眶尖综合征18例临床分析

Clinical Analysis of 18 cases with orbital apex syndrome

目的探讨眶尖综合征的临床特征、病因和预后。方法回顾性总结18例眶尖综合征患者的临床资料,并结合文献进行分析。结果所有患者均出现视力减退、眼睑下垂、复视、前额头痛或眼痛等表现,但其首发症状可不同,视力下降或丧失8例,头痛、眼痛者7例,牙痛1例,鼻塞、流涕1例和眼球突出的1例。病因包括外伤6例(33%),占位5例(28%),非特异性炎症4例(22%)、感染3例(17%)。住院期间6例外伤性患者中视力、眼球活动障碍等症状有好转的5例,其中3例病情较轻者恢复更好,1例受伤较重的无好转;5例占位患者中1例蝶窦粘液囊肿患者手术后视力、眼球活动障碍等症状均有好转,其余4例诊断为眼眶腺样囊性癌或放疗后骨肉瘤患者无好转;4例非特异性炎症疾病患者治疗后2例视力、眼球活动障碍等症状较轻、病程较短的有好转,而另2例症状较重、病程较长的症状则无明显好转;3例感染性疾病者1例病程较短的症状有好转,而另2例病程较长或合并颅内感染患者无好转。结论眶尖综合征由多种病因引起,首发症状具有多样性,其预后与病因、是否及时就诊、早期诊断和早期治疗相关。

Objective To explore the clinical characteristics, etiology and prognosis of orbit apex syndrome. Methods Clinical data of 18 patients with orbit syndrome was summarized and analyzed. Results All patients developed vision loss, ptosis and diplopia, such as a headache or sore eyes forehead performance. However, the onset symptoms varied including vision decline or loss in 8 cases, headache in 7 cases, eye pain in 1 case, toothache in 1 case, stuffy nose and runny nose in 1 case and exophthalmos in 1 cases. The Causes included trauma in 6 cases （33%）, mass lesion in 5 cases （28%）, nonspecific inflammation in 1 cases （22%）, infection in 3 cases （17%）. Vision and eye movements disorder were improved in 5 cases of 6 patients with trauma in which 3 mild cases recovered better and one severe case did not recovered. Of 5 patients with mass lesion, the vision and eye movement were improved in one patients with sphenoid sinus mucocele receiving surgical operation, but not in the rest 4 cases with orbital adenoid cystic carcinoma or osteosareoma patients receiving either surgical operation or radiotherapy. Of 4 patients with nonspecific inflammatory disease, eye movements were improved in 2 mild cases but not in 2 severe cases. Of 3 infectious diseases, eye movements were improved in 1 mild case. Conclusion Orbital apex syndrome is a heterogeneous disorder with multiple etiologies, presenting with a variety of initial symptoms. The prognosis depends on causes, timely diagnosis, early diagnosis and early treatment.