Holds J B, Patrinely J R, Zimmerman P L, Anderson R L
Department of Ophthalmology, St. Louis University School of Medicine, MO 63104.
Ophthalmology. 1993 Oct;100(10):1475-82. doi: 10.1016/s0161-6420(93)31453-3.
A high-pressure stream from mechanical equipment may inject gas or liquids deep into the orbit with few initial clinical signs. Aggressive surgical debridement as used in the extremities for the treatment of injection injuries is not possible in the orbit.
Four patients with orbital injection injuries from farm or industrial equipment are presented. Previously reported cases of high-pressure injection injury are reviewed.
Two patients suffered localized anterior orbital inflammation partially responsive to steroidal and nonsteroidal anti-inflammatory agents. Late debridement was required in one patient for a persistent lipogranuloma. Two patients suffered more dramatic and diffuse injections of hydrocarbon mixtures, requiring emergent early surgical debridement and decompression for compressive orbital signs. All patients attained an adequate functional outcome, with one patient's vision limited by a coexisting ocular injury.
High-pressure orbital injection injuries manifest a spectrum of signs ranging from acute inflammation with tissue necrosis and compressive visual loss to late chronic inflammation with a pseudotumor-like course. The authors recommend the initial treatment of orbital injection injuries with systemic antibiotics followed by prompt neuroradiologic imaging. Systemic corticosteroids should be added for confirmed injection injuries with surgical debridement of discrete masses and orbital decompression when indicated. Continued therapy with anti-inflammatory medication may be required to suppress chronic inflammation with selective late surgical debridement of lipogranulomas.
机械设备产生的高压流可能将气体或液体深深注入眼眶，初期临床症状较少。在眼眶部位无法像在四肢那样采用积极的手术清创来治疗注射伤。
介绍了4例因农用或工业设备导致眼眶注射伤的患者。回顾了先前报道的高压注射伤病例。
2例患者出现局限性眼眶前部炎症，对甾体类和非甾体类抗炎药有部分反应。1例患者因持续性脂肪肉芽肿需要进行后期清创。2例患者遭受了更严重且弥漫性的碳氢化合物混合物注射，因出现眼眶压迫体征需要紧急早期手术清创和减压。所有患者均获得了良好的功能预后，1例患者的视力因并存的眼外伤而受限。
高压眼眶注射伤表现出一系列体征，从伴有组织坏死和压迫性视力丧失的急性炎症到具有假瘤样病程的后期慢性炎症。作者建议眼眶注射伤的初始治疗采用全身抗生素，随后进行快速神经放射学成像检查。对于确诊的注射伤，应加用全身糖皮质激素，必要时对离散肿块进行手术清创并进行眼眶减压。可能需要持续使用抗炎药物来抑制慢性炎症，并对脂肪肉芽肿进行选择性的后期手术清创。
