眼窩下壁骨折整復術後光覚喪失症例に対し星状神経節ブロックが有効であった1例

Stellate ganglion block was effective in a case of visual loss following reconstruction of blowout fracture of orbital floor

　24歳男性がボクシング中に右眼を打撲され複視が生じた。視力は1.5だったという。眼窩下壁骨折と診断され，受傷3週間後に上顎洞経由での骨折整復術を受けた。その翌日に光覚を失い，ただちに受診した。右眼には，マーカス・ガン瞳孔以外には，前眼部，眼底，眼窩などに異常はなかった。耳鼻科で骨片プレートを除去し，眼窩内圧減圧術が行われた。ステロイドパルス療法，血管拡張薬点滴，星状神経節ブロックでは視機能が改善しなかった。初診7日目から1日2回の星状神経節ブロックを開始し，2日後に光覚弁となった。ステロイドパルス療法を併用し，初診17日目に視力は1.0に回復した。以後6か月間経過は順調である。重篤な視神経障害に対して星状神経節ブロックが奏効したと考えられる症例である。

A 24-year-old male developed diplopia after being hit in his right eye during boxing. The visual acuity was reportedly 1.5 after onset of diplopia. He was diagnosed with blowout fracture of orbital floor. He received recon-struction of blowout fracture via the maxillary sinus 3 weeks later. He had no light perception next day of surgery and visited us immediately. His right eye and orbit were found normal except Marcus-Gunn pupil. He received removal of implanted bone plate and orbital decompression. His vision failed to improve after 7 days of treatment with systemic prostaglandin, pulsed corticosteroid, and stellate ganglion block once a day. He then received stellate ganglion block twice daily and pulsed corticosteroid. His visual acuity became light perception 2 days later and improved to 1.0 17 days after his initial visit. He has been doing well until 6 months later. This case illustrates that stellate ganglion block may have been effective for severe optic nerve damage.