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Sample records for blepharoptosis

  1. Blepharoptosis in myasthenia gravis.

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    Castronuovo, S; Krohel, G B; Kristan, R W

    1983-08-01

    We reviewed the records of 23 patients with systemic myasthenia gravis and blepharoptosis. The overall prognosis for improvement of blepharoptosis in these patients was favorable when multiple modes of therapy, including anticholinesterase medication, were used. Four of five patients with disabling blepharoptosis were stable enough after three to four years of their disease to consider corrective lid surgery. Two patients underwent levator resection with good results. Patients with systemic and ocular myasthenia gravis who are refractory to systemic therapy should be considered candidates for ptosis surgery when their blepharoptosis has been stable over a three- to four-year period.

  2. Blepharoptosis correction with buried suture method.

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    Park, Jang Woo; Kang, Moon Seok; Nam, Seung Min; Kim, Yong Bae

    2015-02-01

    Many surgical techniques have been developed to correct blepharoptosis, including the anterior levator resection or advancement, tarsoaponeurectomy, and Fasanella-Servat Müllerectomy. However, to minimize surgical scarring and reduce the postoperative recovery time, the procedure has been developed from a complete incision to a partial incision, which is appealing to patients. To aid the procedural development, this study describes a surgical technique in which the correction of blepharoptosis and a double eyelid fold operation are performed using a buried suture technique during the same operation. A retrospective review was conducted using the medical records and preoperative and postoperative photography of 121 patients who underwent simultaneous correction of blepharoptosis and had a double eyelid fold created between October 2010 and July 2011. All of the patients had mild (1-2 mm) or moderate (3-4 mm) bilateral blepharoptosis and excellent or good levator function (>8 mm). The average preoperative marginal reflex distance (MRD1) measured 1.174 (0.3) mm. No intraoperative complications occurred. The average postoperative MRD1 measured 3.968 (0.2) mm. There was statistical significance improvement between preoperative MRD1 and postoperative MRD1 (P<0.05). No symptomatic dry eye and exposure keratopathy were noted. Blepharoptosis correction using the buried suture technique is an effective technique for young patients experiencing mild to moderate blepharoptosis who want to have the double eyelid fold operation using the buried suture technique.

  3. Outcomes of levator resection in blepharoptosis patients with grafted corneas.

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    Paik, Ji Sun; Doh, Sang Hee; Kim, Man Soo; Yang, Suk-Woo

    2010-09-01

    To present the surgical results of, and postoperative complications after, resection of the levator aponeurosis as a treatment for aponeurotic blepharoptosis in patients with grafted corneas. Nine eyes with grafted corneas displaying aponeurotic blepharoptosis were investigated. Undercorrective resection of levator aponeurosis was performed on all nine patients. The margin reflex distance 1 (MRD1) values prior to the operation and at 7 days and 6 months after the operation were compared. The postoperative MRD1 values of patients with both poor and fair levator function were also evaluated. Differences in visual acuity and visual field before and after surgery were also assessed. The MRD1 values at 7 days and 6 months after the surgery were higher than before surgery, and there was no difference between the MRD1 values of patients with poor and fair levator function at these time points. Levator function 6 months after surgery improved compared with that before surgery. Neither visual acuity nor the visual field changed after the blepharoptosis surgery. There was no preoperative corneal problem in any patient, and postoperative corneal erosion in some patients resolved with only conservative care. In blepharoptosis patients with grafted corneas, the undercorrection of blepharoptosis by levator resection showed satisfactory surgical results regardless of levator function status (poor or fair), and did not adversely affect the survival of grafted corneas.

  4. Analysis of Levator Function and Ptosis Severity in Involutional Blepharoptosis.

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    Lai, Hsin-Ti; Weng, Shih-Feng; Chang, Chih-Hau; Huang, Shu-Hung; Lee, Su-Shin; Chang, Kao-Ping; Lai, Chung-Sheng

    2017-03-01

    Involutional blepharoptosis is the most common type of acquired blepharoptosis. The etiology is believed to be the degeneration of the levator aponeurosis, and levator superioris muscle function was believed to be normal. However, there are a few studies analyzing levator function (LF) in involutional blepharoptosis. Our study aimed to access the LF abnormality in involutional blepharoptosis and analyze the correlation between LF and ptosis severity in involutional blepharoptosis in Taiwan. We reviewed the medical records of patients who underwent ptosis correction surgery between October 2011 and December 2015 after receiving a diagnosis of involutional blepharoptosis. This study examined patient sex and age, preoperative LF, margin reflex distance of the upper eyelid (MRD1), and ptosis severity. Linear regression was performed for statistical analysis. Levator muscle specimen was sent for pathologic examination. We analyzed 231 eyelids of 126 patients. Average MRD1 was 0.43 ± 2.15 mm. Average LF was 14.30 ± 2.51 mm. Overall, 77.1% (178/231) of involutional blepharoptotic eyelids had normal LF (more than 12 mm). Forty-three (18.6%) of 231 were good (10-12 mm), and 10 (4.3%) of 231 were fair (6-9 mm). No patients with poor levator function (≤5 mm) were observed in our case series. A positive correlation between LF and MRD1 was observed after statistical analysis. On average, a 0.6-mm reduction in LF was observed for each 1.0-mm decrease in MRD1. Fat infiltration in levator muscle is observed both grossly and microscopically in most cases with varied degrees. Levator function and MRD1 were positively correlated in patients with involutional blepharoptosis. In our study, 77.1% (178/231) of eyelids had normal levator function, which meant there was 23.0% (53/231) of eyelids had abnormal LF, in contrast to current literature. Fat infiltration was common in our series. In Asian involutional blepharoptosis, LF was not always excellent and it had positive correlation

  5. [Frontalis suspension with polytetrafluorethylene for the treatment of blepharoptosis].

