Why does my eye hurt when I blink? Causes and treatments

A range of different causes can be responsible for pain in the eye when blinking. Some of these require medical attention.

Eye pain when blinking can occur across the whole eye or in specific regions, such as the corner of the eye or on the eyelid.

This article will discuss possible causes for eye pain when blinking, as well as how they are treated.

It is common for debris, such as dirt or sand, to get caught in the eye and cause pain when blinking. However, it can also be caused by an injury or medical condition.

Causes of pain while blinking include:

1. Injury

Share on PinterestThere may be many different causes of pain in the eye when blinking, including sinusitis, dry eye, and injury.

The eye is relatively vulnerable to damage. Acute trauma or debris can injure the eye, or the eye socket, and cause pain while blinking.

Scratches to the surface of the eye (the cornea) are a common type of injury that can easily occur from rubbing or touching the eye.

It is also possible for the eye to sustain a burn from overexposure to ultraviolet light from the sun or from contact with certain substances.

There are three types of chemical burns that can occur:

• Alkali burns: These are the most severe type of burn and are often caused by cleaning products that contain ammonia, caustic soda, or lime.
• Acid burns: These are not as severe as alkali burns and can be caused by vinegar or certain types of polish that contain hydrofluoric acid.
• Irritants: Irritants rarely damage the eye, but can be uncomfortable. They can be caused by detergents or pepper spray.

2. Conjunctivitis

Conjunctivitis refers to inflammation of the clear membrane that covers the eye and the underside of the eyelid.

Blood vessels can become swollen, making the white parts of the eye red and sore.

The condition is caused by infections or allergies, such as hay fever or a pet allergy. Conjunctivitis caused by infection is contagious.

3. Stye

A stye is when the eyelash follicles or oil glands on the eyelid become infected. It causes swelling on the eyelid, which may cause pain when blinking.

While the stye itself is not contagious, the bacteria that caused it can be passed on to another person.

Most styes are caused by bacteria such as Staphylococcus aureus (a “staph” infection), which can spread to others through close contact.

4. Tear duct infection

The tear duct can become infected by bacteria if it is blocked, for example, by debris in the eye. This can cause a pain in the corner of the eye when blinking.

5. Blepharitis

Blepharitis is a condition where the edges of the upper or lower eyelids become inflamed. The eyelids can become sore and cause pain when blinking.

The condition can be caused by bacteria, a blocked gland, or certain skin conditions, such as seborrheic dermatitis.

6. Corneal ulcer

A corneal ulcer is an open sore that develops on the surface of the eye. They usually occur as a result of an infection, but can also develop from injuries, such as a scratch or burn.

7. Sinusitis

Sinuses are small cavities around the eyes and nose. Sinusitis is when the sinuses become inflamed, usually due to a viral infection.

This can cause pain while blinking, as well as a blocked nose, facial tenderness, a headache, and other flu-like symptoms.

8. Optic neuritis

Optic neuritis occurs when the optic nerve becomes inflamed, disrupting the transmission of visual information between the eye and the brain.

This inflammation can cause pain when the eyes or eyelids move.

It can also cause temporary vision loss and difficulty seeing colors properly.

9. Dry eye syndrome

Dry eye syndrome, also known as dry eye disease, is a condition where the production of tears is disrupted. This causes the eyes to become dry and irritated. It may be a source of pain while blinking.

10. Graves’ disease

Graves’ disease is an autoimmune condition that causes the thyroid to overproduce antibodies that mistakenly attack the body. It is also called hyperthyroidism or an overactive thyroid.

It can cause inflammation in and around the eyes, which may cause pain while blinking.

Other symptoms include anxiety, hyperactivity, itchiness, mood swings, problems sleeping, and persistent thirst.

11. Keratitis

Keratitis refers to an infection of the cornea caused by bacteria or a virus. This infection can cause pain, a gritty or sandy feeling in the eye, and light sensitivity.

Treatment for pain when blinking will vary depending on the cause:

Injuries

Share on PinterestEye drops may be recommended to ease discomfort.

Eye drops can be used to ease discomfort or prevent infections.

