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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 -
Transactions of the American... 2001To investigate, for the first time, the psychosocial implications of blepharoptosis and dermatochalasis.
PURPOSE
To investigate, for the first time, the psychosocial implications of blepharoptosis and dermatochalasis.
METHODS
Two hundred ten individuals rated whole-face photographs of a series of patients on the basis of 11 different personal characteristics: intelligence, throat, friendliness, health, trustworthiness, hard work, mental illness, financial success, attractiveness, alcoholism, and happiness. Preoperative and postoperative photographs of both male and female patients with bilateral blepharoptosis and/or dermatochalasis were used. The paired t test was used to compare preoperative and postoperative ratings on the 11 characteristics.
RESULTS
The preoperative photographs were rated more negatively than the postoperative photographs (P < .01-P < .001) on all 11 characteristics for both male and female patients by the 210 study subjects.
CONCLUSIONS
Members of society seem to view individuals with blepharoptosis and dermatochalasis negatively. These psychosocial attitudes may lead to unjust bias toward affected patients, and surgical correction likely provides benefits beyond improved visual function.
Topics: Aged; Aged, 80 and over; Attitude to Health; Blepharoplasty; Blepharoptosis; Cutis Laxa; Facial Expression; Female; Humans; Male; Middle Aged; Photography; Quality of Life; Rhytidoplasty; Spatial Behavior
PubMed: 11797321
DOI: No ID Found -
Scientific Reports Oct 2023Blepharoptosis is a recognized cause of reversible vision loss and a non-specific indicator of neurological issues, occasionally heralding life-threatening conditions....
Blepharoptosis is a recognized cause of reversible vision loss and a non-specific indicator of neurological issues, occasionally heralding life-threatening conditions. Currently, diagnosis relies on human expertise and eyelid examination, with most existing Artificial Intelligence algorithms focusing on eyelid positioning under specialized settings. This study introduces a deep learning model with convolutional neural networks to detect blepharoptosis in more realistic conditions. Our model was trained and tested using high quality periocular images from patients with blepharoptosis as well as those with other eyelid conditions. The model achieved an area under the receiver operating characteristic curve of 0.918. For validation, we compared the model's performance against nine medical experts-oculoplastic surgeons, general ophthalmologists, and general practitioners-with varied expertise. When tested on a new dataset with varied image quality, the model's performance remained statistically comparable to that of human graders. Our findings underscore the potential to enhance telemedicine services for blepharoptosis detection.
Topics: Humans; Artificial Intelligence; Blepharoptosis; Neural Networks, Computer; Algorithms; ROC Curve
PubMed: 37845333
DOI: 10.1038/s41598-023-44686-3 -
Revista de Neurologia Mar 2022The finding of an eyelid ptosis in a manuscript of the xiii century raises the differential diagnosis of injury to the third cranial nerve. This nerve was not... (Review)
Review
INTRODUCTION
The finding of an eyelid ptosis in a manuscript of the xiii century raises the differential diagnosis of injury to the third cranial nerve. This nerve was not differentiated from the other oculomotors until the xvi century and only in the xix century a clinicopathological correlation was established for its paralysis.
AIM
Describe the characteristics and differential diagnoses of an eyelid ptosis illustrated in the Book of Divine Works (1173) by Hildegard of Bingen.
DEVELOPMENT
In the mentioned work the nun Richardis of Stade is portrayed with her left eyelid drooping. Two conspicuous signs are described, ptosis and corresponding raising of the eyebrow. The deviation of the eye downward and outward is inferred from the shape that adopts the eyelid by the position of the eye and the curvature of the cornea. The picture is consistent with an isolated paralysis of the oculomotor nerve. The causes of ptosis are discussed: aponeurotic due to levator palpebrae dehiscence; myogenic, congenital and acquired; of the neuromuscular junction, and neuropathic, the latter being the most probable in this case and of a compressive mechanism. The nun's unexpected natural death suggests a ruptured brain aneurysm.
CONCLUSIONS
Richardis of Stade's portrait shows an oculomotor paralysis centuries before its anatomy, function, and clinicopathological expression were known. Credit for this original description must go to Hildegard, whose medical vocation has long been recognized.
Topics: Blepharoptosis; Diagnosis, Differential; Eyelids; Female; Humans; Oculomotor Muscles; Ophthalmoplegia
PubMed: 35275396
DOI: 10.33588/rn.7406.2021383 -
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 -
Arquivos Brasileiros de Oftalmologia 2022To evaluate the clinical features of pediatric patients with acute-onset, unilateral transient acquired blepharoptosis.
PURPOSE
To evaluate the clinical features of pediatric patients with acute-onset, unilateral transient acquired blepharoptosis.
METHODS
In this retrospective study, the clinical records of patients between April 2015 and June 2020 were reviewed for evaluation of demographic features, accompanying neurological and ophthalmologic manifestations, symptom duration, etiological cause, and imaging findings. Patients with congenital and acquired blepharoptosis with chronic etiologies were excluded.
RESULTS
Sixteen pediatric patients (10 boys and 6 girls) with acquired acute-onset unilateral transient blepharoptosis were included in this study. The patients' mean age was 6.93 ± 3.16 years. The most commonly identified etiological cause was trauma in 7 patients (43.75%) and infection (para-infection) in 5 patients (31.25%). In addition, Miller Fisher syndrome, Horner syndrome secondary to neuroblastoma, acquired Brown's syndrome, and pseudotumor cerebri were identified as etiological causes in one patient each. Additional ocular findings accompanied blepharoptosis in 7 patients (58.33%). Blepharoptosis spontaneously resolved, without treatment, in all the patients, except those with Miller Fisher syndrome, neuroblastoma, and pseudotumor cerebri. None of the patients required surgical treatment and had ocular morbidities such as amblyopia.
