創傷性眼眶積氣及皮下氣腫－二例報告

眼眶爆裂性骨折是因眼球受鈍器撞擊，使眼眶內壓增加，導致眼眶四壁發生骨折。臨床上病人呈現複視、視力減退、眼球運動受限、眼球內陷、眼眶周圍腫脹及皮下氣腫等症狀，其發生率一般以底部骨折最常見。單純的內壁骨折較罕見，易造成眼眶與篩竇的單向瘻管，由於可存在多年，病人在用力擤鼻後突然造成眼眶積氣和皮下氣腫，求診時常已忘記前創傷史。本科在1998年6月間連續接獲兩起眼科轉診而來，因擤鼻造成眼凸臉腫的病人，1例是剛發生臉部創傷，另1例則回溯3年前曾有右眼創傷的病史，兩例經電腦斷層攝影診斷為眼眶內壁骨折，因病人皆視力正常，無眼球運動受限及眼球內陷，經內科治療，且告誡病人不可用力擤鼻後，追蹤至今4個月顯示已無復發或其他併發症。

關鍵字

眼眶爆裂性骨折；眼球內陷；眼眶積氣；皮下氣腫

並列摘要

Orbital blow-out fracture is a fracture of the four walls of the orbit result-ing from a sudden increase in intraorbital pressure due to blunt impact. Clin-ically, the patient has diplopia, decreased visulal acuity, limited eye ball movement, enopththalmus, peri-orbital swelling and subcutaneous emphy-sema. Orbital floor fracture is the most common fracture. Simple medial wall frature, on the other hand, is much rarer and often complicated with a one way fistula between he orbit and the ethmoid sinus which may persist for years. The patient might seek help because of the symptoms and signs of pneumo-orbitum and subcutaneous emphysema after forceful nose blow-ing and may not even remember past trauma. In June 1998, two patients were consecutively referred to us by an ophthalmologist due to exophthal-mos and facial swelling after a nose blowing. One of them suffered only from facial trauma while the other had history of a trumatic injury to the right eye three years ago. Both were diagnosed with orbital medial wall fracture after computed tomography scan examination. Since both patients had no visual acuity impairment, extraocular movement limitation or enoph-thalmos, they received conservative treatment and were instructed not to blow their noses. They were followed for four months without any recur-rences or complications. Orbital blow-out fracture does not always need surgery, depending on the patient’s clinical condition.

並列關鍵字

orbital blow out fracture ； enophthalmos ； pneumo-orbitum ； subcutaneous emphysema

國際替代計量

創傷性眼眶積氣及皮下氣腫－二例報告

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