A flash burn must be protected from further damage by using sunglasses and avoiding ultraviolet light. In some cases, an eye patch may be necessary to protect the eye and allow it to heal.

Medication may also be used to reduce pain, prevent infection, or to relax the eye muscles.

In the case of a chemical burn, the affected eye should be rinsed immediately using sterile saline or cold water. Serious burns will require medical treatment and may even need surgery.

Conjunctivitis

Conjunctivitis may be treated at home by:

• avoiding the allergen or substance that triggered the condition
• avoiding touching or rubbing the eyes
• using a cool compress to alleviate irritation
• removing contact lenses until symptoms disappear completely
• keeping eyes and hands clean
• taking lubricating eye drops can help to reduce symptoms

In some cases, medication may be required to reduce severe symptoms or provide faster relief.

Stye

A stye can usually be treated at home using a warm compress several times a day to reduce swelling.

People should avoid wearing makeup around the stye or using contact lenses until the stye has fully healed.

If the stye does not respond to home treatment after a few days, medical attention may be required.

Tear duct infection

Tear duct infections are typically treated using antibiotics. Eye drops may also be prescribed to help reduce symptoms. In rare cases, surgery may be required.

Blepharitis

It is not possible to cure blepharitis, but symptoms can be managed by:

• Keeping the eyelids clean. This may include the use of eyelid scrubs and eyelid cleansers.
• Using a warm compress for 5 to 10 minutes to help soften the skin and remove crusts.
• Gently massaging the eyelids to help with the secretion of oil.

In more serious cases, antibiotics may be necessary.

Corneal ulcer

Corneal ulcers are usually treated using antibiotic, antifungal, or antiviral medication. Using a cool compress and avoiding rubbing or touching the eye will help reduce symptoms. Severe cases may require surgery.

Sinusitis

Many cases of sinusitis can be treated at home. A person can reduce symptoms by:

• using a warm compress on the area for 5 to 10 minutes, several times a day
• taking over-the-counter pain relievers, such as ibuprofen
• breathing in steam
• using a nasal saline solution
• staying rested and hydrated

Optic neuritis

Many cases of optic neuritis do not require medical treatment and will heal on their own. However, persistent cases may be treated using steroids to reduce inflammation. Steroids can be given through injections or tablets.

Dry eye syndrome

Dry eye syndrome can usually be treated with over-the-counter eye drops and anti-inflammatory medications.

Lifestyle changes can also be helpful, such as reducing screen time, staying hydrated, and limiting caffeine consumption. In more serious cases, surgery may be required.

Graves’ disease

Thyroid hormone levels can be reduced using antithyroid medication or radioactive iodine therapy. This can also be achieved using surgery, but surgery is usually only offered to younger candidates.

Keratitis

Mild cases of keratitis are treated using antibacterial eye drops. More severe cases may require antibiotic medication to fight the infection. In rare cases, surgery may be required.

Share on PinterestA doctor should be consulted if there are additional symptoms such as severe headaches, sensitivity to light, or loss of vision.

Most cases of eye pain while blinking can be treated at home with simple remedies, such as using warm compresses and avoiding irritants.

However, people with additional symptoms should see a doctor, as some causes of eye pain can cause permanent vision loss if left untreated.

Symptoms that may require medical attention include:

• loss of vision
• visual disturbances, such as flashing lights
• severe headaches
• pain deep in the eyes
• sensitivity to light
• severe redness of the eye

A doctor should see any severe symptoms immediately so they can develop the best course of treatment.

Causes of eye socket pain

This is an automatically translated article.

Eye socket pain is a sign that can be encountered in many different diseases. This can be a sign of a dangerous disease and seriously affects vision if not detected and treated early.

1. Eye socket pain is what disease?

The eye socket is composed of many different bones including the maxillary bone, the frontal bone, the cheekbone, the lacrimal bone, the ethmoid bone, and the sphenoid bone. Not only that, the inside of the eye socket also contains soft tissue including the optic nerve, blood vessels, eye muscles, eyeball…
Orbital pain can be caused by many different causes. It can also be a sign of a dangerous disease in the eye such as orbital inflammation, glaucoma, tumor… that needs to be treated early otherwise it will cause many dangerous complications.

