ABSTRACT
A proptose do globo ocular é uma das consequências comuns do trauma e a enucleação é um procedimento de escolha em caso de impossibilidade de reversão do quadro. Nota-se a infrequência de relatos de enucleação do globo ocular resultante de proptose traumática, o que torna importante a descrição deste caso, a qual objetiva fornecer relevantes informações e contribuições para o desenvolvimento da oftalmologia e clínica cirúrgica veterinária. Uma cadela filhote foi atendida no HVU - UFPI/CPCE, apresentando o globo ocular direito prolapsado. A enucleação foi selecionada em decorrência do intervalo prolongado entre a detecção da lesão e a busca por assistência médica, da presença de uma alta carga de corpos estranhos observados e da ausência de reflexos pupilares. A cirurgia iniciou-se com a cantotomia seguida da dissecação da musculatura do globo ocular. Foi realizado o pinçamento dos vasos sanguíneos e do nervo óptico, e fez-se a ressecção do globo ocular. Depois de uma ligadura invaginante e redução do espaço morto, removeu-se as bordas palpebrais e realizou-se a blefarorrafia. Cerca de 40 dias após a enucleação, a cadela apresentou-se estável e com uma evolução cicatricial satisfatória do ferimento cirúrgico. Esse procedimento, foi realizado de forma semelhante ao que é visto na literatura, embora, majoritariamente, seja recomendada a enucleação em decorrência de afecções diferentes da proptose traumática.(AU)
Proptosis of the eyeball is one of the common consequences of trauma and enucleation is the procedure of choice if it is impossible to reverse the condition. There are few reports of enucleation of the eyeball resulting from traumatic proptosis, which makes it important to describe this case, which aims to provide relevant information and contributions to the development of ophthalmology and veterinary surgical practice. A female puppy was seen at the HVU - UFPI/CPCE, presenting with a prolapsed right eyeball. Enucleation was selected due to the prolonged interval between detecting the lesion and seeking medical assistance, the presence of a high foreign body burden and the absence of pupillary reflexes. Surgery began with canthotomy followed by dissection of the eyeball muscles. The blood vessels and optic nerve were clamped and the eyeball was resected. After an invaginating ligature and reduction of the dead space, the eyelid edges were removed and blepharorrhaphy was performed. Around 40 days after enucleation, the dog was stable and had satisfactory healing of the surgical wound. This procedure was carried out in a similar way to that seen in the literature, although enucleation is mostly recommended for conditions other than traumatic proptosis.(AU)
La proptosis del globo ocular es una de las consecuencias comunes de los traumatismos y la enucleación es el procedimiento de elección si es imposible revertir la condición. Existen pocos relatos de enucleación del globo ocular resultante de proptosis traumática, lo que torna importante la descripción de este caso, que pretende proporcionar informaciones relevantes y contribuciones para el desarrollo de la oftalmología y de la práctica quirúrgica veterinaria. Una cachorra fue atendida en el HVU - UFPI/CPCE con prolapso del globo ocular derecho. Se optó por la enucleación debido al prolongado intervalo entre la detección de la lesión y la búsqueda de asistencia médica, la presencia de una elevada carga de cuerpo extraño y la ausencia de reflejos pupilares. La cirugía comenzó con una cantotomía seguida de la disección de los músculos del globo ocular. Se pinzaron los vasos sanguíneos y el nervio óptico y se resecó el globo ocular. Tras una ligadura invaginante y la reducción del espacio muerto, se retiraron los bordes de los párpados y se realizó una blefarorrafia. Unos 40 días después de la enucleación, el perro estaba estable y la herida quirúrgica había cicatrizado satisfactoriamente. Este procedimiento se llevó a cabo de forma similar a lo visto en la bibliografía, aunque la enucleación se recomienda sobre todo para afecciones distintas de la proptosis traumática.(AU)
Subject(s)
Animals , Female , Eye Enucleation/veterinary , Exophthalmos/surgery , Dogs/surgeryABSTRACT
El acceso transconjuntival asociado a cantotomía lateral ha sido utilizado para permitir una mejor visualización de fracturas del piso de órbita. Esta técnica ha reportado entropión, ectropión y complicaciones en el reposicionamiento tarsal. Para disminuir la morbilidad descrita, hemos complementado este acceso con otra técnica denominada "Cantolisis Lateral" la que ha sido ampliamente utilizada como tratamiento de urgencia para hematoma retrobulbar, con pocos reportes sobre su utilidad en el tratamiento de las fracturas orbitarias. Reportamos los resultados post operatorios de la aplicación de la técnica cantolisis lateral como complemento al acceso transconjuntival en una serie de casos de 16 pacientes. La distopía cantal y la discontinuidad del tarso inferior fueron las complicaciones más frecuentes reportadas. Sin embargo, los pacientes no se percataron de ellas. No se reportaron ectropión ni entropión.
