内镜下经筛肌锥内脂肪减压矫治Graves眼病性突眼

目的研究一种矫正以脂肪增生为主的Graves眼病(GO)性过度眼球突出的新方法。方法对以脂肪增生为主的GO患者采取内镜下经筛径路眶肌锥内脂肪减压术(ETIFD)治疗。所有GO患者均确诊为处于非炎症活动期的以脂肪增生为主型GO。术后6个月分析眼球突出矫正度以及并发症等,以评价疗效。结果共收集资料齐全者24例44眼。术前眼球突出度(19.98±1.80)mm(17～23)mm,术后6个月眼球突出度为(12.93±0.76)mm(12～14)mm,平均眼球突出矫正度达(7.05±1.40)mm(4～10)mm(P<0.001)。所有患者双眼眼球突出度差值均小于2mm。10例患者术后出现水平复视,其中8例术后1个月内完全消失,2例术后6个月仍存在予以三棱镜矫正。无其他并发症发生。结论 ETIFD为矫治以脂肪增生为主型GO突眼的一种较理想方法。     

眼眶减压术治疗甲状腺相关性眼病的围手术期护理10例

甲状腺相关性眼病（thyroid-associated ophthalmopathy，TAO），也称Graves眼病，是最常见的眼眶病之一。近年来发病率日益增高，其发病机制不清。患者主要症状为眼球突出，部分患者眼外肌肌腹明显增大，在眶尖部压迫视神经，导致视神经萎缩，严重影响患者的视功能。本病目前尚无可行的治疗方法，一般使用类固醇、放疗等手段，但不能获得满意的疗效，病情持续恶化。我院对治疗的TAO患者10例，经行眼眶减压术并精心护理，获得了较满意的疗效，现报道如下。     

眼眶内外平衡减压术治疗甲状腺相关眼病病人的护理

[目的]总结眼眶内外平衡减压术治疗甲状腺相关眼病病人的护理。[方法]对56例(73眼)甲状腺相关眼病病人行眼眶内外平衡减压术,同时加强围术期护理。[结果]56例73眼眼球突出度缓解2mm～7mm,24眼视力有明显提高,其中10眼视力无改变;眼睑闭合不全角膜暴露者术后闭合良好,外观满意;6例出现复视,随访1个月～2个月复视逐渐消失;6眼眼球运动受限者术后稍有好转;术后5例并发眼球移位。[结论]加强甲状腺相关眼病病人行眼眶内外平衡减压术的护理是手术成功的保证。     

开眶减压治疗Graves眼病42例分析

目的：探讨根据眼球突出度分别采取二壁或三壁眶减压治疗Graves眼病临床疗效。方法：眼球突出度〈27 mm采用经鼻内窥镜二壁减压（其中7只眼二壁减压效果欠佳,后经眶外壁减压症状改善）;〉27 mm采用三壁减压。结果：眼球突出度〈27 mm采用二壁减压术眼球平均回缩4 mm,眼球突出度〉27 mm采用三壁减压眼球平均回缩7 mm;角膜病变均恢复;39只眼视力下降者,30只眼提高,8只眼视力没有改变,1只眼视力下降;眼球活动度及外观均改善。结论：开眶减压是治疗Graves眼病的有效方法,但应根据眼球突出度进行二壁或三壁减压。     

眼眶减压术治疗甲状腺相关性眼病的围手术期护理10例

甲状腺相关性眼病(thyroid-associated ophthalmopathy,TAO),也称Graves眼病,是最常见的眼眶病之一.近年来发病率日益增高,其发病机制不清.患者主要症状为眼球突出,部分患者眼外肌肌腹明显增大,在眶尖部压迫视神经,导致视神经萎缩,严重影响患者的视功能.本病目前尚无可行的治疗方法,一般使用类固醇、放疗等手段,但不能获得满意的疗效,病情持续恶化[1,2].我院对治疗的TAO患者10例,经行眼眶减压术并精心护理,获得了较满意的疗效,现报道如下.     

