眼窩蜂巣炎症状を伴った桐沢型ぶどう膜炎の1例

A case of orbital cellulitis as an early manifestation of acute retinal necrosis

　52歳男性が左眼の違和感で受診した。左眼に前部ぶどう膜炎と乳頭周囲の浮腫出血があった。6日後に眼瞼腫脹と結膜浮腫が生じ，眼窩蜂巣炎が疑われた。さらに3日後に周辺部眼底に黄白色滲出斑が生じ，桐沢型ぶどう膜炎と診断した。ステロイド薬とアシクロビル，硝子体手術などで眼内病変は寛解した。右眼は全経過中異常はなかった。三叉神経第1枝が眼窩と眼内組織に分布していることから，本症例での眼窩蜂巣炎と桐沢型ぶどう膜炎とには共通した原因が関係していると推定された。

A 52-year-old male presented with abnormal feelings in his left eye. The affected eye showed anterior uveitis with edema and hemorrhages around the optic disc. He developed chemosis and swelling of the eyelid 6 days later. The findings were suggestive of orbital cellulitis. Another 3 days later, exudates appeared in the peripheral retina leading to the diagnosis of acute retinal necrosis. Clinical cure was obtained following systemic corticosteroid, acyclovir and vitrectomy. His right eye has been free of abnormal manifestations throughout. Since the first branch of trigeminal nerve serves both the orbit and the eyeglobe, we presumed that common pathogenic factors were involved in the orbital cellulitis and acute retinal necrosis in this patient.