睡醒後表現的中心網膜動脈阻塞合併眼肌麻痺—病例報告

Waking Up with Central Retinal Artery Occlusion and Ophthalmoplegia - A Case Report

報告一中心網膜動脈阻塞合併眼肌麻痺之病例。一59歲女性起床後發現左眼視力喪失。因使用過量安眠藥物，睡眠期間可能有持續性眼球壓迫。就診時左眼視力為僅光覺，檢查發現左頰腫脹、左眼上斜位、相對性瞳孔傳入障礙及視網膜水腫。類固醇脈衝治療後，視神經盤仍於兩週後喪白。脊椎手術後產生的中心網膜動脈阻塞併眼肌麻痺的病例曾被提出。眼動脈可能因外在壓迫而阻塞。壓迫解除後血流恢復但缺血性傷害喪失不可逆。

Purpose: To report a case of central retinal artery occlusion with ophthalmoplegia. Method: Case report. Result: A 59-year-old woman woke up with left eye blindness. A history of persisting eyeball compression during sleeping was likely due to overdose of sleeping pills. Her visual acuity was LP. Swelling of the left cheek, left hypertropia, relative afferent pupillary defect, and retinal edema were noted. She received methylprednisolone pulse therapy. A pale disc developed 2 weeks later. Discussion: A combination of central retinal artery occlusion and ophthalmoplegia was reported after spinal surgery. Ophthalmic artery occlusion due to compression was the probable cause. The perfusion was restored when the patient’s position changed, but the ischemic damage was irreversible.