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1.病例介绍 患者,女,57岁,因鼻塞、流涕、头痛5年,以双上颌窦囊肿收住院,入院后在局麻下行左侧上颌窦囊肿摘除术加根治术,术中用2％利多卡因15ml加5滴肾上腺素作左侧翼腭窝、眶下孔阻滞麻醉及唇龈沟浸润麻醉后,发现左上睑下垂,眼球突出约3mm,眼球运动受限,视力:光感消失,角膜清亮,前房(-),瞳孔直径约6mm,直接、间接对光反应均消失,眼底检查:视乳头色稍淡,后极部视网膜反光增强,视网膜动脉粗细不均,呈痉挛状态,立即给予50％G.S 40ml加地塞米松10ml静脉推注。术毕光感恢复,术后给予复方丹参,CoA,ATP,VitB_o,地塞米松等治疗,次日床前测左眼视力:1米外指数,术后5天,患者诉左眼眶胀痛,加强抗感染治疗,炎症控制。术后10天出院,出院时眼科情况:右眼视力5.2,左眼视力4.6,眼球无明显突出,各方位活动正常,角膜清,前房(-),瞳孔直径约3mm,直接、间接对光反应存在,眼底:视乳头色界清,网膜动静脉之比约2:3,无交叉压迹,后极部网膜反光稍增强,无出血及水肿。
1. Case description The patient, female, 57 years old, due to nasal obstruction, runny nose, headache for 5 years to double maxillary sinus cyst admitted to hospital, left under local anesthesia underwent maxillary sinus cyst excision and radical mastectomy, 2 % Lidocaine 15ml plus 5 drops of epinephrine for the left pterygopalatine fossa, orbital foramen block anesthesia and lip gingival sulcus anesthesia, we found that the left upper eyelid ptosis, prominent about 3mm, eye movement is limited, visual acuity: light sense Disappeared, the cornea clear, anterior chamber (-), the pupil diameter of about 6mm, direct and indirect light reaction disappeared, fundus examination: papilla color slightly light, the posterior pole retina reflex enhanced retinal artery thickness unevenness was spastic , Immediately give 50% GS 40ml dexamethasone 10ml intravenous injection. Postoperative recovery of light perception, postoperative compound salvia miltiorrhiza, CoA, ATP, VitB_o, dexamethasone and other treatment, the next day bedtime left eye visual acuity: 1 meter index, 5 days after the patient complained of left orbital pain, Strengthen anti-infection treatment, inflammation control. 10 days after discharge from the hospital, discharge of ophthalmology: right eye vision 5.2, visual acuity of 4.6 left eye, the eye without significant prominence, the activities of all directions normal, anterior chamber (-), pupil diameter of about 3mm, direct, indirect light Response, fundus: papilla color boundary, retinal arteriovenous ratio of about 2: 3, no cross indentation, posterior pole retinal reflex slightly enhanced, no bleeding and edema.