An Unusual Case of Orbital Inflammation Preceding Herpes Zoster Ophthalmicus.
10.3341/jkos.2017.58.9.1099
- Author:
Ji Hyun PARK
1
;
Ji Eun LEE
Author Information
1. Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea. ddalkieco@gmail.com
- Publication Type:Case Report
- Keywords:
Dacryoadenitis;
Herpes zoster ophthalmicus;
Optic perineuritis;
Orbital inflammation
- MeSH:
Acyclovir;
Aged, 80 and over;
Dacryocystitis;
Diagnosis;
Diagnosis, Differential;
Edema;
Exanthema;
Exophthalmos;
Female;
Gallbladder Neoplasms;
Herpes Zoster Ophthalmicus*;
Herpes Zoster*;
Humans;
Hypertension;
Inflammation*;
Keratitis;
Lacrimal Apparatus;
Magnetic Resonance Imaging;
Neuralgia, Postherpetic;
Ophthalmoplegia;
Optic Nerve;
Orbit*;
Pupil;
Pupil Disorders;
Steroids;
Trigeminal Nerve;
Uveitis;
Visual Acuity
- From:Journal of the Korean Ophthalmological Society
2017;58(9):1099-1105
- CountryRepublic of Korea
- Language:Korean
-
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.
