眼眶内巨大植物性异物一例

患者女性，47岁。因摔倒致花枝插入右眼3h，于2003年5月10日来我院就诊。全身检查无异常．眼部检查：视力右眼0．15，左眼0．4；右眼睑高度肿胀，内眦与眼球间、皮肤面可见大小不同植物性异物插入，泥土附于其上(图1，2)。左眼无异常。右眼球CT轴位和冠状位扫描检查示异物由上至下进入右眼眶，达上颌窦上壁、筛窦外下壁；上颌窦上壁和筛窦外下壁不完全骨折(图3，4)；右眼球CT矢状位重建检查可见眼球完整，     

眼眶内多发性植物性异物取出一例

患者男 ,31岁。因右眼外伤后右眼部、右鼻腔和咽部出现脓性分泌物 5ｄ ,于 2 0 0 0年 5月 18日来我院就诊。 2个月前患者奔跑中被竹杆戳伤右眼 ,在外院就诊 ,诊断为右眼眶皮肤全层裂伤、眶内异物 ,予以清创缝合治疗 ,自右眼眶内取出 4 0ｃｍ× 0 8ｃｍ× 0 2ｃｍ竹片 1块 ;1个月前患者因右眼肿胀再次在外院就诊 ,自右鼻腔取出竹片 1块 ;此后陆续自鼻腔取出细竹丝。此次入院全身体检正常。眼部检查 :右眼视力 1 5 ,下睑鼻侧眶缘可扪及硬块 ,眼球内、外转动均受限 ,结膜明显充血水肿 ,以鼻侧为甚 ,结膜囊内可见脓性分泌物 ,余未见明显异常…     

眼眶植物性异物的诊断和治疗

目的：通过对眼眶植物性异物的临床分析，该病最好的诊断和治疗方法。方法：复习我院收治的眼眶植物性异物21例,分析其各项检查及治疗方法。结果：眼眶瘘管形成占眼眶植物性异物的57．14％；B型超声检查异常者占64．70％，可提示异物存在者占41．18％；CT扫描异常者94．12％，可提示异物存在者占41．18％；2例行MRI检查均清晰地显示出异物影像，21例患者均手术取出异物，证实术前诊断。结论：眼眶植物性异物影像学检查显示率较低，对于显示异物，MRI优于超声和CT。正确诊断必须结合病史和眼部体征，尤其是眼眶瘘管的存在，手术摘出异物的同时需将瘘管一同切除，以求彻底治愈。     

眼眶内植物性异物致眼眶瘘管一例

1病例 患者男,55岁。因右眼被芦苇刺伤后红肿6个月于我院就诊。患者于2013年11月不慎被芦苇刺伤右眼上睑,伤后患侧眼睑红肿,并出现少量流血,不伴明显眼红,眼胀或眼痛等症状,未作特殊处理。2014年5月9日自觉右眼眼睑肿胀加重,局部可触及小硬结,来我院就诊,门诊MRI示右眼眶内异物,遂以“右眼眶内异物”收住入院。     

眼眶副鼻窦内巨大植物性异物一例

1病例 患者男,33岁。因骑摩托车摔倒致枯树枝插入双眼6小时,于2009年5月12日凌晨1：40急诊入院。人院检查：全身情况良好。前额眉问至鼻梁及双眼内眦部见一巨大树枝存留（图1,2,3）。双眼睑高度肿胀,眶压高,睁眼困难,左侧面部见血迹,异物主体位于前额眉间,成3个分支,前额部分支仅在皮肤外,右侧分支刚刺人右眼内眦眼睑结膜表面,左侧分支由内眦部向下进人左眼眶。右跟视力0．6,左眼视力0．04。     

眼眶内巨大植物性异物1例

患者男性,66岁。右眼外伤致视物不见伴脓性分泌物1年余,于2012年2月14日来我院住院治疗。患者于1年前因跌倒被硬物戳伤右眼,当即感剧痛,视物不见,并伴有肿痛,立即于当地医院就诊,行眼眶CT检查未见明显异常,给予清创缝合、抗炎等对症处理。半月后创口流脓、不愈,遂来我院就诊,查见瘘管形成,手术取出表面异物,症状稍有缓解。今患者眼部仍有脓性分泌物,拟“右眼眶内占位”收住入院。眼科检查：Vod无光感,Vos 0．8。右眼睑轻度肿胀,内眦皮肤可见一大小约1 cm溃疡面,     

