다한증 치료로 B형 보툴리눔 독소 피하주사 후 발생한 일과성 조절장애 1예
Temporary Accommodation Difficulties after Botulinum Toxin Type B Injection for the Treatment of Hyperhidrosis
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목적: 손과 발의 다한증을 치료하기 위해 B형 보툴리눔 독소를 피하주사 후 발생한 일시적인 조절장애를 경험하였기에 이를 보고하고자 한다. 증례요약: 27세 여성이 내원 3주 전 양손과 발의 다한증 치료를 위하여 개인 피부과 의원에서 B형 보툴리눔 독소(MyoblocⓇ)를 양 손바닥과 발바닥에 각각 3000 MU (mouse unit)의 용량으로 피하주사 치료를 받고 나서 다한증 증상은 완전히 호전되었으나, 시술 2주후부터 가까운 것을 볼 때 흐리게 보이는 증상으로 내원하였다. 초진 시 시행한 굴절검사는 양안 각각 정시였고, 안구운동검사는 정상이었다. 조절근점은 우안 32 cm, 좌안 25 cm였고, 눈모음근점은 10 cm였으며, 단안 조절력은 우안 1.5 디옵터, 좌안 2.0 디옵터였고,근거리 안경으로 1.0 디옵터의 안경을 필요로 하였다. 3주 후 내원 시 조절근점은 호전되었고, 근거리 작업의 불편 증상은 소실되었으며, 다한증은 재발하지 않았다. 결론: B형 보툴리눔 독소의 다한증 치료에 있어 자율신경계 관련 안과적 부작용으로 일시적 조절장애가 발생할 수 있으므로, 시술 전이에 대한 설명이 필요하다.
Abstract
Purpose: To report a case of temporary accommodation difficulties after botulinum toxin injections for the treatment of palmar and plantar hyperhidrosis. Case summary: A 27-year-old woman presented with difficulties performing near work that had begun 1 week prior. She underwent injections of botulinum toxin type B (Myobloc®) for the treatment of both palmar and plantar hyperhidrosis 3weeks earlier. The patient had subdermal injections of 3000 MU (mouse unit) of Myobloc® on each palm and sole. On manifest refraction, the patient was emmetropic. Near point of accommodation was 32 cm in the right eye and 25 cm in the left eye, near point of convergence was 10 cm, and the monocular accommodative power measured with minus lenses was 1.5 diopter (D) in the right eye and 2.0 D in the left eye. After 3 weeks, accommodation difficulties were completely resolved and hyperhidrosis symptoms did not recur. Conclusions: Ophthalmologic adverse effects related to the autonomic nervous system such as accommodation difficulties may occur with injections of botulinum toxin type B for the treatment of hyperhidrosis. These symptoms should be explained carefully to the patient before the botulinum toxin injection procedure.
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