Transconjunctival approach associated with lateral canthotomy has been used to allow a better visualization of orbital floor fractures. This technique has reported entropion, ectropion and complications in tarsal repositioning. To decrease the described morbidity, we have complemented this approach with another technique called "Lateral Cantholysis" which has been widely used as an emergency treatment for retrobulbar hematoma, with few reports about its usefulness in the treatment of orbital fractures. We report the postoperative results of the application of the lateral cantholysis technique as a complement to the transconjunctival approach in a case series of 16 patients. Cantal dystopia and lower tarsal discontinuity were the most frequent complications reported. However, patients were not aware of them. No ectropion or entropion were reported.
Subject(s)
Humans , Male , Female , Orbital Fractures , Therapeutics , Emergency TreatmentABSTRACT
Resumen Durante la cirugía endoscópica nasosinusal, la sección inadvertida y retracción hacia la órbita de la arteria etmoidal anterior (AEA) es el mecanismo habitual del hematoma orbitario (HO); éste se manifiesta con proptosis, dolor y déficit visual potencialmente irreversible. El déficit visual es secundario a isquemia del nervio óptico por aumento de la presión intraocular, siendo suficientes treinta minutos para que ocurra daño visual permanente. Por sus secuelas el tratamiento del HO debe ser rápido y agresivo. Presentamos el caso de un varón de 72 años con diagnóstico de rinosinusitis crónica con pólipos nasales refractaria a tratamiento médico que se sometió a cirugía endoscópica nasal y que desarrolló en el posoperatorio inmediato con un HO. Se manejó precozmente con cantotomía-cantolisis, descompresión orbitaria medial endoscópica y control vascular de la AEA. El paciente evoluciona favorablemente, sin déficit visual. En este artículo se discutirán el diagnóstico y manejo oportunos del hematoma orbitario iatrogénico.
Abstract During endoscopic sinonasal surgery, inadvertent section of the anterior ethmoidal artery (AEA) with retraction into the orbit is the usual mechanism of orbital hematoma (OH), leading to proptosis, pain, and potentially irreversible visual loss. Thirty minutes is sufficient for retinal ischemia and permanent visual loss. The explanation for blindness is due to increased intraorbital pressure. The treatment of iatrogenic HO must be quick and aggressive, because if it is not managed in time, it can cause a permanent visual deficit. We present the case of a 72-year-old man with a diagnosis of chronic rhinosinusitis with nasal polyps refractory to medical treatment who underwent nasal endoscopic surgery, evolving in the immediate postoperative period with an HO, requiring canthotomy - cantolysis and early surgical reintervention for endoscopic medial orbital decompression and vascular control of AEA. The patient evolves favorably, without visual deficit. This article will discuss the timely diagnosis and management of iatrogenic orbital hematoma.
