Symptom >> Otorhinolaryngology >> Ophthalmology

Persistent, stabbing, or tearing pain in the orbit

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Eye muscle paralysis is accompanied by pain before and after, which is a kind of persistent, acupuncture or tearing pain, and some severe pain is unbearable. The painful part occurs mostly in the posterior eyelid of the ball or radiates to the temporal side and the forehead, and is repetitive. This symptom appeared earliest and disappeared the earliest. The result of stimulation of the nerve branch of the V-brain nerve.

Cause

Cause

Causes of persistence, acupuncture or tearing pain in the eyelids:

(1) Causes of the disease:

In the past, the disease was thought to be caused by syphilis and tuberculosis. It is generally considered that this disease belongs to the category of idiopathic orbital inflammatory pseudotumor, except that the lesion is mainly in the cavernous sinus, and then invading the sacral sinus, and some cases involve the apical apex. The true cause is not well understood. It may be an autoimmune disease. Corticosteroid treatment has special effects and it is also an immune disease.

(2) Pathogenesis:

The exact pathogenesis of painful ophthalmoplegia is still unclear. There are two inferences based on pathological examination and clinical application of corticosteroids:

Hunt reviewed the autopsy results of Tolosa in 1957 and concluded that it is a non-specific chronic inflammation of the cavernous sinus. A 47-year-old female patient reported by Tolosa had pain in the right temporal region, nausea, vomiting, and cranial nerve involvement in III, IV, and VI. Carotid angiography revealed a narrow siphon. Craniotomy revealed no significant changes in the sellar region and died 3 days after surgery. No aneurysms or tumors were found at autopsy. Open the cavernous sinus, see the carotid artery surrounded by granulation tissue, the sinus cavity is not completely blocked, this segment of the carotid artery is narrow, the artery is yellow, and its wall is brittle. Microscopic examination showed thickening of the carotid adventitia, non-specific granulation around the artery, and spread to the adjacent cranial nerve trunk. Lake reported a 47-year-old male patient with increased X-ray findings of right sphenoid winglet density. Surgical exploration revealed a thin layer of gray-red granulation tissue on the outside of the cavernous sinus, and the periosteum of the sphenoidal wing was thickened. Biopsy sees the cavernous sinus wall as inflammatory tissue, including polymorphonuclear cells. There is necrosis of the dura mater on the supraorbital sac, with granulation tissue on the surface, containing polymorphonuclear cells and monocytes. Smith supports the inference of chronic inflammation of the supracondylar and cavernous sinus. It is worth noting that some cases of cerebrospinal fluid examination found that the total number of white blood cells increased and Kernig's sign was positive, combined with patients with nausea, vomiting and other meningeal irritation symptoms, may be caused by inflammation extended to the skull base arachnoid. Of the 10 patients reported by Cui Guoyi in China, 6 underwent CT and MRI examinations. 4 cases of bilateral cavernous sinus asymmetry, sinus density was abnormal, 5 cases of sphenoid winglet density increased, and 3 cases of cerebrospinal fluid white blood cells total >30/mm3. Shi Dapeng et al reported 17 cases of MRI findings: 5 cases showed patchy or nodular shadows in the supracondylar region, and 7 cases showed different degrees of enlargement and enlargement of the cavernous sinus, resulting in asymmetrical shape of the cavernous sinus .

Mathew suggested that it may be related to defects in the immune system. Hallpike found that the disease is the same as that seen in the sputum inflammatory pseudotumor, presumably an immune-reactive disease. This hypothesis is supported by the successful use of immunosuppressive steroids.

The pathogenesis of this disease should be summarized as follows: 1 chronic inflammatory stimulation of the sphenoid sinus, involving the cavernous sinus and internal carotid artery, producing non-specific granulation tissue, typical clinical symptoms appearing in the adjacent nerve trunk; 2 internal carotid aneurysm , nasopharyngeal tumor, sellar tumor and acoustic neuroma and other adjacent nerve trunk; 3 hypertension arteriosclerosis caused by thickening of the internal carotid artery wall, stenosis involving the nerve trunk; 4 immune function abnormalities, corticosteroid treatment sensitive support this theory.

Examine

an examination

Related inspection

Ophthalmic examination of the eye and sacral area CT examination

Examination and diagnosis of persistence, acupuncture or tearing pain in the eyelids:

1. Blood routine, blood electrolytes.

2. Blood glucose, immune items, and cerebrospinal fluid examinations have abnormal diagnostic significance.

The following check items have abnormal diagnostic significance:

1. CT, MRI, DSA examination, often no obvious abnormalities; can also be expressed as soft tissue swelling in the sputum.

2. Intracranial angiography generally has no special findings.

3. EEG.

4. Skull base film, paranasal sinus film.

5. Eye examination.

Diagnosis

Differential diagnosis

Symptoms of persistent, acupuncture or tearing pain in the eyelids:

To be differentiated by eyelid pain. Eyelid pain: sustained or paroxysmal pain of the eyelids caused by various damage stimuli.