I-Retrobulbar Hemorrhage kunye ne-Orbital Compartment Syndrome: I-Rock-Hard Proptotic Eye kunye ne-Lateral Canthotomy Window¶

I-Retrobulbar hemorrhage (RBH) ebangela ukuba I-Orbital Compartment Syndrome (OCS) yenye yezona ngxamiseko ezikhawulezayo ezisongela umbono kuwo wonke amayeza: i-arterial okanye i-venous bleed ebanjwe emva kwe-eyeball ngaphakathi kwe-cone eqinile, ene-bony cone ye-socket (i-orbit) ehamba ngokukhawuleza kwi-nerve ye-optic ukunqumla i-nerve. Ibangelwa kukwenzakala kobuso okanye i-orbital (inqindi, i-baseball, i-airbag, okanye ukuwa), utyando lwe-cosmetic eyelid (blepharoplasty), iibhloko ze-anesthesia ze-retrobulbar, utyando lwe-sinus, okanye unyango lwe-anticoagulation, ukunyuka koxinzelelo ngaphakathi kwi-orbit evaliweyo kutyhalela phambili i-eyeball (proptosis d ), yolula i-eyelid * lukhuni iglowubhu), ikhubaza intshukumo yamehlo (ophthalmoplegia), kwaye ibangela i-Relative Afferent Pupillary Defect (RAPD) kunye nombono okhawulezayo wokuncipha. Ukuba umntu onomonzakalo wamehlo wamva nje okanye utyando lwenkophe uba neentlungu ezinzulu ze-orbital, iliso elirhabaxa, ukubona kabini, okanye ukubona luzizi, fowunela indawo ohlala kuyo. amanani kaxakeka ngoko nangoko. Ngelixa ulindele uthutho lukaxakeka, phinda uqwalasele isikhokelo esinxulumeneyo ukwenzakala kwamehlo ngokubanzi kunye nokhathalelo lweglowubhu olugqabhukileyo, ukuvaleka komthambo ophakathi we-retinal kunye ne-eye stroke, kwaye iglaucoma ebukhali yokuvalwa kwe-angle kunye ne-retinal detachment.

Ngenxa yokuba iiseli ze-retinal ganglion zihlupheka ngokusisigxina, ukufa okungenakuguquleka kwe-ischemic emva nje ** i-60 kwimizuzu ye-90 (ukuya kwi-120 imizuzu ephezulu) ** yokunyanzeliswa kwe-vascular, ukugcinwa kwamehlo kuxhomekeke ekuqaphelisweni ngokukhawuleza ecaleni kwebhedi, ukuhlala isigulane ngokuthe tye kwi-degrees ze-45, ** ungaze ubeke isiqwenga esiqinileyo okanye ucinezele, uvumele isigulane ukuba sifumane * isigulane, sivumele isigulane ukuba sifumane * ugqirha ongxamisekileyo okanye i-ophthalmologist eya kwenza ibhedi ngokukhawuleza ** I-Lateral Canthotomy kunye ne-Inferior Cantholysis (LCIC) **, ngaphandle kokulinda i-CT scan, ukukhulula uxinzelelo olubanjwe.