2. What causes eye socket pain?

Orbital pain is a sign that can appear due to causes related to the internal organs of the eye socket. This is also a manifestation of some diseases in other organs. Here are the common causes of orbital pain symptoms :
2.1 Orchitis This is a condition caused by an infection of the soft tissues in the orbit and the muscles around the eye by microbiological agents such as bacteria and viruses. bacteria, viruses or fungi.
Orchitis is a disease that can affect the components that make up the orbit. This is a serious condition that, if not treated in time, can lead to irreversible vision loss, and even lead to life-threatening sepsis.
Orbital cellulitis can occur at any age, but is more common in children under 7 years of age and can worsen rapidly in children, increasing the risk of blindness. The manifestations of orbital cellulitis in children include:
Appearance of visual impairment. Swelling and pain in both upper and lower eyelids, possibly with swelling of the eyebrows and cheeks. Change in red or purple eyelid color. Fever over 39 degrees. Difficulty moving your eyes and feeling pain with eye movement Your eyes bulge and feel very sore in the eye sockets. Tired, children refuse to play. 2.2 Tumor in the orbit The tumor can originate from many different tissues and it can compress the nerves in the orbit causing pain in the orbit. Tumors can occur at any age and can be benign or malignant.
Benign tumors: Some benign tumors include hemangiomas, dermoid cysts, fibrous dysplasia in children, optic nerve tumors in adults… Melanoma: Some malignancies including rhabdomyosarcoma, bone malignancy, metastatic cancer, lymphoma. ..

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2.3 Glaucoma Glaucoma is an eye disease that is more common in the elderly and can be called by different names such as glaucoma, glaucoma. Glaucoma occurs when the pressure in the eye is abnormally high, causing damage to the optic nerve, leading to vision loss or blindness if not diagnosed and treated early.
Glaucoma is mainly divided into 2 types including:
2.3.1. Open-angle glaucoma Open-angle glaucoma usually progresses slowly and gradually increases, it takes a later stage to manifest itself. Symptoms usually appear one eye at a time. Manifestations of open-angle glaucoma may include:
See things more blurred. Reduced visual field of the eye causes tunnel vision. That is, all vision around is lost and only forward vision is visible. Red eyes, eye pain, and eye discomfort Some people may experience headaches. 2.3.2. Angle-closure glaucoma Angle-closure glaucoma can be divided into three categories: acute, subacute, and chronic. In which, chronic angle-closure glaucoma is very rare, often occurs gradually, the symptoms are similar to those of open-angle glaucoma. In the case of acute and subacute angle-closure glaucoma, the onset will be sudden with the following signs:
Visibly reduced vision, seeing a halo of color like when looking at a lightbulb Feeling severe headache, pain in the socket fierce eyes. Eye pain, red eyes. Nausea and vomiting. Irreversible visual impairment due to glaucoma. Therefore, to detect the disease early, it is necessary to have regular eye exams to screen for disease. If detected early, vision loss can be prevented or slowed. The treatment of these two types of glaucoma is completely different, so it is necessary to have an accurate diagnosis of closed-angle glaucoma or open-angle glaucoma to give an appropriate treatment plan.
2.4 Eye trauma After a direct or indirect injury to the eye socket can cause a number of conditions such as hemorrhage of the eyeball, bruising of the organization in the eye, foreign body in the eye socket. .. Expression of pain Traumatic eye sockets can be caused by many factors. But if you experience orbital pain after an eye injury, you need to see a doctor to find the cause quickly.