内镜在眼眶深部植物性异物摘出中的应用

目的探讨内镜在眼眶深部植物性异物摘出术中的临床应用价值。方法术前行眼眶CT或MRI冠状和水平扫描准确定位,应用硬性内窥镜沿异物窦道或皮肤切口进入眶内,沿异物长轴方向夹取异物。结果5例眼眶异物均成功摘出,同时在内窥镜下清除窦道内肉芽及坏死组织,手术后伤口均一期愈合,无手术并发症。结论应用内镜取眼眶深部异物损伤小,恢复快,异物容易取尽无残留：     

眼眶内巨大植物性异物一例

1病例 患者男，20岁，山西大同人。2005年5月24日转诊到北京大学眼科中心住院。主诉14小时前骑摩托车摔入沟中被枯树枝插和右眼，当时无意识丧夫，在当地医院行CT检查，示右眼眶内异物（图1），右眼视神经挫伤，右筛骨、蝶骨骨折，大脑额叶挫裂伤。入院后检查：患者意识清醒，情绪烦躁不安。     

眶内异物16例临床分析

目的：总结眶内非金属异物的临床特征及诊治方法。 方法：回顾性系列病例研究。收集2005/2011年眶内异物患者资料16例,总结临床表现、影像学征象、治疗与随访结果。 结果：患者16例中13例接受眶内异物取除术,11例一次手术取出异物及周围腐烂组织（其中2例眶-颅异物与神经外科合作完成）。术后6mo随访,伤口愈合良好,症状改善,未见与手术相关并发症。 结论：眶内异物病情复杂 ,处置不当易致诸多并发症。CT为首选检查方法。正确认识病史及临床表现,运用恰当的手术技巧,彻底清除异物,预后良好。     

Clinical features, radiological imaging, and treatment strategies of nonmetallic intraorbital foreign bodies: a retrospective analysis

AIM: To provide comprehensive data on nonmetallic intraorbital foreign bodies (IOFBs) by summarizing and analyzing material types, clinical manifestations, imaging features, and treatment strategies. METHODS: Totally 28 nonmetallic IOFB cases treated at Shengjing Hospital of China Medical University from 2012 to 2020 were retrospectively reviewed. The types of foreign bodies, clinical features, imaging manifestations, and treatment outcomes were analyzed. RESULTS: Among all cases, 67.8% (19/28) of the foreign bodies were organic. The top three entrances were the upper eyelid skin (7/28), lower fornix conjunctiva (6/28), and lower eyelid skin (4/28). In most cases (11/28, 39.3%), foreign bodies remained in the medial orbits. The major clinical manifestations included eyelid redness and swelling (20/28, 71.4%), conjunctival congestion and edema (17/28, 60.7%), and ophthalmoptosis (15/28, 53.6%). Infection was the main complication, which occurred in 57.1% (16/28) of all cases. Computerized tomography (CT) values differed for different foreign bodies and varied in the different periods after injury. The plant- and grease-derived foreign bodies and the surrounding pus cysts showed different signals on magnetic resonance imaging (MRI). The prognosis varied with different foreign body types, surgery timing, and intraoperative management. CONCLUSION: The majority of nonmetallic IOFBs are organic and often remain in the superior, medial, and inferior areas of the orbit. Clinical manifestations vary owing to their different textures. CT and MRI facilitate the identification of foreign body materials. Plant-derived foreign bodies should be completely removed, and surgical treatment is a complicated process.     

