Enoftalm is a pathological condition of an eyeball at which there is its excessive zapadeniye in an orbit cavity. It is clinically shown by a diplopiya, scotomas, violation of mobility of eyes, decrease in visual acuity. Diagnostics of an enoftalm is based on results of external examination, a palpation, ekzoftalmometriya, X-ray analysis, BRIDLES in the V-mode, KT, a vizometriya. Tactics of treatment is defined by an etiology. Decrease in volume of retrobulbarny cellulose – the indication to introduction of a suspension of adipocytes or implantation of artificial materials. At traumatic genesis of a disease the repozition of bone fragments is carried out, at inflammatory process antibacterial and kortikosteroidny therapy is performed.
Enoftalm is the disease in ophthalmology which is characterized by eyeball shift in back department of an orbit. For the first time pathology was described by the English surgeon V. Lang in 1889 when diagnosed eyeball shift on 8 mm in the post-traumatic period. The congenital option of pathology with an identical frequency occurs among persons men's and female. Often this kind of a disease is diagnosed at early children's age. Enoftalm of a traumatic origin comes to light at men of average years more often. The senile form of pathology develops in connection with involutional reduction of volume of retrobulbarny cellulose. It is found in patients 60 years are more senior. Features of geographical prevalence of a disease are not noted.
Reasons of an enoftalm
Distinguish the congenital and acquired forms of an enoftalm. Development of a disease can be caused by the reduction of the size of an eyeball caused mikroftalmy or a subatrophy as a result of a trauma. The chronic inflammation, age involution, violation traffic or a lipodistrofiya leads to atrophic or sclerous changes of soft tissues of eye-socket. Increase in the size of a sagittalny axis from a back pole to top of an orbit is observed at a congenital form of an enoftalm, anomalies of development of bones of a skull, is more rare after a trauma.
The eye arrangement in an eye-socket is influenced by extra-and intraorbital pathological processes. The most common cause of a zapadeniye of an eyeball – a change of bone structures of an orbit. Often leads the traumatic damage of its lower wall arising in a zone of an infraorbital opening to it. Enoftalm is one of symptoms of a fracture of malar bone. Depending on the direction of shift of otlomk at gunshot wounds can develop ekzo-or . Eye-socket injuries quite often are followed by an atrophy of soft fabrics that aggravates process even more. Less often the etiology of an enoftalm is connected with an atrophy of retrobulbarny cellulose at patients of old age, owing to the postponed inflammatory process or hemorrhage.
At the course of malignant process develops in cavities of an eye-socket (retinoblastoma) which after performing surgical treatment and radiation therapy can be replaced enoftalmy. This disease is included into simptomokompleks of a triad of Claude-Bernard-Horner at which there is also an omission of a century and . Injury of sympathetic nerves of cervical department is the reason of pathology. Injuries, a compression the aneurism increased by a thyroid gland, lymph nodes, malignant or good-quality new growths become provocative factors. Cases of development of an enoftalm at heavy exhaustion of an organism (cholera, anorexia, a paraneoplastic syndrome), a miksedema, peritonitis are described and in the agony period.
Symptoms of an enoftalm
From the clinical point of view distinguish early, late and imaginary forms of a disease. Often is monocular pathology, the asymmetric arrangement of eyeballs comes to light at an eyeball zapadeniye on 1 mm and more. The early option develops in a zone of shift of bone otlomk practically right after traumatizing. Only post-traumatic hypostasis of retroorbital cellulose can mask clinical manifestations. Emergence of a late form of an enoftalm is caused by a hypoplasia and sclerous changes of soft fabrics, an atrophy of glazodvigatelny muscles. It is more often observed after an inflammation, hemorrhage or defeat of cervical department of a sympathetic trunk. The clinic of an imaginary enoftalm is more characteristic of a congenital mikroftalm.
Patients with enoftalmy show complaints to doubling before eyes, loss of sites of a field of vision. Decrease in visual acuity is caused by injury of an optic nerve or retina at a trauma. In most cases is followed by violation traffic of glazodvigatelny muscles that when progressing a disease leads to their atrophy. At the same time patients note restriction of mobility of eyes, continuous narrowing of a pupil. Depending on localization of pathological process at a trauma development of a strabizm is possible. Also is a cosmetic defect at which against the background of deeply put eyes the specific folds on upper eyelids caused by retraction orbital furrows are formed.
