Kelpin John P, Fahrenkopf Matthew P, Van Pelt Andrea E
Michigan State University College of Human Medicine.
Spectrum Health/Michigan State University Plastic and Reconstructive Surgery Residency.
J Craniofac Surg. 2018 Oct;29(7):1829-1831. doi: 10.1097/SCS.0000000000004521.
Injection injuries occur most commonly in the hand and digits; however, there are a limited number of reports in the literature describing injection injuries involving the orbit. High-pressure orbital injection injuries pose a number of unique challenges to the treating physician, and the approach to treating these injuries remains controversial. Often times, the extent of tissue damage is not fully appreciated at presentation, which may lead to missed diagnoses or inadequate initial treatment. In this study, the authors describe a rare incidence of high-pressure orbital injection injury. A 19-year-old male presented to the emergency department after injection of his left orbit with oil-based paint. Worsening clinical symptoms and increasing intraocular pressures within the first 24 hours necessitated take back to the operating room for orbital decompression and debridement. After an initial improvement in symptoms, the patient's clinical status deteriorated again, requiring further orbital decompression and additional periorbital debridement. Two weeks after initial presentation, soft tissue reconstruction of the surgical wounds was performed with full thickness skin grafts. The patient's globe and vision were both preserved. Orbital injection injuries, though rare, are potential globe threatening injuries. Physicians should have a low threshold for intervention and patient's must be observed closely over the first 72 hours after injury. Early diagnosis, prompt debridement, and a multidisciplinary approach are keys to improving patient outcomes.
注射伤最常发生于手部和手指；然而，文献中描述涉及眼眶的注射伤的报告数量有限。高压眼眶注射伤给治疗医生带来了许多独特的挑战，并且治疗这些损伤的方法仍存在争议。通常，在就诊时组织损伤的程度并未得到充分认识，这可能导致漏诊或初始治疗不充分。在本研究中，作者描述了一例罕见的高压眼眶注射伤病例。一名19岁男性在左眼眼眶注射油性颜料后就诊于急诊科。在最初24小时内临床症状恶化且眼内压升高，因此需要返回手术室进行眼眶减压和清创。症状初步改善后，患者的临床状况再次恶化，需要进一步的眼眶减压和额外的眶周清创。初次就诊两周后，用全厚皮片对手术伤口进行软组织重建。患者的眼球和视力均得以保留。眼眶注射伤虽然罕见，但却是潜在的威胁眼球的损伤。医生应降低干预阈值，并且必须在受伤后的最初72小时内密切观察患者。早期诊断、及时清创以及多学科方法是改善患者预后的关键。
