Concurrent hyphema and orbital apex syndrome following herpeszoster ophthalmicus in a middle aged lady
INTRODUCTION: Hyphema and orbital apex syndrome occurring concurrently in a patient with herpeszoster ophthalmicus have not been reported previously. We present a case with these unique findingsand discuss the pathogenesis of these conditions and their management.PRESENTATION OF CASE: A 59-year-old...
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| Language: | English |
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Elsevier
2017
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| Online Access: | http://eprints.usm.my/38481/ http://eprints.usm.my/38481/1/Concurrent_hyphema_and_orbital_apex_syndrome_following.pdf |
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| author | Othman, Khairuddin Tai, Evelyn Li Min Mohd Noor, Raja Azmi Muhammed, Julieana Ahmad Tajudin, Liza Sharmini John, Tharakan Muhd Besari, Alwi Embong, Zunaina Ismail, Shatriah |
| author_facet | Othman, Khairuddin Tai, Evelyn Li Min Mohd Noor, Raja Azmi Muhammed, Julieana Ahmad Tajudin, Liza Sharmini John, Tharakan Muhd Besari, Alwi Embong, Zunaina Ismail, Shatriah |
| author_sort | Othman, Khairuddin |
| building | USM Institutional Repository |
| collection | Online Access |
| description | INTRODUCTION: Hyphema and orbital apex syndrome occurring concurrently in a patient with herpeszoster ophthalmicus have not been reported previously. We present a case with these unique findingsand discuss the pathogenesis of these conditions and their management.PRESENTATION OF CASE: A 59-year-old Malay lady with underlying diabetes mellitus presented withmanifestations of zoster ophthalmicus in the left eye. Two weeks later, she developed total hyphema,and complete ophthalmoplegia suggestive of orbital apex syndrome. She was treated with combinationof intravenous acyclovir and oral corticosteroids, and regained full recovery of ocular motility. Totalhyphema persisted, and she required surgical intervention.DISCUSSION: Hyphema is postulated to occur due to an immune vasculitis affecting the iris vessels. Orbitalapex syndrome is probably due to an occlusive vasculitis affecting the vasculature of the extraocular mus-cles and optic nerve, resulting from a direct invasion by varicella zoster virus or infiltration of perivascularinflammatory cells. Magnetic Resonance Imaging of the brain is essential to exclude possibility of localcauses at the orbital apex area.CONCLUSION: Herpes zoster ophthalmicus is an uncommon ocular presentation. Managing two concur-rent complications; persistent total hyphema and orbital apex syndrome is a challenging clinical situation.Early diagnosis and prompt treatment are essential to prevent potential blinding situation. |
| first_indexed | 2025-11-15T17:32:02Z |
| format | Article |
| id | usm-38481 |
| institution | Universiti Sains Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-15T17:32:02Z |
| publishDate | 2017 |
| publisher | Elsevier |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | usm-384812018-01-23T06:17:16Z http://eprints.usm.my/38481/ Concurrent hyphema and orbital apex syndrome following herpeszoster ophthalmicus in a middle aged lady Othman, Khairuddin Tai, Evelyn Li Min Mohd Noor, Raja Azmi Muhammed, Julieana Ahmad Tajudin, Liza Sharmini John, Tharakan Muhd Besari, Alwi Embong, Zunaina Ismail, Shatriah R5-920 Medicine (General) RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry RE Ophthalmology INTRODUCTION: Hyphema and orbital apex syndrome occurring concurrently in a patient with herpeszoster ophthalmicus have not been reported previously. We present a case with these unique findingsand discuss the pathogenesis of these conditions and their management.PRESENTATION OF CASE: A 59-year-old Malay lady with underlying diabetes mellitus presented withmanifestations of zoster ophthalmicus in the left eye. Two weeks later, she developed total hyphema,and complete ophthalmoplegia suggestive of orbital apex syndrome. She was treated with combinationof intravenous acyclovir and oral corticosteroids, and regained full recovery of ocular motility. Totalhyphema persisted, and she required surgical intervention.DISCUSSION: Hyphema is postulated to occur due to an immune vasculitis affecting the iris vessels. Orbitalapex syndrome is probably due to an occlusive vasculitis affecting the vasculature of the extraocular mus-cles and optic nerve, resulting from a direct invasion by varicella zoster virus or infiltration of perivascularinflammatory cells. Magnetic Resonance Imaging of the brain is essential to exclude possibility of localcauses at the orbital apex area.CONCLUSION: Herpes zoster ophthalmicus is an uncommon ocular presentation. Managing two concur-rent complications; persistent total hyphema and orbital apex syndrome is a challenging clinical situation.Early diagnosis and prompt treatment are essential to prevent potential blinding situation. Elsevier 2017 Article PeerReviewed application/pdf en http://eprints.usm.my/38481/1/Concurrent_hyphema_and_orbital_apex_syndrome_following.pdf Othman, Khairuddin and Tai, Evelyn Li Min and Mohd Noor, Raja Azmi and Muhammed, Julieana and Ahmad Tajudin, Liza Sharmini and John, Tharakan and Muhd Besari, Alwi and Embong, Zunaina and Ismail, Shatriah (2017) Concurrent hyphema and orbital apex syndrome following herpeszoster ophthalmicus in a middle aged lady. International Journal of Surgery Case Reports, 30. pp. 197-200. ISSN 2210-2612 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5219611/ |
| spellingShingle | R5-920 Medicine (General) RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry RE Ophthalmology Othman, Khairuddin Tai, Evelyn Li Min Mohd Noor, Raja Azmi Muhammed, Julieana Ahmad Tajudin, Liza Sharmini John, Tharakan Muhd Besari, Alwi Embong, Zunaina Ismail, Shatriah Concurrent hyphema and orbital apex syndrome following herpeszoster ophthalmicus in a middle aged lady |
| title | Concurrent hyphema and orbital apex syndrome following herpeszoster ophthalmicus in a middle aged lady |
| title_full | Concurrent hyphema and orbital apex syndrome following herpeszoster ophthalmicus in a middle aged lady |
| title_fullStr | Concurrent hyphema and orbital apex syndrome following herpeszoster ophthalmicus in a middle aged lady |
| title_full_unstemmed | Concurrent hyphema and orbital apex syndrome following herpeszoster ophthalmicus in a middle aged lady |
| title_short | Concurrent hyphema and orbital apex syndrome following herpeszoster ophthalmicus in a middle aged lady |
| title_sort | concurrent hyphema and orbital apex syndrome following herpeszoster ophthalmicus in a middle aged lady |
| topic | R5-920 Medicine (General) RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry RE Ophthalmology |
| url | http://eprints.usm.my/38481/ http://eprints.usm.my/38481/ http://eprints.usm.my/38481/1/Concurrent_hyphema_and_orbital_apex_syndrome_following.pdf |