Rose Geoffrey E, Lund Valerie J
Orbital Service, Moorfields Eye Hospital, London, England.
Ophthalmology. 2003 Apr;110(4):819-26. doi: 10.1016/S0161-6420(02)01994-2.
To review the clinical and radiologic characteristics of a group of patients who experienced late enophthalmos after bone-removing orbital decompression. The surgical management of these patients is presented and a hypothesis proposed to explain the idiopathic "imploding antrum" ("silent sinus") syndrome.
Retrospective, noncomparative case series.
Six patients experienced relative enophthalmos, hypoglobus, and upper eyelid sulcus deformity at between 3 and 6 months after bone-removing orbital decompression for thyroid orbitopathy. Five left orbits and one right orbit were affected.
All patients underwent middle meatal antrostomy, together with mobilization and elevation of the collapsed orbital contents by firm packing of the affected maxillary antrum through a buccal antrostomy, the pack being removed about 3 weeks after placement.
Symptomatic improvement and reduction in the degree of relative enophthalmos, hypoglobus, and upper eyelid sulcus deformity.
Late-onset enophthalmos after orbital decompression was associated with clinical and radiologic features that resemble the idiopathic imploding antrum syndrome. In all patients, the ethmoidal infundibulum was obstructed by prolapsed orbital fat with secondary antral consolidation, and inward bowing of the maxillary walls was present in five of six patients. After antral drainage and packing, there was an improvement in enophthalmos (mean, 2.7 mm; range, 0-4 mm) and all but one globe returned to within 2 mm of exophthalmometry of the contralateral eye. For recurrent enophthalmos in two patients (minor in one patient and marked in the other), later repair of the orbital floor was undertaken through a lower eyelid swinging flap, using porous polythene sheet, with good cosmetic outcome.
Late-onset enophthalmos after bone-removing orbital decompression seems to be the result of obstruction of maxillary antral aeration, with secondary fluid retention and a subatmospheric pressure in the sinus. This iatrogenic condition, associated in most cases with inward collapse of the maxillary walls, provides a guide to a hypothetical mechanism for the idiopathic imploding antrum (silent sinus) syndrome.
回顾一组在眼眶减压术后出现晚期眼球内陷患者的临床及影像学特征。介绍这些患者的手术治疗方法，并提出一个假说来解释特发性“鼻窦内陷”（“静息性鼻窦”）综合征。
回顾性、非对照病例系列研究。
6例因甲状腺相关性眼病行眼眶减压术后3至6个月出现相对性眼球内陷、眼球下转及上睑沟畸形的患者。受累眼眶中，5例为左侧，1例为右侧。
所有患者均接受中鼻道上颌窦造瘘术，同时通过颊侧上颌窦造瘘对上颌窦进行紧密填塞，使塌陷的眶内容物得以活动并抬高，填塞物在放置约3周后取出。
症状改善情况以及相对性眼球内陷、眼球下转和上睑沟畸形程度的减轻。
眼眶减压术后晚期眼球内陷与一些临床及影像学特征相关，这些特征类似于特发性鼻窦内陷综合征。所有患者的筛漏斗均被脱垂的眶脂肪阻塞，继发鼻窦实变，6例患者中有5例出现上颌窦壁向内凹陷。上颌窦引流及填塞后，眼球内陷有所改善（平均改善2.7mm；范围为0至4mm），除1例患者外，其余患者的眼球突出度均恢复至与对侧眼相差2mm以内。对于2例复发性眼球内陷患者（1例为轻度，另1例为重度），后期通过下睑旋转瓣，使用多孔聚乙烯片对眶底进行修复，美容效果良好。
眼眶减压术后晚期眼球内陷似乎是上颌窦通气受阻、继发液体潴留及窦内负压的结果。这种医源性情况在大多数病例中与上颌窦壁向内塌陷相关，为特发性鼻窦内陷（静息性鼻窦）综合征的假说机制提供了指导。
