Acute Orbital Compartment Syndrome in a Patient with Sinusitis after Lacrimal Irrigation-A Case Report

鼻竇炎病人做完淚囊沖洗術後產生急性眼框腔室症候群之病例報告

劉俊賢(Chun-Hsien Liu) ； 蔡曉萱(Hsiao-Hsuan Tsai) ； 林珮玉(Pei-Yu Lin) ； 陳記得(Chi-Te Chen) ； 蔡傑智(Chieh-Chih Tsai) ； 高淑卿(Shu-Cing Kao) ； 許紋銘(Wen-Ming Hsu)

《中華民國眼科醫學會雜誌》 47卷1期 (2008/03) Pp. 75-79

https://doi.org/10.30048/ACTASOS.200803.0011

摘要

目的：報告一個患有急性鼻竇炎的青少年，在做完淚囊沖洗術之後，造成罕見的急性眼窩腔室症候群的案例
方法：病例報告
結果：一個14歲健康女孩，在接受鼻淚管沖洗術之後，左眼疼痛，眼球突出無法轉動，視力變模糊合併發燒。在眼科檢查，左眼窩壓力增加，眼壓43mmHg，最佳矯正視力左眼6/60，有結膜下充血及水腫。電腦斷層顯示有上頷竇及篩狀竇嶺炎，合併其旁邊左側眼窩上側及鼻側二處大範圍的骨膜下膿瘍。緊急替病患做左側外眥韌帶切開及分離術，並在二處骨膜下膿瘍處，分別用空針各抽出5c.c．紅褐色膿液，其左眼窩的壓力及疼痛立即得到緩解。但因為靜脈注射抗生素治療無效及眼眶腔室症候群復發，耳鼻喉科即安排內視鏡引流膿瘍手術，術後病人恢復良好，僅在眼角膜下方留下些須結疤。
結論：在急性鼻竇炎的病人，合併做完淚囊沖洗術之後，可能發生罕見的急性眼窩腔室症候群。

並列摘要

Purpose: To present an unusual case of acute orbital compartment syndrome in a patient with sinusitis after lacrimal irrigation.
Method: Interventional case report.
Results: A 14-year-old young girl presented with fever, acute proptosis, chemosis, decreased vision, and total ophthalmoplegia of left eye after lacrimal irrigation. Ophthalmologic evaluation showed a tense orbit and increased intraocular pressure reaching 43 mmHg. Computed tomography (CT) revealed the presence of sinusitis involving the maxillary and ethmoid sinuses and two large subperiosteal abscesses in left orbit. Immediate left lateral canthotomy and cantholysis, as well as needle aspiration of 10 ml of pus discharge relieved temporarily her orbital tension. However, the symptoms progressed despite intravenous antibiotics. Endoscopic surgical drainage was then performed by otolaryngologist. The patient recovered completely except for an inferior corneal scar.
Conclusion: Although rare, orbital compartment syndrome may develop in a patient with sinusitis after lacrimal irrigation.

並列關鍵字

Acute orbital compartment syndrome ； sinusitis ； subperiosteal abscess ； lacrimal irrigation