鼻内镜下眼眶减压术治疗甲状腺相关眼病的临床观察及护理

甲状腺相关眼病(thyroid-associated ophthalmopathy,TAO)在临床上十分常见,其特点为眼球突出、眼外肌肥大、眼睑退缩、暴露性角膜炎及伴有视神经病变等,严重者可致失明.我科自2002年1月-2007年12月对病情严重、经保守治疗效果不佳的甲状腺相关眼病病人49例(73眼)采用经鼻、结膜联合进路内镜下眼眶减压术治疗,疗效满意.现将护理报告如下.     

高质量围手术期护理对眼眶减压术治疗甲状腺相关性眼病患者预后的影响

甲状腺相关性眼病（thyroid—associatedophthalmopathy,TAO）,也称Graves眼病,是最常见的眼眶病之一。近年来甲状腺相关性眼病发病率呈增高趋势,但其具体发病机制目前尚未研究清楚。该病突出症状表现为眼球突出、眶周水肿、眼睑退缩、眼睑裂开、复视、角膜暴露并伴有角膜损伤甚至溃疡,部分患者眼外肌肌腹明显增大,在眶尖部压迫视神经,导致视神经萎缩,严重影响患者的视功能导致视力下降甚至完全丧失。     

眼眶减压术治疗甲状腺相关眼病的配合及护理

目的：探讨眼眶减压术的术前准备和术中配合技巧。方法：分析、总结58例眼眶减压术患者的手术情况。结果：47眼术后视力有明显提高。结论：做好术前、术中、术后的护理配合，对手术顺利完成和治疗效果至关重要。     

甲状腺相关眼病手术患者的护理现状

甲状腺相关眼病(简称TAO)是一种自身免疫性疾病,也是发病率最高的成人眼眶疾病。本文对TAO手术治疗及护理进行了归纳总结。手术方法包括眶减压术、眼肌手术、眼睑手术,根据不同的临床表现采用不同手术方案,不同手术方法又有各自不同术后并发症与不良反应。文中着重阐述了TAO手术患者的术前心理护理,不同手术方案的术后护理,以及常规术后护理。眼科护理人员应全面掌握TAO患者的各种护理措施,更好的为TAO患者服务。     

眶窦联合入路治疗眼眶爆裂性骨折2例的护理

眼眶爆裂性骨折伴眶内容嵌顿，必须通过手术达到理想的眼位及消除复视．而眶窦联合人路是严重眶下壁骨折最佳术式。做好手术前、后的护理是手术成功的关键：术前加强心理护理，协助医生做好术前检查及准备；术后加强病情观察，教会患眼球运动的训练方法，特别是观察眼球突出度和复视尤为重要。     

Grave's眼病内窥镜下经筛径路眼眶减压术患者的护理

目的 探讨内窥镜下经筛径路眼眶减压术(endoscopic transethmoid orbital decompression,ETOD)治疗Grave's眼病(Grave's ophthalmopathy,GO)的有效护理措施.方法 分析31例(57只眼)在我科实施ETOD的治疗及临床护理经验.结果 31例GO患者经过有效的治疗和精心护理,出院时31例(57只眼)眼球突出度均矫正满意,9例(16只眼)视力下降患者术后均有所提高.术后并发眼球移位2例.结论 积极的治疗与有效的护理,是提高手术安全性,减少并发症的有效保障.

Abstract：

Objective To introduce an effective nursing practice for patients with Grave's ophthalmopathy(GO) undergoing endoscopic trans-ethmoid orbital decompression(ETOD). Methods The treatment and nursing experience of 31 cases (57 eyes) undergoing orbital decompression through endoscopic trans-ethmoid approach were reviewed and analyzed. Results Three months after operation, exophthalmos was corrected in all 31 cases (57 eyes) with satisfying result, and the visual acuity was improved in all 9 cases (16 eyes),who complained of visual loss preoperatively. At the 3-months' review, 2 patients presented diplopia on the primary eye position due to newly on-set global displacement. Conclusions Advanced treatment and careful nursing are very important to improve the surgical safety and decrease the complications.     

