Puskesmas Sumberpitu Primary Health Care, Pasuruan, East Java, Indonesia.
Bunda Pengharapan Hospital, Merauke, South Papua, Indonesia.
Pan Afr Med J. 2023 Mar 17;44:136. doi: 10.11604/pamj.2023.44.136.38426. eCollection 2023.
Proptosis, an abnormal protrusion of the eyeball, is a manifestation of a wide variety of pathologies. The complication to be vision- or life-threatening makes early diagnosis is important, especially in rural primary health centers (PHCs) with far-distance referrals to capable hospitals. This case report examines a patient with obvious unilateral proptosis and blurry vision on the right eye for 4 years, with neglect because of prior inadequate diagnosis and explanation before the current complication. Examination shows no light perception, obvious proptosis (30 mm), exodeviation, and ophthalmoplegia. Referral for radiological examination showed a regular extra-axial lesion, well-defined, and broad-based on the right sphenoid wing with hyperostosis. The patient was diagnosed with sphenoid wing meningioma, which complicated into proptosis and blindness. This report aims to explain the current challenges of rural PHCs in Indonesia critically and to emphasize that rural PHCs should overcome the low level of public education, self-awareness of health, and tendency to reject the referral process. Clinicians also have a crucial role in early detection and prompt treatment to reduce further neglected cases.
眼球突出是一种异常突出，是多种疾病的表现。由于需要转诊到有能力的医院，因此早期诊断对于那些危及视力或生命的并发症尤为重要，尤其是在农村基层医疗中心（PHC）。本病例报告检查了一位患者，其右眼有明显的单侧眼球突出和视力模糊，已持续 4 年，由于之前的诊断不足和解释不充分，患者一直被忽视，直到目前出现并发症。检查发现无光感，明显的眼球突出（30 毫米），外斜视和眼肌麻痹。转诊进行影像学检查显示右侧蝶骨翼上有规则的、边界清楚的、基底宽阔的外轴位病变，并有骨质增生。患者被诊断为蝶骨翼脑膜瘤，并发眼球突出和失明。本报告旨在批判性地解释印度尼西亚农村 PHC 目前面临的挑战，并强调农村 PHC 应克服公众教育水平低、自我保健意识和对转诊过程的排斥倾向。临床医生在早期发现和及时治疗方面也起着至关重要的作用，以减少进一步被忽视的病例。
