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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 -
Korean Journal of Ophthalmology : KJO Jun 2023Acupuncture is recognized as a component of alternative medicine and is increasingly used worldwide. Many studies have shown the various effects of acupuncture around... (Review)
Review
Acupuncture is recognized as a component of alternative medicine and is increasingly used worldwide. Many studies have shown the various effects of acupuncture around the eyes for ophthalmologic or nonophthalmologic conditions. For ophthalmologic conditions, the effect of acupuncture on dry eye syndrome, glaucoma, myopia, amblyopia, ophthalmoplegia, allergic rhinoconjunctivitis, blepharospasm, and blepharoptosis has been reported. Recently, several studies on dry eye syndrome have been reported and are in the spotlight. However, given the variety of study designs and reported outcomes of periocular acupuncture, research is still inconclusive, and further studies are required. In addition, although a systematic and reliable safety assessment is required, to the best of our knowledge, there have been no reports of a literature review of ocular complications resulting from periocular acupuncture. This review collected cases of ocular injury as severe adverse events from previously published case reports of periocular acupuncture. A total of 14 case reports (15 eyes of 14 patients) of adverse events published between 1982 and 2020 were identified. This review article provides a summary of the reported cases and suggestions for the prevention and management of better visual function prognosis.
Topics: Humans; Acupuncture Therapy; Glaucoma; Dry Eye Syndromes; Blepharoptosis; Amblyopia
PubMed: 37068839
DOI: 10.3341/kjo.2022.0111 -
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 -
Eye (London, England) Jul 2021The present study aimed to explore the association between body composition indices, such as fat mass (FM) and lean body mass (LBM), and blepharoptosis.
BACKGROUND
The present study aimed to explore the association between body composition indices, such as fat mass (FM) and lean body mass (LBM), and blepharoptosis.
METHODS
The study evaluated 12,168 Korean adults aged 40 years or older using data from the Korea National Health and Nutrition Examination Survey (2008-2011). FM index (FMI, kg/m) and LBM index (LBMI, kg/m) were used to correct for the effects of body size. Multivariable logistic regression analysis was performed to investigate the association between blepharoptosis and body composition indices such as FMI, LBMI, and fat percentage of whole body or head. Stratified analyses were also performed by levator function.
RESULTS
Higher FMI and head fat percentage were significantly associated with blepharoptosis (adjusted odds ratio [aOR] = 1.35, 95% confidence interval [CI] = 1.10-1.65; and aOR = 1.32, 95% CI = 1.03-1.69 in the highest tertile compared with the lowest, respectively). In the subgroup with good levator function (≥8 mm), higher FMI, head fat percentage, and head lean mass were significantly associated with blepharoptosis (aOR for the right eye [aORr] = 1.42 and aOR for the left eye [aORl] = 1.36; aORr = 1.41 and aORl = 1.37; and aORr = 1.50 and aORl = 1.49 in the highest tertile compared with the lowest, respectively; all p < 0.05).
CONCLUSIONS
Body compositions with high adiposity indices, such as high FMI and head fat percentage, were positively associated with blepharoptosis. Awareness of the potential correlation between obesity-associated fat deposition and blepharoptosis could improve management of the condition and contribute to understanding the pathogenesis of blepharoptosis.
Topics: Adipose Tissue; Adult; Blepharoptosis; Body Composition; Body Mass Index; Cross-Sectional Studies; Humans; Nutrition Surveys; Republic of Korea
PubMed: 33024321
DOI: 10.1038/s41433-020-01214-1 -
Scientific Reports Jan 2022Cataract and blepharoptosis are both commonly encountered ophthalmic problems in older adults. Since they share similar risk factors, it is plausible that there may be...
Cataract and blepharoptosis are both commonly encountered ophthalmic problems in older adults. Since they share similar risk factors, it is plausible that there may be an association between the two conditions. We examined data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2010-2012 to determine if there is an association between age-related cataract and blepharoptosis. Multivariable adjusted logistic regression analysis was conducted to examine the odds ratio (OR) and 95% confidence interval (CI) for association of each specific type of cataract with presence of blepharoptosis. Of the 10,387 eligible participants, 4782 (46.0%) had cataract and 1419 (15.8%) had blepharoptosis. There were more participants with blepharoptosis in the cataract group, compared with those in the no cataract group. After adjusting for potential confounders, participants with blepharoptosis had a higher risk of total cataract (OR: 1.557, 95% CI 1.201-2.019) and nuclear subtype cataract (OR: 1.305, 95% CI 1.050-1.620). Blepharoptosis was associated with significantly higher odds of cataract in obese participants when compared with non-obese participants (p for interaction = 0.0236). Our study revealed a positive association between age-related cataract and blepharoptosis; it suggests that thorough ophthalmic assessment is needed when assessing patients who are planning cataract or blepharoptosis surgery.
Topics: Age Factors; Blepharoptosis; Cataract; Cross-Sectional Studies; Databases, Factual; Female; Humans; Male; Middle Aged; Nutrition Surveys; Prevalence; Republic of Korea; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors
PubMed: 35013495
DOI: 10.1038/s41598-021-04381-7 -
The British Journal of Ophthalmology Aug 1969
Topics: Adult; Amphotericin B; Blepharoptosis; Blindness; Contact Lenses; Diabetes Complications; Eye Diseases; Female; Humans; Middle Aged; Mucormycosis
PubMed: 5811223
DOI: 10.1136/bjo.53.8.542 -
BMC Ophthalmology Mar 2020To evaluate the prevalence of blepharoptosis among Korean adults and the characteristics of blepharoptosis patients, and to determine an appropriate age threshold for...
