早期治療で改善した急性外眼筋麻痺を伴った無疱疹性眼部帯状疱疹の2例

Early treatment was effective in two cases of ophthalmic zoster sine herpete with extraocular muscle palsy

要約　目的：急性外眼筋麻痺を伴う疱疹のない眼部帯状疱疹2症例の報告。症例：症例は66歳女性と67歳男性で，それぞれ症状自覚から2日後と20日後に受診した。所見：1例には激しい右顔面痛と右眼の内転・上転・下転制限があり，上下複視があった。他の1例には左眼外転制限と複視があった。両症例とも眼窩上孔Valleix圧痛点に圧痛があり，病歴と問診から無疱疹性帯状疱疹と診断した。1例にはアシクロビル，他の1例にはバラシクロビルを全身投与した。両症例とも約1週間後に眼球運動制限と複視が消失した。結論：急性外眼筋麻痺があり，眼窩上孔Valleix圧痛点に圧痛があり，病歴と問診から帯状疱疹ウイルスの関与が疑われるときには，抗ウイルス薬の早期投与が奏効することがある。

Abstract.　Purpose：To report two cases who presented with acute palsy of extraocular muscles and who were suspected of ophthalmic herpes sine herpete. Cases：A 66-year-old female and another 67-year-old male were seen 2 days and 20 days respectively after presumed onset. Findings：One case showed severe right hemifacial pain and limitation of ipsilateral ocular movements with diplopia. The other case showed limited abduction in his left eye with diplopia. Both cases were positive for pressure at the Valleix point at the site of supraorbital foramen. Both were diagnosed with ophthalmic zoster sine herpete. One case was treated by systemic acyclovir and the other by baracyclovir. Limitation in ocular movement with diplopia disappeared in both cases one week later. Conclusion：These cases illustrate that early systemic treatment with antiviral drugs may be effective in cases who show extraocular muscle palsy with supraorbital pain and who are suspected of ophthalmic zoster sine herpete.