外傷性眼窩内血腫に対し経皮的眼窩内血腫除去術を行った1例

Percutaneous removal of traumatic subperiosteal hematoma in the orbit

要約　目的：左眼打撲後に眼窩内骨膜下血腫を生じ，経皮的眼窩内血腫除去術を施行された症例の報告。症例と経過：45歳男性が左眼を打撲し，翌日に眼痛と視力障害で受診した。左眼の矯正視力は30cm指数弁，眼圧は33mmHgであった。眼球突出と眼球運動障害，相対的入力瞳孔反射異常，網膜浮腫と桜実紅斑，視神経乳頭の軽度発赤を認めた。コンピュータ断層撮影で左眼窩上壁の骨折と同部の骨膜下血腫を認め，眼窩内圧の上昇による眼循環障害が疑われ，経皮的眼窩内血腫除去術が施行された。矯正視力は0.3と改善し，眼球突出と眼球運動障害は消失した。結論：眼循環障害による高度な視力障害を伴う眼窩内骨膜下血腫では，早期の血腫除去が重要と考えられる。

Abstract.　Purpose：To report a case of traumatic subperiosteal hematoma in the orbit treated by percutaneous removal of the subperiosteal hematoma. Case：A 45-years-old male had subperiosteal hematoma in the left orbit after suffering a bruise to the left orbit. He visited our hospital the next day. Initial corrected visual acuity was counting fingers and intraocular pressure was 33 mmHg in left eye. Percutaneous removal of the hematoma was performed,because of severe exophthalmos and ocular motility disorder,and severe visual loss from disturbance in the optic circulation caused by increased orbital pressure. After the treatment,visual acuity improved to 0.3 and exophthalmos and ocular motility disorder disappeared. Conclusion：This case suggests that early invasive removal of the subperiosteal hematoma,which causes severe visual loss with disturbance in the optic circulation,is needed.