Orbital varicose veins
Introduction
Introduction to intraocular varicose veins Varicose varicose (varixcele) is a common venous malformation that occurs in the orbit, accounting for 6.3% of eyelid disease. From the clinical and pathological point of view, it can be defined as follows: 1 deformed blood vessels are composed of veins of different sizes, and the input and output blood vessels are all veins. 2 There is a lack of fibrous tissue between the malformed vessels. 3 Clinically, it is characterized by orthostatic ocular protrusion. It is not uncommon for varicose veins to be in the orbital space-occupying lesions. Since the pathological biopsy specimens are rarely obtained, the actual incidence rate is higher than that reported in the literature. basic knowledge The proportion of illness: 0.0006% Susceptible people: no special people Mode of infection: non-infectious Complications: optic atrophy
Cause
Cause of varicose veins
Causes:
Although this kind of lesions are mostly caused by young people, they are thought to be caused by congenital factors. There are two types of orbital varices, one is primary, and there is no vascular malformation caused by any prodromal factors. Hair, increased venous pressure drives blood vessels to dilate, such as carotid-cavernous sinus caused by varicose veins.
Prevention
Intraocular varicose vein prevention
1, go to bed early and get up early, exercise the body. Insufficient sleep can reduce the body's immune function, and it is also easy to stimulate the fire, causing external injuries.
2. Keep your mind calm. Avoid anger in the spring, do not be too impatient, always keep your peace of mind.
3. Quit smoking, drink less and drink coffee. Smoking is the most vulnerable to damage to the respiratory surface barrier and induces disease onset. Tobacco, alcohol and coffee all stimulate nervous excitement. Some people want to "eliminate tension and fatigue", but actually weaken the body's disease resistance.
4. Keep away from allergens and stay away from crowded places.
5, diet should be light and nutritious and easy to digest, eat less greasy frying and spicy food.
Complication
Endodontic varices complications Complications optic atrophy
Orbital varicose veins generally do not affect vision, such as confined to the tip of the fistula, can cause increased pressure, affect the optic nerve blood supply, causing permanent vision loss, and some cases with intracranial vascular malformations.
Symptom
Orbital varicose veins common symptoms varicose veins nausea eyeballs eyeball retraction optic nerve atrophy
Although this disease is a congenital vascular abnormality, it usually occurs in adolescence, lack of gender tendency, and more infringement of one eyelid, left and right sides are equal, and occasionally occur on both sides.
1. Orthostatic eyeballs, bowing, coughing, sputum, sputum (Valsalva's maneuver) and other causes of increased internal jugular venous pressure can cause the eyelids of the affected side, such as the introduction of large blood vessels, causing obvious eyeballs within a few seconds, upright Eyeball protrusion is also eliminated quickly. If the traffic vessels are not smooth, the signs will appear in a few minutes after bowing, and the disappearance will be slower. The difference in orthostatic eyeballs is generally 3 to 14 mm. In severe cases, the eyeball can be removed from the cleft palate. The prominent direction is different depending on the location of the abnormal blood vessels. Because the deformed blood vessels are mostly in the muscle cone, the clinical is mostly axially prominent. The eyeballs are accompanied by symptoms of increased internal iliac pressure, such as pain in the sputum area, nausea and vomiting. Vision loss, diplopia, eye movement disorders and eyelids cover the eyeballs, these symptoms disappear after standing upright.
2. The eyeball is invaded for a long time, the venous congestion of the sacral vein, compressing the fat tissue, so that it absorbs, the volume is reduced, and the eyeball is invaginated when standing upright. In severe cases, the difference between the two eyes can reach 6 mm or more, and the eyeball and the surrounding eyelids are both Invagination, the edge of the sputum is revealed.
3. When the eyeball is pulsating, the infant is sick, the dilated blood vessel is compressed and the sacral fissure is cracked, and the fissure is enlarged. The pulsation of the brain is transmitted to the eyelid through the supraorbital fissure, causing the eyeball to pulsate. This pulsation is more obvious when the eyeball is invaginated. Arteriovenous fistula, the eyeball pulsation of the brain is different, the latter two cases are accompanied by eyeball protrusion when standing upright.
