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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