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BMJ Case Reports Jan 2015A 64-year-old man presented with a 2-day history of acute onset painless left ptosis. He had no other symptoms; importantly pupils were equal and reactive and eye...
A 64-year-old man presented with a 2-day history of acute onset painless left ptosis. He had no other symptoms; importantly pupils were equal and reactive and eye movements were full. There was no palpable mass or swelling. He was systemically well with no headache, other focal neurological signs, or symptoms of fatigue. CT imaging showed swelling of the levator palpebrae superioris suggestive of myositis. After showing no improvement over 5 days the patient started oral prednisolone 30 mg reducing over 12 weeks. The ptosis resolved quickly and the patient remains symptom free at 6 months follow-up. Acute ptosis may indicate serious pathology. Differential diagnoses include a posterior communicating artery aneurysm causing a partial or complete third nerve palsy, Horner's syndrome, and myasthenia gravis. A careful history and examination must be taken. Orbital myositis typically involves the extraocular muscles causing pain and diplopia. Isolated levator myositis is rare.
Topics: Blepharoptosis; Diagnosis, Differential; Diplopia; Eye Movements; Eyelids; Horner Syndrome; Humans; Male; Middle Aged; Muscle, Skeletal; Myasthenia Gravis; Oculomotor Muscles; Oculomotor Nerve Diseases; Orbital Myositis; Prednisolone
PubMed: 25564592
DOI: 10.1136/bcr-2014-207720 -
The Journal of Craniofacial SurgeryTo explore the ocular surface changes after ptosis surgery in patients with severe congenital blepharoptosis.
OBJECTIVE
To explore the ocular surface changes after ptosis surgery in patients with severe congenital blepharoptosis.
METHODS
The patients were divided into group A and group B, Group A received conjoint fascial sheath suspension, and group B received frontal muscle flap suspension. The ocular surface changes were followed upon the 7th day and in the 1st and 3rd month after operation, which included Schirmer test (ST), break-up time (BUT), tear meniscus height (TMH). For normal distribution variables, t test was used before and after operation, and the Wilcoxon test was used for variables with abnormal distribution.
RESULTS
Compared to preoperative status, the ST and TMH were not significantly changed after surgery (P > 0.05), but BUT higher on the 7th day and in the 1st and 3rd month after operation (P < 0.05). The fluorescence staining (FL) score was higher in the 3rd month than that in the 1st month (P < 0.05), but was not significantly different between the 7th and in the 1st month after operation (P > 0.05). The ST, TMH, and BUT after surgery were not significantly different between groups of A and B (P > 0.05), but the FL score lower in the 3rd month than on the 7th day and in the 1st month after operation (P < 0.05).
CONCLUSIONS
The ST, BUT, and TMH were not significantly changed after surgery between groups of A and B, but the FL score was lower in group A than that in group B in early postoperative time.
Topics: Blepharoptosis; Eye; Fascia; Humans; Muscles; Surgical Flaps
PubMed: 34172687
DOI: 10.1097/SCS.0000000000007693 -
Assessing the corneal sub-basal nerve plexus by confocal microscopy in patients with blepharoptosis.Annals of Medicine Dec 2022To assess confocal microscopy features of corneal sub-basal nerve plexus in patients with congenital or aponeurogenic blepharoptosis using a fully automated software...
BACKGROUND
To assess confocal microscopy features of corneal sub-basal nerve plexus in patients with congenital or aponeurogenic blepharoptosis using a fully automated software (ACCMetrics).
PATIENTS AND METHODS
This prospective study included 33 patients with blepharoptosis and 17 normal controls. The corneal sub-basal nerve plexus was assessed using confocal microscopy, and the ocular surface status was evaluated by tear break-up times.
RESULTS
The mean age of 33 patients with blepharoptosis and 17 normal controls were 38.77 ± 22.81 years and 48.35 ± 17.15 years, respectively. The mean duration of blepharoptosis was 16.42 ± 15.60 years. In 13 patients with unilateral blepharoptosis, there was no significant difference between affected eyes and contralateral eyes (all s > .05), except for wider corneal nerve fibre width (CNFW) in affected eyes (0.024 ± 0.001 versus 0.023 ± 0.001 mm/mm, = .021). In 20 patients with bilateral blepharoptosis, there was no significant difference between the eyes. No significant difference was detected between 19 cases with congenital blepharoptosis and 14 cases with aponeurogenic blepharoptosis. When compared with normal controls, eyes with both unilateral and bilateral blepharoptosis had significantly wider CNFW. But from the point of aetiology, only eyes with congenital blepharoptosis presented with wider CNFW ( = .001), rather than the eyes with aponeurogenic blepharoptosis ( = .093). Besides, four young patients with congenital blepharoptosis revealed very sparse sub-basal nerve plexus.
