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JNMA; Journal of the Nepal Medical... Jul 2021Tolosa-Hunt Syndrome is a rare disease characterized by painful ophthalmoplegia affecting third, fourth, and/or sixth cranial nerve caused by non-specific inflammation...
Tolosa-Hunt Syndrome is a rare disease characterized by painful ophthalmoplegia affecting third, fourth, and/or sixth cranial nerve caused by non-specific inflammation in the cavernous sinus or superior orbital fissure of unknown etiology. We presented a 67-year-old female with Tolosa-Hunt Syndrome. She had a right-sided headache and periorbital pain with double vision. Examination showed right-sided ptosis, right-sided trochlear and abducens nerve palsy, and partial right-sided oculomotor nerve palsy with hypoesthesia in the area of the ophthalmic division of the trigeminal nerve. Magnetic resonance imaging of head and orbit showed altered signal intensity changes in the optic nerve and lateral rectus muscle. After steroid therapy, pain and ptosis were significantly improved in 72 hours. Tolosa-Hunt Syndrome is a diagnosis of exclusion, with clinical presentation, normal investigations, magnetic resonance imaging findings, and response to steroid therapy crucial in making the diagnosis.
Topics: Aged; Blepharoptosis; Female; Humans; Magnetic Resonance Imaging; Pain; Tolosa-Hunt Syndrome
PubMed: 34508416
DOI: 10.31729/jnma.5700 -
Pediatric Neurology Apr 2024Currently, there is no universally accepted standard treatment for ocular myasthenia gravis (OMG) in children. We aimed to investigate the possible proper regimens and...
BACKGROUND
Currently, there is no universally accepted standard treatment for ocular myasthenia gravis (OMG) in children. We aimed to investigate the possible proper regimens and timing of treatment for pediatric OMG cases based on the clinical manifestations: OMG with ptosis only and OMG with other features.
METHODS
One hundred and forty two OMG cases attended at the Department of Pediatrics, Xiangya Hospital, Central South University, from 2010 to 2019 were included, and information from medical records was reviewed and recorded. Comparisons of clinical characteristics between patients with OMG with ptosis only and patients with OMG with other features as well as between patients treated with glucocorticoid (GC) within or after six months from disease onset were performed.
RESULTS
OMG with other features constituted about 54.9% of the cases, and 66.2% of the patients achieved optimal outcome. Patients with OMG with ptosis only responded to pyridostigmine alone more than patients with OMG with other features who required several therapies (P < 0.001). Patients with OMG with ptosis only had a larger proportion of optimal outcome than the patients with OMG with other features (P = 0.002), and the difference remained significant even when the individual outcome groups were compared (P < 0.001). Patients who received GC within six months had a greater proportion of optimal outcome than those who received it after six months (P < 0.001).
CONCLUSIONS
Although OMG with other features is a more common subtype of OMG, it is also more severe than OMG with ptosis only. An earlier addition of GC leads to optimal outcome.
Topics: Humans; Child; Myasthenia Gravis; Blepharoptosis; Pyridostigmine Bromide; Glucocorticoids; Retrospective Studies
PubMed: 38382246
DOI: 10.1016/j.pediatrneurol.2024.01.014 -
Ophthalmic Plastic and Reconstructive...To describe the frequency of blepharoptosis and factors affecting it after the pars plana vitrectomy (PPV) procedure.
PURPOSE
To describe the frequency of blepharoptosis and factors affecting it after the pars plana vitrectomy (PPV) procedure.
METHODS
In a prospective study, patients were recruited consecutively from October 2016 to June 2018. Upper eyelid margin reflex distance 1 and 2 (MRD1 and 2), upper eyelid crease height, and levator function were measured before, 1 and at least 6 months after surgery by the same investigator. Clinical and Clinically significant ptosis were defined as ≥0.5 and ≥2 mm drop of MRD1.
RESULT
There were 60 eyes from 57 patients. The majority of surgeries were performed by the fellows (63.3%, 38/60) and under general anesthesia (95.0%, 57/60). Clinical and clinically significant ptosis following PPV were 47.2% (25/53) and 11.3% (6/53) at the last follow up (at least 6 months), respectively. MRD2 (p = 0.389) and eyelid crease height (p = 0.057) did not significantly change. Surgeons' level, time of the procedure and other variables were not significantly impacting the frequencies.
CONCLUSION
Persistent clinically significant ptosis was observed in 11% of patients undergoing PPV. No variable was significantly associated with persistent postoperative ptosis after PPV.
