Akpek E K, Gottsch J D
Cornea and External Diseases Service, The Wilmer Eye Institute, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21287-9238, USA.
Ocul Immunol Inflamm. 2000 Jun;8(2):115-8.
To report a case of herpes zoster sine herpete presenting with hyphema.
A 69-year-old man was referred for traumatic hyphema and corneal edema in his left eye after a sandblast exposure three weeks previously. Slit-lamp examination demonstrated hyphema, anterior chamber inflammation, mid-dilated pupil, impaired corneal sensation, and high intraocular pressure, without any facial skin lesions. Iris fluorescein angiography revealed tortuosity and extensive occlusion of iris vessels. The patient was treated with oral acyclovir and intensive topical steroids with a presumed diagnosis of severe herpes zoster uveitis.
Clinical findings improved dramatically within several days. Typical sectorial iris atrophy with pupillary sphincter dysfunction and complete loss of corneal sensation developed after the resolution of intraocular inflammation.
Herpes zoster should be considered in patients with uveitis and hyphema even in the absence of typical skin rash.
报告一例表现为前房积血的无疱疹性带状疱疹病例。
一名69岁男性因三周前喷砂暴露后左眼外伤性前房积血和角膜水肿前来就诊。裂隙灯检查显示前房积血、前房炎症、瞳孔中度散大、角膜感觉减退和眼压升高，面部无任何皮肤损害。虹膜荧光素血管造影显示虹膜血管迂曲和广泛阻塞。该患者被给予口服阿昔洛韦和强化局部类固醇治疗，初步诊断为严重的带状疱疹性葡萄膜炎。
数天内临床症状显著改善。眼内炎症消退后出现典型的扇形虹膜萎缩伴瞳孔括约肌功能障碍和角膜感觉完全丧失。
即使没有典型皮疹，葡萄膜炎和前房积血患者也应考虑带状疱疹。
