眼窩先端部症候群で失明後に残存する疼痛に対しステロイド局所投与が奏効した1例

Local corticosteroid treatment for pain in orbital apex syndrome: a case report

要約　目的：視機能を喪失した眼窩先端部症候群の眼周囲疼痛に対して，ステロイド局所投与で疼痛管理できた1例を経験したので報告する。

症例：80歳，女性。複視と左眼視力低下を主訴に前医にて眼窩先端部症候群と診断され，精査中に急激に悪化し左眼は失明した。結核感染が判明したためステロイド全身投与は中止し，疼痛治療目的で当院へ紹介となった。初診時に左眼窩深部から頭頂部にかけての疼痛の症状があり，左眼の眼瞼下垂，全外眼筋麻痺を認めた。トリアムシノロンアセトニド（TA）40mgの球後注射を計5回施行後も残存する左前額部痛に対して，TA 12mgの皮下注射とTA 28mgの球後注射を3回ずつ追加し疼痛は消失した。その後，2回ずつ投与を追加し疼痛の再発は認めていない。

結論：ステロイドの球後注射と皮下注射で全身への影響を最小限にし，良好な疼痛コントロールを得られる可能性が示唆された。

Abstract　Purpose：We report our experience from a case of painful blind eye with orbital apex syndrome, which achieved successful pain management upon topical steroid treatment.

Case：An 80-year-old woman presented to the previous hospital with chief complaints of diplopia and decreased visual acuity in the left eye. Her case was diagnosed as orbital apex syndrome. During the investigation for the cause of her condition, her symptoms deteriorated rapidly, eventually leading to loss of vision in the left eye. Tuberculosis was confirmed by examination, and a planned treatment with systemic steroid was canceled. The patient was referred to our hospital for pain management. Initial examination revealed pain from the deep left orbit to the parietal region, ptosis of the left eye, and total external ophthalmoplegia. A total of 5 retrobulbar injections of 40 mg triamcinolone acetonide（TA） were administered. Subcutaneous injections of 12 mg TA and retrobulbar injections of 28 mg TA were administered three times for residual left forehead pain, following which the pain disappeared. Subsequently, such administration was conducted twice, and no recurrence of the pain was observed.

Conclusion：We experienced a case of orbital apex syndrome, which achieved successful management of pain after retrobulbar and subcutaneous steroid injections. Topical steroid administration can minimize the systemic side effect of the treatment. Additionally, early interventions may be associated with favorable management of pain.