Topics: Blepharoplasty; Blepharoptosis; Eyelids; Humans; Oculomotor Muscles; Prospective Studies; Retrospective Studies; Vitrectomy
PubMed: 33229954
DOI: 10.1097/IOP.0000000000001890 -
Ophthalmic Plastic and Reconstructive... 2020To investigate the prevalence and frequency of patients with blepharoptosis who take anticholesterol therapies. To our knowledge, this is the first large single-center...
PURPOSE
To investigate the prevalence and frequency of patients with blepharoptosis who take anticholesterol therapies. To our knowledge, this is the first large single-center series to evaluate this association.
METHODS
A retrospective chart review of adult patients presenting with ptosis on concomitant anticholesterol medications.
RESULTS
Two hundred ninety-three adult patients with ptosis taking anticholesterol therapy were identified from October 2011 to October 2016. Forty-seven patients (16.0%) reported muscle weakness. Laboratory markers including creatine kinase (CK) and myoglobin levels were obtained. Of the 47 patients, 13 patients (4.4%) were identified to have ptosis and laboratory confirmed anticholesterol therapy-induced myopathy. Two additional patients with statin-induced myositis and rhabdomyolysis were identified from the period 2008-2011. All patients had measurably elevated CK and/or myoglobin levels. All patients experienced improvement in ptosis or systemic symptoms after discontinuation or changing medications. Nine patients (60%) demonstrated statistically significant improvement in the ptosis.
CONCLUSIONS
Many patients with involutional ptosis also have both cardiovascular disease and hyperlipidemia and thus take cholesterol-lowering medication. Our study demonstrates a World Health Organization-defined probable association between ptosis and anticholesterol-induced myopathy. The frequency of anticholesterol-induced myopathy in adult ptosis was 4.4%, which is substantially higher than previously predicted. Anticholesterol-induced myositis can cause a reversible ptosis, and thus, a thorough evaluation of adult patients presenting with involutional ptosis includes inquiry into the use of anticholesterol drugs and associated muscle weakness.Anticholesterol medication may induce or exacerbate myogenic ptosis in some individuals.
Topics: Adult; Blepharoptosis; Cholesterol; Humans; Muscular Diseases; Myositis; Retrospective Studies
PubMed: 31574043
DOI: 10.1097/IOP.0000000000001476 -
Turkish Journal of Ophthalmology Apr 2023The aim of this study was to investigate the incidence of postoperative ptosis after primary trabeculectomy and the possible factors contributing to ptosis.
OBJECTIVES
The aim of this study was to investigate the incidence of postoperative ptosis after primary trabeculectomy and the possible factors contributing to ptosis.
MATERIALS AND METHODS
A total of 312 patients (339 eyes) who underwent trabeculectomy with mitomycin-C between 2015 and 2020 were retrospectively evaluated. Patients who had regular follow-up for at least 6 months and no history of ptosis or ptosis surgery were included. Age, sex, glaucoma type, preoperative and postoperative intraocular pressure, preoperative and postoperative antiglaucoma medications, number of antiglaucoma drops, duration of antiglaucoma medication use, history of eye itching due to antiglaucoma medication-associated allergy, duration of follow-up, postoperative needling, needling time, and ocular massage were recorded. Ptosis was defined as ≥2 mm reduction in margin-reflex distance 1 from preoperative levels. Ptosis that had not improved for at least 6 months was considered persistent ptosis. Multivariate logistic regression was used to determine potential predictors of ptosis development.
RESULTS
Ptosis after trabeculectomy was observed in 35 of 339 eyes (10.3%). Thirty eyes of 30 patients (8.8%) had transient ptosis and 5 eyes of 4 patients (1.5%) had persistent ptosis. Preoperative duration of antiglaucoma medication use, drug(s) used (prostaglandin analogs, beta-blockers, alpha-2 agonists, carbonic anhydrase inhibitors, or combinations of these), needling time, and ocular massage after trabeculectomy did not differ significantly between groups (p>0.05). Needling and eye itching due to antiglaucoma medication-associated allergy were significantly higher in patients with ptosis (p<0.05).
CONCLUSION
Ptosis after trabeculectomy is an important problem for glaucoma patients. It has been observed that needling and a history of eye itching due to antiglaucoma drug-associated allergy may increase the risk of ptosis.
Topics: Humans; Trabeculectomy; Incidence; Retrospective Studies; Postoperative Complications; Glaucoma; Blepharoptosis; Hypersensitivity
PubMed: 37089010
DOI: 10.4274/tjo.galenos.2022.58812 -
The Journal of Craniofacial Surgery 2019Oncoplastic lower eyelid reconstruction is a challenging task due to the complicated structure of the eyelid and requirement of high operative accuracy. Poorly treated...
