Pereira Filipe José, Bettega Ronaldo Brandão de Proença, Velasco e Cruz Antonio Augusto
Departamento de Plástica Ocular, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil.
Arq Bras Oftalmol. 2011 Jan-Feb;74(1):58-60. doi: 10.1590/s0004-27492011000100014.
This report describes the only case in the literature of globe luxation due to traumatic cerebrospinal fluid fistula to the orbit caused by fire gun with ocular globe maintenance. E.N., female, white, 7 months, admitted with left orbitocranial injury by fire gun. Ocular globe luxation was detected with complete ocular motility restriction and absence of pupillary reflex in the left orbit. Computed tomography showed fracture of the medial orbital wall; bone fragments near the apex of the orbit and a stretched optic nerve. Surgical exploration was performed, showing liquor fistula through the ethmoid-sphenoid wall that was blocked with sponge (Gelfoam®) plus organic glue in the left orbit posterior wall, with immediate resolution of the proptosis and ocular integrity maintenance. Although controversial, maintenance of the ocular globe instead of enucleation was performed due to the integrity of the globe in this case. Despite the blindness, we considered the result to the proposed treatment excellent, once the maintenance of the ocular globe provides a good appearance and will contribute to an adequate facial bone development.
本报告描述了文献中唯一一例因火枪导致创伤性脑脊液瘘至眼眶并伴有眼球保留的眼球脱位病例。E.N.，女性，白人，7个月大，因火枪致左眶颅损伤入院。检查发现左眼眶眼球脱位，眼球运动完全受限，瞳孔反射消失。计算机断层扫描显示眶内侧壁骨折；眶尖附近有骨碎片，视神经拉长。进行了手术探查，发现有脑脊液瘘通过筛骨 - 蝶骨壁，在左眼眶后壁用海绵（明胶海绵®）加生物胶封堵，眼球突出立即缓解，眼球完整性得以维持。尽管存在争议，但鉴于该病例中眼球的完整性，未行眼球摘除术而是保留了眼球。尽管患眼失明，但我们认为所提议的治疗效果极佳，因为保留眼球能保持良好外观，且有助于面部骨骼的正常发育。
