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Impressum
Uveitis and internal ophthalmoplegia complicating chickenpox
Heger T., Dithmar S., Kolling G. H.
University Eye Hospital Heidelberg
Background: Total internal ophthalmoplegia is a very rare complication
of varicella infection. There have been only a few cases reported until
now and pharmacological testing was, if done only partially.
Case report: A 5-year-old boy attended the eye hospital with unilaterally
light fixed pupil. 3 months before an uveitis on this eye had been appeared
in association with chickenpox. The inflammation had been disappeared
after starting local treatment with corticosteroids and mydriatic agents,
but the pupil remained fixed and dilated after finishing the administration
of the drops. There was no direct or consensual light reflex and no response
to accommodation. The shortest distance for accommodation was 16 cm on
the left and 7 cm on the right eye. The objective measurement of refraction
was R +2,0sph, L +4,0sph/-0,5cyl/160o. Visual acuity on the left eye was
0.16 without and 1.0 with spectacles. He was able to read 1.0 at 30 cm
with a +3.00 sphere added. Pharmacological testing excluded a possible
lesion of the sphincter muscle (after administration of pilocarpin 1%
the pupil's diameter reduced from 8 to 2 mm on the left and from 5 to
4 mm on the right eye). This hypersensitivity is caused by a true denervation
of the sphincter muscle. The result of testing with an inhibitor of cholinesterase
(physiostigmin) was convenient to a postganglionic lesion of the parasympathicus
(reduction of the left pupil's diameter from 8 to 6, on the other side
from 5 to 2.5mm). We prescribed bifocal spectacles, which are well accepted
by the patient
Conclusion: Involvement of the internal parts of the eye by chickenpox
are extremely rare. In this case we suppose a viral invasion of the ciliary
ganglion causing first an inflammatory reaction (uveitis) and then a lesion
of the ciliary nerve endings. This was clinically similar to the symptoms
of an internal ophthalmoplegia. According to the few similar reported
cases an irreversible nerve fiber lesion has to be suggested. Univ.Eye
Hospital, INF 400, 69120 Heidelberg