Yenza oku ngoku¶

1. Fowunela inombolo yakho kaxakeka yasekuhlaleni okanye uye kwisebe elikufutshane lesibhedlele likaxakeka ngokukhawuleza. Cofa u-911 eUnited States naseKhanada, 112 kulo lonke elaseEuropean Union, 999 eUnited Kingdom, 000 eOstreliya, okanye ujonge kuluhlu lwethu lweencwadi amanani kaxakeka. Tshela i-dispatcher okanye umongikazi we-triage triage ngokucacileyo: * "I-retrobulbar hemorrhage / i-orbital compartment syndrome ekrokrelwayo: ukutshatyalaliswa kwamehlo okutsha nje (okanye utyando lwe-eyelid) kunye ne-bulging, i-rock-hard eye kunye nokulahlekelwa kombono, kufuna ukuthotywa kwebhedi ngokukhawuleza ngaphakathi kwe-60 kwimizuzu ye-90."
2. Hlalisa isigulana sime nkqo kwi-engile ye-45-degree ukuya kuma-90-degree-degree kwaye uzigcine zizolile. Ungaze ulalise isigulana esikrokreleka ukuba yi-retrobulbar sopha emqolo. Ukuhlala ngokuthe tye kusebenzisa umxhuzulane ukuthoba uxinzelelo lwe-arterial kunye ne-venous hydrostatic ngaphakathi kwentloko kunye ne-orbit, ukucotha ukopha kwe-retrobulbar kunye nokwehlisa kancinci uxinzelelo lwe-intraocular.
3. UNGAZE ufake iqhosha leliso eliqinileyo, ibhandeji loxinzelelo, okanye ipakethi yomkhenkce ucinezela ngqo kwibhola yeliso. Kwi-orbital compartment syndrome, uxinzelelo olungaphakathi kwisokethi yeso sele lunyukile ukusuka kwi-10 ukuya kwi-20 mmHg ukuya phezulu kudlule 40 ukuya kuma-80 mmHg. Ukucinezela iliso okanye ukubopha iphedi ye-gauze kwiinkophe tyhala i-eyeball ngasemva kwi-cone ezaliswe ligazi, ngoko nangoko ukudilika komthambo osembindini we-retinal. Ukuba ufuna ukukhusela iliso ngexesha lokuthutha, tape i-rigid intsimbi okanye iplastiki I-Fox eye shield (okanye ezantsi kwekomityi yephepha) ukuze umphetho wayo uphumle kuphela kwi-brow bone kunye ne-cheekbone, ungaze uchukumise iglowubhu.
4. Yalela isigulana UNGAZE sivuthele impumlo yaso, ukuthimla ngomlomo ovaliweyo, ukukhohlela ngamandla, ukugoba, okanye ukutsala nzima (Valsalva). Ukwenzakala okubuhlungu okungenamagingxigingxi rhoqo kuqhekeza udonga oluphakathi oluliphepha okanye umgangatho wesokethi yeliso kumda we-ethmoid kunye ne-maxillary sinuses. Ukuvuthela impumlo kubetha umoya woxinzelelo oluphezulu ophuma kumngxunya wempumlo ngokuthe ngqo ngokuqhawuka kwisokethi yeso (tension orbital emphysema), ngelixa ukhohlela, ugabha, okanye ucinezela i-spikes orbital venous pressure kwaye ikhawulezisa ukopha kwemithambo emva kweliso.
5. Ukuba isigulana senziwa nje uqhaqho lwe-cosmetic inkophe (i-blepharoplasty) kunye nokuthungwa kwesikhumba sangaphandle okanye iteyiphu ebambe isinxibo, yazisa ugqirha kwaye uye ngqo kwigumbi likaxakeka. I-Post-blepharoplasty retrobulbar hemorrhage idla ngokuhlasela kwisithuba sokuqala ** ezi-3 ukuya kwiiyure ezingama-24** emva kotyando (oludla ngokubangelwa kuxinzelelo lwegazi, ukugabha, i-epinephrine yasekhaya iyaphela). Esibhedlele okanye ekliniki, ukukhulula ngokukhawuleza amabhandeji aqinileyo angaphandle kunye nokuvula imithunga yenxeba esecaleni kunokunceda ukuphuma kwegazi elingaphezulu phambi kokuba i-canthotomy epheleleyo.
6. Gcina isigulana singqongqo ngomlomo (akukho nto yokutya okanye eselwayo) kwaye uze noluhlu lwazo zonke izinto ezinciphisa igazi. Musa ukunika i-aspirin, ibuprofen, okanye idosi eyongezelelweyo ye-anticoagulants echazwe ngugqirha (i-apixaban, i-rivaroxaban, i-warfarin, i-clopidogrel), njenge-ejenti zokubuyisela umva (ezifana ne-4-factorrate i-prothrombin efunekayo ngokukhawuleza okanye i-traxamic concentrate inokuba yi-traxamic concentcent.

Umthi wesigqibo: i-triaging orbital trauma, iproptosis, kunye ne-Orbital Compartment Syndrome¶

flowchart TD
    Start["Iliso eliBlunt/Ingozi yoBuso, uTyando lweNkophe (Blepharoplasty), uTyando lweSinus, okanye iBlock yeRetrobulbar"] --> CheckOCS{"Jonga i-5 Cardinal Signs of Orbital Compartment Syndrome: 1. Proptosis (Bulging Eye) 2. I-Rock-Hard Globe / Iinkophe Eziqinileyo 3. Umbono Owehlileyo 4. Intshukumo Yamehlo Engumkhenkce 5. Isiphene soMfundi (RAPD)?"}

    CheckOCS -->|"EWE: Proptosis + Tense Globe + Vision Loss okanye RAPD"| Emergency["UMBONO NGOKUNGOMANGQINAYO-WOMNGXELO WE-ORBITAL COMPARTMENT SYNDROME (60 ukuya kwi-90 Minute Retinal Ischemia Window): Fowuna 911 / 112 / 999"]

    CheckOCS -->|"HAYI: Jonga iiMpawu eziVulekileyo zeGlobe ezivulekileyo"| OpenGlobe{"I-Teardrop/incochoyi yomfundi, igumbi elimcaba elingaphambili, izicubu ze-iris ezimnyama, okanye i-360-degree bloody chemosis eneliso elithambileyo?"}

    OpenGlobe -->|"EWE"| Ruptured["Umrhanelwa wokuQhamuka kweGlobe evulekileyo: Ikhaka leFox eliqinileyo ngaphaya komphetho wethambo KUPHELA, iqanda elingenaxinzelelo lweliso, i-anti-emetics, ukulungiswa okungxamisekileyo kwegumbi lokusebenza."]

