Orbital hematoma

Introduction to eyelid hematoma Hematocele is a mass composed of blood or blood products. It is also referred to by the author as hematic-cyst. The literature has different interpretations of the meaning of hematoma and hecycyst (bloodcyst, hematocele). It is generally believed that the blood is locally concentrated in a blood group after the eyelid hemorrhage. basic knowledge The proportion of illness: 0.0017%--0.0025% Susceptible people: no special people Mode of infection: non-infectious Complications: eyeballs, nausea and vomiting, eye movement disorders

Causes of orbital hematoma

Cause

Eyelid hemorrhage is divided into two types: traumatic and spontaneous. The most common cause of spontaneous intra-orbital hemorrhage is venous vascular malformation, such as varicose veins and venous hemangioma. These vascular wall components are often incomplete or meager after congestion, caused by any cause. Bleeding can occur if there is no increase in internal jugular venous pressure or no obvious cause, and it occurs before the symptoms and signs of the primary disease have occurred. Others such as intraorbital tumor, hemophilia, leukemia, vitamin C deficiency, arteriosclerosis, hypertension, Aneurysms, anticoagulants and vasomotor instability can cause spontaneous intra-orbital hemorrhage. It has been reported that sinusitis or mucinous cyst secondary infection spreads to the eyelids, which can cause eyelid hemorrhage and form a hematoma for a long time.

Orbital hematoma prevention

1. Take care to avoid trauma to the eye, so as not to cause eyelid hematoma.

2. Pay attention to active treatment of diseases that cause increased blood pressure around the eyelids, such as eyelid tumors, hypertension, and hardening of the arteries.

3. Pay attention to the active treatment of bleeding disorders, so as not to cause secondary eyelid hematoma, such as hemophilia, leukemia, scurvy and thrombocytopenia.

4. Inflammation infection caused, please pay attention to active treatment related to the primary disease, such as sinusitis, dacryocystitis.

Orbital hematoma complications Complications, ocular occlusion, nausea and vomiting, ocular dyskinesia

Acute orbital hematoma leads to acute high sputum pressure, prominent eyeballs, accompanied by pain, nausea, vomiting, diplopia, ocular dyskinesia, loss of vision or loss, and orbital and conjunctival edema, congestion, blue-purple ecchymoses under the eyelids or subconjunctiva. Bleeding in the muscle cone can lead to retinal compression, optic disc atrophy and mild eye movement.

Spontaneous bleeding can be accompanied by bleeding in other organs and tissues.

Symptoms of orbital hematoma Common symptoms Young people's eye bags, pain, edema, congestion, visual acuity, morning vision, fat skin, conjunctiva, conjunctiva, conjunctival congestion, eye movement, no nausea

Spontaneous hemorrhage occurs in healthy adolescents, mostly in one eyelid, and hematoma causes acute high pressure. The most significant symptoms and signs are eyeballs, accompanied by pain, nausea, vomiting, diplopia, eye movement disorders, vision. Decreased or lost, as well as eyelid and conjunctival edema, congestion, and then blue-purple ecchymoses under the eyelids or conjunctiva, the eyeballs often reach a peak within a few minutes or hours, the difference between the two eyes can reach 10mm, the protruding direction can judge the lesion Position, pain is caused by a sharp increase in intra-orbital pressure, impaired perceptual nerve endings and increased intraocular pressure. The hematoma of the sacral tip causes optic nerve blood supply disorder, sudden loss of vision, and even loss of light perception. Bleeding outside the muscle cone tends to move forward. Disperse to the subcutaneous or subconjunctival, absorbed within 2 to 3 weeks, generally does not endanger vision.

The bleeding in the muscle cone, due to the limitation of the four rectus muscles and the muscle interval, remains in the local area for a long time, and is surrounded by the fibrous membrane, which can be slowly absorbed. After the symptoms of acute high sputum pressure disappear, it appears as a sign of benign space-occupying lesion. Such as mild or moderate eyeball protrusion, retinal compression sign, optic disc atrophy and eye movement are slightly restricted, the tumor is larger, the iliac crest can be swollen and swollen, and spontaneous eyelid hemorrhage can be repeatedly bleeding before its cause is removed.

Eyelid hematoma examination

1. Blood routine examination and PT, APTT measurement for auxiliary diagnosis, to rule out hemorrhagic diseases of the blood system.

2. Pathological examination Hematoma is a local accumulation of liquid blood or blood clots, and there are often cell reactions around, such as fibroblast proliferation and chronic inflammatory cell infiltration, due to the large amount of bleeding, can not be quickly absorbed, the surrounding connective tissue hyperplasia, formation Hard pseudo-capsule wall, lacking true endothelium or epithelial cell lining, filled with old blood and blood cell lysates, such as cholesterol, hemosiderin, foreign body cells, pigment-bearing macrophages and fat-containing foam Cells, etc., the color of the tumor is from purple red, brown to blue-green, blood cysts formed by hemorrhage in lymphangioma or venous hemangioma, the wall of the capsule is thin, and it is lined with endothelial cells.

3. Ultrasound examination found that the subperiosteal above the eyelid (ultrasound is often above the superior rectus muscle) flat hypoechoic area, A super low reflection or liquid level, no obvious sound attenuation, and spontaneous hematoma mostly caused by orbital vascular malformation, often Eyelid hemorrhage is the first symptom. Ultrasound shows hypoechoic space-occupying lesions in the eyelid. The shape is irregular. It is a diagnostic feature after treatment or self-reduction. If the lesion is reduced, it can be observed regularly. If the lesion has a large occupancy effect, consider aspiration. Or surgery to remove the hematoma.

4. CT scan of the subperiosteal hematoma or hemorrhage on the coronary CT showed a flat high-density space-occupying lesion above the superior rectus muscle, the superior rectus muscle was displaced, and the lesion was slightly enhanced or not enhanced.

5. MRI hemorrhage or hematoma is better in MRI. MRI can often judge the bleeding time according to the signal, which is very helpful for diagnosis. Hemoglobin in red blood cells after hemorrhage experiences from oxyhemoglobin-deoxyhemoglobin-methemoglobin (high signal) - The evolution of hemosiderin (low signal), ferrous hemoglobin has characteristic images (high signal) in high field MRI before and after erythrocyte lysis, and its T1, T2 value and iron The paramagnetic nature of the ions is closely related, so the MRI signal of the hematoma depends on the time of bleeding and is related to time.

MRI can show hyperacute and acute bleeding like CT, especially good at showing subacute, chronic and residual bleeding. The main component in subacute and chronic hemorrhage is freely diluted methemoglobin, which is on T1WI. Proton density and T2WI are high signals, which can last for several months or even years, and become the main basis for intratumoral blood and repeated bleeding. The deposition of hemosiderin in the residual cavity of hemorrhagic foci shows the most clear on T2WI. A short T2 low signal is a sign of old bleeding.

Diagnosis and differentiation of orbital hematoma

diagnosis

Diagnosis can be made based on medical history, clinical manifestations, and examination.

Differential diagnosis

It is differentiated from orbital tumor, conjunctival and choroidal hemorrhage.

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