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    Silvério, Juliana; Sugano, Débora Mayumi; Lucci, Lúcia Miriam Dumont; Rehder, José Ricardo Carvalho Lima

    2009-01-01

    To evaluate the functional results and complications of the use of expanded polytetrafluoroethylene in frontalis suspension surgery for the treatment of blepharoptosis. Frontalis suspension procedure with polytetrafluoroethylene was performed between 2003 and 2007 on 23 patients (36 eyes) with blepharoptosis. An average follow-up time was 15.8 months (range, 3 to 36). Surgical technique used was described by Fox. The causes of blepharoptosis found were: congenital in 20 patients (86.95%), blepharophimosis in 2 (8.69%) and traumatic in 1 (4.35%). At the first week of postoperatory 6 (26.08%) patients related palpebral asymmetry, 4 (17.39%) noticed local edema, 3 (13.04%) presented granulomas and 1 (4.35%) presented facial cellulitis on the ipsilateral frontal region. After 3 months of follow-up 3 (13.04%) patients related palpebral asymmetry and 1 (4.35%) persisted the granuloma. Polytetrafluoroethylene - Model CV3, 6.0 (Gore-tex(R), W.L. Gore & Associates Inc, Flagstaff, AZ, EUA) is an adequate material with good functional results (86.9%), relatively few complications (4.35%) and insatisfaction (13.4%) that could be an alternative for fascia lata in the surgery of frontalis suspension for the treatment of blepharoptosis.

  6. Structural abnormalities in the levator palpebrae superioris muscle in patients with congenital blepharoptosis.

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    Iljin, Aleksandra; Zielinska, Anna; Karasek, Michal; Zielinski, Andrzej; Omulecka, Aleksandra

    2007-01-01

    To evaluate structural and ultrastructural abnormalities of the levator palpebrae superioris (LPS) complex in patients with congenital blepharoptosis. Samples of the LPS complex were obtained from patients operated on for congenital blepharoptosis between 2000 and 2001 and studied under light microscopy (15 cases) and electron microscopy (9 cases). Findings of light microscopy evaluation of the LPS complex correlated closely with the clinical grading of congenital blepharoptosis-hypoplasia, decreased number and varying diameter of muscle fibers, and fibrous tissue hyperplasia in the endomysium and perimysium. The Müller's muscle preserved a normal appearance. Mild blepharoptosis revealed proliferation of collagen fibers on electron microscopy. Moderate blepharoptosis showed abnormal distribution of myofibrils and distortion of the tubular system and mitochondria in addition to the changes observed in mild blepharoptosis. Severe blepharoptosis showed mitochondria loss, cytoplasm thinning, and homogenous fiber areas in addition to the changes observed in mild and moderate blepharoptosis. The clinical degree of severity of congenital blepharoptosis correlates positively with the degree of histopathologic changes in the levator palpebrae superioris muscle.

  7. [Upper eyelid surgery for treatment of congenital blepharoptosis].

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    Mesa Gutiérrez, J C; Mascaró Zamora, F; Muñoz Quiñones, S; Prat Bertomeu, J; Arruga Ginebreda, J

    2007-04-01

    [corrected] To revise techniques and indications for surgical treatment of childhood blepharoptosis. Review of the medical literature and case reports. The treatment of blepharoptosis is not easy. There are different techniques for its correction, depending on invasivity and aetiological approach. Most used techniques are resection of the levator muscle through a skin incision in moderate ptosis and frontal suspension for severe cases. The indication of each technique depends on the type of ptosis, severity, features of levator muscle and age. Simple congenital ptosis is the most frequent type of ptosis in children although is necessary to consider types associated to rectus superior palsy, blepharofimosis syndrome and Marcus-Gunn phenomenon. It is important to evaluate ptosis severity and its repercussions on visual acuity and compensating torticolli. The timing for surgical treatment varies depending on age, severity and laterality.

  8. Elevator Muscle Anterior Resection: A New Technique for Blepharoptosis.

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    Zigiotti, Gian Luigi; Delia, Gabriele; Grenga, Pierluigi; Pichi, Francesco; Rechichi, Miguel; Jaroudi, Mahmoud O; d'Alcontres, Francesco Stagno; Lupo, Flavia; Meduri, Alessandro

    2016-01-01

    Blepharoptosis is a condition of inadequate upper eyelid position, with a downward displacement of the upper eyelid margin resulting in obstruction of the superior visual field. Levator resection is an effective technique that is routinely used to correct aponeurotic ptosis. The anterior levator resection is the procedure of choice in moderate blepharoptosis when there is moderate to good levator muscle function, furthermore, with an anterior approach, a greater resection can be achieved than by a conjunctival approach. The authors describe a modification in the Putterman technique with a resection done over a plicated elevator, plication that was suggested by Mustardè. The technique has been named as elevator muscle anterior resection. The elevator muscle anterior resection inspires from the Fasanella-Servat operation by the use of a clamp, making the operation simple and predictable.

