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49歳,男性が頭痛と眼痛で近医を受診し,急性結膜炎の所見と74mmHgの高眼圧が両眼にあった。2日後の当科初診で,流行性角結膜炎の所見があり,眼圧は右48mmHg,左58mmHgであった。前房は深く、開放隅角であった。涙液からアデノウイルスが検出された。眼圧下降薬などで眼圧はいったん正常化したが,初診から6日後に眼圧は両眼とも70mmHg前後に上昇した。初診から約2週後に結膜炎は消退し,眼圧は20mmHg以下に下降し,以後安定した。高眼圧の既往はなく,ステロイド緑内障である可能性は否定された。本例での高眼圧は流行性角結膜炎に続発したと推定され,潜在的に併発した強膜炎の関与が疑われた。
A 49-year-old male sought medical advice for headache and ocular pain. Both eyes showed signs of acute conjunctivitis with elevated intraocular pressure (IOP) of 74mmHg each. When seen by us 2 days later, he showed typical features of epidemic keratoconjunctivitis with IOP of 48mmHg right and 58mmHg left. Both eyes had deep anterior chamber with wide-open angle. Adenovirus was detected in the tear fluid. After temporary decrease in IOP following medications, the IOP rose again to about 70mmHg in either eye from 6 days after visiting us. The IOP decreased spontaneously below 20mmHg after the conjunctivitis subsided about 2 weeks after his initial visit. He had no history of ocular hypertension. Corticosteroid glaucoma was also ruled out. This case illustrates that acute ocular hypertension is a liability in epidemic keratoconjunctivitis, presumably secondary to concomitant scleritis.
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