완전한 회복을 보인 외상성 단독 눈꺼풀처짐 1예
A Case of Complete Recovery of Isolated Neurogenic Ptosis after Trauma
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목적: 좌측 안와 외상 후 발생한 편측 신경성 눈꺼풀처짐이 완전히 회복된 1예를 보고하고자 한다. 증례요약: 기저질환 없는 41세 남자 환자가 좌안 외상 후 발생한 시력 저하와 좌측 눈꺼풀처짐을 주소로 내원하였다. 내원 시 좌안시력은 안전수동, 안압은 29 mmHg, 윗눈꺼풀에 혈종이나 부종은 경미하였고, 표재성 찰과상을 동반한 눈꺼풀처짐, 안와 내벽 골절,전방 출혈, 동공조임근 파열, 홍채 해리, 결막 열상이 관찰되었다. 동공조임근 파열로 동공반응은 확인할 수 없었고, 안구운동은 모든방향에서 정상이었다. 좌측 윗눈꺼풀은 완전히 감겨져 뜰 수 없었고, 눈꺼풀올림근 기능검사(LFT)상 0 mm로 신경성 단독 눈꺼풀처짐의 진단하에 프레드니솔론 1 mg/kg 용량으로 투여를 시작하여 1주 간격으로 용량을 감량하였다. 한달 후에는 눈꺼풀처짐이 완전히회복되었다.
Abstract
Purpose: To report a rare case of isolated neurogenic blepharoptosis secondary to eyelid trauma. Case summary: A previously healthy 41-year-old male was evaluated for decreased visual acuity and blepharoptosis in the lefteye after ocular trauma. On ophthalmologic examination, visual acuity in the left eye was hand motion, intraocular pressure was29 mm Hg, hematoma and eyelid edema were minimal. The patient had complete unilateral ptosis with superficial upper eyelidlaceration. Additional findings in the left eye included fracture of the medial orbital wall, hyphema, iris sphincter muscle tear, iridodialysisand conjunctival laceration. The other examinations were unremarkable with full ocular motility. Because of iris sphinctermuscle tear and iridodialysis, the pupillary reaction could not be evaluated. His left upper eyelid drooped completely and levatorfunction test (LFT) was 0 mm. He was diagnosed with an isolated neurogenic blepharoptosis and received oral prednisolone ata dose of 1 mg/kg per day for 7 days with gradual tapering. One month later, the patient had normal symmetric lid height andcompletely restored levator function.
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