    OpenGlobe -->|"HAYI: Umbono oqhelekileyo, iinkophe ezithambileyo, abafundi abaqhelekileyo, iintshukumo zamehlo ezingagungqiyo"| Fracture["Vavanya i-Orbital Blowout Fracture engantsonkothanga okanye iHyphema: Hlala ngokuthe tye, AKUKHO ukuvuthela impumlo, i-ophthalmology esibhedlele ngokukhawuleza kunye novavanyo lwe-CT"]

    Emergency --> FirstAid["1. Hlala ngokuthe tye kwi-45-90 Degrees; Ngokungqongqo AKUKHO kuBamba iliso, AKUKHO uxinzelelo kwiGlobhi, kwaye AKUKHO kuVuthelwa impumlo okanye ukuQinisa"]

    FirstAid --> NoCT["2. UNGALIBAZI NGE-CT SCAN: Uxilongo lwe-Clinical Bedside Diagnosis luchaza ukuthotywa kwangoko ukuba umbono uncitshisiwe okanye i-IOP> 40 mmHg"]

    NoCT --> LCIC["3. I-Emergency Bedside Lateral Canthotomy & Inferior Cantholysis (LCIC) + IV Mannitol / Acetazolamide / High-Dose Corticosteroids"]

I-Pathophysiology: kutheni i-orbit yamathambo iziphatha njenge-cooker yoxinzelelo etywiniweyo¶

Ukuqonda ukuba kutheni iitispuni legazi emva kweliso linokumfamekisa umntu ngeyure ngelixa iliso elikhulu elimnyama esidleleni lingenabungozi, kufuneka ujonge i-anatomy ye-orbital cavity kunye ne-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. Ibhokisi encinci, enganyibilikiyo engama-30-millilitha yamathambo: Isokethi yeliso lomntu yiphiramidi eneendonga ezine zethambo eliqinileyo (uphahla, umgangatho, udonga oluphakathi, kunye nodonga olusecaleni) oluhlehla ngasemva ukuya kwincopho emxinwa apho i-optic nerve ingena kukhakhayi. Umthamo wonke we-orbit yabantu abadala kuphela ** i-30 milliliters (malunga ne-2 tablespoons) **, esele ifakwe ngokuqinileyo nge-eyeball (7 mL), i-nerve ye-optic, imisipha emithandathu ye-extraocular, i-nerve, kunye ne-retrobulbar fat.
2. Ucango lwangaphambili olutshixiweyo (i-Orbital Septum kunye ne-Canthal Tendons): Ngenxa yokuba iindonga ezine zamathambo azikwazi ukwanda ngaphandle, ekuphela kwendlela yokunyuka koxinzelelo ngaphakathi kwesokethi yeso ukubaleka kukuba ** phambili ** ngokutyhala i-eyeball ngaphandle kwesokethi (**proptosis **). Nangona kunjalo, ukuvulwa kwangaphambili kwe-orbit kutywinwe ngapha nangapha kwiphepha eliqinileyo elibizwa ngokuba yi-**orbital septum ** kwaye ibotshelelwe ngokuqinileyo kwiirim zangaphakathi nangaphandle zamathambo yi- **medial kunye ne-lateral canthal tendon ** (ebambelela iinkophe ezingaphezulu nezisezantsi njengeentambo zegitare eziqinileyo phambi kwamehlo).
3. I-Preseptal vs. Postseptal (Retrobulbar) Ukopha:
4. I-Preseptal Hematoma ("Iliso Elimnyama Elilula"): Igazi liqokelela phambi kwe-septum ye-orbital ngaphakathi kwesikhumba esikhululekileyo esingaphantsi kweenkophe kunye nesihlathi. Naxa iinkophe zidumba mfusa kakhulu, ukhozo lweliso ngaphantsi luhlala luthambile, luqhelekile kwindawo, kwaye lukhuselekile ngokupheleleyo.
5. I-Postseptal / Retrobulbar Hemorrhage (I-Orbital Compartment Syndrome): Igazi liqokelela emva kwe-septum ye-orbital ngaphakathi kwe-cone yamathambo etywiniweyo eyi-30 mL (idla ngokukrazulwa umthambo we-infraorbital, umthambo ongaphambili okanye ongasemva we-ethmoidal, okanye umthambo wamehlo). Nje ukuba i-eyeball ityhalelwe phambili nje ngeemilimitha ezimbalwa, i-lateral canthal tendon ifikelela kumda wayo olastiki kwaye itshixe igubu lenkophe liqine ngokuchasene neglowubhu.
6. I-Vascular Strangulation Cascade (Kutheni i-IOP> 40 mmHg imfamekisa iliso): Nje ukuba iinkophe zingasakwazi ukolulela phambili, yonke imililitha eyongezelelweyo yegazi emva kweliso idubula i-intraorbital kunye noxinzelelo lwe-intraocular (IOP) ukusuka kwisiqhelo sayo 10 ukuya ku-21 mmHg ukuya kuthi ga ku-40,1g0, 1g0,1g060 mmHg* okanye Hg 60 mmHg. Xa uxinzelelo lwe-orbital lugqithise uxinzelelo lwe-perfusion ye-i-posterior posterior ciliary arteries (eyondla intloko ye-optic nerve) kunye ** ne-central retinal artery ** (eyondla i-retina yangaphakathi), ukuhamba kwegazi kwi-retina kunye ne-optic nerve kuyeka ngokupheleleyo, kubangela **ischemic optic neuropathy ** kunye ne-CRA ye-occlusion ye-retinal.

