非特异性炎症致眶尖综合征临床特征分析

目的 总结眶尖非特异炎症导致眶尖综合征患者的临床特征。设计 回顾性病例系列。研究对象 2016年6月至2019年5月北京同仁医院神经眼科及北京市普仁医院眼科眼眶非特异性炎症致眶尖综合征15例（16眼）。方法 回顾患者的临床症状、体征、化验及影像学检查、激素治疗效果及病情转归。主要指标 临床表现、眼眶及头颅CT、MRI表现。结果 15例中男性8例，平均年龄（53±16）岁。14/15例单眼发病。病灶均局限于眶尖区，7例同时累及海绵窦。首先出现患侧眼眶疼痛，相继出现眶尖综合征表现。眼眶MRI均显示眶尖部条片状不规则实性病灶，呈等T1WI、等T2WI信号，均匀强化。经全身或眼球局部糖皮质激素治疗后14眼（87.5%）眼痛完全消失，13眼（81.3%）上睑下垂改善，11眼（68.8%）眼球运动及复视症状改善。3个月后复查眼眶MRI病灶均缩小。仅一半患者治疗后视力提高，其余8眼（50.0%）视力无改善。随访过程中2例（12.5%）病变复发。结论 局限于眶尖的非特异炎症可导致严重的眶尖综合征。早期无眼红肿等炎症表现，眼球突出亦不明显，表现为眶周疼痛、眼球运动障碍，继而视力进行性损伤，易被误诊。临床表现和神经影像学是诊断主要依据。糖皮质激素治疗能有效改善眼球运动障碍和疼痛，但视力恢复困难，且病变有复发可能。（眼科，2021，30： 56-61）

Analysis of the clinical features of orbital apex syndrome induced by non-specific inflammation

Objective To investigate the clinical characteristics of a group of cases with orbital apex syndrome caused by non-specific inflammation.Design Retrospective case series.Participants 15 patients(16 eyes)with orbital apex syndrome caused by non-specific inflammation of orbital apex in Beijing Tongren Hospital and Beijing Puren Hospital from June 2016 to May 2019.Methods The clinical symptoms,physical signs,ophthalmic imaging,laboratory examination,hormone treatment effect and prognosis were reviewed.Main Outcome Measures The clinical symptoms and signs,orbital and head CT,MRI image features.Results Of the 15 patients,8 were male,with an average age of(53±16)years.14/15 patients were attacked by monocular.The lesion of all cases was confined to the orbital apex,7 of which were both involved in the cavernous sinus.Periorbital pain occurred in the eyebrow arch or radiated to the zygomatic temporal part,orbital apex syndrome gradually appeared after the pain.The irregular solid lesions of orbital apex in orbital MRI showed equal T1WI and equalT2WI signals,which could be enhanced uniformly.The patients who were finally diagnosed as non-specific orbital inflammation were treated with systemic and/or ocular local hormone treatment.The symptoms of 15 patients were totally relieved,the periorbit pain of 14 eyes(87.5%)were completely disappeared.The blepharoptosis of 13 eyes(81.3%)were relieved,and ocular movement and diplopia of 11 eyes(68.8%)were improved.All the lesions in orbital MRI shrinked after 3 months hormone treatment.The recovery of visual function,however,was unsatisfactory.The vision of 8 eyes(50%)had no improvement,2 eyes(12.5%)relapsed during the period of follow-up.Conclusion The orbital apex syndrome induced by non-specific inflammation is characterized by local ocular pain and oculomotor disturbance in early stage,and then the visual impairment happened quickly.Clinical manifestations and neuroimaging examination are the main diagnostic basis.Systemic and/or local hormone therapy can effectively improve eye movement disorders and pain.But the recovery of visual acuity is difficult and the recurrence is possible.(Ophthalmol CHN,2021,30:56-61)