BACKGROUND
To evaluate the prevalence of blepharoptosis among Korean adults and the characteristics of blepharoptosis patients, and to determine an appropriate age threshold for recommending blepharoptosis evaluation.
METHODS
The Korean National Health and Nutrition Examination Survey (KNHANES-V) was conducted in 2010-2012. We extracted data on 17,878 Korean adults aged more than and equal to 19 years included in KNHANES-V, and determined blepharoptosis prevalence according to age, to determine the cutoff age for recommending blepharoptosis evaluation. We also determined the possible association between blepharoptosis and obesity parameters, such as body mass index (BMI) and waist circumference (WC).
RESULTS
There was astrong association between older age and the prevalence of blepharoptosis. The cutoff age for recommending blepharoptosis evaluation was 63 years for males, 70 years for females, and 66 years for all patients. Patients with a high BMI and large WC had a higher prevalence of blepharoptosis in all age groups except for those aged over 80 years. The association of blepharoptosis with BMI according to age group showed that in the 50-59 and 60-69 years age groups, blepharoptosis prevalence and BMI were higher. However, in the 70-79 and 80-89 years age groups, extremely obese patients (BMI > 30) showed a decreased blepharoptosis prevalence.
CONCLUSIONS
Moderate to severe blepharoptosis can result in poor visual function and exacerbate headaches and depression, leading to decreased quality of life. This study proposed an appropriate age threshold for recommending evaluation of patients with blepharoptosis among the general population of Korea.
Topics: Adult; Blepharoptosis; Body Mass Index; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nutrition Surveys; Prevalence; Quality of Life; Republic of Korea; Retrospective Studies; Risk Factors
PubMed: 32169048
DOI: 10.1186/s12886-020-01350-y -
Orbit (Amsterdam, Netherlands) Apr 2022Epiphora remains an often difficult to manage ocular complaint for ophthalmologists in all subspecialties. This review seeks to examine the safety and efficacy of... (Review)
Review
PURPOSE
Epiphora remains an often difficult to manage ocular complaint for ophthalmologists in all subspecialties. This review seeks to examine the safety and efficacy of botulinum toxin injection for management of chronic epiphora.
METHODS
The authors conducted a Pubmed search for studies on the use of lacrimal and transplanted salivary gland botulinum toxin injections for the management of epiphora within the past 20 years. Studies included had a minimum of four glandular injections.
RESULTS
The authors identified 14 studies and divided them by indication for injection; either functional epiphora, non-functional epiphora, or mixed studies. Seven studies examined injections for cases of functional epiphora, four for non-functional epiphora, and four for mixed cases. The number of glandular injections reported ranged from 4 to 65. Side effects reported were limited to diplopia, eyelid or lacrimal gland hematoma, papillary conjunctivitis, dry eye, ptosis, and bleeding.
CONCLUSIONS
Glandular botulinum toxin injection should be considered as a viable treatment strategy for both functional and nonfunctional epiphora. From the studies reviewed, botulinum toxin injection was shown to be effective in both children and adults. Injection can be performed in the outpatient setting, is minimally invasive, technically easy to administer, has a favorable side effect profile, and good efficacy. Furthermore, repeat injections can be performed with similar efficacy.
Topics: Adult; Blepharoptosis; Botulinum Toxins, Type A; Child; Humans; Injections; Lacrimal Apparatus; Lacrimal Duct Obstruction; Treatment Outcome
PubMed: 34396904
DOI: 10.1080/01676830.2021.1966810 -
PloS One 2021In this study, we aimed to evaluate the characteristics of astigmatism preoperatively and 1 month postoperatively in patients with age-related ptosis (AP) and contact...
In this study, we aimed to evaluate the characteristics of astigmatism preoperatively and 1 month postoperatively in patients with age-related ptosis (AP) and contact lens-related ptosis (CLP), and investigate surgery-induced astigmatism (SIA) using the Jaffe vector analysis and the Cravy method. Consecutive patients who underwent blepharoptosis surgery between January 2019 and December 2019 were included. The patients were divided into AP and CLP groups. Computerized corneal topography was used to assess the magnitude and axis of corneal astigmatism. Astigmatism was classified as with-the-rule (WTR), against-the-rule (ATR), or oblique astigmatism (OA) pre- and postoperatively. SIA was calculated by vector analysis using the Cravy and Jaffe methods. The correlation between SIA and margin reflex distance (MRD) was calculated. One hundred and eight eyes from 58 patients (AP group: 85 eyes from 45 patients, CLP group: 23 eyes from 13 patients) were included. The AP group (73.8±7.6 years) was significantly older than the CLP group (47.7±6.6 years). The MRD increased significantly after treatment in both groups. The proportions of WTR, ATR, and OA were 52%, 22%, and 25%, and 86%, 9%, and 4% in the AP and CLP groups, respectively. A shift in astigmatism type was observed in 41% and 13% of patients in the AP and CLP groups, respectively. The average SIA measured using the Cravy method was 0.11±1.22 D in the AP group and -0.28±1.07 D in the CLP group (WTR astigmatism). The SIA calculated using the Jaffe method was 0.78±0.70 D in the AP group and 0.82±0.88 D in the CLP group. There was no significant correlation between SIA calculated using the Cravy and Jaffe methods and MRD. ATR was most common in age-related ptosis and WTR was most common in contact lens-related ptosis. Upper eyelid re-positioning may affect visual functions due to astigmatic changes in the short term postoperatively.
Topics: Aged; Astigmatism; Blepharoptosis; Contact Lenses; Female; Humans; Male; Middle Aged; Postoperative Complications; Visual Acuity
PubMed: 34710107
DOI: 10.1371/journal.pone.0258688