  9. Isolated Muller's muscle resection for the correction of blepharoptosis.

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    Khooshabeh, R; Baldwin, H C

    2008-02-01

    To assess the outcome of isolated Muller's muscle resection with preservation of conjunctiva in patients with blepharoptosis and good to moderate levator function. This study was designed as a prospective, nonrandomised case series. Thirty-four eyes of 27 blepharoptosis patients were operated on, who were phenylephrine test-negative as well as positive. Open-sky Muller's muscle resection was performed with preservation of the conjunctiva. Main outcome measures were increase in margin reflex distance (MRD1), eyelid contour, and symptoms and signs of dry eye. The mean increase in MRD1 was 2.75 mm. All but one patient (96%) had upper lid margins resting at or up to 1 mm below the limbus and obtained symmetry to within 0.5 mm of the fellow eye. No patients had symptoms or signs of dry eye. Isolated Muller's muscle resection is effective for the correction of ptosis in patients with moderate to good levator function. This is irrespective of the lid's response to phenylephrine. Preservation of conjunctival tissue eliminates concerns about dry eye, and also preserves the full height of the fornix.

  10. Comparison of Blepharoptosis Correction Using Müller-aponeurosis Composite Flap Advancement and Frontalis Muscle Transfer

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    David Dae Hawan Park, MD, PhD

    2014-08-01

    Conclusions: In our study, we confirmed that Müller aponeurosis composite flap advancement and the frontalis transfer technique are both effective in the correction of severe blepharoptosis; our results showed no significant differences between the 2 techniques.

  11. Frontalis muscle flap suspension for the correction of congenital blepharoptosis in early age children.

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    Dianju Hou

    Full Text Available BACKGROUND: We aimed to report our successful use of frontalis muscle flap suspension for the correction of congenital blepharoptosis in early age children. METHODS: This retrospective study included 61 early age children (41 boys, 20 girls with an average age of 6 years (range, 3-10 years with congenital blepharoptosis who received surgery during the period from March 2007 to January 2011. There were 39 cases of unilateral blepharoptosis and 22 cases of bilateral blepharoptosis, thus a total of 83 eyes were affected. If patient had bilateral blepharoptosis, both eyes were operated on in the same surgery. Patients were followed for 3 months to 5 years. The procedure was performed without complications in all cases. RESULTS: The postoperative healing grade was good in 81 eyes (97.6%; the correction of blepharoptosis was satisfactory, the double eyelid folds were natural and aesthetic, the eyelid position and the curvature were ideal, and the eyes were bilaterally symmetrical. The postoperative healing grade was fair in 2 eyes (2.4%; blepharoptosis was improved compared with that before surgery. At discharge, lagophthalmos was noted in 10 eyes of which 4 cases resolved by the last follow-up. The remaining 6 cases were mild. Eleven eyes received reoperation for residual ptosis after the first surgery. The curvature of the palpebral margin was not natural in 4 eyes. These unnatural curvature possibly was caused by an excessively low lateral fixation point or postoperative avulsion. CONCLUSION: Frontalis muscle flap suspension under general anesthesia for the correction of congenital blepharoptosis in early age children can achieve good surgical results.

  12. Improvement of the Marginal Reflex Distance-1 in Blepharoptosis Surgeries.

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    Hwang, Kun; Ko, Yeong Seung

    2016-03-01

    The aim of this study was to predict the improvement of the marginal reflex distance (MRD1) in each blepharoptosis surgery.In PubMed and Scopus, the search terms 1. (blepharoptosis) AND 2. (surgery) AND 3. (levator OR outcome OR MRD OR function OR ptosis amount) were used and 1268 titles were found. Among them 28 papers were analyzed: Aponeurotic surgery (A-group, 8), Muller muscle resection (M-group, 10), Levator resection (L-group, 4), and Frontalis suspension (F-group, 6).The preop-MRD1 was greatest in L-group (1.7 ± 1.0 mm) followed by the A-group (1.3 ± 0.5 mm) and the M-group (1.3 ± 0.5 mm). The F-group had the lowest (-0.4 ± 0.7 mm). Age was oldest in the M-group (58.6 ± 11.9 years) followed by the A-group (42.4 ± 18.9 years) and the F-group (27.2 ± 17.9 years). The L-group was the youngest (18.9 ± 11.5 years). The mean improved amount of MRD1 (ΔL) was 2.15 ± 0.90 mm. The ΔL was different among the four operative methods. The F-group was greatest (2.4 ± 1.5 mm) followed by the A-group (2.3 ± 0.5 mm) and the M-group (2.0 ± 0.6 mm). The L-group had the least improved amount of MRD1 (1.8 ± 0.8 mm). There were significant differences between the groups (P < 0.05), except between the F-group and the A-group (P = 0.284). The mean follow-up period was 8.1 ± 7.0 months. In the 3 groups except A-group, the ΔL decreased in follow-up periods, with different degree of decrement. Only in A-group, ΔL increased slightly in follow-up periods. We think this is due to relatively well preserved levator function and short follow-up period (5.4 ± 3.3 months) of A-group patients.The results of this review can be used in choosing blepharoptosis correction methods.

