Invagination

Introduction The retreat of the eyeball position is called the eyeball invagination. It is the opposite of the eyeball, which is less common than the eyeball. Eyeball invagination refers to the eyeball invagination caused by reasons other than the eyeball. It must be differentiated from the eyeballs that reduce the lesions (small eyeballs, eyeball atrophy, eyeball spasm) and the collapse of the eyeball position caused by the reduction of the cleft palate. Open. Common eyelid diseases include various orbital tumors or cysts, thyroid-related eye diseases (hyperthyroidism), inflammatory pseudotumors, and tibiofibular fractures.

Cause

Common reasons are:

1. The eyeball is too small: such as congenital small eyeball and acquired eyeball atrophy.

2. Sympathetic palsy: makes the eyelid Miller muscle and the smooth muscle of the iliac flaccid and paralyzed, so the upper eyelids are slightly drooping, the cleft palate is reduced, the eyeball is invaginated, and the sacral muscles are paralyzed, causing the sleeping holes to shrink. These three items are called Horrer. Syndrome.

3. Loss of eyelid fat: The elderly are common in the case of progressive hemifacial atrophy and progressive fat disappearance after severe illness, or after the removal of the ankle tumor or bleeding.

4. Trauma: Due to the fracture of the sacral floor, the sacral cavity is enlarged, or part of the content enters the maxillary sinus, which causes acute traumatic eyeball retraction. In addition, even if it does not cause bone trauma, it can be caused by chronic traumatic eyeball retraction due to the mechanization and contraction of the tissue behind the ball.

5. Over-contraction of rectus muscle: After strabismus surgery, due to excessive shortening of a certain muscle, eyeball retraction occurs, or due to periostitis, part of fluid and eye muscle and sarcolemma, causing paralytic contraction and eyeball retraction occurs.

an examination

Related inspection

Ultrasound examination of the eye and eyelids by ophthalmoscopy

Physical examination:

Pay attention to the general condition, whether there is serious illness with dehydration, whether there is progressive fat malnutrition and signs of facial atrophy. Eye examinations pay attention to whether there is soft tissue swelling, wounds and subcutaneous congestion in the periorbital period, and there is no tenderness around the week. In addition to the eyeball invagination, pay attention to the size of the split on both sides, whether it is symmetrical, whether there is ptosis, the relationship between the size of the split and the rotation of the eyeball. Pupil size, whether the sides are equal, how is the light response? And fundus performance. To further find the cause of eyeball invagination.

Device inspection:

The application of the eyeball is a reliable way to understand whether the eyeball is invaginated and the degree of invagination. X-ray plain film or CT scan to understand the fracture of the tibia, whether there is blood in the sacral cavity, the presence or absence of broken bone fragments in the maxillary sinus, and the position of the eyeball are helpful for diagnosis. The author encountered a case of a ruptured tibiofibular fracture with a marked invagination of the eyeball. Most of the eyeball was invaded into the ethmoid sinus by CT scan.

Differential diagnosis

Symptom identification of eyeball invagination :

1. Intraocular oblique: The intraocular oblique is characterized by esotropia, which is commonly called cross-eyed eye and is the most common type of strabismus. The symptom is that the eyes are skewed to the nasal side. Some children are born with this condition, but most of the esotropia begins to appear around the age of two to three. Some cases can be corrected with appropriate glasses, because the glasses can alleviate the situation of esotropia caused by excessive adjustment of the focal length; however, in some cases, after treatment with glasses and covering, it is still necessary to correct with eye muscle surgery.

2. Contraction, eyelid drooping and eyeball retraction: The so-called Horner's syndrome refers to a characteristic group of eye symptoms caused by damage to the autonomic nerves of the cervical sympathetic ganglia. This disease can occur in any part of the cervical sympathetic pathway. It is extremely rare to be caused by central nervous system lesions above the first thoracic cord. Mainly manifested as: the pupil of the affected side is reduced, the eye is cracked, the eyeball is invaginated, the face is less sweaty or sweat-free. This phenomenon is called Horner syndrome. Also known as Horner's syndrome.

diagnosis:

First of all, to understand the age of the patient, if the elderly, or seriously ill with dehydration, can lead to decreased fat and sputum content shrinkage, and the eyeball invagination, generally bilateral. Whether the whole body suffers from facial atrophy and progressive lipodystrophy, the former is mostly unilateral, and the latter can be bilateral ocular invagination. If accompanied by ipsilateral ptosis, dilated pupils, and cleft palate, the presence or absence of Horne syndrome should be further excluded. There is no strabismus or Duane retraction syndrome in the medical history, which can cause eyeball retraction due to shortening of the extraocular muscles. Attention to the presence or absence of eyelid inflammation, surgery, trauma history, especially the burst fracture of the tibia and bone, have the possibility of causing eyeball retraction.

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