BACKGROUND
Oncoplastic lower eyelid reconstruction is a challenging task due to the complicated structure of the eyelid and requirement of high operative accuracy. Poorly treated defects result in ectropion and ptosis which may lead to keratitis and corneal ulceration. Previous related studies do not include a detailed comparison of the common reconstructive methods of the lower eyelid in terms of results and complication rates.
OBJECTIVE
The authors aim to demonstrate whether the choice of reconstruction affects the aesthetic and functional outcome of oncoplastic lower eyelid reconstruction.
METHODS & MATERIALS
The authors performed a 10-year retrospective review of all oncoplastic lower eyelid reconstructions carried out in our hospital. Information on patient background, diagnosis and the choice of reconstructive method were evaluated. Postoperative photographs of each patient were then subjectively evaluated for color match, cosmesis, quality of shape, symmetry, and overall appearance. The authors hypothesized that the outcome is related to the main trajectory of the flap. Patients treated with local flaps of horizontal and vertical trajectories were then compared in terms of outcome and complication rates.
RESULTS
Reconstructions based on a horizontal trajectory compared with a vertical trajectory resulted with lower rates of ectropion and ptosis occurrence. The results were statistically significant.
Topics: Aged; Aged, 80 and over; Blepharoptosis; Ectropion; Eyelids; Female; Hospitals; Humans; Male; Middle Aged; Postoperative Period; Plastic Surgery Procedures; Retrospective Studies; Surgical Flaps
PubMed: 31577649
DOI: 10.1097/SCS.0000000000005639 -
Ophthalmic Plastic and Reconstructive...To describe the incidence of anophthalmic ptosis, identify clinical factors associated with its development, and evaluate the effects of enucleation on eyelid mechanics. (Observational Study)
Observational Study
PURPOSE
To describe the incidence of anophthalmic ptosis, identify clinical factors associated with its development, and evaluate the effects of enucleation on eyelid mechanics.
METHODS
In this observational cohort study, measurements and photographs were reviewed in 139 patients who underwent enucleation between 2007 and 2016. Patient demographics, pre- and postoperative eyelid measurements, and exophthalmometry were used to assess the incidence of ptosis and effects of surgery on eyelid function.
RESULTS
Preoperative ptosis was common and more often present in patients with enophthalmos (p = 0.0305) or reactive blepharospasm (p < 0.0001). The incidence of new-onset ptosis and improvement of preexisting ptosis following enucleation were similar (40%). Surgical repair was performed in 7% of patients with ptosis. Contralateral levator function declined with age and was positively correlated with exophthalmometry (p < 0.0001). Anophthalmic levator function was greater with increased anterior projection of the implant (p < 0.0001) and prosthesis (p < 0.0001). Patients with larger implants had improved levator function, with (p = 0.0065) and without (p = 0.0007) the prosthesis. Superior sulcus deepening was associated with decreased levator activity, but not margin-reflex distance.
CONCLUSIONS
Preoperative ptosis was common, and often related to reactive blepharospasm or enophthalmos. Levator function declined with age, and correlated to greater anterior projection of the implant and prosthesis following enucleation. The surgeon can counsel patients regarding the similar likelihood (40%) of preoperative ptosis improving and new ptosis developing after enucleation. The primary factor the surgeon can modify to improve postoperative eyelid function is to maximize implant size, which is associated with greater levator activity.
Topics: Anophthalmos; Blepharoplasty; Blepharoptosis; Eyelids; Humans; Oculomotor Muscles; Prosthesis Implantation; Retrospective Studies
PubMed: 32852373
DOI: 10.1097/IOP.0000000000001823 -
European Journal of Ophthalmology Sep 2022While ptosis is a well-known consequence of glaucoma surgery, some isolated case reports point to the possibility of upper eyelid retraction occurring after glaucoma...
BACKGROUND
While ptosis is a well-known consequence of glaucoma surgery, some isolated case reports point to the possibility of upper eyelid retraction occurring after glaucoma surgery. This study aims to analyze the occurrence of ptosis and eyelid retraction after glaucoma surgery and to evaluate factors contributing to these palpebral fissure changes.
METHODS
Cross-sectional study including 100 eyes of 100 patients that had undergone unilateral glaucoma surgery. Upper eyelid height in the operated eye was measured by digital photography and compared with the fellow, non-operated eye. The main outcome was to determine if ptosis or retraction occurred in the operated eye in comparison with the fellow eye. The secondary outcome was to determine if any variable was associated with ptosis or retraction. A clinically significant difference (either toward ptosis or retraction) was defined as a difference ≥1 mm between both eyes.
