全身熱傷後にみられた瞳孔緊張症の1例

A case of tonic pupil following generalized burn

（展示164）　35歳男性が車内にガソリンを撒いて点火し，自殺を試みたが未遂に終った。7週後に鏡を見て左眼の散瞳を自覚した。初診時の矯正視力は各眼1.5。左眼瞳孔は散瞳し，対光反射は消失していた。眼位と眼球運動は正常で，中間透光体と眼底に異常はなかった。血液一般検査では軽度の炎症所見があったが，他に異常はなかった。患眼の瞳孔は0.1ピロカルピン点眼で縮瞳し，過敏性を呈した。電子瞳孔計で近見反応を検査すると，tonicな反応があった。以上の所見からAdieの瞳孔緊張症と診断し，その原因としての全身の熱傷が強く疑われた。

A 35-year-old male attempted suicide by spraying gasoline and setting fire in the car where he was sitting. He noticed myariasis in his left eye while looking at a mirror 7 weeks after the failed attempt. The corrected visual acuity was 30/20 in either eye. The left pupil was 6.0 mm wide and did not respond to light. The pupil showed supersensitive response to 0.1% pilocarpine and tonic near reflex by electronic pupillogram. Eye position and movement were normal. No abnormal findings were present in the anterior segment, media or the fundus. Blood test showed slightly elevated CRP and ESR values with normal virus antibody titers. These findings led to the diagnosis of Adie's tonic pupil. It appeared to have been caused by the generalized burn. Systemic inflammatory state due to burn and psychosomatic reaction may have acted as contributing factor.