Concurrent hyphema and orbital apex syndrome following herpeszoster ophthalmicus in a middle aged lady

Othman, Khairuddin and Tai, Evelyn Li Min and Mohd Noor, Raja Azmi and Muhammed, Julieana and Ahmad Tajudin, Liza Sharmini and John, Tharakan and Muhd Besari, Alwi and Embong, Zunaina and Ismail, Shatriah (2017) Concurrent hyphema and orbital apex syndrome following herpeszoster ophthalmicus in a middle aged lady. International Journal of Surgery Case Reports, 30. pp. 197-200. ISSN 2210-2612

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INTRODUCTION: Hyphema and orbital apex syndrome occurring concurrently in a patient with herpeszoster ophthalmicus have not been reported previously. We present a case with these unique findingsand discuss the pathogenesis of these conditions and their management.PRESENTATION OF CASE: A 59-year-old Malay lady with underlying diabetes mellitus presented withmanifestations of zoster ophthalmicus in the left eye. Two weeks later, she developed total hyphema,and complete ophthalmoplegia suggestive of orbital apex syndrome. She was treated with combinationof intravenous acyclovir and oral corticosteroids, and regained full recovery of ocular motility. Totalhyphema persisted, and she required surgical intervention.DISCUSSION: Hyphema is postulated to occur due to an immune vasculitis affecting the iris vessels. Orbitalapex syndrome is probably due to an occlusive vasculitis affecting the vasculature of the extraocular mus-cles and optic nerve, resulting from a direct invasion by varicella zoster virus or infiltration of perivascularinflammatory cells. Magnetic Resonance Imaging of the brain is essential to exclude possibility of localcauses at the orbital apex area.CONCLUSION: Herpes zoster ophthalmicus is an uncommon ocular presentation. Managing two concur-rent complications; persistent total hyphema and orbital apex syndrome is a challenging clinical situation.Early diagnosis and prompt treatment are essential to prevent potential blinding situation.

Item Type: Article
Subjects: R Medicine > R Medicine (General) > R5-920 Medicine (General)
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
R Medicine > RE Ophthalmology
Divisions: Kampus Kesihatan (Health Campus) > Pusat Pengajian Sains Perubatan (School of Medical Sciences) > Article
Depositing User: Mr Noorazilan Noordin
Date Deposited: 23 Jan 2018 06:17
Last Modified: 23 Jan 2018 06:17

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