Othman Khairuddin, Evelyn-Tai Li Min, Raja-Azmi Mohd Noor, Julieana Muhammed, Liza-Sharmini Ahmad Tajudin, Tharakan John, Besari Alwi Muhd, Zunaina Embong, Shatriah Ismail
Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Int J Surg Case Rep. 2017;30:197-200. doi: 10.1016/j.ijscr.2016.12.010. Epub 2016 Dec 21.
Hyphema and orbital apex syndrome occurring concurrently in a patient with herpes zoster ophthalmicus have not been reported previously. We present a case with these unique findings and discuss the pathogenesis of these conditions and their management.
A 59-year-old Malay lady with underlying diabetes mellitus presented with manifestations of zoster ophthalmicus in the left eye. Two weeks later, she developed total hyphema, and complete ophthalmoplegia suggestive of orbital apex syndrome. She was treated with combination of intravenous acyclovir and oral corticosteroids, and regained full recovery of ocular motility. Total hyphema persisted, and she required surgical intervention.
Hyphema is postulated to occur due to an immune vasculitis affecting the iris vessels. Orbital apex syndrome is probably due to an occlusive vasculitis affecting the vasculature of the extraocular muscles and optic nerve, resulting from a direct invasion by varicella zoster virus or infiltration of perivascular inflammatory cells. Magnetic Resonance Imaging of the brain is essential to exclude possibility of local causes at the orbital apex area.
Herpes zoster ophthalmicus is an uncommon ocular presentation. Managing two concurrent complications; persistent total hyphema and orbital apex syndrome is a challenging clinical situation. Early diagnosis and prompt treatment are essential to prevent potential blinding situation.
之前未曾报道过患有眼部带状疱疹的患者同时出现前房积血和眶尖综合征。我们报告一例具有这些独特表现的病例，并讨论这些病症的发病机制及其治疗方法。
一名59岁患有糖尿病的马来女性，出现左眼眼部带状疱疹的症状。两周后，她出现了全前房积血以及提示眶尖综合征的完全性眼肌麻痹。她接受了静脉注射阿昔洛韦和口服皮质类固醇的联合治疗，眼肌运动功能完全恢复。全前房积血持续存在，她需要接受手术干预。
推测前房积血是由于影响虹膜血管的免疫性血管炎所致。眶尖综合征可能是由于水痘带状疱疹病毒直接侵袭或血管周围炎性细胞浸润，导致影响眼外肌和视神经血管系统的闭塞性血管炎。脑部磁共振成像对于排除眶尖区域局部病因的可能性至关重要。
眼部带状疱疹是一种不常见的眼部表现。处理两种并发的并发症；持续性全前房积血和眶尖综合征是具有挑战性的临床情况。早期诊断和及时治疗对于预防潜在的致盲情况至关重要。