眶内非金属异物25例临床分析

目的 总结眶内非金属异物的临床特征及诊治方法.方法 回顾性系列病例研究.收集2002至2009年经手术证实的眶内非金属异物患者资料25例,总结临床表现、影像学征象、治疗与随访结果.结果 外伤性异物23例,包括:植物性异物11例,玻璃、油脂和石块各3例,塑料笔头2例,爆竹残渣1例.另2例为医源性异物.特征性临床表现为眶周皮肤或结膜瘘道,共11例,发生率为44%,以植物性异物最为多见.CT征象因异物性质不同而各异.植物性异物在外伤早期呈低密度,随时间延长密度逐渐增高,压缩窗宽,异物显示更加清晰.油脂异物表现为与脂肪相近的低密度,石块和玻璃表现为高密度块影.植物性异物在MRI的T1和T2加权像均呈低信号,周围的脓液在T2加权像呈环形高信号影,异物周围的炎性组织强化明显.油脂异物在T1和T2加权像均呈高信号,脂肪抑制显像呈低信号.所有患者均在全身麻醉下接受眶内异物清除术,均经一次手术清除全部异物及周围腐烂组织,感染伤口一期不予缝合.术后半年随访,伤口愈合良好,症状改善,未见与手术相关并发症.结论 眶内非金属异物种类较多,病情复杂各异,处置不当易眶内残留.CT为首选检查方法.正确认识病史及临床表现,运用恰当的手术技巧,彻底清除异物,预后良好.

Abstract：

Objective To evaluate the clinical features,diagnostic methods and treatment of intraorbital nonmetallic foreign body injuries. Methods In a retrospective study,the records of 25 consecutive cases with nonmetallic foreign bodies in the orbit confirmed by surgery were analyzed with special attention to the types of injury,history,clinical manifestations,imaging findings,treatment and follow-up results. Results Among 25 cases with nonmetallic foreign bodies,23 cases were caused by trauma,including 11 cases with wooden bodies,3 cases with glass,grease,or stone,2 cases with plastic pen point,and one case with firecrackers. The remaining two cases had iatrogenic foreign bodies. The distinctive clinical manifestation was the periorbital fistula recorded in 11 (44%) cases,mostly in patients with wooden foreign bodies. The CT findings were different in various foreign bodies. The wooden foreign bodies showed low density in the acute stage and the density increased gradually from the acute to the chronic stage. CT images with lower windows could distinguish a wooden foreign body better. The grease was seen as low density mimicking orbital fat on CT. The stone or glass showed as masses with high density. Wooden foreign bodies displayed low signals on both MRI T1- and T2-weighted images. The surrounding pus was seen as a ring with high signal on T2-weighted images. The inflammatory infiltration showed marked enhancement. The grease displayed high signal on both T1- and T2-weighted images and showed lower signal than that of the fat. All patients underwent surgical removal of retained foreign bodies and the surrounding decomposed tissues. The infected wounds were not sutured at one stage operation. After follow-up for 6 months,all wounds healed normally and all patients recovered well No complications were encountered.Conclusions There are various types of intraorbital nonmetallic foreign bodies. The clinical manifestations of these different foreign bodies are complex. CT is the preferred examination for this condition. With the combination of correct diagnosis,proper surgical skills,and complete removal of foreign bodies and surrounding decomposed tissues,nonmetallic foreign bodies can be treated efficiently.     

眼眶异物的临床特点和手术治疗

目的总结眼眶异物的临床特点和手术治疗方法。方法回顾性系列病例研究。分析中山大学中山眼科中心2002年1月至2013年7月期间诊治的22例眼眶异物患者的资料,对其临床表现、影像学资料和手术治疗方法进行统计。结果22例患者中,男19例,女3例;年龄3~67岁,≤14岁者占46%;右眼眶10例,左眼眶12例。植物性异物占73%,异物位置以眼眶上部最多,占41%;其次分别为内侧（27%）、外侧（18%）、下部（9%）和锥后段（4%）。术前视力损害占50%,眼球运动受限、斜视和上睑下垂占46%。眼眶CT和MRI显示植物性异物均有条状、棒状等高密度异物影或低信号异物影。全部病例均完整取出异物,其中前路开眶21例,侧壁开眶1例;21例行1次手术,1例行2次手术;所有患者术后随访期内均没有出现新增视力下降和眼球运动受限,仅2例有暂时性轻度上睑下垂。结论眼眶异物以男性儿童多见,影像检查有利于准确诊断,前路开眶手术效果好。     

针刺定位眶内金属异物摘出术临床报告

目的 探讨眶内金属异物摘出术的简易方法。方法 28例眶内金属异物，在X线荧屏下，利用X线交叉投照，以两枚针头交叉刺及、异物定位，沿着针头指引分离，摘出异物。结果 28例眶内金属异物均能顺利地取出，创口Ⅰ期愈合。结论 在X线荧屏下，用两枚针头交叉刺及、异物定位法摘出眶内金属异物，具有损伤少，摘出快的优点。     

