外傷性前房出血に対するアトロピン散瞳中に外斜視を発症した1例

Acquired exotropia in a case following instillation of atropine for traumatic hyphema

要約　目的：外傷性前房出血に対するアトロピン点眼後に外斜視が発症した症例の報告。症例：5歳女児が竹とんぼで右眼に受傷し，その翌日に受診した。裸眼視力は右1.0，左0.9で，眼位は正位であった。右眼に瞳孔下縁までの前房出血の貯留があり，中間透光体と眼底には異常がなかった。入院のうえ，1％アトロピンを1日2回，ベタメタゾンを1日4回点眼した。1週間後に前房出血はほとんど消失し，退院した。退院時の視力は右1.2，左1.5であった。退院の翌日に母親が右眼の外斜視を発見した。以後，外斜視と複視が生じ，近見35△，遠見30△の右眼外斜視で，固視交代が可能，眼球運動と輻湊には異常がなかった。改善がなく，5か月後に手術を必要とした。結論：乳幼児ではアトロピン点眼による片眼の不完全遮蔽で斜視が生じる危険がある。

Abstract.　Purpose：To report a child who developed exotropia following unilateral instillation of atropine for one week. Case：A 5-year-old girl presented with injured right eye due to flying piece of bamboo the previous day. Findings：Both eyes were parallel with visual acuity of 1.0 right and 0.9 left. The right eye showed hyphema reaching the lower border of the pupil. She was treated,after hospitalization,by instillation of 1％ atropine twice daily and betamethasone 4 times daily. Hyphema disappeared and medication under hospitalization was discontinued one week later. Exotropia was detected the next day. Eye position was exotropic with 35△for near and 35△for far. Fixation was possible with visual acuity of 1.2 in either eye. Both eyes showed normal eye movement and convergence. Exotropia with diplopia persisted for 5 months necessitating surgery. Conclusion：Instillation of atropine in one eye for one week may induce exotropia in a child.