Orbital Compartment Syndrome and Irreversible Blindness Related to Orbital Varix Thrombosis: A Case Report

BackgroundOrbital compartment syndrome (OCS) is an ocular emergency that can severely threaten the visual potential. The most common etiologies include facial trauma-related orbital wall fractures and postoperative bleeding within the orbit. Nontraumatic cases were also reported sporadically, although they are rare. The orbital volume limits the compliance to expand when space-occupying lesions develop. Both direct compression of the optic nerve and depleted perfusion from elevated intraorbital pressure subsequently lead to ischemic optic neuropathy and vision loss.Case ReportA 74-year-old man experienced headache, bulging left eye, dull pain, vision loss, nausea, and vomiting within 1 day. Computed tomography and magnetic resonance imaging revealed a heterogeneous mass extending from the orbital apex and connected with the ophthalmic vein. Lateral canthotomy and cantholysis were performed at bedside for emergent orbital decompression. The proptosis and pain relieved after surgery, but visual loss remained irreversible. Surgical exploration was conducted and pathology proved the diagnosis of varix of the ophthalmic vein with thrombosis.Why Should an Emergency Physician Be Aware of This?Clinicians should be aware of the presentation of OCS and perform timely orbital decompression, which could reverse visual impairment. These patients might also benefit from immediate consultants with ophthalmologists and radiologists.     

鼻源性眼眶并发症的鼻内镜手术治疗

目的探讨在鼻内镜下经鼻腔手术治疗鼻源性眼眶并发症的治疗效果。方法16例（17眼）鼻源性眼眶并发症患者在全麻或局麻下分别用鼻内镜经鼻腔行鼻窦内镜手术以及眼眶手术治疗，手术开放了病变的鼻窦，清除了鼻腔、鼻窦内不可逆的病变，对眼眶脓肿彻底引流，行眶内容物减压。术后鼻内镜下鼻腔鼻窦随访、眼科随访0．5a。结果全部患者的病变鼻腔鼻窦以及其所累及眼眶的感染均治愈，术后坚持随访0．5a共15例（1例失访），该15例患者（16眼）术后2～6个月的鼻窦术腔均完全上皮化。视力恢复情况：手术0．5a后6眼视力恢复到正常水平，4眼视力状况不同程度改善，3眼无改善，无视力恶化的病例；术后眼部其他症状：13例患者的眼睑肿胀、突眼等症状基本消失，2例患者术后突眼得到改善。结论在鼻内镜下经鼻对鼻源性眼眶并发症的手术治疗是安全性高、疗效显著、不影响面容、具有明显优点的治疗方式。     

Frontoethmoid sinus osteoma as a cause of subperiosteal orbital abscess

A 65-year-old woman presented with severe periorbital pain and swelling of the left eye, with complete ptosis, proptosis, and conjunctival chemosis. The eye was in a hypotropic position, and activity in the left superior rectus was inadequate. A firm, elastic, 2-cm mass was palpated near the superior orbital rim. Computed tomography revealed a subperiosteal abscess (SPA) at the superior portion of the orbit and a large frontoethmoidal sinus osteoma. After the SPA had been surgically drained and the osteoma completely removed, the patient recovered, with resolution of proptosis, ptosis, and motility limitations. Osteomas of the paranasal sinuses are usually asymptomatic and rarely cause SPA and orbital cellulitis. Therefore, osteoma cases must be closely followed to ensure that early diagnosis and treatment of SPA are successful in preventing severe visual loss and rescuing the patient’s vision.     

经鼻内镜眶尖和视神经管减压术治疗创伤性视神经病

目的探讨经鼻内镜眶尖和视神经管减压术治疗创伤性视神经病的疗效和影响因素。方法对该科2004年10月～2005年11月41例（42眼）经鼻内镜眶尖和视神经管减压术患者的临床资料进行回顾性分析。结果42眼中，21眼视力获得提高，有效率50．00％。伤后有残余视力和无眶尖骨折者疗效优于伤后无光感和有眶尖骨折者（P〈0．05）。伤后7d内接受手术和无视神经管骨折者术后视力提高百分比较7d后手术者和有视神经管骨折者高，但无统计学意义（P〉0．05）。结论经鼻内镜眶尖和视神经管减压术是治疗创伤性视神经病的有效手术方式。     

