J Korean Ophthalmol Soc > Volume 58(9); 2017 > Article
Journal of the Korean Ophthalmological Society 2017;58(9):1099-1105.
DOI: https://doi.org/10.3341/jkos.2017.58.9.1099    Published online September 15, 2017.
An Unusual Case of Orbital Inflammation Preceding Herpes Zoster Ophthalmicus.
Ji Hyun Park, Ji Eun Lee
Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea. ddalkieco@gmail.com
안와 염증이 피부 병변에 선행하여 나타난 눈대상포진 1예
박지현⋅이지은
메리놀병원 안과
Correspondence:  Ji Eun Lee,
Email: ddalkieco@gmail.com
Received: 6 July 2017   • Revised: 31 July 2017   • Accepted: 23 August 2017
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.
Key Words: Dacryoadenitis;Herpes zoster ophthalmicus;Optic perineuritis;Orbital inflammation


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