松山赤十字病院眼科における外傷性眼窩内異物の検討

Review of post-traumatic foreign body treated at the Department of Ophthalmology, Matsuyama Red Cross Hospital

要約　目的：松山赤十字病院眼科で摘出した外傷性眼窩内異物の報告。

対象と方法：対象は2018年10月までの178か月で松山赤十字病院眼科において眼窩内異物に対して摘出手術を行った7例である。受傷年齢，異物の種類，異物先端の到達部位，感染の有無および視力予後について検討した。

結果：年齢分布は3歳以下と58〜67歳の2相性を示した。異物の種類は金属2例，ガラス2例，木片3例であった。異物先端部の到達位置は外眼筋の筋腹が3例，眼窩先端部2例，副鼻腔2例であった。木片異物の3例とも病原性細菌が検出された。予後として硬膜外血腫を合併し，眼窩先端部に木片が刺入した1例は術後に脳ヘルニアのため死亡したが，その他の症例では異物摘出後に矯正視力の改善がみられた。

結論：木片異物では3例とも細菌感染を伴っており，植物性異物の症例では手術的な異物の摘出が必要と考える。

Abstract　Purpose：To report cases of post-traumatic foreign body treated at the Department of Ophthalmology, Matsuyama Red Cross Hospital.

Cases and Method：We reviewed 7 cases of post-traumatic foreign body seen during 15 years through 2018. Cases were evaluated regarding age, type and location of foreign body, orbital infection, and final visual acuity.

Results：The series comprised 2 infants aged less than 3 years and 5 adults aged from 58 to 67 years. The foreign body was metallic in 2 cases, glass in 2 cases, and wooden in 3 cases. It was located close to extraocular muscles in 3 cases, in the orbital apex in 2 cases, and in the paranasal sinus in 2 cases. Infection by microorganisms was present in all the 3 cases of injury by wood. Visual acuity improved in 6 cases after removal of foreign body. On case injured by wood in the orbital apex died because of brain herniation following epidural hematoma.

Conclusion：Surgical removal of foreign body in or near the orbit is necessary, particularly when the injury is due to piece of wood that may induce infection.