前頭洞囊胞感染により眼瞼腫脹・開瞼困難・複視をきたした1例

A case of eyelid swelling, difficulty in eyelid opening, and diplopia due to frontal sinus cyst infection

要約　緒言：前頭洞囊胞感染から皮下膿瘍を形成し，眼瞼腫脹・開瞼困難・複視を出現した1例を経験したので報告する。

症例：75歳，男性。左上眼瞼の腫脹を自覚しており，近医で麦粒腫として抗菌治療を行い一時的に腫脹は改善したものの，症状が再燃したため横浜市立大学附属病院眼科を紹介され受診した。初診時，左上眼瞼から眉弓下縁にかけて著明な発赤と腫脹を認め，開眼困難であり複視も認めた。画像検査では両側汎副鼻腔炎，右篩骨洞と左前頭洞に囊胞性病変と，左前頭洞の囊胞性病変の前面から左眼瞼の皮下にかけて膿瘍形成を認めた。耳鼻科を併診し，前頭洞囊胞の穿刺吸引細胞診と培養検査を施行したところ，細胞診では悪性所見はなく多数の炎症細胞を認め，培養からはStreptococcus intermediusが検出された。両側汎副鼻腔炎，右篩骨洞囊胞，左前頭洞囊胞感染による皮下膿瘍の診断で全身麻酔下内視鏡下鼻副鼻腔手術を行った。術後速やかに左上眼瞼の腫脹は改善し開瞼可能となり，複視も改善された。その後，症状再燃はない。

結論：前頭洞囊胞感染により眼瞼腫脹・開瞼困難・複視をきたした症例を経験した。眼瞼や前額部の腫脹を認める際には，副鼻腔囊胞やその感染も鑑別に挙げる必要がある。

Abstract　Background：We report a case of eyelid swelling, difficulty in opening the eyelid, and diplopia due to a subcutaneous abscess formed from a frontal sinus cyst infection.

Case：The patient was a 75-year-old. He was aware of the swelling of the left upper eyelid. Although the swelling temporarily improved with antibacterial treatment, malignant tumor was suspected by his family doctor, and he was referred to our department because his symptoms flared up again. At the time of the initial visit, there was marked redness and swelling extending from the left upper eyelid to the lower margin of the brow arch. Imaging studies showed bilateral pan-sinusitis, cystic lesions in the right ethmoid sinus and left frontal sinus, and abscess formation from the anterior aspect of the cystic lesion in the left frontal sinus to the subcutaneous area of the left eyelid.

The patient was referred to an otolaryngologist, who performed a puncture aspiration cytology and culture examination of the cyst in the frontal sinus. Cytology showed no evidence of malignancy and numerous inflammatory cells, and culture detected streptococcus intermedius. The patient was diagnosed with bilateral pan-sinusitis, right ethmoid sinus cyst, and subcutaneous abscess caused by the left frontal sinus cyst infection and underwent endoscopic rhino-sinus surgery under general anesthesia. Postoperatively, the swelling of the left upper eyelid improved quickly, the eyelid could be opened, and the patient's diplopia improved. No symptom recurrence was observed.

Conclusion：We experienced a case of eyelid swelling, difficulty in opening the eyelid, and diplopia due to a frontal sinus cyst infection. When eyelid or forehead swelling is present, sinus cysts and their infection should be considered among the differential diagnoses.