안와농양과 동반된 중심망막동맥 폐쇄 1예
A Case of Orbital Abscess with Central Retinal Artery Occlusion
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목적: 급격히 진행된 안와농양과 동반된 중심망막동맥 폐쇄 1예를 보고하고자 한다. 증례요약: 60세 남환이 3일 전부터 발생한 우측 안와 주위 통증 및 부종을 주소로 내원하였다. 우안 나안시력은 1.0이었으며 우안안압은 37 mmHg로 증가되어 있었고 3 mm의 우측 안구 돌출소견과 안구운동 장애를 보였다. 안와 전산화 단층 촬영에서 우측 안와내측의 2.5×1 cm 크기의 격막이 있는 낭성 종괴가 관찰되어 안와 농양 진단하에 전신 항생제 및 배농치료 위해 입원하였다. 입원2일째 우안 안압은 18 mmHg로 감소되었으나 우측 안와 주위 종창 및 발적은 지속되었고 우안 교정시력은 광각으로 감소하였으며상대적 구심성 동공장애 및 창백해진 망막과 앵두반점 소견 관찰되어 응급 절개 배농술 및 안구마사지를 시행 후 전신 항생제 치료유지하였다. 술 후 안와 주위 부종 및 안구돌출은 개선되었으나 중심망막동맥은 개통되지 않았으며 시력은 호전되지 않았다. 결론: 급격한 진행을 보이는 안와농양과 동반된 중심망막동맥 폐쇄의 예가 국내에선 알려진 바 없어 보고하고자 하였으며 이러한 안와농양의 경우 절개 배농 및 전신 항생제 치료 등의 즉각적인 대처가 필요할 것으로 생각한다.
Abstract
Purpose: To report a case of rapidly progressed orbital abscess after central retinal artery occlusion. Case summary: A 60-year-old man with right periorbital pain and edema starting 3 days earlier visited the hospital. His first visual acuity was 1.0 for the right eye with peripheral edema and tenderness; severe hemorrhagic chemosis, proptosis (approximately 3 mm) and extraocular motility limitation were also observed. According to the CT findings, a 2.5 × 1cm-sized encapsulated cystic mass was found in the right orbital cavity, along the medial orbital wall; with a diagnosis of orbital abscess, he was hospitalized with systemic antibiotic treatment and abscess drainage. On the second day of hospitalization,the best corrected visual acuity was reduced to light perception, and relative afferent pupillary defect, pale retina and cherry red spot were found. Therefore, emergent incisional drainage, optic massage, and antibiotics were given to the patient. Immediately after the surgery, the peripheral edema and proptosis improved; nevertheless, central retinal artery occlusion did not resolve and vision did not improve. Two months later, best corrected visual acuity for the right eye was counting fingers and central retinal artery occlusion showed no further improvement. Conclusions: No case report on rapidly progressing orbital abscess has been proposed in Korea to date. In the case of rapidly progressed orbital abscess, incisional drainage and antibiotics should be administered promptly.
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