  13. Small incision transcutaneous levator aponeurotic repair for blepharoptosis.

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    Baroody, Michael; Holds, John B; Sakamoto, Douglas K; Vick, Valerie L; Hartstein, Morris E

    2004-06-01

    Patients presenting with blepharoptosis due to disinsertion or thinning of the levator aponeurosis require surgical repair. A minimally invasive approach directed specifically at the levator aponeurotic anatomic defect may provide benefits to the patient. Proposed advantages of a small eyelid incision (8-13 mm) include less local anesthetic and tissue distortion, less ecchymosis and edema, decreased operative times, a shortened recovery period, and improved surgical results. We describe our results with the use of a small incision ptosis repair in select patients. A retrospective chart review between January 2000 and September 2001 included 91 patients and 118 eyelids with blepharoptosis due to aponeurotic disinsertion, corrected by a minimally invasive approach. The small incision technique comprised levator aponeurotic resection and advancement. Pre- and postoperative upper eyelid marginal reflex distances (MRD1), eyelid contour, need for reoperation, and complications (overcorrection, undercorrection, hematoma, and infection) were recorded. The average preoperative MRD1 measured 0.5 +/- 1.1 mm, with a range of -2.0 to 2.5 mm. The average postoperative MRD1 measured 2.6 +/- 0.8 mm, with a range of 1 to 5.5 mm (P < 0.0001). Of the 118 eyelids corrected by a small incision technique, there were 4 overcorrections, 3 undercorrections, 1 failure, 1 postoperative ptosis procedure of the contralateral upper eyelid secondary to Hering's law ptosis, and 4 patients requesting surgical treatment of dermatochalasis. No symptomatic dry eye, exposure keratopathy, or other complication resulted in association with the overcorrections. No contour abnormalities, infections, hematomas, or other complications were noted. Our experience suggests that utilization of a small skin incision is safe, precise, and efficient and allows for more rapid recovery from surgery. The authors note a decreased incidence of reoperation and postoperative complaints compared with historical larger

  14. Tarsoaponeurectomy as an alternative in difficult blepharoptosis cases.

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    Sendul, Selam Yekta; Dirim, Burcu; Demir, Mehmet; Acar, Zeynep; Demir, Atilla Gokce; Olgun, Ali; Tiryaki, Semra; Ucgul, Cemile; Guven, Dilek

    2016-03-31

    The purpose of this study was to evaluate the results of tarsoaponeurectomy in patients with unsuccessful results after repetitive surgery or who developed post-traumatic blepharoptosis. The files of 107 patients (136 eyes) on whom surgery was performed between January 2010 and December 2014 due to blepharoptosis were scanned retrospectively. Among these patients, the files and operational notes of eight patients who underwent surgery through the method of tarsoaponeurectomy were examined in detail. The epidemiological data, indication for surgery, previous ptosis and/or eyelid surgeries and trauma histories, preoperative and postoperative measurement data (palpebral space (PS), margin reflex distance (MRD1, MRD2), levator muscle function (LMF)) of the patients were recorded. The follow-up time of the patients was 7 to 34 months with an average of 16 months. A total of eight patients consisting of three females and five males were included in the study. The age range was 19 to 63 years with an average of 39 ± 16.2 years. Four patients had traumatic ptosis history whereas four patients had previous multiple levator procedure surgery history. Those patients with a history of ptosis had undergone surgery with levator procedure at least two times. Additionally, one patient had upper eyelid entropion, one had anophthalmic socket syndrome, and one had exposure keratopathy and traumatic dilated pupil. Seven patients had ptosis in the left eye whereas one patient had ptosis in the right eye. All patients were given a tarsoaponeurectomy as the basic surgical procedure while the patient with entropion was given a tarsal fracture and ear cartilage grafting as additional surgery. Two patients with vertical notching were also given a vertical blepharotomy through which a strip of tarsus was removed. Tarsoaponeurectomy is an alternative method for oculoplastic surgeons used to deal with patients on whom sufficient and desired results have not been achieved despite

  15. Evaluation of Polybutylate-Coated Braided Polyester (Ethibond) Sutures for Levator-Advancement Blepharoptosis Repair

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    Yulish, Michael; Pikkel, Joseph

    2012-01-01

    Purpose. To evaluate the efficacy and safety of polybutylate-coated braided polyester (Ethibond* 5-0) suture for levator aponeurosis suturing to the anterior tarsal surface in involutional blepharoptosis repair surgery. Methods. Ten consecutive patients (16 eyes) with acquired blepharoptosis which resulted from levator aponeurosis dehiscence with good levator function had gone through surgery and were followed up for, at least, one year. Results. There was no significant change between postoperative MRD1 measurements. No serious complications, such as infection of the sutures, inflammation, granuloma formation or ptosis recurrence, were registered. Conclusion. Polybutylate-coated braided polyester (Ethibond* 5-0) suture is a safe and effective material for involutional blepharoptosis repair surgery. PMID:24558592

