An Unusual Case of Orbital Inflammation Preceding Herpes Zoster Ophthalmicus
Journal of the Korean Ophthalmological Society
; : 1099-1105, 2017.
Article
em Ko
| WPRIM
| ID: wpr-83993
Biblioteca responsável:
WPRO
ABSTRACT
PURPOSE: To present a case of orbital inflammation and optic perineuritis preceding vesicular eruption in herpes zoster ophthalmicus(HZO). CASE SUMMARY: An 84-year-old woman with a history of gall bladder cancer and hypertension complained of left periorbital erythematous edema and discomfort. On examination, visual acuity was 20/25 bilaterally; no tenderness, proptosis or ophthalmoplegia was observed. Pupils were equal, round, and reactive to light without relative afferent pupillary defects. Slit-lamp examination revealed severe conjunctival injection and chemosis without keratitis or uveitis. The remainder of the ocular examination was unremarkable. Magnetic resonance imaging confirmed left-sided preseptal swelling with an enlarged left lacrimal gland, high signal intensity of the retrobulbar fat and optic nerve sheath. Systemic antibiotic therapy with steroids was started under a presumed diagnosis of idiopathic orbital inflammatory disease, but the clinical presentation was unresolved. After 2 days, vesicular lesions confined to the first division of the trigeminal nerve and pseudodendritic keratitis developed on the left side leading to a diagnosis of HZO. Treatment with acyclovir immediately resolved anterior segment inflammation and periorbital edema. While on therapy, visual acuity deteriorated to 20/125 and the pupil became dilated and unresponsive to light over a few days. All signs and symptoms of acute orbitopathy and postherpetic neuralgia had resolved 3 months later with the exception of pupil abnormality and visual acuity. CONCLUSIONS: HZO may present with symptoms and signs of orbital inflammation and optic perineuritis even in the absence of a vesicular rash. Thus, HZO should be considered in the differential diagnosis of unexplained acute orbital syndromes.
Palavras-chave
Texto completo:
1
Índice:
WPRIM
Assunto principal:
Nervo Óptico
/
Órbita
/
Esteroides
/
Nervo Trigêmeo
/
Uveíte
/
Aciclovir
/
Imageamento por Ressonância Magnética
/
Acuidade Visual
/
Oftalmoplegia
/
Pupila
Tipo de estudo:
Diagnostic_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
Idioma:
Ko
Revista:
Journal of the Korean Ophthalmological Society
Ano de publicação:
2017
Tipo de documento:
Article