An intraorbital metallic foreign body

A 30-year-old male presented with diplopia for 20 days post occupational accident involving left side of his nose, while he was working with a nail gun. He was fully conscious and did not have any neurological deficits. Patient narrated the mechanism of injury and was sure that the nail fell down after hitting the left side of his nose. He had normal vision, but extra ocular movements were restricted and painful. Computed tomography (CT) scan revealed a curved metal object lodged in the posterior aspect of the left orbit extending diagonally from medial wall to the anterior-superior aspect of the orbital roof. The object was removed via a small surgical approach, inflicting least possible surgical trauma. Post surgery, the patient recovered with complete resolution of diplopia. The original aspects of this case are the lack of signs of a foreign body entry and its relative harmlessness in spite of its large size.     

应用探测器定位摘出眼眶内金属异物

目的：探讨应用探测器定位摘出眼眶内金属异物的利和弊。方法：对1986－1998年连续在我科住院，术中应用探测器定位并摘出异物的132例（132眼）进行回顾分析。结果：探测器术中定位的准确性为100％，而摘出成功率为131／132（99．24％），失败1例（0．76％）；手术未造成视力的进一步下降；有13例术后致上睑下垂和眼外肌功能障碍,其中约半数病例经中医治疗得以治愈和改善。结论：本探测器对最大长径＞1.5mm的眶内金属异物能准确定位，位于外下象限距角膜缘平面之后≤25mm之磁性异物摘出较易；位于角膜缘平面之后≥26mm之非磁性金属异物是否手术，应具体分析，权衡利弊。     

眶内异物强力磁铁在眼眶深部磁性异物取出术中的应用

目的:探讨眼眶深部磁性异物摘出术中眶内异物磁铁应用的手术方法和治疗效果.方法:回顾性分析河北省眼科医院2014-06/2017-05眼眶深部磁性异物住院患者23例23眼的临床资料,其中肌锥外眶内异物14眼,眼球后肌锥内异物9眼.应用眶内异物强力磁铁摘出眶内深部磁性异物,观察异物摘出成功率和术后并发症情况.结果:肌锥内异物9眼均顺利摘出,成功率100%;14眼肌锥外眶内异物者中摘出异物12眼,成功率86%.术后轻度眶内出血2眼,未发生视力下降、眶内大量出血、眼球运动受限等并发症.结论:眼眶深部磁性异物应用眶内异物强力磁铁进行手术,手术创伤小、成功率高、时间短、并发症少.     

眶内异物摘出病例分析及切口部位选择的探讨

目的：对57例眶内异物手术患者治疗情况进行分析并对手术切口部位选择进行探讨。方法；57例眶内异物患者，根据不同情况分别采用原伤口，结膜切口，异物对应部位皮肤切口，外侧开眶及眼球摘出联合眶内异物摘出等方法进行手术，结果：57例一次手术摘出51例，二次手术摘出4例，三次手术摘出2例，术后视力提高37例，不变16例，下降4例，术后复视3例，轻度上睑下垂2例，经治疗后均于10天内消失，结论：眶内异物摘出术应注意切口部位的选择，避免损伤眼部重要组织，球后较大异物及视神经旁异物外侧开眶比X线透视下摘出异物更为安全，小而较深且无不良反应的异物最好保守治疗。     

玻璃体切除术摘出眼内异物的临床探讨

目的 探讨玻璃体切除术摘出眼内异物的手术时机和手术方法.方法 从2005年1月至2007年12月用玻璃体切除术摘出眼内异物的70例(71只眼)患者的临床资料进行回顾性分析.结果 71l眼中69只眼经玻璃体手术摘出异物,成功率97.18%.1只眼因术后发牛新生血管性青光眼摘除眼球,其余70跟眼球得以保存.术后视力改善48只服(67.61%),无变化11只眼(15.49%),视力下降12只眼(16.90%).术后发生视网膜脱离9只眼;继发性青光眼3只眼;眼内炎1只眼;硅油从贯通伤后巩膜伤口漏出至结膜下1只眼.结论 玻璃体切除术具有在直视下摘出眼内异物,提高手术成功率,同时处理伴随病变,为视功能恢复创造条件等优点,应尽早手术摘出眼内异物.早期手术和术中恰当的处理是取得较好疗效的关键.