  16. Digital Analysis of Eyelid Features and Eyebrow Position Following CO2 Laser-assisted Blepharoptosis Surgery

    OpenAIRE

    Zheng, Xiaodong; Kakizaki, Hirohiko; Goto, Tomoko; Shiraishi, Atsushi

    2016-01-01

    Background: To compare the margin reflex distance of the upper (MRD-1) and lower (MRD-2) eyelids and the eyebrow height (EBH) in patients with involutional and hard contact lens wear--induced blepharoptosis before and after ptosis surgery. Methods: Sixty patients with acquired blepharoptosis were studied. Group 1 consisted of 30 patients with involutional ptosis (age, 75.8???6.4 years), and group 2 consisted of 30 patients with hard contact lens wear?induced ptosis (age, 50.2???7.1 years). Al...

  17. The Impact of Hering's Law in Blepharoptosis: Literature Review.

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    Chen, Austin Deng; Lai, Ya-Wei; Lai, Hsin-Ti; Huang, Shu-Hung; Lee, Su-Shin; Chang, Kao-Ping; Lai, Chung-Sheng

    2016-03-01

    The aim of this literature review is to examine Hering's law, a well-documented phenomenon in blepharoptosis patients, with 10% to 20% noted in cases of unilateral ptosis. Predominantly presenting as contralateral eyelid drop postoperatively, it poses a challenge for eyelid surgeons in the pursuit of symmetry and appropriate eyelid height. Proper preoperative evaluation is of utmost importance, consisting of one of either lifting test, covering test, or phenylephrine test. A deeper understanding of Hering's law further provides adequate information for optimal management of ptosis. In regard to ptosis etiology, congenital ptosis does not appear to have a distinct relation to positive Hering's law, commonly associated with a low incidence, when compared with acquired ptosis. Ptosis in the dominant eye seems to be related to a higher incidence of the phenomenon than ptosis in the nondominant eye, with statistical significance in studies ranging from P ptosis severity and levator function appear to be of lesser importance than ptosis etiology, with minimal incidence of Hering's law in congenital ptosis regardless of these factors. It is, however, noted that ptosis severity has direct association with contralateral eyelid position in acquired ptosis, whereas there is a lack of studies for levator function. In the event of preoperative contralateral eyelid drop, surgeons should consider simultaneous surgery instead of delayed surgery for bilateral ptosis (P = 0.002). For unilateral ptosis, although reoperation is done per patient request, it may be more appropriate to first wait for roughly 2 weeks and reassess for self-regulation to a normal eyelid position.

  18. Surgical Correction of the Intractable Blepharoptosis in Patients With Ocular Myasthenia Gravis.

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    Lai, Chung Sheng; Lai, Ya Wei; Huang, Shu Hung; Lee, Su Shin; Chang, Kao Ping; Chen, Austin Deng

    2016-03-01

    Treatment of blepharoptosis caused by ocular myasthenia gravis (OMG) is challenging in patients with serious side effects or failed response to medical therapy. Only a few surgical reports have been published for refractory myathenic blepharoptosis. This study is aimed at the evaluation of the surgical outcome of blepharoptosis correction in intractable OMG patients. Twelve OMG patients who accepted frontalis sling with frontalis orbicularis oculi muscle (FOOM) flap for blepharoptosis correction were reviewed. Patients' demographies, perioperative changes of the interpalpebral fissure height (IPFH), margin reflex distance 1 (MRD1), levator function (LF), and quality of life (QOL) score were evaluated. The duration of OMG ranged from 3 to 31 years. LF was normal in 6 patients, good in 5, and poor in 1. There is no significant change of LF before and after surgery. MRD1 improved significantly from -1.8 mm (range, 0 to -5 mm) preoperatively to 2.9 mm (range, 2-4 mm) postoperatively. IPFH improved significantly from 3.8 mm (range, 2-6 mm) preoperatively to 7.8 mm (range, 6-9 mm) postoperatively. Upper eyelid margin was above the pupil in all patients. QOL score improved significantly from 18.2 (range, 14-23) preoperatively to 5.8 (range, 0-10) postoperatively. Our report reveals that surgical correction of the blepharoptosis is effective for patients with intractable OMG and that frontalis suspension with FOOM flap is a valuable option because of its ready availability and pliability. All patients are satisfied with the results, especially the improvement of QOL.

  19. Transconjunctival Blepharoptosis Surgery: A Review of Posterior Approach Ptosis Surgery and Posterior Approach White-Line Advancement

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    Patel, Vikesh; Malhotra, Raman

    2010-01-01

    Posterior approach blepharoptosis surgery, via the transconjunctival route, was probably the first method of surgery employed to shorten the levator palpebrae superioris (LPS) muscle. A review of the literature demonstrates how surgery has evolved since Blaskovics’ first described his technique in 1923. We describe our newer method of posterior approach white-line advancement blepharoptosis repair which is now an option in the majority of aponeurotic ptosis with moderate to good levator funct...

