안와관통상으로 인해 발생한 안와첨증후군의 장기 경과 관찰 1예
A Case of Orbital Apex Syndrome Induced by Penetrating Orbital Injury with Long-Term Results
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목적: 철사에 의한 안와관통상 후 발생한 안와첨증후군과 그 임상적 회복 과정 1예를 경험하였기에 보고하고자 한다. 증례요약: 고개를 숙이다가 철사에 좌안 내측 하측 결막부분으로 안와관통상을 입은 40세 여자로 수상 당시 최대교정시력은 0.6이었으며 좌안 동공은 산대되어 있고 움직이지 않았다. 좌안에 안검하수와 전방향에서 안구운동장애를 보였다. 안저검사상 시신경 유두부종이 관찰되었으며 시야검사상 하측 시야장애 소견을 보였다. 안와전산화단층촬영에서 경도의 구후부출혈 소견을 보였고, 안와 골절은관찰되지 않았다. 안와자기공명영상에서는 시신경초의 조영증강 소견이 관찰되었다. 스테로이드 정주 치료 후, 수상 1개월째, 부분적으로 시력이 회복되었으며, 안검하수 및 외전장애의 호전이 관찰되었다. 수상 3개월까지 내전 및 하전 장애가 회복으며 동공 반응도회복되었다. 그 뒤 1년 경과관찰 시점까지는 더 이상의 호전은 관찰되지 않았다. 결론: 안와첨증후군의 회복이 수상 후 초기 3개월 동안 이루어졌으며, 손상기전에 따라 그 회복과정에서 차이가 있을 수 있고, 가역적손상을 입은 부분에 대해서는 증상호전을 기대할 수 있으므로 정확한 진단과 적절한 치료가 필요하다.
Abstract
Purpose: To report a case of orbital apex syndrome induced by penetrating orbital injury by a wire with the recovery process and clinical outcomes. Case summary: A 40-year-old female visited our clinic after a penetrating orbital injury through the left inferomedial conjunctiva by a wire. The best corrected visual acuity of the left eye was 0.6, and ptosis and total ophthalmoplegia were observed. The patient showed a dilated pupil, swelling of the optic disc on fundus exam, and an inferior field defect on the automated perimetry. The computed tomography image revealed mild retrobulbar hemorrhage, but there was no orbital bony fracture. Enhancement of the optic nerve sheath was observed on the magnetic resonance image. The patient was admitted and received systemic antibiotics and steroid treatment. After 1 month, visual acuity, ptosis, and limitation in adduction were partly improved. After 3 months, depression and adduction were improved and the pupil size was normalized. However, further improvement was not observed after the one-year follow-up. Conclusions: The recovery from orbital apex syndrome was achieved until 3 months after injury. The final outcomes may depend on the mechanism and pathophysiology of the injury. Emergent diagnosis and proper management are essential to achieve optimal clinical results.
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