya kwa phaposing ya maemo a tshoganyetso ka bonako.

Ke ka ntlha yang fa ngwana yo o kgwang pelo e itaya ka bonya morago ga go itewa mo leitlhong gantsi a sa lemogiwe ka tsela e e sa siamang gore o na le bolwetse jwa go thuthumela?¶

Bana ba na le marapo a fa fatshe a a kgonang go fetofetoga a a phanyegang fa a thulana mme a bo a tswalega jaaka lebati le le nang le diporeng, a tshwaratshwara mesifa ya leitlho le le kwa tlase la rectus kwantle ga go tlogela leitlho le lentsho le lentsi kwa ntle. Go otlolla mosifa oo wa leitlho o o tshwaregileng go dira gore pelo e nne le **reflex ya leitlho** ya trigeminal-vagal, e e bakang go feroga sebete thata, go kgwa, letlalo le le bosetlha, go lapa le go itaya ga pelo ka tsela e e kotsi (bradycardia). Ka metlha kopa ngwana ope fela yo o nang le kgobalo ya sefatlhego go leba kwa godimo ka tlhamalalo go ya kwa siling; fa leitlho le lengwe le sa kgone go ya kwa godimo, ke go robega ga orbital go go tshwaregileng, e seng fela go thunya.

A go kgaola leitlho ka fa thoko le go kgaola leitlho go tlogela ntho e e senyang sebopego sa leruri mo sekhutlong sa letlhokwa la leitlho?¶

Nnyaa; canthotomy e e fa thoko ga bolao le cantholysis e e kwa tlase ke go kgaola go go nnye, go go phepa ga disentimetara di le 1 kwa lefelong le le kwa ntle la tlholego la letlhokwa la leitlho koo dingaka tsa go itshasa tsa matlho di dirang ditshego ka metlha gone. Fa go ruruga ga retrobulbar go sena go rarabologa mo malatsing a le mmalwa, ngaka ya matlho kgotsa ngaka e e arang ya polasetiki e ka roka motlhofo fela gore mosifa le sekhutlo sa letlhokwa la leitlho di boe di nne le mabadi a a batlang a sa bonale, fa go palelwa ke go sega mo metsotsong e le 90 go dira gore motho a nne sefofu sa leruri, se se ka se busediweng morago.

A dithubego tsotlhe tsa orbital blowout di tlhoka karo go tsenya poleiti mo lesobeng la leitlho?¶

Nnyaa; go feta halofo ya dithubego tsa batho ba bagolo tsa fa fatshe le tsa lebota le le fa gare di fola ka pabalesego kwantle ga go ariwa. Dingaka tsa matlho le tsa maxillofacial di dira fela Ka bonako (mo lobakeng lwa diura di le 24 go ya go di le 48) fa mosifa wa leitlho o tshwaregile ka motšhini o o bakang oculocardiac reflex kgotsa pono e e sa rarabologeng ya pono e e gabedi, kgotsa ka tsela e e kwa tlase (mo lobakeng lwa malatsi a le 7 go ya go a le 14 go khurumetsa thobego e e fetang ya orbital floor, e baka pono e e sa kgaotseng gabedi mo tebelong ya ntlha ya go bala, kgotsa e dira gore bolo ya leitlho e nwelele kwa morago (**enophthalmos**) ka dimilimitara di feta 2.

A nka fofa ka sefofane kgotsa ka ya go thuma mo metsing ke na le go robega ga orbital blowout go go sa alafiwang?¶

Difofane le dingaka tsa matlho ka kakaretso di gakolola go leta go fitlha go robega ga modikologo o o nang le tlhaeletsano ya sinus kgotsa mowa wa modikologo (pneumo-orbit) o sekasekilwe le go phepafadiwa (ka tlwaelo dibeke di le 1 go ya go di le 2 mo difofaneng tsa khabine tsa kgwebo fa mowa wa retrobulbar o le teng, ka gonne mowa o o tshwaregileng mo teng ga khabine ka e3. bogodimo go ya ka Molao wa ga Boyle, go gatelela tshika ya leitlho). Go thuma mo metsing go thibetswe thata go fitlha marapo a fola ka botlalo (dibeke di le 4 go ya go di le 8), ka gonne go pitlagana ga mask le barotrauma ya sinus go ka baka go dutla madi a a kotsi mo orbital kgotsa emphysema.

Dikaedi tse di tsamaelanang¶

• Dikgobalo tsa matlho le tlhokomelo ya tshoganyetso
• Selo se sele mo leitlhong, go kgotlhokgolwa ga lethapo la leitlho, le folashe ya go momaganya
• Dikgobalo tsa tlhogo le go roroma ga tlhogo
• Selulitis ya mothapo, go tswa ga madi mo dinkong tsa leroba, le ditshwaetso tsa sefatlhego tse di kotsi tsa khutlotharo

Metswedi le kaelo ya semmuso¶

• Komiti ya Kholetšhe ya Dingaka tsa Amerika (ACS, United States) ya Kgobalo: Buka ya Khoso ya Baithuti ya Tshegetso ya Botshelo ya Kgobalo e e Gatetseng Pele (ATLS) (Bolwetse jwa Kgobalo ya Matlho le Bolwetse jwa Tshoganyetso jwa Karolo ya Orbital / Diporothokholo tsa Lateral Canthotomy le Cantholysis).
• Sekolo sa Amerika sa Kalafi ya Matlho (AAO, United States): EyeWiki le Dipolelo tsa Tleliniki ka ga Taolo ya Dithubego tsa go Thunya ga Matlho, Dithubego tsa Bana tsa Matlho a Masweu a Trapdoor, le Go Dula Madi ga Retrobulbar.
• Kholetšhe ya Segosi ya Kalafi ya Maemo a Tshoganyetso (RCEM) le Kholetšhe ya Segosi ya Dingaka tsa Matlho (RCOphth, United Kingdom): Kaelo ya Tiriso e e Molemo go gaisa: Bolwetse jwa Karolwana ya Matlho e e Utlwisang Botlhoko le go Kgaola Matlho ka Tshoganyetso le go Kgaola Matlho ka Tshoganyetso.
• Kholetšhe ya Amerika ya Dingaka tsa Maemo a Tshoganyetso (ACEP, United States): Ditsamaiso tsa Kalafi mo Kalafing ya Maemo a Tshoganyetso: Taolo e e Bogale ya Kgobalo ya Matlho le ya Sefatlhego.
• Kholetšhe ya Dingaka tsa Matlho ya Bogosi ya Australia le New Zealand (RANZCO): Dikaelo tsa Kalafi tsa Kgobalo e e Botlhoko ya Matlho le Tshireletso ya Lefatshe le le Bulegileng.