探讨鼻内镜手术在治疗鼻眼相关疾病中的应用

目的:探讨鼻内镜手术在治疗鼻眼相关疾病中的应用及其疗效。方法:经鼻内镜手术治疗鼻眼相关疾病119例。结果:慢性泪囊炎71例(99眼),行泪囊鼻腔造孔术,痊愈91眼;鼻窦囊肿伴有眶内并发症21例,行鼻窦囊肿开放术,全部痊愈;外伤性视神经病变23例,行视神经管减压术,好转11例;外伤性眶内壁骨折2例,经鼻行眶内壁骨折整复术痊愈;眶内异物1例,成功取出;球后血肿1例,经筛窦纸板入路行血肿清除术,基本痊愈。随访期:6个月~3年。结论:经鼻内镜手术治疗鼻眼相关疾病具有不破坏患者面貌,有效,简单,损伤小,恢复快等优点,值得推广。     

眶内炎性假瘤MRI分析

目的：探讨眶内炎性假瘤的MRI影像特征及鉴别诊断。方法回顾性分析48例眶内炎性假瘤的MRI平扫及其增强扫描的影像学特征,均为手术病理或随访结果证实。结果48例炎性假瘤根据影像学表现分为四型：①肿块型,表现为边界清楚的软组织肿块,位于肌锥内;②弥漫炎症型,眶内被病灶填充,边界模糊,眼直肌与病灶分界不清,视神经被包绕,压脂增强扫描T1 WI显示视神经不强化;③泪腺炎型,表现为泪腺增大,T1 WI信号稍低、T2 WI呈中等信号,压脂序列呈稍高信号;④肌炎型,眼外肌不同程度增粗,主要累及上直肌和内直肌。结论 MRI能清楚显示眶内炎性假瘤的信号特征、大小、形态与邻近结构的关系,因此对眶内炎性假瘤能够做出定位、定性诊断。     

Prediction of tissue decompression in orbital surgery

OBJECTIVE: A method to predict the relationships between decompressed volume of orbital soft tissues, backward displacement of globe after osteotomy, and force exerted by the surgeon, was proposed to improve surgery planning in exophthalmia reduction. DESIGN: A geometric model and a poroelastic finite element model were developed, based on computed tomography scan data. BACKGROUND: The exophthalmia is characterized by a protrusion of the eyeball. Surgery consists in an osteotomy of the orbit walls to decompress the orbital content. A few clinical observations ruling on an almost linear relationship between globe backward displacement and tissue-decompressed volume are described in the literature. METHODS: Fast prediction of decompressed volume is derived from the geometric model: a sphere in interaction with a cone. Besides, a poroelastic finite element model involving morphology, material properties of orbital components and surgical gesture was implemented. RESULTS: The geometric model provided a better decompression volume estimation than the finite element model. Besides, the finite element model permitted to quantify the backward displacement, the surgical gesture and the stiffness of the orbital content. CONCLUSIONS: The preliminary results obtained for one patient, in accordance with the clinical literature, were relatively satisfying. An efficient aid for location and size of osteotomies was derived and seemed to be able to help in the surgery planning.     

Frontal sinus mucocele with orbital extension drained via a combined upper lid skin crease and endoscopic approach

This case report discusses the ophthalmic complications of frontal sinus mucoceles and describes the favorable long‐term surgical outcomes of a combined endoscopic and upper‐lid skin crease drainage approach carried out jointly with otorhinolaryngology. A 47‐year‐old single mother presented to eye casualty with markedly swollen eyelids and visual acuity of 6/6 in the left eye, no perception of light in the right. Ophthalmic examination revealed right‐sided hypoglobus and proptosis with exposure keratopathy inferiorly. There was complete ophthalmoplegia in the right eye and a hemorrhagic optic disc visible on fundoscopy. CT orbit with contrast confirmed a diagnosis of giant frontal mucocele with orbital extension. The patient underwent mucocele drainage via a modified anterior orbitotomy approach and FESS (Functional Endoscopic Sinus Surgery) drainage performed jointly with otorhinolaryngology. Two weeks post‐operatively her proptosis was resolving and by three months she had regained full extraocular motility. As expected, vision was not restored in the right eye. At one year, the patient''s upper lid skin crease scar was completely buried in the eyelid''s natural contour, and repeat CT scanning confirmed no re‐stenosis or mucocele recurrence. This case demonstrates, that a multidisciplinary approach to far‐lateral frontal sinus mucoceles with orbital extension and ophthalmic complications which combines an upper lid skin crease incision with FESS drainage, allows adequate access to the frontal sinus while preserving cosmesis.