2.5 Some infectious diseases Pain in the eye socket is not only a sign of eye diseases but also can be a manifestation of some diseases such as:
Sinusitis: Especially frontal sinusitis is a common cause. pain in the eye socket, which increases when the head is lowered. In addition to symptoms of pain in the eye socket, the patient may have a runny nose and possibly a fever. Dengue fever: This is a viral disease transmitted by mosquito bites. In the early stages, the patient may appear high fever, body aches, pain in both eyes, headache. Viral fever: In addition to dengue fever, some other viral causes of fever can also cause systemic symptoms such as fever, body pain, orbital pain, etc. Infectious diseases often cause high fever and symptoms. The main pain is not orbital pain and the pain may be intermittently intermittent. Unlike orbital inflammation, eye pain is constant and accompanied by other eye symptoms.
2.6 Vasculitis Orbital vasculitis also causes orbital pain and other systemic symptoms such as fever.
2.7 Varicose Veins In the eye socket, if dilated, it will cause blood stagnation, causing the eye to bulge and pain in the eye socket. When having varicose veins in the eye socket, the patient needs to rest and avoid working too much.
2.8 Graves’ disease is an immune-related hyperthyroidism, one of the effects of the disease is to cause protrusion and the cause is not really clear. This condition causes pain in the orbits, bulging eyes, difficulty moving the eyes, feeling dazzled, eyestrain, watery or dry eyes, puffiness, and blurred or double vision. In addition, there are other symptoms such as rapid heart rate, heat, sweating, enlarged thyroid gland, eating a lot and being thin…
2.9 Graves’ disease causing eye socket pain Graves is a thyroid disease that can cause protrusion and glare Eyes, watery, sometimes burning sensation. .. For lower eyelids can be edematous, may be paralyzed, eyelids can’t be closed, the risk of complications can lead to corneal ulcers, dry eyes.
2.10 Other systemic diseases Some diseases such as high blood pressure, diabetes can cause eye complications and thereby cause orbital pain.

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3. What to do when you have eye socket pain?

Orbital pain has many causes, if you see orbital pain accompanied by symptoms such as blurred vision, severe pain, high fever, bulging eyes, prolonged pain… Children who encounter these signs need to to go to medical facilities to be examined and find the cause, get treatment early to limit the risk of complications, if any.
Hopefully through the article you have learned what orbital pain is and how to recognize it in cases that need early treatment to avoid complications. Regular eye exams are very important to help detect diseases that have no obvious symptoms and help patients access early treatment.

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Eyes hurt when pressed and blinking

Pain in the eyes when pressed or even the slightest blinking can signal various problems. Among them are inflammation of the muscles of the eye, high blood pressure, migraine, overwork of the body or infectious diseases. Pressure pain in this case is a symptom of the current disease, and not a separate disease, so you need to listen to the general condition as a whole.

In addition, pain can be caused by a foreign body in the eyeball, which is much easier to diagnose. Let’s separately analyze the most popular causes of discomfort. In modern times, overwork of the eye muscles is the most common ailment. This is due to the huge pastime for mobile and electronic devices, hard work and general anxiety. Do not forget that not only our joints suffer from long work and hypothermia can develop, but also our eyes, as a result of which their dryness, tearing, pain are observed, and vision irreversibly sits down. In addition to consulting a doctor, which is a must, you should reconsider the time spent at a computer or laptop, and possibly purchase special corrective glasses.

Diagnose the appearance of your eyes, whether they are swollen. A slight redness or swelling may indicate an infection, such as the imminent appearance of an eye stye. Barley occurs as a result of a general decrease in immunity against the background of infection entering the body, as a result of which the sebaceous glands of the eye become inflamed, and a purulent sac begins to mature, but after some time it breaks through and passes safely. This disease does not carry a serious danger, however, it can be confused with a chalazion – a spherical seal in the eye area, which can occur both inside the eye and outside. In this case, the eye will feel pressure and the presence of a foreign body, and most importantly, that the swelling and the visible “ball” may not go away for a very long time, but only get bigger and bigger. In the event of a chalazion, surgical intervention is very often necessary, when the doctor makes an incision and helps the pus to come out artificially.

Pay attention to the optics you are using. These can be corrective glasses or lenses, which are most likely not chosen correctly if they cause discomfort. Do a little experiment – try not to use your usual accessories for a week and watch how it feels.

If the optics do not suit you, contact your doctor and describe any problems that arise so that the doctor selects the correct corrective products.

If a foreign body gets into the eyes, it is better not to postpone going to the doctor, but immediately go to the emergency room, where the doctor will remove the mote from the eye with a professional tool. In no case do not pick inside the eyes with dirty hands – this greatly increases the risk of infection. In addition, in this way it is possible to drive a foreign object even further and it will have to be removed surgically. If the mote is not removed from the eye for a long time, there is a risk of not only increasing pain, but also a greater likelihood of losing vision due to physical injury to the eye.