  20. Obesity as a Potential Risk Factor for Blepharoptosis: The Korea National Health and Nutrition Examination Survey 2008-2010.

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    Ji-Sun Paik

    Full Text Available To examine obesity parameters as potential risk factors associated with blepharoptosis in a representative Korean population.We analyzed the Korea National Health and Nutrition Examination Survey (KNHANES, conducted between 2008 and 2010. 10,285 Korean adults (4,441 men and 5,844 women aged 40 years or older was enrolled. We compared body mass index (BMI, waist circumference (WC and percentage body fat (BF, according to the severity of blepharoptosis. Multiple logistic regression analysis was conducted to examine the associations of each obesity parameter with blepharoptosis.The overall prevalence of age-related blepharoptosis was 14.8 % in South Korea. There were significant and graded associations between increasing blepharoptosis severity and the mean value of obesity parameters (P for trend < 0.05. As marginal reflex distance 1 (MRD1 decreased, the prevalence of general obesity and overweight status increased (P for trend=0.121 in men and < 0.001 in women; the prevalence of abdominal obesity increased (P for trend < 0.001 for both genders; the prevalence of highest quartile of percentage BF increased (P for trend ≤0.001 for both genders. Blepharoptosis was significantly associated with general obesity in women (adjusted odds ratio (aOR, 2.14; 95% confidence intervals (CI, 1.32-3.47; and with the highest quartile of percentage BF in men (aOR, 2.01; 95% CI, 1.34-2.97 and in women (aOR, 1.52; 95% CI, 1.06-2.3317, after adjusting for age, smoking exercise, drinking alcohol, total energy intake, fat intake, total cholesterol, and high density lipoprotein cholesterol, diabetes, hypertension, and family history of eye disease.The etiology of age-related blepharoptosis may be multifactorial and is unclear. Our results suggest that obesity parameters such as BMI, WC and percentage BF might be potential risk factors for age-related blepharoptosis in a representative Korean population.

  1. Obesity as a Potential Risk Factor for Blepharoptosis: The Korea National Health and Nutrition Examination Survey 2008-2010.

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    Paik, Ji-Sun; Jung, Su-Kyung; Han, Kyung-Do; Kim, Sang-Duck; Park, Yong-Moon; Yang, Suk-Woo

    2015-01-01

    To examine obesity parameters as potential risk factors associated with blepharoptosis in a representative Korean population. We analyzed the Korea National Health and Nutrition Examination Survey (KNHANES), conducted between 2008 and 2010. 10,285 Korean adults (4,441 men and 5,844 women) aged 40 years or older was enrolled. We compared body mass index (BMI), waist circumference (WC) and percentage body fat (BF), according to the severity of blepharoptosis. Multiple logistic regression analysis was conducted to examine the associations of each obesity parameter with blepharoptosis. The overall prevalence of age-related blepharoptosis was 14.8 % in South Korea. There were significant and graded associations between increasing blepharoptosis severity and the mean value of obesity parameters (P for trend MRD1) decreased, the prevalence of general obesity and overweight status increased (P for trend=0.121 in men and < 0.001 in women); the prevalence of abdominal obesity increased (P for trend < 0.001 for both genders); the prevalence of highest quartile of percentage BF increased (P for trend ≤0.001 for both genders). Blepharoptosis was significantly associated with general obesity in women (adjusted odds ratio (aOR), 2.14; 95% confidence intervals (CI), 1.32-3.47); and with the highest quartile of percentage BF in men (aOR, 2.01; 95% CI, 1.34-2.97) and in women (aOR, 1.52; 95% CI, 1.06-2.3317, after adjusting for age, smoking exercise, drinking alcohol, total energy intake, fat intake, total cholesterol, and high density lipoprotein cholesterol, diabetes, hypertension, and family history of eye disease. The etiology of age-related blepharoptosis may be multifactorial and is unclear. Our results suggest that obesity parameters such as BMI, WC and percentage BF might be potential risk factors for age-related blepharoptosis in a representative Korean population.

  2. Effects of local anesthesia with bupivacaine plus epinephrine on blepharoptosis and levator palpebrae muscle function.

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    Aghai, Gholam Hoseyn; Vazirnia, Maryam; Poormatin, Rama; Falavarjani, Khalil Ghasemi

    2013-01-01

    To evaluate the effect of local anesthesia with bupivacaine plus epinephrine on the extent of blepharoptosis and levator palpebrae muscle function. : In this prospective interventional case series, patients with blepharoptosis who were candidates for aponeurotic surgery were included. After initial preparations in the operating room, a total of 1 ml of a mixture of bupivacaine 0.5% plus epinephrine 1:100,000 were injected into the upper eyelid. The margin reflex distance 1 (MRD1) and the extent of levator muscle function were measured before and 2, 5, 10, and 15 minutes after injection. A total of 36 eyes including 21 men (58.3%) and 15 women (41.7%) with an average age of 41.81 ± 23.09 (17-83 years) were studied. There were 21 eyes with myogenic and 15 eyes with aponeurotic blepharoptosis. The mean MRD1 was 1.18 ± 1.06 mm before injection and -0.02 ± 0.85, 0.52 ± 0.98, 0.98 ± 1.05, and 1.02 ± 1.06 mm at 2, 5, 10, and 15 minutes after injections, respectively. The changes in the MRD1 measurements were statistically significant at all time points. The MRD1 values decreased during the first 2 minutes after injection in 88.8% of eyes, but returned to initial value after 15 minutes in 84.3%. The change in the levator muscle function measurements was statistically significant at 2 and 5 minutes after injections; however, the differences were clinically negligible. : The local anesthesia of the eyelid with 1 ml bupivacaine plus epinephrine causes a temporary increase of blepharoptosis within the first few minutes with minimal effect on levator muscle function measurements.

