Left Sixth Cranial Nerve Palsy with Herpes Zoster Ophthalmicus
A 62-year-old man reported acute left retro-orbital pain of one week's duration. Physical examination revealed no abnormalities. Three days later, double vision developed, and the next day a rash appeared on the forehead. On repeated examination, it was noted that the patient had swelling of the left upper eyelid, conjunctival congestion, restricted abduction of the left eye, which is diagnostic of a left sixth cranial nerve palsy (right, center, and left gaze; Panels A, B, and C, respectively), and binocular horizontal diplopia. The rash was distributed over the left frontal area. The rest of the eye examination, including extraocular movements, visual acuity, visual field, pupillary evaluation, and funduscopy, was normal. The blood glucose level, erythrocyte sedimentation rate, and C-reactive protein level were normal. A computed tomographic scan of the paranasal sinuses and orbits showed thickened mucosa of the sinuses but was otherwise unremarkable. A diagnosis of herpes zoster ophthalmicus was made. The patient was treated with gabapentin and acyclovir for one week. Six weeks later, he had minimal residual diplopia, with no postherpetic neuralgia. It is important that this diagnosis be made early, to minimize complications such as corneal ulceration and uveitis, which may threaten vision.
一例眼部带状疱疹患者左侧第六颅神经麻痹
患者XXX，男，62岁，急性左侧眼眶向后疼痛1周。
PE：未发现异常。
3天后，出现复视，第四天前额部出现皮疹，体检患者上眼睑肿胀，结膜充血，左眼外展受限，诊断：左侧第六颅神经麻痹（如图A、B、C分别为向右，前及向左凝视），双眼水平复视。疱疹分布在左额部。其它眼部检查，包括其它眼部运动、视力、视野、瞳孔及眼底镜检查，均正常。血糖、血沉及CRP水平也正常。CT扫描鼻旁窦及眼眶部，示粘膜增厚但不显著。诊断为：眼部带状疱疹，给予加巴喷丁(抗焦虑药)、阿昔洛韦治疗1周。6周后，仍后遗有轻度复视，没有带状疱疹后神经痛。
重要的是要早诊断，使并发症减到最少，特别是严重影响视力的并发症如：角膜溃疡、眼葡萄膜炎等。