Schoenlaub P, Grange F, Nasica X, Guillaume J C
Service de dermatologie, Hôpital Pasteur, Colmar.
Ann Dermatol Venereol. 1997;124(5):401-3.
Only few studies focus on ocular motor paralyses in herpes zoster ophtalmicus. We report 2 cases of complete ptosis resulting from paralysis of the superior lid levator, appearing at day 6 and 7 of an ophtalmic herpes zoster under treatment with acyclovir.
Case 1: A 68 year old woman presented an history of ophtalmic herpes zoster with kerato-conjunctivitis and uveitis treated with acyclovir. At the third day of the treatment and 7th day of the ophtalmic zoster, an incomplete paralysis of the oculomotor nerve appeared resulting in a complete ptosis. The treatment was carried on until the 21st day without improvement. Four months later, all symptoms had completely cleared. CASE 2: A 66 year old woman was treated with acyclovir for an ophtalmic herpes zoster without ocular involvement. At the 4th day of the treatment and 6th day of the onset of the ophtalmic zoster, a paralytic ptosis and a acute epithelial keratitis appeared. Acyclovir treatment was continued for 10 days. The ptosis resolved gradually during 2 months.
The manifestation of a complete ptosis with paralysis of the oculomotor nerve or of one of its branch is rarely seen in ophtalmic herpes zoster. However minor symptoms are often detected when patients were carefully examined with regard to external ocular movements. The physiopathological mechanism are discussed about. The possible action of an early antiviral treatment on the prevention of these complications is not known. In our two cases, a paralytic ptosis broke out suddenly, even under treatment with acyclovir for respectively 3 and 4 days. For future prospective studies about antiviral drugs for ophtalmic herpes zoster, a systematic evaluation of these neurological symptoms would be interesting.
仅有少数研究关注眼部带状疱疹的眼球运动麻痹。我们报告2例因提上睑肌麻痹导致的完全性上睑下垂病例，这2例患者在接受阿昔洛韦治疗的眼部带状疱疹病程第6天和第7天出现上述症状。
病例1：一名68岁女性，有眼部带状疱疹伴角膜结膜炎和葡萄膜炎病史，接受阿昔洛韦治疗。治疗第3天，即眼部带状疱疹病程第7天，出现动眼神经不完全麻痹，导致完全性上睑下垂。治疗持续至第21天，症状无改善。4个月后，所有症状完全消失。病例2：一名66岁女性因眼部带状疱疹接受阿昔洛韦治疗，无眼部受累。治疗第4天，即眼部带状疱疹发病第6天，出现麻痹性上睑下垂和急性上皮性角膜炎。阿昔洛韦治疗持续10天。上睑下垂在2个月内逐渐消退。
眼部带状疱疹很少见动眼神经或其分支之一麻痹导致完全性上睑下垂的表现。然而，当仔细检查患者眼球外运动时，常可发现轻微症状。文中讨论了其病理生理机制。早期抗病毒治疗对预防这些并发症的可能作用尚不清楚。在我们的2例病例中，即使分别接受了3天和4天的阿昔洛韦治疗，仍突然出现麻痹性上睑下垂。对于未来关于眼部带状疱疹抗病毒药物的前瞻性研究，对这些神经症状进行系统评估将很有意义。
