Pupillary and Accommodative Disorders After Idiopathic Oculomotor Nerve Palsy in Childhood: A Case Report

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  • Nogami Tsuyoshi
    Department of Orthoptics and Visual Sciences, International University of Health and Welfare Department of Ophthalmology, International University of Health and Welfare Hospital
  • Suzuki Kenji
    Department of Orthoptics and Visual Sciences, International University of Health and Welfare Department of Ophthalmology, International University of Health and Welfare Hospital
  • Hara Naoto
    Department of Orthoptics and Visual Sciences, International University of Health and Welfare Department of Ophthalmology, International University of Health and Welfare Hospital
  • Fujiyama Yukiko
    Department of Orthoptics and Visual Sciences, International University of Health and Welfare Department of Ophthalmology, International University of Health and Welfare Hospital
  • Sato Tsukasa
    Department of Orthoptics and Visual Sciences, International University of Health and Welfare Department of Ophthalmology, International University of Health and Welfare Hospital
  • Niida Takahiro
    Department of Orthoptics and Visual Sciences, International University of Health and Welfare Department of Ophthalmology, International University of Health and Welfare Hospital

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Other Title
  • 小児の特発性動眼神経麻痺後における瞳孔・調節障害を客観的に観察できた1例

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Description

A 10-year-old girl who complained of left upper eyelid pain and diplopia was diagnosed with left oculomotor nerve palsy by a previous doctor. However, computed tomography, magnetic resonance imaging, blood examination, and spinal fluid analysis revealed no abnormalities. The patient underwent steroid pulse therapy, which was not successful. She was referred to our department for a second opinion. The clinical features were ptosis, ocular motility disorder, disorders of accommodation, and reduced pupillary light reflex in the left eye. At 2 months after onset, ptosis and ocular motility disorder completely resolved. At 25 months after onset, the disorders of accommodation slightly improved but the pupillary light reflex did not. Moreover, light-near dissociation, segmental palsy of the iris sphincter, and denervation supersensitivity by an ocular injection of pilocarpine hydrochloride（0.125％）in the pupil of the affected eye were observed. Therefore, the lesion responsible for tonic pupil in the patient was considered to be of postganglionic origin.

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