Izizathu eziqhelekileyo ze-retrobulbar hemorrhage kunye ne-tension orbit¶

Ngelixa i-high-energy blunt trauma yimbangela ye-#1 kumasebe angxamisekileyo, utyando oluninzi, unyango, kunye neemeko ezingxamisekileyo ze-sinus zivelisa i-Orbital Compartment Syndrome efanayo:

Ukuqaphela i-Orbital Compartment Syndrome vs. "iliso elimnyama" elingenabungozi¶

Ngenxa yokuba phantse sonke isigulana somonzakalo ebusweni sidumbile, sityumke iinkophe, ababukeleyo kunye nee-paramedics kufuneka bazi indlela yokwahlula i-benign preseptal black eye kwiliso elisongela ukubona **i-retrobulbar hemorrhage ** kunye neglobhu evulekileyo evulekileyo:

Itheyibhile yokuthelekisa esecaleni kwebhedi: Preseptal Black Eye vs. Retrobulbar Hemorrhage vs. Open Globe Rapture¶

Uyijonga njani iProptosis kunye ne-Afferent Pupillary Defect (RAPD) kwimizuzwana engama-30¶

1. Ibunzi "LeNtaka-Ntaka" Khangela iProptosis: Yima ngqo ngasemva okanye entla kwentloko yesigulana esihleliyo, ujongise isilevu saso phezulu kancinci, kwaye ujonge ngqo ezantsi phezu kwebunzi laso ngaphaya kwamashiya aso kuzo zombini izidlele. Kwiliso elilula elimnyama, lusu lwenkophe oluthambileyo kuphela olukhuphayo. Kwi ** i-retrobulbar hemorrhage **, uya kubona i-corneal dome yangempela ye-eyeball echaphazelekayo ** iqhubela phambili i-millimeters eziliqela ezidlulileyo kwi-brow ridge ** xa kuthelekiswa neliso elingenakulimala.
2. UVavanyo lwe-Red Desaturation (Uphawu lwangaphambili lwe-Optic Nerve Compression): Bamba into ebomvu eqaqambileyo (efana nekepusi yebhotile ebomvu okanye ikepusi yeyeza likaxakeka) phambi kweliso elilungileyo lesigulana, emva koko phambi kweliso elonzakeleyo. Ngaphambi kokuba isigulane silahlekelwe ukukwazi ukufunda iileta, i-nerve ye-ischemic optic ilahlekelwa ukukwazi ukubona obomvu obomvu: isigulane siya kuxela ukuba i-cap ebomvu ibonakala ** "iphelile, ihlanjwe i-orange, i-brown, okanye i-grey"** kwiliso elenzakeleyo.
3. Uvavanyo lwe-Swinging Flashlight ye-RAPD (uMarcus Gunn Pupil): Nokuba isigulana singekho zingqondweni, sifakwe ngaphakathi, okanye sidumbe kakhulu ukuba singafunda itshathi yamehlo, uVavanyo lwe-Swinging Flashlight* lukuxelela ngoko nangoko ukuba umthambo-luvo uyafa:
4. Nciphisa izibane zegumbi kwaye ukhanyise ipenlight kwi-iliso elingalimalanga (elilungileyo)* imizuzwana emi-3: bobabini umfundi olungileyo kunye nomfundi owenzakeleyo babambene ngokuqinileyo (impendulo yemvumelwano).
5. Ukujiwuzisa ngokukhawuleza umqadi wokukhanya ukuwela ibhulorho yempumlo ngqo kwi-iliso elenzakeleyo*: ngenxa yokuba i-nerve ye-optic echotshoziweyo kwiliso elenzakeleyo ayikwazi ukuhambisa umqondiso wokukhanya ebuchotsheni, ingqondo icinga ukuba igumbi liye laba mnyama, kwaye ** bobabini abafundi babonakala banweba (bandisa) ngqo kwi-beam yokukhanya **. I-RAPD eqinisekileyo ngexesha, iliso le-proptotic luphawu olupheleleyo lwe-Lateral Canthotomy kunye neCantholysis.