CONCLUSIONS
These data suggested that corneal confocal microscopy demonstrated no significant changes in patients with blepharoptosis as compared with normal controls, except for relatively wider CNFW in congenital affected eyes. However, in some children and young adults with congenital blepharoptosis, the density of corneal sub-basal nerve plexus was evidently decreased, which needs to be cautioned when ones with congenital blepharoptosis want to take corneal surgeries or wear contact lens.Key messagesWhen compared with normal controls, no significant effect was found in the influence of blepharoptosis on the most of corneal nerve parameters, except for corneal nerve fibre width (CNFW) in the group of congenital blepharoptosis.The age of onset of blepharoptosis may influence corneal nerve fibres, so timely surgical treatment of congenital blepharoptosis is not only conducive to the development of normal vision, but also beneficial to the reduction of corneal nerve lesions to some extent.We noted that some young blepharoptosis patients revealed sparse corneal nerve, which should be taken precaution when ones with congenital blepharoptosis who want to take corneal surgeries or wear contact lens.
Topics: Adult; Blepharoptosis; Child; Cornea; Humans; Microscopy, Confocal; Nerve Fibers; Prospective Studies; Young Adult
PubMed: 35014936
DOI: 10.1080/07853890.2021.2024246 -
Eye (London, England) Jun 2017PurposeThis study aimed to evaluate the prevalence and associated factors of involutional blepharoptosis in a nationwide representative sample in...
PurposeThis study aimed to evaluate the prevalence and associated factors of involutional blepharoptosis in a nationwide representative sample in Korea.MethodsCross-sectional study 20 941 Korean men and women 40 years of age and older who participated in last 2 years (2008 and 2009) of the 4th wave of the Korean National Health and Nutrition Examination Survey (KNHANES) IV and the first 2 years (2010 and 2011) of KNHANES V. Ocular examinations were performed by ophthalmologists trained in procedure and grading methods, and blepharoptosis was defined as a marginal reflex distance <2 mm on either eye.ResultsThe prevalence of involutional blepharoptosis in the Korean adult was 13.5% (95% CI: 12.1%, 14.9%). It was increasing along with aging (5.4% among 40's and 32.8% in people over 70 years old). A statistically significant negative association between levator function and blepharoptosis was found. With right eye, while only 5.4% (95% CI: 4.5%, 6.2%) had blepharoptosis among people whose levator function was excellent (≥12 mm), 71.4% (95% CI: 60.0%, 85.9%) of people whose levator function was poor (≤4 mm) had blepharoptosis. Hypertension, diabetes, higher body mass index (BMI), and lower education had statistically significant association with blepharoptosis adjusting all other confounders.ConclusionsThe distribution and proportional changes of levator function and marginal reflex distance 1 (MRD1) with aging implicate a contributory role of muscular degeneration. Strong association with hypertension, diabetes, BMI, and education level suggests that etiology of involutional blepharoptosis would be multifactorial and further investigation would be necessary to determine precise mechanism and contribution of factors.
Topics: Adult; Age Factors; Aged; Blepharoptosis; Body Mass Index; Cross-Sectional Studies; Diabetes Mellitus; Female; Humans; Hypertension; Male; Middle Aged; Nutrition Surveys; Overweight; Prevalence; Republic of Korea; Retrospective Studies; Risk Assessment; Risk Factors
PubMed: 28338663
DOI: 10.1038/eye.2017.43 -
Turkish Journal of Ophthalmology Jun 2020To evaluate the impact of upper eyelid blepharoplasty on contrast sensitivity in dermatochalasis patients.
OBJECTIVES
To evaluate the impact of upper eyelid blepharoplasty on contrast sensitivity in dermatochalasis patients.
MATERIALS AND METHODS
Best corrected visual acuity, ophthalmologic examination, eyelid examination, lash ptosis, contrast sensitivity using sine-wave contrast sensitivity chart, keratometric parameters, and corneal aberrations of 34 eyes of 34 patients who underwent upper eyelid blepharoplasty due to dermatochalasis in our clinic between the years 2014 and 2018 were evaluated preoperatively and at postoperative 3 months.
RESULTS
Twenty-three (68%) of the patients were females and 11 (32%) were males. Mean age was 63.1±7 (52-81) years. Mean best corrected visual acuity was 0.036±0.06 (0-0.15) logMAR preoperatively and postoperatively (p>0.05). Contrast sensitivity values of the patients at the frequencies of 1.5, 3, 6, 12, and 18 cycles per degree were 44.38±19.5, 59.03±27.2, 41.44±34.1, 15.15±19.3, and 5.15±4.26 preoperatively and 44.80±20.9, 76.85±33.4, 63.21±46.4, 28.21±31.1, and 10.5±9.5 postoperatively, respectively. The difference between contrast sensitivity values was statistically significant at the frequencies of 3, 6, 12, and 18 cpd (p=0.005, =0.001, <0.001, and <0.001, respectively). Although lash ptosis of the patients improved significantly after the surgery, there was no correlation between lash ptosis improvement and change in contrast sensitivity (p>0.05). Keratometric values and corneal high order aberrations did not change significantly after the surgery (p>0.05).
