外用ステロイド剤により緑内障・白内障を併発したと思われる日光皮膚炎の1例

Glaucoma and posterior subcapsular cataract after longterm use of corticosteroid lotion in a case with photodermatitis

　両眼に開放隅角緑内障および後嚢下白内障を認めた日光皮膚炎の1例を経験した．皮疹は顔面の他全身露出部にみられ，10年間ステロイド剤を外用していた．外用ステロイドによる下垂体-副腎皮質機能抑制を認めたが，他の全身的ステロイド副作用はなかった．ステロイドを眼周囲に塗布しており，緑内障・白内障はいずれも皮疹の強い右側に先行したこと，ステロイド点眼にて著明に悪化する角膜障害も認められたことなどから，緑内障・白内障は経角膜的に吸収されたステロイドの局所作用によると推測された．眼周囲皮膚疾患の外用ステロイド治療時には定期的な眼科的検査が望まれる．

A 44-year-old male presented with advanced open-angle glaucoma, moderate posterior subcapsular cata-ract and recurrent bullous keratopathy bilaterally. Because of photodermatitis, the patient had been apply-ing corticosteroid cream or ointment to his exposed skin areas, particularly the face and the periorbital region, for the past 10 years. While the elevated intraocular pressure was controlled by filtering surgery, the cataract started to rapidly progress after he was prescribed clobetasol 17-propionate, a potent corticos-teroid, for his skin condition.

While his pituitary-adrenal system was severe sup-pressed, the serum cortisol level returned to normal 40 days after discontinuation of topical corticosteroid. He manifested no other systemic complications due to corticosteroid such as moon face, buffalo appearance, acne or striae of the skin. The ocular complications seemed to be induced through absorption of corticosteroid through the cor-nea, since the photodermatitis was more severe in his right periorbital region than the left and the eye mani-festations were also in a more advanced state in the right eye than the left.

Rinsho Ganka (Jpn J Chn Ophthalmol) 40(12) : 1345-1349, 1986