眼窩骨膜下快速加大的膿瘍－病例報告

Rapid Progressed Subperiosteal Abscess in Orbital Cellulitis-A Case Report

林鴻源(Horng-Yourn Lin) ； 蘇家聖(Jia-Sheng Su) ； 薛琴(Ching Shiue)

《中華民國眼科醫學會雜誌》 33卷4期 (1994/12) Pp. 524-530

https://doi.org/10.30048/ACTASOS.199412.0016

摘要

副鼻竇炎及其手術造成的併發症一般都是很輕微的，但偶而也會有嚴重的併發症產生。本篇報告一例23歲男性，2個月前接受副鼻竇手術治療，現在突然發生左眼眶紅、腫、熱、痛、視力降低、凸眼及高眼壓，並且快速惡化。以超音波及電腦斷層發現是眼窩骨膜下快速加大的膿瘍，我們認為是復發性副鼻竇炎或手術造成的併發症；因膿瘍侵犯並破壞血管，引起出血流入膿瘍，因此膿瘍快速加大。經外眥切開、在超音波引導下進行穿刺引流及抗生素治療，配合耳鼻喉科手術清除殘餘的肉芽腫及息肉，將病人的狀況迅速改善並挽救了病人的視力。
本例在臨床上很罕見，故提出以討論早期診斷、適當抗生素治療和及時手術治療的重要。

並列摘要

Most of the complications caused by the paranasal sinusitis itself and surgical treatment are very mild. But sometimes a few severe complications may happen. We report a 23 year-old male who had received bilateral surgical treatment of the chronic paranasal sinusitis. Sudden onset of painful progressive exophthalmus and severe deterioration of the visual acuity of left eye were noted 2 months after surgical treatment. Local heat and swelling over orbital area, downward displacement of the glob, abnormal pupillary signs and high intraocular pressure were also found. Orbital CT and sonography revealed a rapid progressed subperiosteal abscess in orbit. The Symptoms and signs subsided after canthotomy, drainage under sonographic guide and systemic antibiotic treatment, also in combination with endoscopic sinus drainage. We successfully saved the vision of the patient. Because of its rarity we reported it and discussed the importance of the early diagnosis, sensitive antibiotics and surgical intervention in time.

並列關鍵字

Orbital Subperiosteal Abscess ； Paranasal Sinusitis