4. Repeated intra-orbital hemorrhage of the vascular lumen, thin wall, any increase in internal jugular vein pressure, can cause abnormal blood vessel rupture, sudden eyeball protrusion, bleeding diffuse to the subconjunctival or subcutaneous absorption, a few cases, Even intraorbital hemorrhage is the first clinical sign, and postural orbital protrusions occur several years later.
5. Vision loss and optic atrophy in the orbital varicose veins, most cases have normal vision, Rosenblum et al said that 15% of the cases spontaneously lost vision, domestic varicose veins spontaneous occultation accounted for 3% to 6%, reasons for vision loss:
1 tip bleeding;
2 a wide range of thrombosis, increased pressure, affecting the supply of optic nerve;
3 high eyeballs, excessive optic nerve elongation, for whatever reason, damage to the optic nerve, eventually causing optic atrophy, individual cases due to embolization blocked the connection with the systemic circulation, orthoscopic eyeball protrusion can relieve itself.
6. Conjunctival, orbital and other parts of the venous anomalous conjunctival vascular mass is more common in the lower iliac crest or the medial side. This is a continuation of the abnormal iliac vein of the internal iliac vein. The orbital sac is visible in the forehead. The thick vein is purple-blue mesh or strip. It is sag when standing upright, and it is congested and dilated when it is lowered. It extends to the abnormal blood vessels in the cranial fossa, and can be seen in the bone hole, hard palate, buccal mucosa and maxillofacial region. The object is evidence of congenital dysplasia.
Examine
Examination of varices in the orbit
Pathological examination: The pathological changes of orbital varices are different from the dilatation of the lower extremities, vagina and esophagus. These blood vessels are not often stressed, the vein wall is thin and has a large elasticity, and there is resistance to the fat in the sputum. Less extended beyond the eyelids, in terms of its form:
1 saccular vasodilation, located in the fat of the sputum, one end connected to the blood vessel, the other side is the blind end, like a purple grape-like, as the pressure in the cavity increases, the cyst expands, the wall is thin, separated by vascular clamp The surrounding fat can be broken, and the ruptured wall shrinks and becomes as elastic as the bladder;
21 or several blood vessels are dilated and entangled into a block with large sinusoids inside, and the vessel wall is also easily broken;
3 The deformed venous blood vessels are highly dilated, resulting in the absorption of all or most of the fat in the muscle cone. The blood vessel wall is very thin, attached to the surface of the functional wall such as the sacral wall, optic nerve, extraocular muscles and nerve vessels. The muscle cone becomes a potential cavity. When the blood is filled, the cavity is filled with blood, so that the functional structure is straightened. During the operation, the cavity is an anemia state, and the eyeball is pulled forward. It can be seen that the muscle cone lacks fat, the optic nerve, the movement and the sensory nerve, the ophthalmic artery and the vein are isolated. The suspension state, similar to the eyelid specimens at the back of the eyelids, and one type outside the muscle cone, is a large range of potential gaps in the anemia, from the upper part to the lower part of the orbit, or the inner side of the ankle, forward to the conjunctiva Under the human body, when the human body is erect, only the eyeball is invaginated, and the internal jugular vein (equivalent to the lower body position) is pressed. The potential gap is congested and expanded, for example, the pressure in the lumen is increased, and even a vascular lake having a slice under the conjunctiva is visible;
4 Another form of varicose veins is mainly characterized by many large honeycomb lumens, which are supported by endothelial cells and fiber bundles. The cavity is dilated when congested. Although it is not one or several vasodilatations, it is clinically expressed as a body position. The eyeball is prominent, and the pathologist sometimes diagnoses this type as a venous or cavernous hemangioma. In short, there are cystic, strip-shaped, massive, honeycomb-like venous cavities in the sputum, and patients with orthostatic ocular protrusions. For primary varicose veins.
