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Facial Plastic Surgery & Aesthetic... 2023Lateral tarsal techniques alone for lower eyelid correction in paralytic lagophthalmos may yield suboptimal outcomes. To describe a lower eyelid sling technique for...
Lateral tarsal techniques alone for lower eyelid correction in paralytic lagophthalmos may yield suboptimal outcomes. To describe a lower eyelid sling technique for primary and revision correction of lower eyelid ptosis and ectropion and evaluate outcomes as measured by margin reflex distance 2 (MRD2). A retrospective review of patients with long-standing unilateral paralytic lagophthalmos who underwent primary or revision lower eyelid ptosis correction by sling suspension between January 2016 and August 2020 at a tertiary medical center was performed. Surgical technique is illustrated with video and technical considerations are discussed. Pre- and postoperative MRD2 values were quantified from databased photographs. Thirty-eight patients were included. Eighteen patients had undergone prior procedures for ptosis correction. Lower eyelid symmetry and paralyzed side MRD2 significantly improved after lower lid sling for primary and revision cases ( < 0.05), and improvement was sustained over the study period (mean follow-up duration 13.3 months, range 1-33 months). No postoperative complications occurred. Lower eyelid sling yielded safe, effective, and durable correction of lower eyelid position in a cohort of patients with paralytic lagophthalmos.
Topics: Humans; Blepharoptosis; Lagophthalmos; Suture Techniques; Eyelids; Ectropion
PubMed: 35969387
DOI: 10.1089/fpsam.2022.0096 -
Scientific Reports May 2018Congenital ptosis may be associated with abnormalities of visual development and function, including amblyopia, strabismus and refractive errors. However, the prevalence... (Meta-Analysis)
Meta-Analysis
Congenital ptosis may be associated with abnormalities of visual development and function, including amblyopia, strabismus and refractive errors. However, the prevalence estimates of these abnormalities vary widely. We performed a systematic review and meta-analysis to estimate the prevalence of amblyopia, strabismus and refractive errors in congenital ptosis. Cochrane, Pubmed, Medline, Embase, and Web of Science were searched by July 2017. We used random/fixed effects models based on a proportion approach to estimate the prevalence. Heterogeneity would be considered signifcant if the p values less than 0.1 and/or I greater than 50%. Subgroup analyses, meta-regression analyses and sensitivity analyses were utilized to explore the potential sources of it. A total of 24 studies selected from 3,633 references were included. The highest prevalence was revealed for myopia with 30.2% (95%CI 3.0-69.8%), followed by 22.7% (95%CI 18.5-27.8%) for amblyopia, 22.2% (95%CI 7.8-63.1%) for astigmatism, 19.6% (95%CI 16.5-23.2%) for strabismus, 17.3% (95% CI 13.1-22.9%) for anisometropia and 4.0% for hyperopia (95%CI 1.8-7.1%). Significant heterogeneity was identified across most estimates. Our findings suggest that amblyopia, strabismus and refractive errors in congenital ptosis are present in much higher percentage. This study highlights the importance of early diagnosis and timely treatment of patients with congenital ptosis.
Topics: Amblyopia; Anisometropia; Astigmatism; Blepharoptosis; Humans; Hyperopia; Myopia; Prevalence; Refractive Errors; Strabismus; Visual Acuity
PubMed: 29844360
DOI: 10.1038/s41598-018-26671-3 -
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 -
European Journal of Ophthalmology Jan 2023Concerning causes of ptosis, most notably third nerve palsy and Horner's syndrome, can be ruled out with normal ocular motility and pupillary examination. Myasthenia... (Review)
Review
BACKGROUND
Concerning causes of ptosis, most notably third nerve palsy and Horner's syndrome, can be ruled out with normal ocular motility and pupillary examination. Myasthenia gravis (MG) however, rarely can present with ptosis as an isolated finding. We reviewed all patients presenting to tertiary neuro-ophthalmology practice with ptosis of unknown etiology to determine the frequency of MG.
METHODS
Retrospective chart review of patients referred to a tertiary neuro-ophthalmology practice with undifferentiated ptosis.
RESULTS
Sixty patients were included in the study. Twenty eight (47%) patients had ptosis along with various abnormalities of ocular motility and/or alignment and 32 (53%) had isolated unilateral ptosis defined as ptosis with absence of diplopia, or symptoms of generalized MG (GMG). Final diagnosis was aponeurotic ptosis due to levator palpebrae dehiscence in the majority (73%) of patients, while 10 (17%) were diagnosed with MG (6 with OMG, 4 with GMG). Diplopia was present in 9/10 patients with MG and 8/10 had abnormal ocular findings on clinical examination such as orbicularis oculi weakness, Cogan's lid twitch or fatiguability of ptosis on sustained upgaze. Only one patient referred for isolated unilateral ptosis was diagnosed with OMG and this patient had orbicularis oculi weakness.
