College of Physicians and Surgeons, Columbia University, New York, NY, USA.
J Neuroophthalmol. 2012 Sep;32(3):246-8. doi: 10.1097/WNO.0b013e318234dafc.
A 90-year-old woman presented with subacute painless left ptosis. Examination of the left eye revealed ptosis with loss of the superior eyelid sulcus, 2 mm of proptosis, mild tenderness with retropulsion, and optic disc edema. Levator function and extraocular movements were normal, and there was no relative afferent pupillary defect. MRI demonstrated thickening of the extraocular muscles in the left orbit with lacrimal gland enlargement and mild enhancement of the optic nerve sheath. Serology revealed a positive enzyme-linked immunosorbent assay for Lyme antibodies and a positive Western blot of Lyme IgG titer. The patient recalled a tick bite 6 months earlier, at which time Lyme serologies were negative. After 3 weeks of intravenous ceftriaxone, she had a significant improvement and a full recovery by 3 months. Lyme disease should be included in the differential diagnosis of orbital inflammation, especially in Lyme-endemic areas.
一位 90 岁女性因亚急性无痛性左侧上睑下垂就诊。左眼检查发现上睑下垂伴有上睑沟消失，眼球突出 2 毫米，轻度压痛伴后退，视盘水肿。提上睑肌功能和眼球运动正常，无相对传入性瞳孔缺陷。MRI 显示左侧眼眶内眼外肌增厚，伴有泪腺增大和视神经鞘轻度强化。血清学检查显示莱姆抗体酶联免疫吸附试验阳性，莱姆 IgG 滴度的 Western blot 阳性。患者回忆起 6 个月前被蜱虫叮咬，当时莱姆血清学检查为阴性。静脉用头孢曲松治疗 3 周后，她的病情显著改善，3 个月时完全康复。莱姆病应纳入眼眶炎症的鉴别诊断，尤其是在莱姆病流行地区。
