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Journal of Cosmetic Dermatology Oct 2021Botulinum toxin A (BoNT-A) has grown tremendously in aesthetic dermatology since 2002 when the United States Food and Drug Administration (FDA) first approved its use... (Review)
Review
BACKGROUND
Botulinum toxin A (BoNT-A) has grown tremendously in aesthetic dermatology since 2002 when the United States Food and Drug Administration (FDA) first approved its use for treating moderate-to-severe glabellar lines. Blepharoptosis, due to local spread of toxin, is a reported side effect of BoNT-A which, although rare, more frequently occurs among inexperienced practitioners.
OBJECTIVES
The purpose of this review is to highlight the causes and management of eyelid ptosis secondary to BoNT-A administration including new anatomic pathways for BoNT-A spread from the brow area to the levator palpebrae superioris muscle.
METHODS
A literature search was conducted using electronic databases (PubMed, Science Direct, MEDLINE, Embase, CINAHL, EBSCO) regarding eyelid anatomy and the underlying pathogenesis, presentation, prevention, and treatment of eyelid ptosis secondary to BoNT-A. Anatomic dissection has been performed to assess the role of neurovascular pedicles and supraorbital foramen anatomic variations.
RESULTS
Blepharoptosis occurs due to weakness of the levator palpebrae superioris muscle. Mean onset is 3-14 days after injection and eventually self-resolves after the paralytic effect of BoNT-A wanes. Administration of medications, such as oxymetazoline hydrochloride or apraclonidine hydrochloride eye drops, anticholinesterase agents, or transdermal BoNT-A injections to the pre-tarsal orbicularis, can at least partially reverse eyelid ptosis. Anatomic study shows that a supraorbital foramen may be present in some patients and constitutes a shortcut from the brow area directly into the orbital roof, following the supraorbital neurovascular pedicle.
CONCLUSION
Providers should understand the anatomy and be aware of the causes and treatment for blepharoptosis when injecting BoNT-A for the reduction of facial wrinkles. Thorough anatomic knowledge of the supraorbital area and orbital roof is paramount to preventing incorrect injection into "danger zones," which increase the risk of eyelid ptosis.
Topics: Blepharoptosis; Botulinum Toxins, Type A; Humans; Neuromuscular Agents; Oculomotor Muscles; Skin Aging
PubMed: 34378298
DOI: 10.1111/jocd.14361 -
Eye (London, England) Sep 2021Blepharoptosis (ptosis) is among the most common disorders of the upper eyelid encountered in both optometric and ophthalmic practice. The unilateral or bilateral... (Review)
Review
Blepharoptosis (ptosis) is among the most common disorders of the upper eyelid encountered in both optometric and ophthalmic practice. The unilateral or bilateral drooping of the upper eyelid that characterises ptosis can affect appearance and impair visual function, both of which can negatively impact quality of life. While there are several known forms of congenital ptosis, acquired ptosis (appearing later in life, due to a variety of causes) is the predominant form of the condition. This review summarises the prevalence, causes, identification, differential diagnosis, and treatment of acquired ptosis. Particular attention is paid to the differential diagnosis of acquired ptosis and emerging treatment options, including surgical and pharmacologic approaches.
Topics: Blepharoplasty; Blepharoptosis; Eyelids; Humans; Prevalence; Quality of Life
PubMed: 33927356
DOI: 10.1038/s41433-021-01547-5 -
Ophthalmic Plastic and Reconstructive...Psychogenic ptosis is a rare ophthalmic manifestation of conversion disorder. The aim of this study was to describe the clinical parameters, etiology, psychological, and... (Review)
Review
PURPOSE
Psychogenic ptosis is a rare ophthalmic manifestation of conversion disorder. The aim of this study was to describe the clinical parameters, etiology, psychological, and clinical aspects of psychogenic ptosis.
METHODS
A retrospective case series was conducted of patients with psychogenic ptosis seen between 1990 to 2020. Medical records were reviewed for patient demographics, including psychiatric history, clinical findings, diagnostic studies, treatment, and resolution rates. A literature review was performed to identify cases of psychogenic ptosis previously published between 1990 and 2020.
RESULTS
Six female patients (aged 14-60 years) were diagnosed with unilateral psychogenic ptosis. Physical trauma preceded the onset of ptosis in all cases. Imaging studies had been previously obtained in all patients, none of who were correctly diagnosed at time of referral. Associated signs included concurrent brow ptosis, orbicularis oculi spasm, squint on upgaze, and variable levator function and eyelid margin measurements. Four patients had preexisting psychological conditions. Patients were primarily managed with reassurance.
CONCLUSIONS
Psychogenic ptosis is an often delayed or misdiagnosed condition, resulting in unnecessary referrals and imaging. Psychogenic ptosis should be considered in patients with atypical findings of ptosis including ipsilateral brow depression, orbicularis oculi spasm, squint on upgaze, and variable eyelid measurements. A prior history of minor trauma and female sex were common in this series. Our experience suggests that psychogenic ptosis can often be treated with reassurance, leading to partial or complete resolution. Given the number of patients with comorbid psychiatric conditions, the authors recommend a low threshold for psychiatric or psychological evaluation.