  3. Socioeconomic Disparities in the Prevalence of Blepharoptosis in the South Korean Adult Population Based on a Nationwide Cross-Sectional Study.

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    Eun Young Rha

    Full Text Available We investigated the association between socioeconomic status (SES and the prevalence of blepharoptosis in a representative South Korean population.This cross-sectional study was based on data obtained in the Korea National Health and Nutrition Examination Survey from 2010 to 2012. In total, 17,178 Korean adults (7,261 men and 9,917 women aged 19 years or older were enrolled. Blepharoptosis was defined as a marginal reflex distance 1 (MDR 1 lower than 2 mm. Household income and education level were used as indicators of SES. Univariate and multiple logistic regression analyses were conducted to analyze the relationship between SES and the prevalence of blepharoptosis.Household income was inversely associated with the prevalence of blepharoptosis in women [adjusted odds ratio (aOR and corresponding 95% confidence interval (95% CI was 1.894 (1.336, 2.685], and educational level was inversely associated with blepharoptosis in both men and women [aORs and 95% CIs were 1.572 (1.113, 2.219 and 1.973 (1.153, 3.376, respectively]. After adjusting for household income and educational level, low SES was associated with a high prevalence of blepharoptosis in women only.Socioeconomic disparities in the prevalence of blepharoptosis were found among women. Indeed, future research using a prospective design to determine the causal relationship between SES and blepharoptosis may identify SES as a risk factor for this condition.

  4. Nonophthalmic symptoms secondary to ocular torticollis from severe blepharoptosis: an underappreciated but treatable condition.

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    Bohnsack, Brenda L; Bhatt, Rina; Kahana, Alon

    2012-01-01

    The purpose of this case report is to describe reversible systemic symptoms associated with ocular torticollis due to blepharoptosis. A retrospective chart review identified patients with symptomatic ocular torticollis due to bilateral congenital or acquired blepharoptosis who underwent surgical correction (levator resection or frontalis sling). Preoperative and postoperative assessment of systemic symptoms in adults and developmental milestones are reported. The authors present 4 cases, 1 adult and 3 young children, all with severe bilateral upper eyelid ptosis. In the adult patient, it caused debilitating back pain that required orthopedic evaluation but was completely relieved with ptosis repair surgery. In the toddlers, subjective developmental motor delay was rapidly reversed following ptosis repair surgery. The authors suggest that primary care physicians, and spine and neuromuscular specialists, consider the possibility of ocular torticollis due to eyelid ptosis in the evaluation of patients with unexplained back and/or neck pain or with gross motor developmental delay. The authors propose that symptomatic ocular torticollis is an indication for ptosis repair.

  5. Non-Ophthalmic Symptoms Secondary to Ocular Torticollis From Severe Blepharoptosis: An Underappreciated But Treatable Condition

    Science.gov (United States)

    Bohnsack, Brenda L.; Bhatt, Rina; Kahana, Alon

    2012-01-01

    Purpose Identify systemic symptoms associated with ocular torticollis due to bilateral blepharoptosis. Methods Retrospective chart review identified patients with ocular torticollis due to bilateral congenital or acquired blepharoptosis who underwent surgical correction (levator resection or frontalis sling). Pre-operative and post-operative assessment of systemic symptoms in adults and developmental milestones are reported. Results We present 4 cases, one adult and three young children, with severe bilateral upper eyelid ptosis. In the adult patient, it caused debilitating back pain that required orthopedic evaluation, but was completely relieved with ptosis repair surgery. In the toddlers, subjective developmental motor delay was rapidly reversed following ptosis repair surgery. Conclusions We suggest that primary care physicians, as well as spine and neuromuscular specialists, consider the possibility of ocular torticollis due to eyelid ptosis in the evaluation of patients with unexplained back and/or neck pain, or with gross motor developmental delay. We propose that symptomatic ocular torticollis is an indication for ptosis repair. PMID:21562438

