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45歳男性が6日前の熱発と4日前からの複視で受診した。矯正視力は右0.8,左0.9であった。前眼部,中間透光体,眼底に異常所見はなく,視野は正常であった。中等度に散瞳し,Marcus Gunn瞳孔は陰性であった。両眼に深部痛があり,全方向に眼球運動が制限され,眼瞼下垂があった。磁気共鳴画像検査(MRI)を含む画像診断で両側の蝶形骨洞と篩骨洞に陰影があり,視神経障害がないことから,これら副鼻腔炎に続発した上眼窩裂症候群と診断した。蝶形骨洞開放術を行い,副腎皮質ステロイド薬と抗生物質を投与した。眼所見は改善し,複視は6か月後に消失した。
A 45-year-old man presented with diplopia since 4 days before. His corrected visual acuity was 0.8 right and 0.9 left. No abnormal findings were present in the anterior ocular segment,optical media,or fundus. The visual field was intact. He showed incomplete mydriasis with negative Marcus Gunn pupil. He complained of bilateral retrobulbar pain. Computed tomography(CT)and magnetic resonance imaging(MRI)showed bilateral paranasal sinusitis involving the sphenoidal and ethmoidal sinus. Because of absence of optic nerve involvement,he was diagnosed with superior orbital fissure syndrome secondary to paranasal sinusitis. He was treated by drainage of bilateral sphenoidal sinus followed by systemic corticosteroid and antibiotics. The ocular findings rapidly improved. Diplopia disappeared 6months after surgery.
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