眼眶急性炎症的病例分析及鉴别诊断

Clinical analysis and antidiastole of eye disorders which manifest as acute orbital inflammation

目的分析表现为眼眶急性炎症患者的临床资料,以期为该病患者的鉴别诊断及治疗提供帮助。方法从2008年1月至2016年12月期间因眼睑红、肿、局部疼痛并伴有功能障碍而就诊的患者中选择临床资料完整的23例(24眼),其中男12例12眼,女11例12眼。对其病史、临床特征、影像学特征、治疗方法及预后逐一进行回顾性分析。结果感染性炎症10例11眼,其中眼眶脓肿5例5眼,眼内炎2例2眼,急性泪囊炎1例2眼,额窦黏液囊肿1例1眼和蝶窦炎伴眶尖综合征1例1眼,病原体主要来自副鼻窦;非感染性炎症9例9眼,其中炎性假瘤7例7眼,干燥综合征1例1眼和甲状腺相关眼病1例1眼;肿瘤4例4眼,其中非何杰金淋巴瘤2例2眼和眶鼻沟通性恶性肿瘤2例2眼。患者平均发病时间:感染性炎症为10.0 d,炎性假瘤为34.0 d,干燥综合征发病为25.0 d,甲状腺相关眼病为7.0 d,恶性肿瘤为140.0 d。所有病例均有眼部急性或亚急性炎症表现,但严重程度和侧重点不同,而影像学检查具有鉴别诊断的价值。治疗方法依据明确的诊断各不相同,在诊断未能明确时,推荐首选及时、足量的局部使用和全身抗生素治疗,同时甘露醇降低眶压,保护视功能。抗生素治疗无效的病例,联合应用小剂量糖皮质激素行诊断性治疗;明确的眼眶肿瘤酌情联合手术综合治疗。根除病因后感染性炎症通常不易复发,炎性假瘤复发率高,恶性肿瘤预后差。结论眼眶急性炎症常常表现为眶蜂窝织炎,但是病因学诊断复杂多样。综合分析病史、临床特征、影像学表现和实验室检查进行鉴别诊断,给予恰当的治疗是避免眼部组织功能损害的保障。

Objective To present instructions and provide treatments to patients with eye disorders in differential diagnosis that appear as orbital acute inflammation by analyzing the etiology,clinical manifestation,imageology,treatments and prognosis.Methods Totally 23 patients(24 eyes) with complete clinical data were selected from the patients who were treated due to eyelid redness,swelling,local pain companying with dysfunction from January 2008 to December 2015,including 12 male(12 eyes) and 11 female(12 eyes).The clinical data was analyzed retrospectively.Results There were 10 patients(11 eyes) that were caused by infective inflammation,including 5 patients(5 eyes) with orbital abscess,2 patients(2 eyes) with endophthalmitis,1 patient(2 eyes) with acute dacryocystitis,1 patient(1 eye) with frontal sinus mucocele and 1 patient(1 eye) with sphenoiditis accompanying with orbital apex syndrome where the pathogens of infective inflammation mostly came from paranasal sinuses.There were 9 patients(9 eyes) that were caused by noninfective inflammation,including 7 patients(7 eyes) with inflammatory pseudotumor,1 patient(1 eye) with sjogren syndrome,and 1 patient(1 eye) with thyroid associated ophthalmopathy.There were 4 patients(4 eyes) that were caused by tumor,including 2 patients(2 eyes) with non-Hodgkin’s lymphoma and 2 patients(2 eyes) with orbital-nasal malignant tumors.The average duration of suffering from disease,such as infective inflammation,inflammatory pseudotumor,sj?gren syndrome,thyroid associated ophthalmopathy and tumors,was 10.0,34.0,25.0,7.0 and 140.0 days separately.All patients had acute or subacute ocular inflammation,but in varying degrees and different peculiarity,and imaging examination had the value in differential diagnosis.The therapies were based on accurate diagnoses.But as an emergency treatment,prompt and adequate use of antibiotics locally and systemically was recommended,and mannitol dehydrate was used to decrease orbital pressure and protect visual function.In the patients of ineffective antibiotic treatment,a small dose of corticosteroid was used in the diagnostic treatment.With regard to the clear orbital tumor,combined operation was executed in the treatment as appropriate.The infectious inflammations usually didn’t relapse after the pathogens eradication.But the recurrence rate of inflammatory pseudotumor was high.Malignant tumors usually had poor prognosis.Conclusion Orbital inflammation is the most common clinical pathologic process in orbital disease.Acute inflammation often performs like orbital cellulitis,but the etiology diagnoses are diverse and complicated.Medical history,clinical manifestation,imaging and lab examinations must be analyzed synthetically in order to make proper etiological diagnosis.The correct diagnosis and appropriate treatment are crucial to avoid ocular function damage.