Yuan Po Hsiang, Micieli Jonathan A
Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Case Rep Ophthalmol. 2021 Jan 7;12(1):11-15. doi: 10.1159/000511100. eCollection 2021 Jan-Apr.
A 61-year-old woman presented with sudden vision loss from a left anterior optic neuropathy in the context of severely elevated intraocular pressure after starting topical steroids for anterior uveitis related to herpes zoster ophthalmicus (HZO). The strong temporal relationship between the vision loss and elevated IOP suggested the vision loss was related to nonarteritic anterior ischemic optic neuropathy (NAION). Anterior chamber paracentesis did not detect varicella zoster virus (VZV) and magnetic resonance imaging of the orbits was normal. Her vision remained stable and the optic disc edema resolved within 3 months. The occurrence of NAION following an acute elevation of intraocular pressure (IOP) is well-documented in the context of surgical procedures, glaucoma, uveitis and trauma. This case indicates that not every optic neuropathy in close temporal relationship with HZO is directly attributable to the virus. NAION may also occur after steroid-related IOP spikes and ophthalmologists should ensure that patients on topical steroids are closely monitored for ocular complications.
一名61岁女性，因与带状疱疹性眼炎（HZO）相关的前葡萄膜炎开始局部使用类固醇后，出现严重眼内压升高，继发左眼前部视神经病变导致突然视力丧失。视力丧失与眼压升高之间存在明显的时间关系，提示视力丧失与非动脉炎性前部缺血性视神经病变（NAION）有关。前房穿刺未检测到水痘带状疱疹病毒（VZV），眼眶磁共振成像正常。她的视力保持稳定，视盘水肿在3个月内消退。在手术、青光眼、葡萄膜炎和外伤等情况下，眼内压（IOP）急性升高后发生NAION已有充分记录。该病例表明，并非每一例与HZO时间关系密切的视神经病变都直接归因于病毒。NAION也可能在类固醇相关的眼压峰值后发生，眼科医生应确保对局部使用类固醇的患者密切监测眼部并发症。
