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Total ophthalmoplegia in a case of herpes zoster ophthalmicus Misa Masaoka 1 , Yuki Hayashi 1 , Keisuke Oba 1 , Atsuki Fukushima 2 1Department of Ophthalmology, Kochi Health Sciences Center 2Department of Ophthalmology, Kochi Medical School pp.931-938
Published Date 2019/7/15
DOI https://doi.org/10.11477/mf.1410213207
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Abstract Purpose:To report a case of herpes zoster ophthalmicus with total ophthalmoplegia.

Case:A 45-year-old male developed vesicular cutaneous eruption in the region of the right trigeminal nerve that followed varicella zoster virus infection, and vidarabine was administrated at nearby medical clinic. One week later, he showed blepharoptosis and ocular motility disorder of the right eye. Cranial magnetic resonance imaging(MRI)showed no remarkable findings. Two weeks later, he developed iritis in the right eye and referred to us. His best corrected visual acuity was 0.2 in the right eye and 1.2 in the left vesicular cutaneous eruption, blepharoptosis, and restricted ocular motility in all directions except abduction were observed. Slit-lamp microscopy showed dilation of pupil, keratic precipitates, and iritis in the right eye. Two weeks later, he developed right abducent palsy. MRI showed gadolinium enhancement from the right cavernous sinus to orbital apex, swelling of extraocular muscles, and continuous long high-signal lesion corresponding to the right spinal trigeminal nucleus and tract, extending from the medulla oblongata to the first cervical segment of the spinal cord. He was treated with intravenous acyclovir and corticosteroid. His corrected visual acuity improved to 0.9, as well as improved ocular motility and blepharoptosis one month later.

Conclusion:In this case, total opthalmoplegia could be due to inflammation in the cavernous sinus area which interfered trigeminal, oculomotor and abducens nerves.


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電子版ISSN 1882-1308 印刷版ISSN 0370-5579 医学書院

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