眶尖部硬膜外血肿致视神经损伤临床分析  

Clinical analysis of optic nerve injury caused by epidural hematoma at orbital apex

作　　者：王玉峰[1] 赵家鹏[1] 张永森[1] 

机构地区：[1]新乡医学院第三附属医院神经外科,河南省新乡市453003

出　　处：《眼科新进展》2009年第10期786-787,共2页Recent Advances in Ophthalmology

摘　　要：目的探讨眶尖部硬膜外血肿压迫引起视神经损伤的诊断与治疗。方法回顾性分析13例(14眼)眶尖部硬膜外血肿压迫引起视神经损伤的患者,患者视力:无光感～0.7,其中无光感1眼,光感(+)3眼,0.06者3眼,0.08者1眼,0.3者2眼,0.4者1眼,0.5者2眼,0.7者1眼。所有患者均采用药物疗法,其中6例6眼患者还采用手术治疗。观察所有患者治疗后视力变化。结果所有患者治疗后视力都有明显改善。治疗后视力:光感(+)～1.2,其中光感(+)1眼,眼前手动1眼,数指/40cm2眼,0.4、0.5、0.6、0.7、0.8、1.1和1.2者各1眼,1.0者3眼。仅采用基础治疗患者视力:光感(+)、眼前手动、数指/40cm者各1眼,余5眼平均视力0.7;基础治疗联合手术治疗患者视力:数指/40cm者1眼,余5眼平均视力0.96。结论眶尖部硬膜外血肿压迫引起的视神经损伤,属于间接损伤,早期诊断、治疗减轻或解除压迫可明显改善视力。Objective To investigate the clinical diagnosis and treatment in patients with optic nerve injury caused by orbital apex compression from epidural hematoma.Methods Thirteen patients（14 eyes） with optic nerve injury caused by the orbital apex compression from epidural hematoma were retrospectively analyzed.The visual acuity of patients was without light perception to 0.7.There were 1 eye without light perception,3 eyes with light perception,3 eyes in 0.06,1 eye in 0.08,2 eyes in 0.3,1 eye in 0.4,2 eyes in 0.5 and 1 eye in 0.7.All patients were taken medicine therapy,and 6 cases（6 eyes） also took surgery treatment.Changes of visual acuity were observed in all patients after surgery.Results Visual acuity was significantly improved in all patients after surgery.Visual acuity was with light perception to 1.2 after surgery.There were 1 eye with light perception,1 eye with hand movement in front of eye,2 eyes with counting fingers at 40 cm,1 eye in each of 0.4,0.5,0.6,0.7,0.8,1.1 and 1.2,respectively,and 3 eyes in 1.0.Only with basic therapy,the visual acuity of patients were 1 eye in each of with light perception,hand movement in front of eye and counting fingers at 40 cm,respectively,and 5 eyes in 0.7.With basic therapy combined with surgery treatment,visual acuity of patients were 1 eye with counting fingers at 40 cm and 5 eyes in 0.96.Conclusions Optic nerve injury caused by orbital apex compression from epidural hematoma is an indirect injury.Early diagnosis and decompression with treatment can significantly improve visual acuity.

关 键 词：硬膜外血肿 视神经损伤 颅脑损伤 

分 类 号：R774[医药卫生—眼科]