CONCLUSIONS
None of the patients with isolated unilateral ptosis and otherwise normal examination had MG. All patients eventually diagnosed with MG had diplopia or orbicularis weakness on examination. Thus, the yield of investigating patients with isolated ptosis for MG is exceedingly low.
Topics: Humans; Diplopia; Retrospective Studies; Ophthalmology; Myasthenia Gravis; Blepharoptosis; Probability
PubMed: 35686323
DOI: 10.1177/11206721221107300 -
European Annals of Otorhinolaryngology,... Feb 2016
Topics: Adult; Blepharoptosis; Diplopia; Female; Hematoma; Humans; Orbital Diseases; Sinusitis
PubMed: 26794089
DOI: 10.1016/j.anorl.2015.05.003 -
Indian Journal of Ophthalmology Oct 2021: To report the frequency of periorbital aesthetic abnormalities in patients undergoing refractive surgery and to report the ability of the patient and the refractive... (Observational Study)
Observational Study
PURPOSE
: To report the frequency of periorbital aesthetic abnormalities in patients undergoing refractive surgery and to report the ability of the patient and the refractive surgeon in picking up these findings compared to the oculoplastic surgeon.
METHODS
Single-center, prospective observational case series. All patients underwent standard pre-operative work-up for refractive surgery, answered a study questionnaire, and underwent face photographs (with and without glasses). The patient, the refractive, and the oculoplastic surgeons evaluated the photographs to categorize the concerns as none, presence of ptosis, tear trough deformity, scleral show, and others. The findings of the oculoplastic surgeon were taken as the standard of reference.
RESULTS
The photographs of 121 patients were analyzed. The mean age was 25.76 ± 3.75 years and 72% were males. The main indication for surgery was to eliminate dependency on glasses in a majority (76%) followed by cosmesis in 23%. The oculoplastic surgeon noted tear trough deformity in 14 (11.5%) cases, scleral show in 51 (42.1%), ptosis in 35 (28.9%), and other findings in 45 (37.1%). When the symmetrical scleral show was excluded, the patient picked up aesthetic concerns in only 8.26%, the refractive surgeon in 14% as compared to 39% by the oculoplastic surgeon (P < 0.01).
CONCLUSION
Periorbital aesthetic significant findings were noted in 39% of the patients undergoing corneal refractive surgery when assessed by an oculoplastic surgeon. The refractive surgeon was able to pick up less than 50% of these. We recommend a basic aesthetic initial evaluation prior to refractive surgery and photographic documentation, especially in cosmetically aware patients.
Topics: Adult; Blepharoptosis; Esthetics; Humans; Male; Ophthalmologic Surgical Procedures; Refractive Surgical Procedures; Surveys and Questionnaires; Young Adult
PubMed: 34571632
DOI: 10.4103/ijo.IJO_471_21 -
British Medical Journal Jun 1973
Topics: Blepharoptosis; Electromyography; Female; Humans; Mandible; Mastication
PubMed: 4733246
DOI: No ID Found -
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 -
Scientific Reports Nov 2023To compare the success of conjunctivo-mullerectomy in patients with varying degrees of ptosis and identify factors affecting outcomes and complications. The prospective...
To compare the success of conjunctivo-mullerectomy in patients with varying degrees of ptosis and identify factors affecting outcomes and complications. The prospective cohort was studied in patients with ptosis undergoing conjunctivo-mullerectomy with or without tarsectomy were enrolled. Ptosis was classified as mild, moderate, and severe per margin-to-reflex distance 1 (MRD1). Postoperative MRD1, complications, and 3-month success rates were evaluated. The study enrolled 258 ptotic eyes of 159 patients. Most eyes (233; 90.3%) achieved surgical success, 14 (5.4%) were overcorrected, and 11 (4.3%) were undercorrected. The success rates for mild, moderate, and severe ptosis were 96.6%, 91.7%, and 83.5%, respectively. The mild and moderate ptosis groups had a nonsignificant difference in success (- 4.9%; 95% CI - 12.0% to 4.5%; P = 0.36). However, the mild and severe ptosis groups' rates significantly differed (- 13.1%; 95% CI - 23.6% to - 1.9%; P = 0.03). For all 3 ptosis groups, the success rates of individuals undergoing surgery without tarsectomy did not significantly differ. Patients undergoing conjunctivo-mullerectomy with tarsectomy had an increased risk of unsuccessful surgery (OR 3.103; 95% CI 1.205-7.986; P = 0.019). In conclusions, Conjunctivo-mullerectomy is safe and effective for all ptosis severities. The success rate was significantly lower for severe ptosis than mild or moderate ptosis. Levator muscle function was not associated with unsuccessful outcomes, but tarsectomy was.
Topics: Humans; Blepharoplasty; Prospective Studies; Oculomotor Muscles; Retrospective Studies; Blepharoptosis; Treatment Outcome
PubMed: 37926725
DOI: 10.1038/s41598-023-46419-y -
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