Swaminathan Swarup S, Yannuzzi Nicolas A, Rong Andrew J, Crane Ashley M, Albini Thomas A
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
Am J Ophthalmol Case Rep. 2019 Feb 13;14:47-50. doi: 10.1016/j.ajoc.2019.01.012. eCollection 2019 Jun.
To describe the rare entity of concurrent herpetic acute retinal necrosis (ARN) and orbital inflammation.
Two cases of ARN with simultaneous orbital inflammation are described. A 40-year old male presented with a painful left eye and hand motion visual acuity (VA). Both panuveitis and orbital inflammation with involvement of the sclera and optic nerve were observed. He was initially treated with oral steroid therapy, after which the orbital inflammation improved but the panuveitis remained. A diagnostic anterior chamber paracentesis was positive for HSV-2 by PCR. He was started on systemic antivirals, but ultimately developed a retinal detachment. The second patient was an 18-year old female with hand motion VA in the left eye. Panuveitis and severe conjunctival chemosis were observed. MRI demonstrated dacryoadenitis with preseptal inflammation. The patient was initially started on oral steroid therapy, which alleviated the orbital inflammation but not the intraocular inflammation. An anterior chamber diagnostic paracentesis was positive for HSV-1, after which the patient underwent vitrectomy for a retinal detachment. The patient was started on systemic antiviral therapy.
Herpetic disease should remain on the differential for cases of concurrent intraocular and orbital inflammation. Early recognition of this process may help prevent severe vision loss. It is important to recognize that orbital inflammation secondary to herpetic disease may be diverse in its presentation.
描述同时发生疱疹性急性视网膜坏死（ARN）和眼眶炎症这种罕见情况。
描述了2例同时伴有眼眶炎症的ARN病例。一名40岁男性，左眼疼痛，视力仅为手动视力。观察到全葡萄膜炎以及累及巩膜和视神经的眼眶炎症。最初给予口服类固醇治疗，之后眼眶炎症有所改善，但全葡萄膜炎仍存在。前房穿刺诊断经聚合酶链反应（PCR）检测HSV-2呈阳性。开始给予全身抗病毒治疗，但最终发生了视网膜脱离。第二名患者是一名18岁女性，左眼视力为手动视力。观察到全葡萄膜炎和严重的结膜水肿。磁共振成像（MRI）显示泪腺炎伴眶隔前炎症。患者最初开始口服类固醇治疗，这缓解了眼眶炎症，但眼内炎症未缓解。前房诊断性穿刺HSV-1呈阳性，之后患者因视网膜脱离接受了玻璃体切除术。患者开始接受全身抗病毒治疗。
对于同时发生眼内和眼眶炎症的病例，疱疹性疾病应始终列入鉴别诊断。早期识别这一过程可能有助于预防严重视力丧失。认识到疱疹性疾病继发的眼眶炎症在表现上可能多种多样很重要。
