脈絡膜皺襞を認めた特発性眼窩炎症の1例

A case of idiopathic orbital inflammation with choroidal folds

要約　目的：脈絡膜肥厚と視神経周囲炎を伴い，強膜炎に合併したと考えられる特発性眼窩炎症の1例を報告する。

症例：症例は83歳，女性。右眼眼痛，充血，開瞼困難にて受診した。全方向への眼球運動障害，眼球突出，結膜充血などが認められた。矯正視力は右眼0.25，左眼1.0，右眼RAPD陽性で，光干渉断層計で黄斑部に著明な脈絡膜皺襞が認められた。MRIでは視神経乳頭に及ぶ全周性の強膜炎が認められた。プレドニゾロン内服を行い漸減した。治療後，すべての症状が改善した。

結論：本症例は特発性眼窩炎症のテノン囊/強膜炎型に該当し，炎症が脈絡膜と視神経乳頭周囲に波及したと考えられる。再発が多いとされ，慎重な経過観察を要すると思われる。

Abstract　Purpose：To report a case of idiopathic orbital inflammation with choroidal thickening and optic perineuritis presumably secondary to scleritis.

Case：An 83-year-old female presented with pain, conjunctival hyperemia, and blepharoptosis in her right eye since 3 days before.

Findings and Clinical Course：Corrected visual acuity was 0.25 right and 1.0 left. The right eye showed proptosis, restricted motility in all directions, and conjunctival hyperemia. The right eye showed relative afferent pupillary defect. Optical coherence tomography（OCT）showed marked choroidal folds in the right fundus. Magnetic resonance imaging（MRI）showed wide-ranging scleritis extending to the optic nerve head. She was treated by tapering dosis of prednisolone. Findings in the right eye rapidly improved in 3 weeks with improved visual acuity to 0.7. She has been doing well for 9 months until present.

Conclusion：The present case appears to have had tenon- or scleritis- type of idiopathic orbital inflammation, with involvement of the optic nerve head.