RESULTS
Of 100 eyes included 81 (81%) showed no change in eyelid height (-0.133 mm ± 0.496), 11 (11%) showed ptosis (-1.348 mm ± 0.387) and 8 eyes (8%) showed retraction (1.705 ± 0.634). A statistically significant relation was found between ptosis and pseudoexfoliation glaucoma (p = 0.003). A trend toward lower postoperative IOP and higher conjunctival blebs was found in eyes with postoperative eyelid retraction.
CONCLUSIONS
Eyelid retraction was present in 8% of patients and ptosis in 11%. Patients with eyelid retraction showed around a 3 mmHg lower postoperative IOP than eyes without retraction The presence of pseudoexfoliation may be a risk factor for this complication. A prospective study with a large number of patients would be required to confirm these results.
Topics: Blepharoptosis; Cross-Sectional Studies; Eyelid Diseases; Eyelids; Filtering Surgery; Glaucoma; Humans; Oculomotor Muscles; Prospective Studies; Retrospective Studies
PubMed: 34812089
DOI: 10.1177/11206721211063723 -
European Journal of Ophthalmology Mar 2021An increasing number of people are undergoing non-surgical aesthetic procedures, especially injections of botulinum toxin and dermal fillers. While toxin injections have...
BACKGROUND
An increasing number of people are undergoing non-surgical aesthetic procedures, especially injections of botulinum toxin and dermal fillers. While toxin injections have lower rates of complications, profound and serious consequences can arise with the use of dermal fillers.
CASE
A 29-year-old woman presented to the eye casualty department with sudden visual loss, ptosis and ophthalmoplegia after having had non-surgical rhinoplasty in a beauty salon in West London. The filler was administered by a healthcare professional not registered with the General Medical Council (GMC) or similar governing body.
DISCUSSION
Despite prompt measures on arrival at our service, the symptoms of visual loss, ptosis and ophthalmoplegia persisted. Attempts from the patient and medical services to report the incident (to trading standards and the police) were to no avail.
CONCLUSION
This case highlights the poor treatment response to filler-related ophthalmic complications. It is also evident that in the United Kingdom, there appears to be poor regulation in the use of these products, a lack of clear guidelines for the management of their complications and finally no recourse for patients to challenge practitioners who lack medical registration and are not held accountable.
Topics: Adult; Arterial Occlusive Diseases; Blepharoptosis; Blindness; Dermal Fillers; Female; Humans; Nose; Ophthalmic Artery; Ophthalmoplegia; Rhinoplasty; Visual Acuity
PubMed: 31187644
DOI: 10.1177/1120672119855856 -
The Journal of Craniofacial SurgeryThe purpose of this study was to investigate changes in the position of the upper and lower eyelids before and immediately after surgery in patients that underwent...
PURPOSE
The purpose of this study was to investigate changes in the position of the upper and lower eyelids before and immediately after surgery in patients that underwent ptosis surgery.
METHODS
The authors retrospectively reviewed the clinical records of patients diagnosed with congenital or aponeurotic ptosis and that were treated with levator advancement with local anesthesia. The marginal reflex distance 1 (MRD1), marginal reflex distance 2 (MRD2), and palpebral fissure height (PFH) were measured using clinical photographs.
RESULT
The preoperative mean MRD1, MRD2, and PFH were 0.27 ± 1.34 mm, 5.73 ± 1.13 mm, and 5.99 ± 1.94 mm, respectively. The postoperative mean MRD1, MRD2, and PFH were 1.76 ± 1.03 mm, 4.22 ± 1.01 mm, and 5.98 ± 1.60 mm, respectively. The postoperative MRD1 was significantly increased and postoperative MRD2 was decreased significantly compared to preoperative values (both, P < 0.001). The preoperative and postoperative PFH values were not significantly different ( P = 0.941).
CONCLUSIONS
It is important to assess the degree of reverse ptosis before surgery in patients that undergo ptosis surgery, and to remember that MRD2 and PFH may be reduced during surgery. Therefore, the position of the upper eyelid should be intraoperatively adjusted based on MRD1, not the PFH, to prevent overcorrection after surgery.
Topics: Blepharoptosis; Eyelids; Humans; Postoperative Period; Preoperative Period; Retrospective Studies; Treatment Outcome
PubMed: 34743157
DOI: 10.1097/SCS.0000000000008364