If the discomfort does not go away, but only intensifies, and there are no visible signs for this, do not put off going to the doctor. You may need to visit not only an ophthalmologist, but also a therapist, because eye pain is often a sign of other serious problems with the body.

Some aspects of restoration of the lower wall of the orbit

List of abbreviations:

CM – maxillary sinus

VCT – fibrous connective tissue

RFCT – reticulofibrous bone tissue

PCT – lamellar bone tissue

MSCT – multislice computed tomography

Fracture of the orbital wall is a common pathology, the incidence of which ranges from 18 to 80% of all traumatic brain injuries [1, 2]. Fracture of the inferior wall of the orbit (of the blow-out type) occurs in 15–20% of all orbital fractures [3, 4]. Restoration of the lower wall of the orbit is a complex and urgent clinical problem, located at the intersection of several specialties: otorhinolaryngology, ophthalmic surgery and maxillofacial surgery. The choice of tactics for managing patients with this pathology is determined by many factors: the size of the defect, the presence of prolapse of the contents of the orbit into the maxillary sinus (MS) or pinching of the oculomotor muscles (disturbances from the organ of vision, the duration of the period elapsed since the injury), the presence of enophthalmos (impaired mobility of the eye apples) and others [5, 6]. Damage to the lower wall of the orbit is usually confirmed by computed tomography, which makes it possible to assess the condition of the bone structures of the orbit, the size and location of the defect, and also allows you to measure any displacement of the bone walls and soft tissues of the orbit to select the optimal method of surgical treatment [3, 7—9].

It is known that early surgery improves the prognosis for the patient. Despite the fact that the surgical reconstruction of the defect of the inferior wall of the orbit can be postponed, in case of damage of the blow-out type, there is a risk of muscle pinching, which requires emergency surgery [5, 6]. To restore the lower wall of the orbit, various materials are used, including titanium constructions and various types of bone grafts, but there is no experimental justification for their use [2, 10–13].

The purpose of the study is to present an experimental and clinical rationale for the use of a non-woven titanium construct and an allogeneic demineralized bone graft to repair a defect in the lower wall of the orbit.

Material and methods

On the basis of the department of morphology of the Federal State Budgetary Institution “All-Russian Center for Eye and Plastic Surgery” of the Ministry of Health of Russia (Ufa), experimental studies were performed on 24 one and a half year old chinchilla rabbits of both sexes. In laboratory animals, a defect in the wall of the maxillary sinus with a diameter of 4 mm was modeled with a dental bur. Previously, it was found experimentally that this size of the defect is not spontaneously replaced by bone tissue. Then, the bone defect was closed using a structure based on porous titanium ( n =12), allogeneic demineralized bone graft ( n =12) using the press-fit technique (“plug”), after which layer-by-layer suturing of the soft tissues over the plastic area was performed.

The developed technologies for closing defects in the lower wall of the orbit were used in accordance with the registration certificate No. FSR 2011/12012 dated 09/30/11. Using these technologies, we operated on 15 patients with defects in the lower wall of the orbit.

Allogeneic bone grafts “Alloplant” (TU 9398-001-04537642-2011), adapted to the size of the defect in the lower wall of the orbit. With extensive (more than 3 cm) defects in the upper wall of the maxillary sinus ( n = 7, or 47%), a non-woven titanium structure manufactured by OOO Prototype (Samara; TU 9437-002-01963143-2010) was used.

Results

Application of non-woven titanium construction. Two months after implantation of the titanium structure, histological preparations revealed a regenerate represented by a complex of bone tissues replacing the defect.

The perifocal zone directly adjacent to the titanium structure was formed from immature coarse fibrous bone tissue, consisting of large-loop thin trabeculae. In the intertrabecular spaces, loose fibrous connective tissue (VCT) infiltrated with fibroblasts was detected. A developed network of blood vessels, adipose tissue and bone marrow cells were found in it. In the cavities of the central zone of the regenerate, fine-cellular (nanostructured) hollow structures were observed, which consisted of many rounded cells grouped together into clusters. Only cell walls were stained pink with hematoxylin and eosin, the gaps were free. These formations did not cause a pronounced inflammatory reaction, however, in the bone cavities they were covered with a thin connective tissue capsule.