Inkqubo engxamisekileyo yesibhedlele: I-Lateral Canthotomy kunye ne-Inferior Cantholysis (LCIC)¶

Xa isigulane sifika kwisebe eliphuthumayo kunye ne-Orbital Compartment Syndrome, ugqirha ophuthumayo okanye i-ophthalmologist yenza inkqubo ye-2-minute yebhedi ebizwa ngokuthi ** I-Lateral Canthotomy kunye ne-Inferior Cantholysis (LCIC) **.

Kutheni ukusika ulusu kuphela ("Canthotomy") Akwanelanga: i-anatomy yeCantholysis¶

Iperile ebalulekileyo yotyando efundiswa kuwo onke amayeza angxamisekileyo kunye nokuhlala kwi-trauma ngumahluko phakathi kwe- **Inyathelo loku-1 (i-Lateral Canthotomy) ** kunye ne-Inyathelo lesi-2 (i-Inferior Cantholysis):

                     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.)

• Kutheni iNyathelo 1 (Canthotomy) iyodwa isilela: Ukwenza ukusika okuthe tye eluswini kwikona engaphandle yeliso (i-lateral canthotomy) yehlisa kuphela uxinzelelo lwe-orbital malunga ne-10 ukuya kwi-14 mmHg kuba i-fibrous enzulu i-crus ephantsi ye-lateral canthal tendon isabambelele kwithambo le-eyelitha elisezantsi (I-Whitnall tubercle).
• Kutheni iNyathelo lesi-2 (I-Inferior Cantholysis) linyathelo lokulondoloza umbono: Ukutsalela inkophe esezantsi phambili ngeforceps kuveza ibhendi emhlophe yefibrous evakala kanye njenge intambo yesiginci eqiniselwe ngokuqinileyo xa ibethwa ngeencam zesikere se-iris esibuthuntu. Ukuqhawula loo mthambo ongaphantsi (**i-cantholysis engaphantsi **) ikhupha ngokupheleleyo i-eyelid engezantsi, ivumela i-eyeball ukuba ihambe phambili kwi-4 ukuya kwi-6 millimeters, ikhuphe igazi elibanjwe kwi-retrobulbar, kwaye ngokukhawuleza ilahle uxinzelelo lwe-intraocular nge-*30 ukuya kwi-50 + mmHg **.

Iimpawu zeklinikhi kunye nenyathelo ngenyathelo lokuhamba kwesibhedlele kwi-LCIC¶

1. Izalathisi ezigqibeleleyo (Yenza kwangoko ecaleni kwebhedi phambi kweCT):
2. Imbali yomonzakalo we-orbital, utyando lwenkophe, okanye ibloko ye-retrobulbar ** PLUS ** iproptosis/iglowubhu yexesha *
   • Ukuncipha kokubona kakuhle,
   • I-Positive Relative Afferent Pupillary Defect (RAPD), OKANYE
   • Uxinzelelo lwe-Intraocular (IOP) **> 40 mmHg **.
3. Inyathelo ngeNyathelo leNdlela yeNdlela yeBhedi (Yenziwa nguGqirha):
4. Ukulungiselela kunye ne-Anesthesia: Coca ikona yangaphandle yeliso nge-ophthalmic povidone-iodine kwaye utofe i-1 ukuya kwi-2 mL ye-**1% okanye i-2% ye-lidocaine nge-1: 100,000 epinephrine ** ngokuthe ngqo kwi-canthus esecaleni ejolise kwi-lateral bony rim (ungaze ubhekise kwiglowubhu).
5. Yenza imithambo-luvo (Ibambile): Bamba i-hemostat ethe tye ngokuthe tye ukunqumla kwicanthus esecaleni ukuya kutsho kungqameko lwe-orbital obungamathambo30 ukuya kwimizuzwana engama-60 ukutyumza imithambo yegazi kwaye udale umkhondo ongenagazi.
6. Inyathelo loku-1 - I-Lateral Canthotomy: Ukusebenzisa iris enencam-buthuntu okanye izikere zikaStevens tenotomy, sika ngokuthe tye ngomgca otyumkileyo ukusuka kwikona engaphandle yeliso 1 ukuya kwi-2 yeesentimitha ecaleni yonke indlela ukuya kwirim ye-orbital engamathambo.
7. Inyathelo lesi-2 - I-Cantholysis eNgaphantsi: Bamba udini olungaphandle lwenkophe engezantsi ngezinyanzelo zamazinyo kwaye uyitsale ngokuqinileyo ngaphambili nangaphezulu ukuya kwisilingi (kude nebala leliso). Sebenzisa iingcebiso ezivaliweyo ze-scissors to palpate ("strum") i-fibrous tight ** i-crus ephantsi ye-tendon ye-canthal ye-canthal ** i-anchoring isiciko esisezantsi kwithambo, bonisa iingcebiso ze-scissor phantsi / kude nehlabathi, kwaye unqumle i-tendon ngokupheleleyo de i-eyelid engezantsi iwele ngokupheleleyo kwaye iyancipha.
8. Phinda ujonge i-IOP & Vision Ngoko nangoko: Phinda ulinganise uxinzelelo lwe-intraocular phakathi kwemizuzu emi-2 ukuya kwemi-5. Ukuba i-IOP ihlala **> i-40 mmHg **, qhubela phambili ku- Isinyathelo sesi-3 (i-Superior Cantholysis) ngokusika i-crus ephezulu ye-tendon ye-canthal yecala phantsi kwe-eyelid ephezulu.
9. Inqaku lokuPhilisa i-Cosmetic kwizigulane: Qinisekisa isigulana kunye nosapho ukuba i-lateral canthotomy yokusikwa iphilisa ngokumangalisayo kwaye ityhulwa ngokulula ngugqirha we-oculoplastic kwiintsuku ezi-3 ukuya kwezi-5 emva kokuba konke ukudumba kwe-orbital kusonjululwe, kushiya phantse kungabikho siva sibonakalayo.