CONCLUSION
Contrast sensitivity significantly increases after upper eyelid blepharoplasty, especially at higher spatial frequencies which are known to deteriorate due to age-related changes in the lens and retina in older adults. Our results show that blepharoplasty may have additional functional indications for elderly dermatochalasis patients in terms of improving the functions such as performing daily tasks and reading.
Topics: Aged; Aged, 80 and over; Blepharoplasty; Blepharoptosis; Eyelids; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patient Satisfaction; Postoperative Period; Retrospective Studies; Visual Acuity
PubMed: 32631001
DOI: 10.4274/tjo.galenos.2019.95871 -
Acta Neurologica Belgica Apr 2023As new treatments are becoming available for patients with myasthenia gravis (MG), it is worth reflecting on the actual status of MG treatment to determine which... (Review)
Review
INTRODUCTION
As new treatments are becoming available for patients with myasthenia gravis (MG), it is worth reflecting on the actual status of MG treatment to determine which patients would most likely benefit from the new treatments.
METHODS
We reviewed the clinical files of all MG patients seen at the Department of Neurology of the Antwerp University Hospital during the years 2019, 2020 and 2021.
RESULTS
163 patients were included. Age at diagnosis varied from the first to the eighth decades, with a peak of incidence from 60 to 70 years for both genders, and an additional peak from 20 to 30 years in women. Diplopia and ptosis were by far the most common onset symptom. At maximum disease severity, 24% of the patients still had purely ocular symptoms and 4% needed mechanical ventilation. 97% of the patients received a treatment with pyridostigmine and 68% with corticosteroids, often in combination with immunosuppressants. More than half reported side effects. At the latest visit, 50% of the patients were symptom-free. Also, half of the symptomatic patients were fulltime at work or retired with no or mild limitations in daily living. The remaining patients were working part-time, on sick leave, or retired with severe limitations.
DISCUSSION AND CONCLUSION
The majority of MG patients are doing well with currently available treatments, but often at the cost of side effects in the short and in the long term. A significant group is in need of better treatments.
Topics: Humans; Female; Male; Belgium; Myasthenia Gravis; Pyridostigmine Bromide; Blepharoptosis; Diplopia
PubMed: 36658451
DOI: 10.1007/s13760-023-02187-0 -
Neurology India 2021Blepharoptosis (ptosis) is classified, based on etiology, into mechanical, cerebral, neurogenic, neuromuscular, myogenic, and due to miscellaneous causes. Primary...
Blepharoptosis (ptosis) is classified, based on etiology, into mechanical, cerebral, neurogenic, neuromuscular, myogenic, and due to miscellaneous causes. Primary myopathic diseases are rare causes of blepharoptosis and many patients with myogenic ptosis undergo a series of extensive investigations before a myopathy is being considered. In this study, we report four patients with different myopathic disorders who had blepharoptosis as a presenting symptom of their disease. Moreover, we highlight frequent diagnostic errors and difficulties in patients with myopathies who present blepharoptosis. Lack of clear cut aggravation of symptoms by fatigue and response to cholinesterase inhibitors treatment, the association of proximal, distal or extraocular muscle weakness, and positive family history or evidence of a multi systemic disorder should prompt evaluation of an underlying myopathy.
Topics: Blepharoptosis; Humans; Muscular Diseases
PubMed: 33642296
DOI: 10.4103/0028-3886.310067 -
BMC Ophthalmology Jun 2023Upper eyelid surgeries, such as blepharoplasty and ptosis correction, are commonly performed procedures worldwide. This review examines the effects of these surgeries on... (Review)
Review
Upper eyelid surgeries, such as blepharoplasty and ptosis correction, are commonly performed procedures worldwide. This review examines the effects of these surgeries on ocular properties and visual function. A search of the PubMed and Google Scholar databases was conducted to identify relevant articles published after 2000. The results demonstrate that the ocular and adnexal organs function as a unified visual system, with changes in one component affecting the functions of others. Eyelid surgery can alter ocular properties and functions by modifying retinal lighting and ocular optics. These alterations can affect intraocular pressure estimation, corneal curvature, corneal epithelial thickness, refractive power of the cornea, and intraocular lens calculation. Additionally, eyelid surgery can exacerbate dry eye symptoms and impact contrast sensitivity, which is a significant factor in visual quality. Therefore, understanding these interactions is crucial before performing eyelid surgery and during follow-up. This review summarizes recent literature on the effects of upper eyelid surgery on corneal properties and visual function, emphasizing the importance of considering these factors when planning or undergoing such procedures.