Topics: Blepharoplasty; Blepharoptosis; Eyelids; Female; Humans; Oculomotor Muscles; Retrospective Studies; Spasm; Strabismus
PubMed: 35323142
DOI: 10.1097/IOP.0000000000002157 -
Journal Francais D'ophtalmologie Feb 2022Ptosis is defined as a drooping of the upper eyelid. It often results in functional and/or aesthetic impairment. Although often benign, ptosis may be the first symptom... (Review)
Review
Ptosis is defined as a drooping of the upper eyelid. It often results in functional and/or aesthetic impairment. Although often benign, ptosis may be the first symptom of a life-threatening condition (carotid dissection, intracranial aneurism, generalized myasthenia). Only a rigorous, systematic and clinical examination will allow the physician to distinguish "benign ptosis" from "urgent ptosis". The history should attempt to detect a daily variation in the ptosis, suggesting myasthenia gravis. Pupillary examination should rule out myosis, which would suggest Claude Bernard-Horner's syndrome (secondary to an internal carotid dissection until proven otherwise), or mydriasis, suggesting an intracranial aneurism. Once an emergency has been ruled out, the clinical examination should assess the levator muscle strength (helpful for determining the underlying etiology) and the Bell's phenomenon (the lack of which is predictive of postoperative corneal exposure). The amount of ptosis is not related to its etiology. At the conclusion of the examination, the physician must be able to classify the ptosis as either pseudoptosis, aponeurotic ptosis, neurogenic ptosis, myogenic ptosis, or junctional ptosis (myasthenia). Except for "urgent ptosis", requiring multidisciplinary medical treatment, surgery is the mainstay of treatment. The surgical technique is based on the etiology of the ptosis, the strength of the levator muscle and the phenylephrine test.
Topics: Blepharoptosis; Eyelid Diseases; Eyelids; Horner Syndrome; Humans; Oculomotor Muscles
PubMed: 34799147
DOI: 10.1016/j.jfo.2021.09.005 -
Nederlands Tijdschrift Voor Geneeskunde Dec 2021A variable ptosis may point towards serious neurological disorders and is presented to general practitioners, ophthalmologists and neurologists.
BACKGROUND
A variable ptosis may point towards serious neurological disorders and is presented to general practitioners, ophthalmologists and neurologists.
CASE DESCRIPTION
Two patients presented at the neurology outpatient clinic with a ptosis confined to awakening from sleep. There were no other neurological complaints and neurological examination was normal. The diagnosis 'awakening ptosis' was made.
CONCLUSION
Awakening ptosis is a benign, but rare disorder. The exact pathophysiology remains unclear. In the case of a classic clinical picture of awakening ptosis, additional examinations are not indicated.
Topics: Blepharoptosis; Humans; Sleep
PubMed: 35138710
DOI: No ID Found -
The Journal of Craniofacial Surgery Oct 2019Lash ptosis is often an overlooked sign that may coexist with congenital and acquired blepharoptosis. This is a report of case series of patients presented in an...
INTRODUCTION
Lash ptosis is often an overlooked sign that may coexist with congenital and acquired blepharoptosis. This is a report of case series of patients presented in an oculoplastic clinic with visual field loss associated with lash ptosis. On examination, the primary pathology was attributed to lash ptosis dehiscence.
METHODS
All patients underwent anterior lamellar repositioning and were followed for an average of 15 (10-24) months.
RESULTS
All patients had resolution of visual field loss and heaviness of eyelids.
CONCLUSIONS
Lash ptosis is associated with abnormalities such as floppy eyelid syndrome. However it may be a primary condition, with no background eyelid pathology and no external explanation for the eyelash ptosis. The condition might result from anatomical changes in the orbicularis oculi, Riolan's muscle, and tarsal plate. Patients in this series complained of upper lid visual field restriction. Anterior lamellar repositioning resulted in complete resolution of complaints. Additional studies are needed to learn about the pathophysiology of this entity.
Topics: Adult; Blepharoptosis; Eyelids; Facial Muscles; Humans; Male
PubMed: 31568158
DOI: 10.1097/SCS.0000000000005984 -
Aesthetic Surgery Journal Aug 2023Eyelid ptosis following periocular onabotulinumtoxinA (BoNT-A) treatment is a known complication that can be frustrating for both patients and practitioners. Iatrogenic...
BACKGROUND
Eyelid ptosis following periocular onabotulinumtoxinA (BoNT-A) treatment is a known complication that can be frustrating for both patients and practitioners. Iatrogenic blepharoptosis occurs due to local spread of the BoNT-A from the periocular region into the levator palpebrae superioris muscle. Although injectors should have a thorough understanding of the relevant anatomy in order to prevent it, BoNT-A induced ptosis can occur even in the most experienced hands.
OBJECTIVES
The aim of this study was to describe a case series of patients treated effectively with topical oxymetazoline HCl 0.1% and pretarsal BoNT-A injections in the setting of botox-induced ptosis.
