继发于眼眶疾病的眼底病变18例临床分析  

18 cases of fundus changes secondary to orbital diseases

作　　者：黄筱敏[1] 颜建华[1] 

机构地区：[1]中山大学中山眼科中心国家眼科学重点实验室,广州510060

出　　处：《中国实用眼科杂志》2012年第6期731-734,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的：探讨眼眶疾病合并眼底改变的临床特征以及二者的关系。方法回顾分析合并眼底改变的18例眼眶疾病，其中甲状腺相关眼病3例，眼眶炎性假瘤2例，泪腺多形性腺瘤3例，眼眶视神经胶质瘤2例，视神经脑膜瘤2例，眼眶神经鞘瘤1例，眼眶副神经节瘤I例，眼眶霍奇金淋巴瘤1例，眼眶海绵状血管瘤1例，眼眶脉管瘤并出血1例，后巩膜炎1例。结果18例眼眶疾病的患眼均有不同程度的眼底改变。甲状腺相关眼病的眼底特征为视盘瘀血性水肿和黄斑皱褶；眼眶炎性假瘤的眼底特征为视盘水肿炎症;眼眶肿瘤的眼底改变表现为肿瘤压迫导致的脉络膜视网膜皱褶和隆起；若肿瘤位于视神经则易合并视乳头肿胀改变；累及眶尖部位则易形成眶内血液回流障碍，出现明显的眼底视网膜静脉扩张迂曲。结论眼眶疾病引起的眼底改变主要为眶内肿物轻度压迫引起的脉络膜视网膜皱褶和明显压迫引起的脉络膜视网膜局部隆起；当眶内病变累及球后近端视神经则易导致视乳头肿胀，累及眶尖部位则易出现视网膜静脉扩张迂曲。眶内疾病合并眼底改变可能与其原发疾病性质、位置有关。Objective To observe the clinical characteristics of fundus changes secondary to or- bital diseases and to find out the relationship between the fundus lesions and orbital diseases. Methods A retrospective review of 18 cases of orbital diseases that showed remarkable orbit-related fundus changes and were seen by the corresponding author in Zhongshan Ophthalmic Center, Sun Yat-sen University, from Feb 2001 to Sep 2009. These included 3 cases of thyroid associated oph- thalmopathy （TAO）, 2 cases of idiopathic orbital inflammatory pseudotumor （IOIP）, 3 cases of pleo- morphic adenoma of lacrimal gland, 2 cases of optic nerve glioma, 2 cases of meningioma of optic nerve, 1 case of orbital neurilemmoma, 1 case of orbital paragangliomas, 1 case of orbital non-hodg- kin＇s lymphoma, 1 case of vascular malformation with orbital bleeding, and 1 case of posterior scler- atitis. Results All 18 cases with orbital diseases had their fimdus changes. The fundus features in pa- tients with TAO were congestive papilledema and macular pucker; those in IOIP were inflammatory papilledema. In patients with orbital tumors, the main findings were choroidal-retinal folds and/or up- lift due to direct tumor compression. If aunors were near or next to the optic nerve, they were easy to have papilledema; if the mass involved the orbital apex, they were easy to result in blood back- flow obstacles and showed apparent retinal vein expansion. Conclusions Main fundus changes in pa- tients with orbital diseases are choroidal-retinal folds due to mild tumor compression and local cho- roidal-retinal uplift due to obvious tumor compression. Orbital lesions involving the proximal optic nerve may result in papilledema and those involving orbital apex may block the blood backflow andshow apparent retinal vein expansion. The fundus changes secondary to diseases of the orbit related probably to the properties and location of primary diseases.

关 键 词：眼眶肿瘤 甲状腺相关眼病 眼眶炎性假瘤 眼底 脉络膜视网膜皱褶 

分 类 号：R777.5[医药卫生—眼科]