Izincedisi zonyango (Isetyenziswe ecaleni kwe-LCIC, ingaze ithathe indawo yokusika i-tendon)¶

Ngelixa ulungiselela i-LCIC ecaleni kwebhedi okanye kwangoko emva koko, oogqirha abangxamisekileyo balawula unyango lwe-intravenous ukuze banciphise umthamo we-vitreous, bacinezele imveliso ye-aqueous humor, kunye nokunciphisa i-optic nerve edema: - Intravenous Mannitol: 1 to 2 g/kg I-IV ifakwe kwimizuzu engama-30 (i-agent ye-hyperosmotic ekhupha ulwelo oluphuma kwiliso kunye ne-orbit). - Intravenous Acetazolamide (Diamox): 500 mg I-IV bolus (i-carbonic anhydrase inhibitor evala imveliso yolwelo olumanzi ngaphakathi kwiso). - I-Topical IOP-Lowering Drops: I-Timolol 0.5% kunye ne-brimonidine yehla (ukuphepha ukuba iglowubhu evulekileyo iyakrokrelwa). - I-High-Dose ye-Intravenous Corticosteroids: I-Methylprednisolone (250 mg to 1,000 mg IV) okanye i-dexamethasone ukunciphisa ukuvuvukala kwe-optic neuropathy. - ** I-Anticoagulant Reversal & Antiemetics: ** I-ondansetron ye-intravenous ukukhusela i-spikes yokuhlanza kwi-venous pressure, ukulawula uxinzelelo lwegazi, kunye nokuguqulwa kwangoko kwe-warfarin, i-apixaban, okanye i-rivaroxaban.

Iinombolo zengingqi zikaxakeka kunye neeprothokholi ze-arhente¶

I-retrobulbar hemorrhage erhanelwayo okanye i-orbital compartment syndrome yi- **Udidi 1 / Okuphambili 1 i-ophthalmology kunye ne-trauma engxamisekileyo ** kunye nefestile engqongqo ye-60-to-90-minute-door-to-decompression window:

• I-United States neKhanada: Cofa u-911* xa ufuna ukuthutha ukuya kweyona ikufutshane iNqanaba loku-1 okanye iZiko leNqanaba le-2 leNgxaki yeNgxaki okanye iSebe likaNgxamiseko lesiBhedlele (ungaze uye kwiofisi kagqirha wamehlo okanye kwiziko lokhathalelo olungxamisekileyo). Ilawulwe ** I-American Academy ye-Ophthalmology (AAO) ** kunye ** I-American College of Surgeons ATLS (i-Advanced Trauma Life Support) ** iiprothokholi ze-trauma, ezigunyazisa i-canthotomy ye-bedside lateral canthotomy kwi-trauma bay ngugqirha ongxamisekileyo ngaphambi kwe-CT scanning.
• EUnited Kingdom: Cofa 999 okanye uye ngokukhawuleza kwisibhedlele esikhulu ISebe leNgxamiseko (A&E). Ngaphantsi ** IKholeji yaseRoyal of Emergency Medicine (RCEM) ** kunye ** IKholeji yaseRoyal of Ophthalmologists ** imigangatho yokwenzakala, iiRejistra zezoNyango oluNgxamisekileyo kunye nabaCebisi baqeqeshwe kwaye baqinisekisiwe ukuba benze ibhedi ngokukhawuleza iLateral Canthotomy kunye neCantholysis ngaphandle kokulinda ukufika kwe-ophthalmology kwi-call.
• I-European Union: Cofa 112. Ukulawulwa phantsi kwe-European trauma resuscitation kunye ne-emergency ophthalmology protocols.
• Ostreliya neNew Zealand: Cofa 000 e-Australia okanye 111 eNew Zealand. Ukulawulwa phantsi kwe-klzzwx0080 kunye ne-RANZCO yezikhokelo ze-acute orbital trauma.
• ** I-Indiya kunye ne-Asia-Pacific: ** Ukudayela ** 112 ** (okanye ** 108 ** eIndiya), ** 995 ** eSingapore, ** 119 ** eJapan naseMzantsi Korea, okanye ** 999 ** eMalaysia naseHong Kong. Qhubekela kwisibhedlele somonzakalo omkhulu okanye isebe lesibhedlele samehlo enqanaba likaxakeka.