Subsequently, the volume of collagen fibers increased, titanium loops were overgrown with loose connective tissue with a small amount of fibroblasts, macrophages and completely immersed in the fibrous matrix. The loose VCT gradually transformed into a dense, irregular connective tissue with thick bundles of collagen fibers and reduced blood vessels. Osteointegration took place: migration of osteogenic cells from the side of the maternal bone and mineralization of collagen fibers formed around the titanium loops (Fig. 1). Rice. 1. Developed fibrosis around the titanium loops (control). Stained with hematoxylin and eosin. Staining with hematoxylin and eosin.

In this case, the titanium loops appeared in the thickness of the bone matrix. Zones of active appositional bone formation were determined around the titanium clusters in the bone. The canals were lined with active type II osteoblasts, located tightly to each other in one row and synthesizing osteoid and bone matrix. The titanium cells themselves acquired a denser structure, between them the VCT with thickened collagen bundles was determined. When stained with hematoxylin and eosin, the cell gaps were stained acidophilically pink and basophilically blue. Some cells lost their original structure and were deformed. Their walls lysed, homogenized, and represented a dense shapeless mass (Fig. 2). Rice. 2. Titanium destruction in bone cavities (control). Stained with hematoxylin and eosin. Staining with hematoxylin and eosin. Thus, titanium was subjected to destruction. Moreover, the rate of biodegradation of the implant was lower than the rate of bone tissue formation.

In the deep zone of the bone regenerate, directly adjacent to the maternal bone, there were signs of a gradual transformation of coarse-fibered immature bone into a mature lamellar bone. Along the entire circumference of the defect, a thin uneven strip of mature spongy bone tissue with numerous bone lacunae filled with osteocytes was determined. Thickened bony trabeculae gradually matured into lamellar bone with a characteristic structure. In the bone matrix of lamellar bone, a developed network of Haversian canals filled with loose connective tissue with blood vessels was found.

Thus, reparative bone formation occurred centripetally – from the periphery to the center (appositional osteopoiesis). Moreover, the rate of osteogenesis and biodegradation of titanium was different — the rate of implant destruction was lower. The mechanism of osteogenesis is represented by intramembranous ossification, i. e., bone formation occurred through the stage of VCT formation with gradual transformation into coarse fibrous bone tissue and further transformation into lamellar bone. The titanium structure does not cause a violent inflammatory reaction and does not have immunogenic activity, but the surrounding tissues react to the implant as if it were a foreign body – it is encapsulated and fibrosis develops.

Application of demineralized bone graft. Slightly different mechanisms of replacement regeneration were found in the area of ​​implantation of a demineralized bone graft into a burr defect of the anterolateral wall of the maxillary sinus. In the early stages (on the 14th day), polymorphocellular infiltration is determined in the transplantation area. At the same time, cells of fibroblastic, osteoblastic and macrophage differons are verified in the infiltrate. It is important to emphasize the absence of representatives of lymphocytic differon and segmented leukocytes in the composition of the cellular infiltrate, which indicates the absence of a purulent infection in the area of ​​allogeneic graft replanting.

On the 45th day, the demineralized bone graft undergoes intense degradation and lysis, as evidenced by the change in its tinctorial properties. However, at this time, the demineralized bone graft still retains a significant part of its volume (Fig. 3). Rice. 3. Experimental model of a defect in the anterolateral wall of the maxillary sinus with its subsequent closure with an allogeneic bone graft. The first experimental series; 45th day. Mallory coloring. Reconstruction. ×100. Mallory staining. reconstruction. ×100. In the peripheral zone, an active vascular reaction from the bone bed was observed. The area of ​​allogeneic bone graft replanting was abundantly vascularized. Vessels from the peripheral zone grew into the transplantation area, which is explained not only by the presence of channels in the bone graft, but also by the stimulating effect of its resorption products on the processes of vascular proliferation. It should be noted the absence of pronounced vascular and cellular reactions from the mucous membrane of the maxillary sinus. There was some thickening and cellular infiltration of the lamina propria in the marginal zone of transplantation.

