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患者男,21岁,于1992年12月7目因左眼被刀刺伤、视力障碍2h 来我院诊治。入院体检未见异常。眼部检查:右眼视力5.2,左眼视力0。双眼压后。左眼睑高度肿胀,近外眦部可见一斜穿上下睑的创口,长达4.0cm,深达眶隔,创口表面有脱出的眶内软组织嵌顿。眼球前突,向各方向运动障碍。球结膜下瘀血水肿,角膜透明,瞳孔散大8mm×8mm,直间接光反射均消失。眼底视神经乳头苍白水肿,整个网膜呈贫血状。右眼除间接光反射消失外余均正常。CT 显示:左眼球突出及眶内软组织肿胀,视神经囊在距眼球在0.5cm 处中断。急诊给予左眼软组织清创缝合术,术后抗炎治疗。伤后10天,待软组织肿胀全部消退后,左眼睑仍不能运动,眼球呈固定状态。考虑病人在被刀刺伤视神经的同时亦把眶上裂的第Ⅲ、Ⅳ、Ⅵ颅神经一并切断,恢复无望。但为慎重起见,仍给予维生素 B_1及 B_(12)肌
Male patient, 21 years old, in December 1992 7 head due to left eye was stabbed, visual impairment 2h to our hospital for treatment. Admission examination no abnormalities. Eye examination: right eye vision 5.2, left eye vision 0. Post-ocular pressure. The left eyelid is highly swollen, and a paracentesis of the upper and lower eyelid can be seen near the upper and lower eyelid. As long as 4.0 cm, deep orbital septum is covered with orbital soft tissue incarceration on the wound surface. Ocular protrusion, dyskinesia in all directions. Bulbar subconjunctival bleeding edema, corneal transparency, mydriasis 8mm × 8mm, straight indirect light reflex disappeared. Optic edema in the ocular fundus showed anemia. Right eye in addition to indirect light reflex disappeared more than normal. CT showed: prominent left eyeball and orbital soft tissue swelling, optic nerve capsule in the eye ball at 0.5cm at the interruption. Emergency left eye soft tissue debridement and suture, postoperative anti-inflammatory treatment. Ten days after injury, until the soft tissue swelling subsided, the left eyelid still unable to exercise, the eye was fixed. Consider the patient was stabbed in the optic nerve at the same time also the superior orbital fissure of the cranial nerves Ⅲ, Ⅳ, Ⅵ cut together, recovery hopeless. However, for the sake of caution, vitamin B_1 and B_ (12) muscles are still given