Topics: Humans; Blepharoplasty; Astigmatism; Cornea; Blepharoptosis; Eyelids
PubMed: 37280563
DOI: 10.1186/s12886-023-03010-3 -
Medicine Jan 2021To evaluate the utility of low-concentration nitrous oxide (N2O) anesthesia in ptosis surgeryThis study was a retrospective consecutive case series that included 54...
To evaluate the utility of low-concentration nitrous oxide (N2O) anesthesia in ptosis surgeryThis study was a retrospective consecutive case series that included 54 successive patients with blepharoptosis who underwent bilateral levator aponeurosis advancement and on whom skin resection performed by the same surgeon between August 2016 and July 2017. Among these patients, 27 were operated with a local anesthesia injection (air group) and 27 with a local anesthesia injection and low-concentration N2O anesthesia (N2O group). All N2O cases used a total of 6 L of gas comprising 70% oxygen and 30% N2O. Preoperative and postoperative blood pressure (BP) and heart rate (HR) and intraoperative pain, anxiety, nausea, and memory were measured immediately after surgery using visual analog scale score (VASS). Additionally, perioperative side effects were examined.There was no significant difference in age, sex, and preoperative and postoperative margin reflex distance (MRD) between the 2 groups (all P > .05). The intraoperative mean peripheral oxygen saturation was significantly higher (97.5% ± 1.6% vs 99.5% ± .6%, P < .001), intraoperative HR was significantly lower (78.2 ± 12.8 vs 70.7 ± 11.6 bpm, P = .02), and operation time was significantly shorter (33.1 ± 8.1 vs 29.4 ± 10.3 minutes, P = .03) in the N2O group than in the air group.Difference between intraoperative and preoperative systolic BP (BPs) (+15.8 ± 18.0 vs + 3.1 ± 21.7 mm Hg, P = .02), diastolic BP (BPd) (+7.0 ± 17.4 vs -2.3 ± 13.6 mm Hg, P = .04), and HR (3.2 ± 8.5 vs -3.9 ± 9.4 bpm, P = .01) was significantly lower in the N2O group than in the air group.VASS of intraoperative pain was significantly lower in the N2O group than in the air group (49.5 ± 24.7 vs 22.6 ± 14.9, P < .001), whereas intraoperative anxiety and memory did not present significant differences between the groups (P = .09 and P = .45, respectively). Intraoperative nausea score was 0 for all cases in both groups. There was no other side effect.Ptosis surgery with anesthesia using 30% N2O may effectively suppress intraoperative BP and HR along with pain and shorten the operation time without side effects such as nausea.
Topics: Aged; Aged, 80 and over; Anesthetics, Inhalation; Anesthetics, Local; Anxiety; Blepharoplasty; Blepharoptosis; Blood Pressure; Female; Heart Rate; Humans; Intraoperative Period; Male; Memory; Middle Aged; Nausea; Nitrous Oxide; Operative Time; Pain Management; Retrospective Studies; Vital Signs
PubMed: 33530174
DOI: 10.1097/MD.0000000000023753 -
The Journal of International Medical... Apr 2020This study was performed to evaluate a novel method of constructing double eyelids by fixation of the orbicularis oculi muscle and orbital septum to the pretarsal fascia...
OBJECTIVE
This study was performed to evaluate a novel method of constructing double eyelids by fixation of the orbicularis oculi muscle and orbital septum to the pretarsal fascia and correction of blepharoptosis.
METHODS
In total, 285 patients requesting aesthetic construction of double eyelids were divided into three groups: those treated by the modified method (Group A, n = 108), those treated by traditional construction of the upper eyelid (Group B, n = 85), and those treated by the Park method (Group C, n = 92). The patients were followed up for 3 to 12 months (average, 6 months). The surgical effects and degree of satisfaction were compared among the three groups.
RESULTS
In Group A, the mean operative time was 1.0 ± 0.2 hours. The degree of satisfaction with the surgical effect was significantly different between Group A (95.37%) and Group B (87.06%). However, no significant difference in satisfaction was noted between Group A (95.37%) and Group C (91.30%) or between Group B (87.06%) and Group C (91.30%).
CONCLUSIONS
The modified technique is simple and effective for construction of double eyelids and correction of blepharoptosis. All patients were satisfied with the surgical and aesthetic effects.
Topics: Adult; Blepharoptosis; Eyelids; Facial Muscles; Fascia; Female; Humans; Male; Middle Aged; Orbit; Surgery, Plastic
PubMed: 32308080
DOI: 10.1177/0300060519870417