The histological changes of varicose veins are large and thin wall, vascular endothelial cells and smooth muscle fibers are loose, large vessels have elastic fibers, and are intermittent to adapt to vasodilation. The aging deformed blood vessel wall can be thickened, glass. Varied, there are many thrombosis in the lumen, this blood flow slow deformed blood vessels are prone to thrombosis, thrombosis machined calcium, eventually forming phleboliths, there are unequal amounts of fibrous tissue between the blood vessels, inside There is chronic inflammatory cell infiltration.
1. Most of the X-ray examinations are normal, about 1/4 of the venous stones are found (Fig. 3), and the sacral cavity enlarges and the supracondylar fissure expands in the young patients.
2. Ultrasound examination of varicose veins has a typical performance on ultrasound. First, when the neck is not pressurized or the patient is erect, the eyeballs often do not protrude or even sag, the deformed veins are not congested, the ultrasound appears as normal orbital images, or the posterior fat is displayed. Less, can also show a smaller range of lesions, when the neck is pressurized, A super shows multiple or single low-reflection lesions, with neck pressure (compression of the jugular vein) relaxed or patient erect, venous return The deformed blood vessels in the sputum gradually empty, and the A super-recovery normal eyelid image. This dynamic change is very valuable for diagnosing varicose veins. After B-ultrasound, the fat becomes larger after the ball, and one or more fats appear in the normal ball. Low-echo occupancy, round, oval or irregular (Figure 4), venous stones often appear in the lesions of the orbital varices, B-ultrasound shows strong echo spots, which is very helpful for diagnosis, B-ultrasound not only Found the extent and shape of the lesion, but also pay attention to the relationship between the lesion and the normal structure of the iliac crest, occasionally venous hemangioma, especially in childhood, the lesion itself also has a certain positional position, that is, neck compression Lesions expand slightly, since the neck pressurized patients exophthalmos, orbital hypertension and less pain and other symptoms, so the inspection time should be short.
3. CDI CDI can provide blood dynamic images for the detection and localization of the blood vessels of the deformed lesions. Since the blood is filled into the sputum after the neck is pressurized, it can show red blood flow signals at the apex or sacral fissure. That is, the flow toward the probe; when the pressure disappears, the blood flows back into the skull, and the blood flow signal changes from red to blue. The patient needs to be patiently examined during the examination to find the blood vessel of the lesion.
4. CT scan CT plain scan generally only shows a small volume of intraorbital high-density space-occupying lesions, or no obvious space-occupying lesions, after neck compression or enhanced scanning, the lesion volume is significantly enlarged, can fill the eyelids, shape and shape The eyelids are consistent, and most of the lesions have vein stones.
If the diseased blood vessels communicate with the intracranial or long-term lesions from childhood, CT may show an enlarged supracondylar fissure, a loss of the temporal bone, and some may involve intracranial vascular malformations.
5. MRI varicose veins and general orbital tumors have similar MRI signals, but varicose vein thrombosis is different in MRI signals according to the time of thrombus and the nature of iron in hemoglobin. The lack of signal flow caused by lack of blood flow in the dilated orbital vein It indicates thrombosis and heterogeneous signal intensity. The low signal in T1WI and the low signal in T2WI are related to the presence of deoxyhemoglobin. The signal enhancement is caused by methemoglobin. The orbital varices can cause thrombosis and hematoma for some reason. signal of.
Diagnosis
Diagnosis and diagnosis of orbital varices
90% of intermittent eyeballs and 95% of signs of ocular protrusion are caused by this disease. The lesions may be in the conjunctiva, eyelids and eyelids. At the same time, the imaging findings, especially the results of iliac vein angiography, can be used to determine the diagnosis.
Varicose veins have typical orthoscopic ocular protrusions, which are generally easy to diagnose, but similar to venous hemangioma in ultrasound. Neurofibromatosis is associated with extensive bone loss and similar orthoscopic ocular protrusion, but the speed is prominent. And other signs are available for identification.