The processes of resorption prevailed over the synthetic activity of fibroblasts and osteoblasts, therefore, on the 45th day, the emerging regenerate had minor inclusions of bone tissue and was represented by 36.48 ± 4.81% of loose BCT.

Further (day 90) further degradation of the allogeneic bone graft occurs. Most of the bone biomaterial is replaced by newly formed reticulofibrous bone tissue (RFCT). Severe infiltration by macrophages in the area of ​​graft replanting is not observed. The rate of bone graft resorption prevailed over the rate of replacement osteogenesis. The graft itself partially retained the structural organization of lamellar bone tissue (PCT). The emerging regenerate is a dense, formed VST with a relatively larger number of cellular elements and vessels than in the surrounding tissues. At the same time, the tortuosity of collagen fibers and the density of their packing are less pronounced in the regenerate. XRF inclusions were determined in the composition of the regenerate. As morphometric analysis shows, the bone tissue in this case makes up a significant volume of the total area of ​​the study area.

As a result of the merger of two opposite fronts of substitution of allogeneic biomaterial, on the 180th day, a continuous XRF array with PCT inclusions is formed (see table). Relative tissue density (in kg/m ³ ) in the regenerate on the 180th day after a trepanation defect of the anterolateral wall of the maxillary sinus with subsequent closure with an allogeneic demineralized bone graft

We present a description of clinical cases of plasty of the lower wall of the orbit with a demineralized bone graft and a non-woven titanium structure.

Case study 1

Patient S. , 17 years old, applied to the neurosurgical department of the hospital of the Neftyanik medical unit with complaints of diplopia that persisted for 1 month after a blunt trauma to the orbit on the right. On multispiral computed tomography (MSCT) of the paranasal sinuses and orbit, a defect in the upper wall of the right maxillary sinus with prolapse of paraorbital fatty tissue into the sinus is determined (Fig. 4). Rice. 4. MSCT of the paranasal sinuses and orbit on the right: coronal and sagittal projections. Defect of the lower wall of the right orbit (upper wall of the maxillary sinus) with prolapse of the paraorbital tissue. Defect of the lower wall of the right orbit (the upper wall of the maxillary sinus) with the prolapse of the paraorbital adipose tissue into the sinus.

Lower orbitotomy was performed under general anesthesia together with a neurosurgeon. The area of ​​the defect in the upper wall of the maxillary sinus is free from scars, the paraorbital tissue is displaced upward. A revision of the maxillary sinus through the upper wall was performed using an Elmed 70° endoscope with a diameter of 4 mm. A pre-modeled fragment of a demineralized bone allogeneic graft was placed in the area of ​​the defect (Fig. 5). Rice. 5. Intraoperative microphoto. The allogeneic graft was fixed in the defect of the lower wall of the orbit using the press fit technique. The soft tissues were sutured in layers, a cosmetic suture was applied to the skin of the lower eyelid. In the nasal cavity for 10 minutes were introduced gauze turundas soaked in a 0.1% solution of oxymetazoline. Then, in order to prevent bleeding and additional anesthesia of the operated area, the mucous membrane of the nasal cavity (in front of the uncinate process, at the base and anterior end of the middle turbinate) was infiltrated with 1% lidocaine solution with adrenaline 1: 100,000. The infiltration procedure was controlled with an Elmed endoscope with a rigid endoscope with a diameter of 4 mm . The raspator was used to sparingly medialize the middle turbinate, the proposed tool for mobilizing the uncinate process was introduced into the middle nasal passage, and the semilunar fissure was expanded due to the medial displacement of the uncinate process.

On the 7th day, a control MSCT was performed, which confirmed the stable position of the allogeneic graft, while there was a slight reactive edema of the maxillary sinus mucosa on the side of the intervention (Fig. 6). Rice. 6. Patient S., 17 years old. The seventh day after the lower orbitotomy on the right with the reconstruction of the lower wall of the orbit. On the left, the pupils are at the same level. Right — MSCT of the paranasal sinuses and orbit on the right, sagittal view. Phenomena of reactive edema of the mucous membrane of the maxillary sinus. The identically leveled pupils (left). MSCT of the right-hand paranasal sinuses and the orbit in the sagittal projection (right). The signs of reactive oedema of the mucous membrane of the maxillary sinus. A cosmetic suture was removed on the lower eyelid, the pupils were at the same level. The patient notes the absence of diplopia.

