眼眶感染性病变34例临床分析

Clinical analysis of orbital infectious diseases of 34 patients

目的探讨眼眶感染性病变的病因、临床表现、影像学特征、治疗原则及预后。方法收集天津医科大学眼科医院及天津市第一中心医院2011年8月—2017年10月收治的34例眼眶感染性病变患者的临床资料,比较分析其病因、感染类型、影像学特征、治疗及预后。结果 21例患者伴有眼眶脓肿形成,13例为单纯眼眶蜂窝组织炎,未形成脓肿。眼眶感染性病变病因主要为副鼻窦炎症,其他包括皮肤疖肿、泪囊炎、外伤、眼内炎、牙源性感染、医源性感染、全身因素等。22例经手术联合抗感染治疗,12例单纯抗感染保守治疗。30例预后良好,无严重并发症,1例因视网膜中央动静脉阻塞,视功能明显受损,3例因眼内炎行眼内容物剜除术,视功能永久丧失。眼眶感染性病变CT表现为受累眼眶软组织肿胀、炎症弥散,边界不清,伴有脓肿形成者,占位效应明显,见低密度脓腔,MR一般显示炎症为长T1、长T2信号影。结论眼眶感染性病变病因较多,病程进展迅速,借助影像学检查可准确定位感染位置、类型及范围。抗感染、对因治疗是关键,必要时手术及多科室联合治疗,避免发生严重并发症。

Objective To discuss the etiology,clinical features,imaging manifestations,treatment principles and prognosis of the orbital infectious diseases.Methods Thirty-four patients with orbital infectious diseases hospitalized in Tianjin Medical University Eye Hospital from August 2011 to October 2017 were collected and retrospectively analyzed.We analyzed clinical data of patients including the etiologies,types of the infection,imaging manifestations,treatments and prognoses.Relsults There were 21 patients with orbital abscesses,13 patients with orbital cellulitis only,no abscess formation.The main cause of the orbital infectious patients disease was related to paranasal sinusitis,others included furuncles of eyelid skin,dacryocystitis,trauma,entophthalmia,odontogenic infection,nosocomial infection and systemic diseases.Twenty-two cases were operated,and 12 cases were treated conservatively.Thirty(30/34)cases acquired well prognoses without serious complications,except 1 occurred central retinal artery and vein occlusion,and 3 were treated by ophthalmectomy and lost their visual function permanently.The CT imaging of orbital infectious diseases showed the swelling,increased density,diffuse inflammation and unclear boundaries of the involved tissues.The imaging of orbital abscesses showed that in addition to inflammation,the abscesses and the masses were obvious in the orbit.MR generally showed long T1 and long T2 signals.Conclusion There are many causes of orbital infectious diseases,and the course progresses rapidly.With the help of imaging examination,it can accurately locates the infection,and shows the type and range,and comprehensively evaluates the disease in combination with clinical features.Anti-infection and etiological therapy are crucial factors,if necessary,surgery and multiple department treatment should be combined to avoid serious complications.