Imibuzo edla ngokubuzwa¶

Ndingawubona njani umahluko phakathi kweliso elimnyama eliqhelekileyo kunye ne-retrobulbar hemorrhage?¶

Kwiliso eliqhelekileyo elimnyama (i-preseptal hematoma), igazi lihlala ngokungenabungozi kwesikhumba esivulekileyo phambi kweenkophe: nokuba iinkophe zikhangeleka zimfusa kwaye zikhukhumele, zivakalelwa kukuba zithambile, i-eyeball ihleli kubunzulu obuqhelekileyo, ukunyakaza kwamehlo kuqhelekile, kwaye umbono ucace ngokupheleleyo xa uphakamisa isiciko. Kwi-retrobulbar hemorrhage, igazi livaleleke emva kwe-eyeball ngaphakathi kwe-socket ye-bony, ukutyhala i-eyeball ngokubonakalayo phambili (proptosis), yolula iinkophe ze-rock-hard ngokuchasene nethambo ukuze zingakwazi ukutsalwa zivuleke, intshukumo yamehlo ekhenkcezayo, kwaye ibangele intlungu enzulu kunye nombono obumnyama.

Kutheni iwindow yemizuzu engama-60 ukuya kwengama-90 ibaluleke kakhulu kwi-Orbital Compartment Syndrome?¶

Iretina kukwandiswa kwezicubu zobuchopho ngeyona ndlela iphezulu yokusetyenziswa kweoksijini ngegram yayo nayiphi na izicubu emzimbeni womntu. Xa ukopha ngaphakathi kwisokethi yethambo le-30-milliliter eqinile iqhuba uxinzelelo olungaphezulu kwama-40 ukuya kuma-50 mmHg, icinezela ivale umthambo osembindini we-retinal kunye nemithambo emincinci ye-ciliary esondla i-optic nerve. Uphononongo lovavanyo kunye neklinikhi lubonisa ukuba emva kwemizuzu engama-60 ukuya kwengama-90 (kwaye phantse kwihlabathi liphela ngaphaya kwemizuzu eyi-120) ye-ischemia ye-retinal epheleleyo, iiseli ze-retinal ganglion zifa ngokusisigxina, okukhokelela kubumfama obungenakuguqulwa ngaphandle kokuba i-lateral canthal tendon isikwe ngexesha.

Kutheni kufuneka oogqirha bangalindeli i-CT scan phambi kokuba benze i-canthotomy esecaleni?¶

I-Orbital Compartment Syndrome ifunyaniswa ngonyango ecaleni kwebhedi ngaphantsi kwemizuzu emibini ngokujonga i-proptosis, iglowubhu ye-rock-hard tense, kunye nokuncipha kokubona okanye i-afferent pupillary defect (RAPD). Ukuthutha isigulane kwi-suite ye-radiology, ukufumana i-CT scan yobuso, kunye nokulinda ukwakhiwa kwakhona komfanekiso kudla ngokuphindaphindiweyo imizuzu engama-30 ukuya kwe-60 yefestile yokusinda ye-retinal yemizuzu engama-90. Ukusika i-tendon ye-canthal ecaleni kwebhedi kuthatha imizuzu emibini phantsi kwe-anesthesia yendawo, ngokukhawuleza ibuyisela ukuhamba kwegazi kwi-retinal, kwaye ivumela isigulane ukuba siphumelele kwi-CT scan ngokukhuselekileyo emva koko.