CONCLUSION
This study demonstrated that acute-onset unilateral transient blepharoptosis, which is rare in childhood, may regress without the need for surgical treatment in the pediatric population. However, serious pathologies that require treatment may present with blepharoptosis.
Topics: Male; Female; Child; Humans; Child, Preschool; Blepharoptosis; Retrospective Studies; Pseudotumor Cerebri; Miller Fisher Syndrome; Neuroblastoma
PubMed: 35170639
DOI: 10.5935/0004-2749.20220082 -
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 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jun 2023To summarize the etiology mechanism and treatment of iatrogenic blepharoptosis after double eyelid surgery in Asia.
OBJECTIVE
To summarize the etiology mechanism and treatment of iatrogenic blepharoptosis after double eyelid surgery in Asia.
METHODS
To extensively review the literature related to iatrogenic blepharoptosis after double eyelid surgery, and to summarize and analyze the related anatomical mechanism, existing treatment options, and indications.
RESULTS
Iatrogenic blepharoptosis is a relatively common complication after double eyelid surgery, sometimes it is combined with other eyelid deformities such as sunken upper eyelid and wide double eyelid, which makes it difficult to repair. The etiology is mainly caused by improper adhesion of tissues and scars, improper removal of upper eyelid tissue, and injury of a link of levator muscle power system. Whether blepharoptosis occurs after double eyelid surgery by incision or suture, it should be repaired by incision. The principles of repair include surgical loosening of tissue adhesion, anatomical reduction, and repair of damaged tissues. The key is to use surrounding tissues or transplanted fat to prevent adhesion.
CONCLUSION
When repairing iatrogenic blepharoptosis clinically, appropriate surgical methods should be selected based on the causes and severity of the blepharoptosis, combined with treatment principles, in order to achieve better repair results.
Topics: Humans; Blepharoptosis; Treatment Outcome; Retrospective Studies; Blepharoplasty; Eyelids; Iatrogenic Disease; Oculomotor Muscles
PubMed: 37331952
DOI: 10.7507/1002-1892.202302060 -
Medicine Jan 2023To investigate the clinical features of ocular myasthenia gravis (OMG) in ophthalmology. A total of 28 patients with ptosis or diplopia who were followed for at least 6...
To investigate the clinical features of ocular myasthenia gravis (OMG) in ophthalmology. A total of 28 patients with ptosis or diplopia who were followed for at least 6 months between March 2016 and February 2022 were included in this study. The clinical symptoms of the patients and test results were analyzed. According to the positivity of serologic or electrophysiologic test, these patients were divided into 2 groups (positive and negative OMG results) and according to the clinical symptoms of diplopia or ptosis for comparison. Ptosis, diplopia, and both ptosis and diplopia were present in 6 (21.43%), 14 (50.0%), and 8 (28.57%) patients, respectively. Acetylcholine receptor auto-antibody (AchR Ab) was positive in 16 (57.14%) of 28 patients and the ice test was positive in 13 (92.86%) of 14 patients with ptosis. Abnormal thymic lesions were presented in 7 (25.0%) patients, and a definite improvement in response to pyridostigmine was observed in 27 (100.0%) patients. Both ptosis and diplopia were significantly higher in the group with positive results than that in the negative results group (P = .025). In addition, both horizontal and vertical diplopia was significantly higher in the group with AchR Ab titer > 5.0 than that in the group with AchR Ab titer < 5.0 (P = .041). After excluding cranial nerve palsy, if there is ptosis and diplopia, especially vertical diplopia, the possibility of OMG should be considered.
Topics: Humans; Diplopia; Ophthalmology; Retrospective Studies; Myasthenia Gravis; Blepharoptosis; Receptors, Cholinergic; Autoantibodies
PubMed: 36637960
DOI: 10.1097/MD.0000000000031972 -
Scientific Reports Jul 2017The study aimed to evaluate the effect of drooped eyelid on corneal tomography in congenital blepharoptosis patients. Sixty-four patients with congenital blepharoptosis...
The study aimed to evaluate the effect of drooped eyelid on corneal tomography in congenital blepharoptosis patients. Sixty-four patients with congenital blepharoptosis and 64 age- and sex- matched healthy subjects were included. According to the eyelid margin to corneal light reflex distance (MRD), eyes with congenital blepharoptosis were categorized as mild, moderate, or severe. The eyes were scanned using the rotating Scheimpflug camera. Increased topometric parameters were observed in moderate and severe blepharoptosis. Back corneal elevations at the thinnest point were significant higher for mild (P = 0.009), moderate (P < 0.001), and severe (P < 0.001) congenital blepharoptosis compared with controls. Maximum Ambrósio's relational thickness (ART) was decreased in eyes with severe blepharoptosis (P < 0.001). Fnal D values were significantly higher in moderate (P < 0.001) and severe blepharoptosis (P < 0.001) groups than that of controls. There were significant correlations between MRD and most corneal tomographic parameters. Our findings indicated there was a trend toward subclinical keratoconus-like changes in the corneas of congenital blepharoptosis, with the increase of ptosis severity.
Topics: Adolescent; Adult; Blepharoptosis; Cornea; Female; Humans; Male; Tomography; Young Adult
PubMed: 28747634
DOI: 10.1038/s41598-017-06823-7