園芸用支柱による外傷性視神経障害の1例

A case of trauma to the optic nerve by a pole supporting plants

59歳女性が転倒して直径5mmの鉢植え支柱に当たり，支柱先端が右眼上方に刺入した。受傷1時間後の診察で矯正視力は右0.08，左1.0であった。右眼RAPDは陽性，眼球運動は正常であった。右眼窩上内側縁の皮膚に5mmの裂傷があった。眼底には異常がなかった。右眼視野は下方一部のみが残存していた。眼球後方への障害による視神経外傷と診断した。その翌日，視力がさらに低下し外転神経麻痺が出現したため，ステロイドパルス療法とマンニトール点滴を行った。以後視力と視野は徐々に改善し，受傷7か月後には右眼の矯正視力が1.2に回復した。上方視野の欠損は残った。

A 59-year-old female stumbled and fell over a pole supporting plants. Her right eye was perforated by the pole of 5 mm in diameter. When seen one hour after the accident,her corrected visual acuity was 0.08 right and 1.0 left. The right eye showed relative afferent pupilary defect（RAPD）. The eye movement was normal. Funduscopy showed normal findings. A skin wound was located along the upper nasal margin of the right orbit. Only a part of inferior sector was preserved in the right visual field. She was diagnosed with optic nerve trauma. Abducens palsy developed the next day followed by further impairment of visual acuity. She was treated by pulsed corticosteroid and mannitol infusion. The visual acuity showed gradual recovery and reached 1.2 7 months after the injury. Defect in the upper visual field still persisted.