A CASE OF POTENTIALLY LETHAL RED EYE: CAVERNOUS SINUS THROMBOSIS CAUSED BY SEPTIC EMBOLI

因海綿竇感染性血栓造成致命性紅眼之個案報告

楊卓凡(Cho-Fan Yang) ； 彭美玲(Mei-Ling Peng)

《中華民國眼科醫學會雜誌》 54卷 (2015/10) Pp. 60-66

https://doi.org/10.30048/ACTASOS.201510_54.0010

摘要

目的：報告一位27 歲男性因感染性血栓而造成之右眼致命性紅眼之個案。方法：病例報告。結果：一名27 歲男性因在家從樓梯摔下後有意識改變合併右側浣熊眼，被救護車送來急診室。後來因細菌性腦膜炎及敗血性休克被送至加護病房治療觀察。在加護病房時雙眼近視力右眼為0.08，左眼為0.5。眼壓右左眼分別為22 及17 毫米汞柱。突眼計測量值為右眼23 釐米，左眼20 釐米。右眼視神經對光線反射異常合併相對性傳入瞳孔缺陷。雙眼眼外肌運動受限，特別是外展之方向。頭部血管攝影則顯示右側海綿竇及上眼靜脈栓塞及左側海綿竇部分栓塞。經過抗生素及糖尿病之治療之後，臨床症狀包括眼睛部分逐漸改善，但眼外肌運動仍持續受限。結論：感染性海綿竇栓塞雖然少見，但是一旦發生相關後遺症及致死率都相當高。它同時也個急症，需要緊急的處理，特別是抗生素的使用。同時也要謹記感染性海綿竇栓塞也是感染性突眼的鑑別診斷之一。

並列摘要

Purpose: To present the case of a 27-year-old man with fatal right red eye caused by septic emboli. Methods: Case report Results: A 27-year old man fell down the stairs, and as a result of the fall, lost consciousness and received a right raccoon eye. He was admitted to a medical intensive care unit under suspicion of bacterial meningitis and sepsis. Bilateral restricted eye motions and proptosis of the right raccoon eye with lid laceration were noted. A ophthalmic exam revealed visual acuity was 0.08 OD and 0.5 OS, and the intraocular pressure was 22 mmHg OD and 17 mmHg OS. Hertel exophthalmometry measured 23 mm OD and 20 mm OS. The right pupil showed a poor light reflex with relative afferent pupillary defect. Limited extraocular movement was noted in all gaze directions in both eyes, especially in abduction. The brain angiography showed right cavernous sinus and right superior ophthalmic vein thrombosis and partial left cavernous sinus thrombosis. After high-dose intravenous antibiotics and diabetic control, the clinical condition improved. His left ophthalmic findings resolved, with the abduction deficit being the last symptom to resolve. Conclusions: Septic cavernous sinus thrombosis is rare but is associated with significant morbidity and mortality. Septic cavernous sinus thrombosis is an emergency, as it can have devastating complications. It requires an interdisciplinary approach and immediate aggressive therapy, especially the use of antibiotics. One must always be kept in mind that proptosis could be caused by an infectious etiology.

並列關鍵字

cavernous sinus thrombosis ； cavernous sinus syndrome ； septic emboli