Kutheni ndingavunyelwa ukuba ndivuthele impumlo yam emva kokuba ndibethwe esweni?¶

Impembelelo ebuthuntu kwiliso idla ngokuqhekeka udonga oluphakathi olubhityileyo kakhulu (i-lamina papyracea) okanye umgangatho wesokethi yamehlo, olwabelana ngodonga kunye ne-ethmoid ezaliswe ngumoya kunye ne-maxillary sinuses zempumlo. Xa uvuthela impumlo yakho, uxinzelelo ngaphakathi kweempumlo zakho lunyukela ngaphezulu kwe-80 ukuya kwi-100 mmHg, umoya oqhushumbayo utyhutyha ithambo emva kwebhola yeliso. Ngenxa yokuba izicubu ezithambileyo zisebenza njenge-valve yendlela enye, umoya uvaleleka emva kweso (tension orbital emphysema) kwaye utyumza imithambo-luvo yakho njengehlwili legazi.

Ngaba ukopha kwe-retrobulbar kwenzeka emva kotyando lokuthambisa lwenkophe (blepharoplasty)?¶

Ewe. I-Retrobulbar hemorrhage yeyona ngxaki yoyikwa kakhulu yokubona i-blepharoplasty ye-cosmetic ephezulu okanye esezantsi ye-eyelid, eyenzeka rhoqo kwiiyure zokuqala ezi-3 ukuya kwezi-24 emva kotyando xa i-epinephrine ye-anesthetic yendawo iphelile okanye ukuba isigulana sikhohlela, sihlanza, sigobe, okanye sixinezelekile. Ukuba uphuhla ngesiquphe iintlungu ezinzulu ezinzulu kwelinye iliso, ukudumba okukhawulezileyo okutyhalela phambili iliso, okanye ukubona luzizi emva kotyando lwenkophe, fowunela u-911 kwaye ugqirha wakho wotyando ngoko nangoko ukuze kukhululwe amabhandeji aqinileyo kunye ne-sutures kwaye kwenziwe i-canthotomy.

Ngaba i-canthotomy esecaleni iyaliphazamisa ngokusisigxina iliso okanye yonakalise iliso?¶

Hayi. I-canthotomy esecaleni kunye ne-cantholysis ayinqumli i-eyeball kwaphela; yenza i-1-to-2-centimeter snip ethe tyaba kwikona engaphandle yeenkophe kwaye inqumle i-tendon encinci ye-fibrous ebambelela kwi-eyelid engezantsi kwithambo. Nje ukuba ukopha kwe-orbital kunye nokudumba kusonjululwe ngaphezulu kweentsuku ezi-3 ukuya kwezi-5, ugqirha wamehlo okanye ugqirha we-oculoplastic uvele athunge i-tendon kunye nekona ye-eyelid yangaphandle ibuyele kunye kwi-crease yendalo yonyawo lwe-crow's-foot, ishiya ibala elibonakalayo ngelixa lisindisa ukubona kwesigulana.

Imithombo kunye nezikhokelo ezisemthethweni¶

• I-American Academy ye-Ophthalmology (AAO, eUnited States): *I-EyeWiki kunye nezikhokelo zokuSebenza kwezonyango: I-Orbital Compartment Syndrome, i-Retrobulbar Hemorrhage, kunye ne-Lateral Canthotomy kunye ne-Cantholysis *.
• ** I-American College of Surgeons (i-ACS, eUnited States): ** * INkxaso yoBomi beNkxaso ePhambili yokuThuthuka (ATLS) Incwadi yeSifundo soMfundi * (i-Ocular Trauma kunye ne-Bedside Orbital Decompression Protocols).
• ** IKholeji yaseRoyal ye-Emergency Medicine (RCEM) kunye neKholeji yaseRoyal ye-Ophthalmologists (eUnited Kingdom): ** *ISikhokelo sokuSebenza esiGqwesileyo: Ulawulo lwe-Traumatic Orbital Compartment Syndrome (OCS) kwiSebe leeNgxamiseko *.
• **ULima V et al. (Ijenali ye-Oral kunye ne-Maxillofacial Surgery ) kunye ne-Hayreh SS (UPhando lwe-Eye loVavanyo): I-Ocular Ischemia kunye nexesha lokunyamezela i-Retina ukuya kwi-Acute Central Retinal Artery Compression (i-90-to-100-Minute Window).
• ** I-International Federation ye-Red Cross kunye ne-Red Crescent Societies (IFRC): *** *I-International First Aid, ukuvuselela, kunye nezikhokelo zeMfundo: I-Eye Trauma kunye ne-Protective Shielding *.

Izikhokelo ezinxulumeneyo¶

• Ukwenzakala kwamehlo, ukugqabhuka kweglowubhu, kunye nokutsha kwamehlo ekhemikhali
• Ukuvaleka komthambo we-retinal ophakathi, ukubetha kwamehlo, kunye ne-giant cell arteritis
• I-acute angle-ukuvalwa kweglaucoma kunye ne-retinal detachment ukulahleka kombono
• Into yangaphandle yamehlo, i-corneal abrasion, kunye ne-welding flash
• I-hematoma ye-auricular, i-hematoma ye-nasal septal, kunye ne-trauma ebusweni