Case study 2

Patient Sh. , 18 years old, applied to the neurosurgical department of the hospital of the Neftyanik medical unit with complaints of diplopia that persisted for 2 weeks after a blunt trauma to the orbit on the right. MSCT of the paranasal sinuses and orbit on the right shows a defect in the upper wall of the maxillary sinus with prolapse of the paraorbital fatty tissue into the sinus (Fig. 7). Rice. 7. Patient Sh., 18 years old. MSCT. Post-traumatic defect of the lower wall of the orbit. Prolapse of paraorbital tissue into the lumen of the maxillary sinus (indicated by an arrow). Prolapse of the paraorbital adipose tissue into the maxillary sinus lumen (indicated by he arrow).

Lower orbitotomy was performed under general anesthesia together with a neurosurgeon. The area of ​​the defect in the upper wall of the maxillary sinus is free from scars, the paraorbital tissue is displaced upward. A revision of the maxillary sinus was performed through the upper wall using an Elmed 70° endoscope with a diameter of 4 mm. A pre-modeled non-woven titanium structure was installed in the area of ​​the defect (Fig. 8). Rice. 8. Patient Sh., 18 years old. Intraoperative photo. A non-woven titanium structure was installed in the area of ​​the defect in the upper wall of the maxillary sinus. The non-woven titanium structure is placed in the defective region in the upper wall of the maxillary sinus.

Soft tissues are sutured in layers, a cosmetic suture is applied to the skin of the lower eyelid. In the nasal cavity for 10 minutes were introduced gauze turundas soaked in a 0.1% solution of oxymetazoline. Then, under the control of an Elmed endoscope with a diameter of 4 mm, the mucous membrane of the nasal cavity was infiltrated (in front of the uncinate process, at the base and anterior end of the middle turbinate) with a 1% solution of lidocaine with adrenaline 1: 100,000. developed tool for mobilization of the uncinate process, the semilunar fissure was expanded due to the medial displacement of the uncinate process.

On the 2nd day, a control MSCT was performed, which confirmed the stable position of the non-woven titanium structure and the absence of reactive changes in the maxillary sinus mucosa. A cosmetic suture was removed on the lower eyelid, the pupils were at the same level. The patient notes the absence of diplopia.

Conclusion

In addition to releasing imprisoned soft tissues, the goal of treatment of an orbital fracture is to restore the anatomy of the orbit and prevent serious rhinogenic intraorbital complications. Clinical evaluation, combined with appropriate radiological examination of operated patients, confirms the efficacy and safety of using a non-woven titanium construct and an allogeneic demineralized bone graft in the reconstruction of the inferior wall of the orbit. On the basis of an experimental study, it was concluded that the use of porous titanium is preferable for large defects in the lower wall of the orbit. This is due to the lower rate of implant destruction compared to bone graft. In general, the choice of a method for reconstructing a defect in the inferior wall of the blow-out orbit should be carried out taking into account the experience of the surgeon and the availability of appropriate material.

The authors declare no conflict of interest.

Author contributions:

Research concept and design: D.Sh., A.I.K., V.K.

Collection and processing of material: D.Shch., A.Shch., A.S.K.

Statistical processing: A.S.K.

Text writing: D.Shch., A.Sh., A.S.K.

Editing: D.Sh., A.I.K., V.K.

Credits

Shcherbakov Dmitry Alexandrovich , Ph.D. [Dmitrii A. Shcherbakov, MD, PhD]; address: Russia, 117152, Moscow, Zagorodnoe highway, 18A, building 2 [address: build. 2, 18A Zagorodnoe highway, 117152 Moscow, Russia]; ORCID: https://orcid.org/0000-0002-4334-3789; eLibrary SPIN: 1594-1907; e-mail: dmst@bk.