贯穿眼眶鼻窦巨大异物摘出术1例报告

A case report:removal of a giant foreign body through the orbit and paranasal sinus

患者男性,53岁,因左眼被勺子插入流血伴视力下降20 h就诊眼科。既往史:精神分裂症、高血压、2型糖尿病。眼科查体所见:左眼视力0.25,眼压33 mmHg(1 mmHg=0.133 kPa)。上睑鼻侧可见不规则裂伤,眼睑肿胀,上睑呈下垂状态,不能上举,鼻侧结膜见裂伤,瞳孔散大,直径4.5 mm,直接对光反射迟钝,相对性传入性瞳孔障碍(+),视网膜平伏。眼位:33 cm角膜映光:+10°R/L 10°,眼球各方向运动均受限。CT提示贯穿眼眶鼻窦巨大条状异物。急诊全麻下行左眼眶异物摘出,术中经鼻内镜下松解异物后端,经原入路完整取出异物,术后视力提高,眼球运动改善。

A 53-year-old male patient presented to the ophthalmology department with 20 hours of bleeding and vision loss due to spoon insertion in his left eye.Past history suggested:schizophrenia,hypertension,and type 2 diabetes.Ophthalmologic examination revealed:visual acuity of left eye 0.25,intraocular pressure 33 mmHg(1 mmHg=0.133 kPa),irregular laceration of the nasal side of the upper eyelid,eyelid swelling,upper eyelid drooping state,unable to lift up,laceration of the nasal conjunctiva,pupil dilation,diameter 4.5 mm,relative afferent pupillary defect(+),and retinal flattening.Eye position was 33 cm;corneal reflection was+10°R/L 10°,and eye movement was limited in all directions.CT showed a giant strip-shaped foreign body passing through the orbit and paranasal sinuses.The foreign body was removed from the left orbit under emergency general anesthesia.During the operation,the rear end of the foreign body was released under nasal endoscopy,and the foreign body was completely removed through the original approach.Postoperative visual acuity and eye movement got improved.