If enters into Claude-Bernard-Horner's simptomokompleks, patients show complaints to the accompanying omission of an upper eyelid with a small raising lower that leads to narrowing of an eye crack. The accompanying symptoms – sweating violation, an injection of vessels of a conjunctiva and hyperaemia of face skin on the party of defeat. Also reaction of a pupil to light owing to narrowing of a pupil is broken. More rare is ophthalmologic manifestation of a syndrome of Parri-Romberg.
Diagnostics of an enoftalm
Diagnostics of an enoftalm is based on results of external examination, a palpation, ekzoftalmometriya, X-ray analysis, computer tomography (CT), ultrasonic diagnostics (BRIDLES) in the V-mode. When carrying out external examination eyeball shift deep into, narrowing of an eye crack, deepening of a skin fold over an upper eyelid comes to light. Palpatorno at a traumatic origin of an enoftalm is defined hypodermic emphysema and the increased morbidity. The method of an ekzoftalmometriya allows to diagnose a vystoyaniye or a zapadeniye of an eyeball not less than on 1 mm. This examination is conducted to patients with suspicion on for the purpose of establishment of the diagnosis and the choice of further tactics of treatment.
The X-ray analysis is shown to all patients enoftalmy at a stage of early diagnostics, the technique allows to visualize lines of a change and sites of shift of bone fragments. KT of an orbit is carried out for establishment of an etiology of a disease and assessment of volume of defeat. In an axial projection eyeball shift in back departments of an orbit, bone fragments, sites of hemorrhage and an atrophy of muscular tissue and retrobulbarny cellulose comes to light. Both methods give information on the X-ray contrast damaging agents (metal details, bullets). If at an enoftalma it is not possible to define exact localization of the trigger, it is necessary to carry out BRIDLES in the V-mode which allows to find foreign matters from a tree or flew down. The method of a vizometriya estimates extent of decrease in visual acuity.
Treatment of an enoftalm
Tactics of treatment of an enoftalm depends on a disease etiology. In case of development of pathology because of reduction of volume of cellulose of retrobulbarny space it is recommended to make an injection of a suspension of adipocytes after their preliminary aspiration of hypodermic fatty cellulose in the field of a forward belly wall of the patient. This procedure allows to carry out an eyeball repozition without development of an allergy and reaction of rejection. In the surgical way at an enoftalma it is possible to introduce in retrobulbarny space implants from solid silicone, the titan or polymeric connections.
Conservative therapy of an enoftalm after a trauma is carried out only to patients with insignificant manifestations (kzada shift less than 2 mm) without interposition of the lower direct ekstraokulyarny muscle and in the absence of doubling before eyes. Tactics of treatment comes down to purpose of a rate of antibacterial medicines and corticosteroids. Enoftalm of a traumatic origin at a zapadeniye more than 2 mm is the indication to a repozition of bone fragments. Surgery is carried out by subtsiliarny, transkonyyunktivalny or transantralny access. At the minimum manifestations of damage of a bottom of an eye-socket low-invasive operation with use of the endoscopic equipment is carried out.
For elimination of a pain syndrome oral administration of not narcotic analgetics is recommended. It is possible to liquidate hypostasis by means of instillation of hypertensive salt solutions. Inflammatory processes of an eyeball or retrobulbarny cellulose are the indication to purpose of antibacterial broad-spectrum agents and performing dezintoksikatsionny therapy.
Forecast and prevention of an enoftalm
Specific prevention of an enoftalm is absent. Nonspecific preventive measures come down to observance of safety rules on production (wearing goggles and a helmet), to timely diagnostics and treatment of inflammatory processes in an orbit cavity. Frequent inflammations of retrobulbarny cellulose or an eyeball besides specific treatment demand correction of a diet with inclusion vitamin-rich and minerals of food, normalization of the mode of a dream and rest. At suspicion on it is necessary to undergo inspection at the ophthalmologist with obligatory carrying out an ekzoftalmometriya, vizometriya. The forecast at this disease for life and working capacity favorable, however, in the started cases possible full loss of sight.