Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
Orbit. 2023 Aug;42(4):445-449. doi: 10.1080/01676830.2022.2034169. Epub 2022 Feb 7.
A 19-year-old with blunt trauma and repeated nose blowing presented with orbital emphysema and orbital compartment syndrome. Orbital emphysema is the abnormal presence of air within the orbit, typically secondary to trauma. Most cases will resolve with observation alone, however orbital compartment syndrome is a feared complication that necessitates urgent decompression. A superior fornix, trans-conjunctival approach was safely utilized to decompress the orbit while avoiding unwanted complications. Various decompression techniques have previously been described, most of which describe trans-palpebral approaches. The key safety benefit to the trans-conjunctival approach is direct visualization of the needle tip adjacent to the superior fornix, therefore posterior to the equator of the globe. With the needle positioned parallel to the curvature of the globe at the equator, the posterior sclera surface curves away from the tip, rendering it difficult to pierce the globe. In addition, the needle needs to be advanced only 3-4 millimeters and traverses only the conjunctiva and Tenon's to enter the central surgical space - the most direct route to the air pocket. The trans-conjunctival approach lowers the risk of damage to eyelid neurovascular structures and is less painful.
一位 19 岁的患者因钝器伤和反复擤鼻而出现眶气肿和眶隔综合征。眶气肿是指眼眶内异常存在空气，通常是外伤引起的。大多数情况下仅通过观察即可解决，但眶隔综合征是一种可怕的并发症，需要紧急减压。采用上穹窿结膜入路安全地对眼眶进行减压，同时避免不必要的并发症。先前已经描述了各种减压技术，其中大多数描述了经皮入路。经结膜入路的关键安全优势是可以直接观察到针尖位于上穹窿附近，因此位于眼球赤道的后方。将针尖定位在赤道处与眼球曲率平行，后巩膜表面从针尖处向外弯曲，使得很难刺穿眼球。此外，只需将针推进 3-4 毫米，并穿过结膜和 Tenon 即可进入中央手术空间-到达气袋的最直接途径。经结膜入路降低了损伤眼睑神经血管结构的风险，并且疼痛较轻。
