Orbital apex syndrome associated with herpes zoster ophthalmicus
Takuji Kurimoto1, Masahiro Tonari1, Norihiko Ishizaki1, Mitsuhiro Monta2, Saori Hirata2, Hidehiro Oku1, Jun Sugasawa1, Tsunehiko Ikeda11Department of Ophthalmology, Osaka Medical College, 2Department of Ophthalmology, Shitennoji Hospital, Osaka, JapanAbstract: We report our findings for a patient wi...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2011-11-01
|
| Series: | Clinical Ophthalmology |
| Online Access: | http://www.dovepress.com/orbital-apex-syndrome-associated-with-herpes-zoster-ophthalmicus-a8632 |
| _version_ | 1818682132082458624 |
|---|---|
| author | Kurimoto T Tonari M Ishizaki N Monta M Hirata S Oku H Sugasawa J Ikeda T |
| author_facet | Kurimoto T Tonari M Ishizaki N Monta M Hirata S Oku H Sugasawa J Ikeda T |
| author_sort | Kurimoto T |
| collection | DOAJ |
| description | Takuji Kurimoto1, Masahiro Tonari1, Norihiko Ishizaki1, Mitsuhiro Monta2, Saori Hirata2, Hidehiro Oku1, Jun Sugasawa1, Tsunehiko Ikeda11Department of Ophthalmology, Osaka Medical College, 2Department of Ophthalmology, Shitennoji Hospital, Osaka, JapanAbstract: We report our findings for a patient with orbital apex syndrome associated with herpes zoster ophthalmicus. Our patient was initially admitted to a neighborhood hospital because of nausea and loss of appetite of 10 days' duration. The day after hospitalization, she developed skin vesicles along the first division of the trigeminal nerve, with severe lid swelling and conjunctival injection. On suspicion of meningoencephalitis caused by varicella zoster virus, antiviral therapy with vidarabine and betamethasone was started. Seventeen days later, complete ptosis and ophthalmoplegia developed in the right eye. The light reflex in the right eye was absent and anisocoria was present, with the right pupil larger than the left. Fat-suppressed enhanced T1-weighted magnetic resonance images showed high intensity areas in the muscle cone, cavernous sinus, and orbital optic nerve sheath. Our patient was diagnosed with orbital apex syndrome, and because of skin vesicles in the first division of the trigeminal nerve, the orbital apex syndrome was considered to be caused by herpes zoster ophthalmicus. After the patient was transferred to our hospital, prednisolone 60 mg and vidarabine antiviral therapy was started, and fever and headaches disappeared five days later. The ophthalmoplegia and optic neuritis, but not the anisocoria, gradually resolved during tapering of oral therapy. From the clinical findings and course, the cause of the orbital apex syndrome was most likely invasion of the orbital apex and cavernous sinus by the herpes virus through the trigeminal nerve ganglia.Keywords: varicella zoster virus, orbital apex syndrome, herpes zoster ophthalmicus, complete ophthalmoplegia |
| first_indexed | 2024-12-17T10:13:59Z |
| format | Article |
| id | doaj.art-7b65251f66984510a5066d7e918cdb56 |
| institution | Directory Open Access Journal |
| issn | 1177-5467 1177-5483 |
| language | English |
| last_indexed | 2024-12-17T10:13:59Z |
| publishDate | 2011-11-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Clinical Ophthalmology |
| spelling | doaj.art-7b65251f66984510a5066d7e918cdb562022-12-21T21:52:57ZengDove Medical PressClinical Ophthalmology1177-54671177-54832011-11-012011default16031608Orbital apex syndrome associated with herpes zoster ophthalmicusKurimoto TTonari MIshizaki NMonta MHirata SOku HSugasawa JIkeda TTakuji Kurimoto1, Masahiro Tonari1, Norihiko Ishizaki1, Mitsuhiro Monta2, Saori Hirata2, Hidehiro Oku1, Jun Sugasawa1, Tsunehiko Ikeda11Department of Ophthalmology, Osaka Medical College, 2Department of Ophthalmology, Shitennoji Hospital, Osaka, JapanAbstract: We report our findings for a patient with orbital apex syndrome associated with herpes zoster ophthalmicus. Our patient was initially admitted to a neighborhood hospital because of nausea and loss of appetite of 10 days' duration. The day after hospitalization, she developed skin vesicles along the first division of the trigeminal nerve, with severe lid swelling and conjunctival injection. On suspicion of meningoencephalitis caused by varicella zoster virus, antiviral therapy with vidarabine and betamethasone was started. Seventeen days later, complete ptosis and ophthalmoplegia developed in the right eye. The light reflex in the right eye was absent and anisocoria was present, with the right pupil larger than the left. Fat-suppressed enhanced T1-weighted magnetic resonance images showed high intensity areas in the muscle cone, cavernous sinus, and orbital optic nerve sheath. Our patient was diagnosed with orbital apex syndrome, and because of skin vesicles in the first division of the trigeminal nerve, the orbital apex syndrome was considered to be caused by herpes zoster ophthalmicus. After the patient was transferred to our hospital, prednisolone 60 mg and vidarabine antiviral therapy was started, and fever and headaches disappeared five days later. The ophthalmoplegia and optic neuritis, but not the anisocoria, gradually resolved during tapering of oral therapy. From the clinical findings and course, the cause of the orbital apex syndrome was most likely invasion of the orbital apex and cavernous sinus by the herpes virus through the trigeminal nerve ganglia.Keywords: varicella zoster virus, orbital apex syndrome, herpes zoster ophthalmicus, complete ophthalmoplegiahttp://www.dovepress.com/orbital-apex-syndrome-associated-with-herpes-zoster-ophthalmicus-a8632 |
| spellingShingle | Kurimoto T Tonari M Ishizaki N Monta M Hirata S Oku H Sugasawa J Ikeda T Orbital apex syndrome associated with herpes zoster ophthalmicus Clinical Ophthalmology |
| title | Orbital apex syndrome associated with herpes zoster ophthalmicus |
| title_full | Orbital apex syndrome associated with herpes zoster ophthalmicus |
| title_fullStr | Orbital apex syndrome associated with herpes zoster ophthalmicus |
| title_full_unstemmed | Orbital apex syndrome associated with herpes zoster ophthalmicus |
| title_short | Orbital apex syndrome associated with herpes zoster ophthalmicus |
| title_sort | orbital apex syndrome associated with herpes zoster ophthalmicus |
| url | http://www.dovepress.com/orbital-apex-syndrome-associated-with-herpes-zoster-ophthalmicus-a8632 |
| work_keys_str_mv | AT kurimotot orbitalapexsyndromeassociatedwithherpeszosterophthalmicus AT tonarim orbitalapexsyndromeassociatedwithherpeszosterophthalmicus AT ishizakin orbitalapexsyndromeassociatedwithherpeszosterophthalmicus AT montam orbitalapexsyndromeassociatedwithherpeszosterophthalmicus AT hiratas orbitalapexsyndromeassociatedwithherpeszosterophthalmicus AT okuh orbitalapexsyndromeassociatedwithherpeszosterophthalmicus AT sugasawaj orbitalapexsyndromeassociatedwithherpeszosterophthalmicus AT ikedat orbitalapexsyndromeassociatedwithherpeszosterophthalmicus |