METHODS
The study group consisted of 8 patients who had undergone recent cosmetic BoNT-A treatment preceding the sudden onset of unilateral upper eyelid ptosis.
RESULTS
A diagnosis of severe ptosis (>3 mm) was made in all the cases in this series. Pretarsal BoNT-A injections alone or in association with topical administration of Upneeq eyedrops (Upneeq, Osmotica Pharmaceuticals, Marietta, GA) significantly reversed the ptosis in all treated cases.
CONCLUSIONS
This is the first documented case series of patients treated effectively with topical oxymetazoline HCl 0.1% and pretarsal BoNT-A injections in the setting of botox-induced ptosis. This treatment combination is a safe and effective option in these cases.
Topics: Humans; Botulinum Toxins, Type A; Blepharoptosis; Oxymetazoline; Clostridium botulinum; Neuromuscular Agents
PubMed: 36943792
DOI: 10.1093/asj/sjad070 -
Ophthalmic Research 2022Congenital ptosis, a birth defects presents at birth or by 1 year of age, is characterized by the drooping of the upper eyelid. Either in isolation (nonsyndromic) or... (Review)
Review
Congenital ptosis, a birth defects presents at birth or by 1 year of age, is characterized by the drooping of the upper eyelid. Either in isolation (nonsyndromic) or with many different systemic disorders (syndromic). The estimated prevalence of ptosis (congenital and acquired) ranges from 0.79 to 1.99 per 10,000 people in different populations, and it is more prevalent in males. The underlying pathogenesis of congenital ptosis is myogenic and neurogenic, related to the development of muscles and nerves. Although most cases are sporadic, there are familial transmission characteristics, including autosomal dominant, recessive mode, and X-linkage inheritance patterns. Moreover, some forms are due to chromosomal aberrations and mutations and deletions in mitochondrial DNA. Genes involved in simple congenital ptosis (SCP) are ZFHX4 and COL25A1. The clinical aspects of various syndromes involving congenital ptosis are partly caused by single-gene mutations. However, the pathogenesis of congenital ptosis is not fully understood. We review the reported epidemiology, genetics, and clinical features of congenital ptosis and associated syndromes here.
Topics: Blepharoptosis; Eyelids; Humans; Infant, Newborn; Male; Muscle Development; Oculomotor Muscles; Syndrome
PubMed: 34969027
DOI: 10.1159/000521575 -
Current Opinion in Ophthalmology Jul 2020Refractive surgery is one of the most popular elective procedures performed in the world. Given that dry eye is a common complaint following keratorefractive surgery,... (Review)
Review
PURPOSE OF REVIEW
Refractive surgery is one of the most popular elective procedures performed in the world. Given that dry eye is a common complaint following keratorefractive surgery, evaluation, and treatment of periocular conditions that further predispose the patient to dry eye symptoms is an important part of the presurgical assessment. Periocular conditions and surgeries can also affect the ocular surface and keratometry, and should be addressed. For example, ptosis, orbital fat herniation, ectropion, and eyelid masses have been shown to induce corneal topography changes and astigmatism. The oculoplastic considerations for refractive surgery include both the contribution of eyelid position on dry eye, ocular surface damage, refractive error, and outcomes, as well as the timing of oculoplastic surgery in relation to the refractive surgery. In this review, the recently published literature on eyelid and orbital surgery in relation to keratorefractive surgery is reviewed to elucidate the relationship of periocular factors with refractive surgery outcomes and complications. To improve keratorefractive surgery outcomes, a literature review is presented, discussing evaluation, management, and timing of management of oculoplastics conditions.
RECENT FINDINGS
Dry eye syndrome is a well known complication of keratorefractive procedures. This is exacerbated with concurrent eyelid or orbital disorders, such as ectropion, lagophthalmos, and thyroid eye disease. In addition to impacting dry eye and ocular surface damage, eyelid surgeries can also affect corneal topography and refraction. Studies have found that patients with ptosis have topographic corneal aberrations from the eyelid exerting pressure on the cornea, while ptosis repair and blepharoplasty patients may undergo an astigmatic change postoperatively. Finally, the corneal flap created in laser-assisted in situ keratomileusis may be at risk for displacement or damage postoperatively with this risk changing, depending on method of flap creation, and time elapsed since keratorefractive surgery.
SUMMARY
Eyelid and orbital conditions that predispose to dry eye syndrome and refractive changes should be evaluated and optimized prior to keratorefractive surgery. Patients electing to have oculoplastic surgery, like ptosis repair, should be fully healed prior to any refractive surgery to allow both refractive changes and eyelid positions to stabilize prior to the refractive surgery.
Topics: Astigmatism; Blepharoptosis; Dry Eye Syndromes; Humans; Keratomileusis, Laser In Situ; Keratoplasty, Penetrating; Orbital Diseases; Postoperative Period; Refraction, Ocular; Refractive Errors; Refractive Surgical Procedures
PubMed: 32487809
DOI: 10.1097/ICU.0000000000000667 -
The New England Journal of Medicine Jul 2022
Topics: Blepharoptosis; Humans
PubMed: 35939581
DOI: 10.1056/NEJMicm2200050