Lei Jia-Ying, Wang Hong
Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China.
World J Clin Cases. 2022 Feb 16;10(5):1689-1696. doi: 10.12998/wjcc.v10.i5.1689.
Orbital hemorrhage can be classified as traumatic or spontaneous depending on its cause. Spontaneous orbital hemorrhage refers to an internal orbital hemorrhage without apparent cause. Therefore, we aimed to describe a case of an orbital hematoma after a severe cough the night before due to inhalation of cooking oil fumes.
A 46-year-old woman was referred to our hospital with a complaint of exophthalmos accompanied with blurred vision, pain, binocular diplopia, and dizziness lasting for 5 h noted on waking in the morning. She also experienced nausea and vomiting due to high pressure of orbit and dizziness. Based on the auxiliary examination and her medical history, the patient was finally diagnosed with bulbar conjunctival vascular lesion combined with spontaneous retrobulbar hematoma. The patient was administered tobramycin and dexamethasone eye ointment, and applied pressure dressing on the left eye to stop the bleeding. Simultaneously, we administered intravenous etamsylate, oral Yunnan Baiyao capsule, intravenous mannitol to reduce orbital pressure, and intravenous dexamethasone injection at 10 mg/dL combined with neurotrophic therapy to reduce tissue edema. Among them, the Yunnan Baiyao capsule is a traditional Chinese herbal medicine to remove stasis and stop bleeding; thus, it promotes blood circulation and relieves pain resulting in reduced edema of the lesion site. The symptoms did not improve significantly during the first 2 d of treatment. We speculate that high orbital pressure and binocular diplopia induced frequent nausea and vomiting in the patient, causing increased pressure on the superior vena cava and leading to repeated orbital bleeding. After the second day, the symptoms started gradually improving.
This case further emphasizes the importance of comprehensive, detailed medical history and careful ophthalmic examination of the patient.
眼眶出血可根据病因分为外伤性或自发性。自发性眼眶出血是指无明显病因的眼眶内出血。因此，我们旨在描述一例因前一晚吸入烹饪油烟后剧烈咳嗽导致眼眶血肿的病例。
一名46岁女性因晨起出现眼球突出伴视力模糊、疼痛、双眼复视和头晕5小时前来我院就诊。由于眼眶压力高和头晕，她还出现了恶心和呕吐。根据辅助检查和病史，患者最终被诊断为球结膜血管病变合并自发性球后血肿。给予患者妥布霉素和地塞米松眼膏，并对左眼进行加压包扎以止血。同时，静脉滴注酚磺乙胺，口服云南白药胶囊，静脉滴注甘露醇以降低眼眶压力，并静脉注射地塞米松10mg/dL联合神经营养治疗以减轻组织水肿。其中，云南白药胶囊是一种活血化瘀、止血的传统中药；因此，它促进血液循环、缓解疼痛，从而减轻病变部位的水肿。治疗的前两天症状改善不明显。我们推测眼眶压力高和双眼复视导致患者频繁恶心和呕吐，导致上腔静脉压力升高，进而导致反复眼眶出血。第二天后，症状开始逐渐改善。
该病例进一步强调了全面、详细的病史和对患者进行仔细眼科检查的重要性。
