眼球運動制限を伴った結膜下脂肪ヘルニアの1例

A Case of Subconjunctival Fat Prolapse with Eye-Movement Restriction

はじめに

　結膜下脂肪ヘルニアはテノン囊の脆弱化により筋漏斗内の眼窩脂肪が球結膜下に脱出して起こるといわれている 1）。通常，耳上側の球結膜下に片側性または両側性に黄色腫瘤として認められ 2），肥満男性に多いとされる 3）。自覚症状としては，異物感や流涙などが報告されているが 4），無症状のことも多い 5）。

　今回，眼球運動制限を伴う結膜下脂肪ヘルニアを経験したので，若干の考察を含めて報告する。

　We report the case details of an instance of subconjunctival fat prolapse with eye-movement restriction. The patient was a 78-year-old man who had noticed masses on the lateral side of both eyes beginning ~10 years before his February 2022 referral to our hospital's plastic surgery department by a local ophthalmology clinic for surgery. He had experienced double vision starting 2 years and discomfort in both eyes starting 1 year before this referral. At his initial visit we observed yellow, dome-shaped masses on the lateral bulbar conjunctiva on both eyes. When the tumor was compressed with a cotton swab, it moved backward. Eye-movement restriction was observed in both eyes when the patient looked laterally upward and downward. In the Hess test, each eye was able to recognize a range of only up to 15°. Surgery under general anesthesia was performed on the left eye at 3 months and on the right eye at 9 months after the first visit. In the surgery, the conjunctiva and tenon were incised, in this time, fuhrer is the orbital fat, the sclera and tenon were sutured, and the conjunctiva was sutured. After the surgery, the diplopia disappeared and no recurrence was observed. In the Hess test, each eye was now able to recognize a range of 30°. Generally, orbital fat prolapse does not cause abnormalities in visual function. We encountered a case in which eye movement was restricted due to giant fat prolapse. Surgery to reduce orbital fat was useful for this patient.