Subject(s)
Humans , Male , Aged , Orbital Diseases/etiology , Nasal Polyps/surgery , Endoscopy/adverse effects , Hematoma/etiology , Endoscopy/methods , Hemorrhage/etiologyABSTRACT
PURPOSE: Lateral canthoplasty is utilized in aesthetic surgery to lengthen the lateral palpebral fissure of the lateral canthal area. However, complication such as recurrence, contour deformity or hypertrophic scar make its results doubtful. Therefore, we developed lateral canthoplasty with lateral canthotomy and Y-V advancement to effectively lengthen the palpebral fissure without recurrence. METHODS: A total number of 117 patients were reviewed from March 1991 to April 2005. The operative procedure was lateral canthoplasty with lateral canthotomy and Y-V advancement. To prevent recurrence, we dissected lateral conjunctiva of lower eyelid and cutted retaining ligament. The author believes that by this procedure, V flap would be able to advance laterally without tension. RESULTS: We performed lateral canthoplasty in 117 patients. There were no recurrence and patients were satisfied with the results. There were 12 patients who presented with complication. Complication included hypertrophic scar in 4 patients, web formation in 3 patients and over-correction in 5 patients. CONCLUSION: Lateral canthoplasty with lateral canthotomy and simple Y-V advancement may be used as an effective method to lengthen palpebral fissure without recurrence.
Subject(s)
Humans , Cicatrix, Hypertrophic , Congenital Abnormalities , Conjunctiva , Eyelids , Ligaments , Recurrence , Surgical Procedures, OperativeABSTRACT
PURPOSE: The globe luxation is a rare phenomenon in which there is a forward displacement of the eye ball so that the eye lids spasmodically close behind it. In Korea, no case has been reported. The authors experienced a case of globe luxation by laceration of the conjunctiva with trauma. METHODS: The authors experienced a case of globe luxation in 64-year-old male who had crushed with infantile marry-go-round handle and complained proptosis and ocular pain. Ocular examination revealed best corrected visual acuity of right eye 0.1, IOP 44mmHg, conjunctival hyperemia and laceration, extraocular muscle limitation in all direction. Exophthalmometer shows right eye 23mm, left eye 19mm. Orbital CT yielded proptosis and globe luxation without avulsion of internal and external rectus muscle and optic nerve. RESULTS: After the lateral canthotomy, we successfully treated with the corticosteroid therapy without visual impairment or eyeball movement disorder. we report a case of globe luxation with the review of literature.
Subject(s)
Humans , Male , Middle Aged , Conjunctiva , Exophthalmos , Hyperemia , Korea , Lacerations , Movement Disorders , Optic Nerve , Orbit , Vision Disorders , Visual AcuityABSTRACT
Cavernous hemangiomas are one of the most common benign tumors of the orbit in adults. We report a case of a longstanding retrobulbar hemangioma that was removed successfully through a temporal transconjunctival approach combined with lateral canthotomy. A 45-year-old female patient, with a 15-year history of slowly progressive proptosis and decreased visual acuity of the left eye, had a corrected visual acuity of finger count at 50 cm OS, compared with 1.0 OD. Exophthalmometry by the Nagle's method measured 15 mm OD by 26 mm OS. Magnetic resonance imaging (MRI) revealed a well-encapsulated retrobulbar main mass, 2.3 x 3.0 x 3.7 cm in size along with multiple small satellite nodules that were displacing the optic nerve and globe superiorly. The tumors were removed through a superotemporal transconjunctival approach combined with lateral canthotomy. Pathological examination revealed an intraorbital cavernous hemangioma. The patient was free of visible scars, proptosis and any other noticeable complications at her last follow-up, 6 months after surgery.
Subject(s)
Female , Humans , Conjunctiva/surgery , Hemangioma, Cavernous/pathology , Magnetic Resonance Imaging , Middle Aged , Ophthalmologic Surgical Procedures/methods , Orbital Neoplasms/pathology , Treatment OutcomeABSTRACT
The authors have encountered two patients who had complete traumatic eyeball extrusion by trauma with different mechanism. One was a 2-year-old child who fell down from a baby stroller and had the left eyeball extrusion without any trauma to the body except eye. The other was 29-year-old man whose right orbit was pierced by a spit and had right eyeball extrusion too. After the authors reposed traumatic complete eyeball extrusion by Kronlein operation, lateral canthotomy, and antholysis, the authors obtained excellent cosmetic results. Especially, these are very rare cases of the pure eye ball extrusion without another trauma of the body. Therefore, the authors report the experience of the operative treatment of these rare cases.