POSTPARTUM ORBITAL NONTRAUMATIC SUBPERIOSTEAL HEMORRHAGE: A CASE REPORT

自然產後導致眼窩骨膜下出血：案例報告

蔣孟君(Meng-Chun Chiang) ； 陳立仁(Lee-Jen Chen)

《中華民國眼科醫學會雜誌》 53卷2期 (2014/10) Pp. 135-141

https://doi.org/10.30048/ACTASOS.201410_53(2).0006

摘要

目的：報告一例自然產後導致眼窩骨膜下出血案例。方法：案例報告。結果：一名28歲女性因自然產後左眼腫脹凸出，視力模糊，被轉診至本院急診。病人左眼的最佳矯正視力為20/25。其左眼有眼外肌活動受限，且眼壓上升至30毫米汞柱。電腦斷層掃描顯示左眼眼窩骨膜下血腫，因此被診斷為左眼眼窩非創傷性眼窩出血。病人接受左眼外眼眥切開併靜脈注射降眼壓藥物治療後，其左眼眼凸及眼球活動受限症狀逐漸改善，雙眼最佳矯正視力恢復至20/20。兩個月後眼窩核磁共振掃瞄顯示眼窩組織無明顯異常。結論：眼窩骨膜下出血通常為眼窩或臉部創傷後罕見的後遺症，亦可能來自非外傷性的成因。本案例希望能提高大家臨床診斷上的警覺。在沒有明顯視神經壓迫的情況下通常可進行觀察性的藥物治療，而及早積極介入進一步的降低眼壓亦可預防病人產生不可逆的永久性視力病變。

並列摘要

Purpose: To report a case of postpartum orbital nontraumatic subperiosteal hemorrhage (NTSPH). Method: A case report. Result: A 28 year-old female was referred to our emergency department with periorbital swelling, proptosis, and blurred vision of the left eye immediately after delivery. Her best-corrected visual acuity (BCVA) in the left eye was 20/25. Mild limitations in extraocular movement and elevated intraocular pressure (IOP) (30mmHg) were observed in the left eye. Computed tomography (CT) of the orbits showed a left superior subperiosteal hematoma; postpartum orbital NTSPH of the left eye was diagnosed. The patient underwent lateral canthotomy with intravenous injection of Mannitol to reduce IOP. The gradual resolution of proptosis was observed, with a nearly complete recovery of ocular motility. Her BCVA returned to 20/20 in both eyes. Orbital magnetic resonance imaging (MRI) performed 2 months later showed no significant abnormalities. Conclusion: Orbital subperiosteal hemorrhage is a rare sequela of traumatic periorbital or facial injury that can also develop without antecedent trauma. Our case highlights the need for the diagnostic suspicion of orbital subperiosteal hemorrhage arising in a nontraumatic setting. Conservative treatment without optic nerve compression is acceptable in many cases. At the same time, early intervention to further reduce IOP may also be considerable, as this may seriously affect the visual prognosis.

並列關鍵字

labor ； orbital hemorrhage ； postpartum ； subperiosteal hemorrhage ； Valsalva maneuver