  6. Histological evaluation of levator palpebralis superior muscle in patients with congenital blepharoptosis

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    Sevda Söker

    2011-03-01

    Full Text Available The aim of this study was to examine levator palpebralis superior muscle histologically in patients with congenital blepharoptosis and to investigate the relationship between these findings and age, sex and degree of blefaroptosis in this patient group.Materials and methods: Levator muscle of 13 patients with congenital ptosis, who had applied to Dicle University Medical Faculty Ophthalmology Clinic and had undergone levator palpebralis superior muscle resection between january 2009-january 2010, has been examined histopathologically in Histology and Embriology Deparment. During preoperative period, ptosis amount, levator function (LF, tear functions, Bell’s phenomenon and jaw-winking phenomenon were evaluated. All patients underwent resection of levator palpebralis superior muscle. Received postoperative levator muscle was examined by light microscopy.Results: The average age of 9 (69.2% male and 4 (30.8% female cases were 10.61 ± 4.77 (4- 19 years. In histological examination, the quality and quantity of the levator muscle fibrils have been assessed. There was no relationship detected between histological features of levator palpebralis superior muscle and patient’s age and gender (p>0.05. Patients with weak levator palpebralis superior muscle were detected to have fatty degeneration histologically. The higher the levator palpebralis superior muscle function revealed decreased fatty degeneration and increased skeletal muscle fibrils.Conclusion: More ultrastructural studies in larger populations are needed to support the relationship between structure and function of levator palpebralis superior muscle in patients with congenital blepharoptosis.

  7. Blepharoptosis repair through the small orbital septum incision and minimal dissection technique in patients with coexisting dermatochalasis.

    Science.gov (United States)

    Jung, Younhea; La, Tae Yoon

    2013-02-01

    To describe a modified surgical technique for blepharoptosis repair through a small orbital septum incision and minimal dissection, along with the results obtained in patients with coexisting dermatochalasis. A retrospective chart review included 33 patients (52 eyelids) with blepharoptosis coexisting with dermatochalasis, surgically corrected through a small orbital septum incision and minimal dissection after redundant upper lid skin excision, by placing a single fixation suture between the levator aponeurosis and the tarsal plate. Outcome measures included the pre- and postoperative marginal reflex distances (MRD1), eyelid contour, post-operative complications, and need for reoperation. The pre- and postoperative MRD1 averaged 1.1 ± 0.8 mm and 2.8 ± 1.1 mm, respectively. Of the 33 patients, 9 patients (9 eyelids) underwent surgery on one eyelid for unilateral blepharoptosis and dermatochalasis (Group I), 5 patients (5 eyelids) underwent a simple skin excision blepharoplasty of the contralateral eyelid (Group II), and 19 patients (38 eyelids) underwent bilateral blepharoptosis and dermatochalasis repair (Group III). Of the 14 eyelids that underwent unilateral ptosis repair (Groups I and II), 12 eyelids (85.7%) showed less than a 1-mm difference from the contralateral eyelid. Of the 38 eyelids that underwent bilateral ptosis repair (Group III), 27 eyelids (71.1%), 5 eyelids (13.1%), and 6 eyelids (15.8%) had excellent, good, and poor outcomes, respectively. Overall, 44 eyelids (84.6%) out of a total of 52 eyelids had successful outcomes; the remaining 8 eyelids demonstrated unsatisfactory eyelid contour was corrected by an additional surgery. Blepharoptosis repair through a small orbital septum incision and minimal dissection can be considered an efficient technique in patients with ptosis and dermatochalasis.

  8. A Skin Crease Preserving Modification of Open-Sky Mullerectomy for Blepharoptosis Correction.

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    Szamocki, Sonia; Shah-Desai, Sabrina

    2015-01-01

    To report the results of skin crease preservation with a modified technique of open-sky Muller's muscle-conjunctival resection that precludes the need to reconstruct the upper eyelid skin crease with full thickness sutures. A nonrandomized, retrospective audit of 45 eyelids of 37 consecutive patients with acquired blepharoptosis, undergoing surgical correction by a single surgeon, between November 2011 and July 2014. Surgical technique involved subtotal resection of Muller's muscle plus underlying conjunctiva, under direct visualization. The stump of Muller's muscle was then reattached to the superior tarsus with buried 7-0 Vicryl. Wound closure was achieved using interrupted buried 7-0 Vicryl, without full thickness skin crease reformation. Outcomes were evaluated according to standards recommended by the British Oculoplastic Surgery Society National Ptosis survey. These included assessment of upper margin reflex distance (MRD1), skin crease, eyelid contour and symmetry and surgical complications. In total, all 45 eyelids met the outcome criteria for success. The median MRD1 increased from 0 mm preoperatively (range: -2 to 2) to 3.1 mm (range: 3-5 mm) following surgery, p value < 0.01. For patients with unilateral blepharoptosis, the average postoperative eyelid height difference between right and left was 0.17 mm (range: 0-1 mm). All patients achieved good eyelid contour and symmetry and none required reoperation as assessed at final follow up following surgery (mean 77 days, range: 24-366). Skin crease was lowered and normalized in all patients with median preoperative and postoperative measurements of 12 mm and 10 mm, respectively, p value < 0.01. Two cases (4.4%) developed early asymptomatic superficial punctate keratopathy, which resolved spontaneously by 4 weeks. Nonstandardized patient experience survey achieved high scores for overall satisfaction and likelihood to recommend treatment to friends and family, with low scores for postoperative

  9. Comparison of Blepharoptosis Correction Using Müller-aponeurosis Composite Flap Advancement and Frontalis Muscle Transfer.

    Science.gov (United States)

    Park, David Dae Hawan; Ramadhan, Anwar; Han, Dong Gil; Shim, Jeong Su; Lee, Yong Jig; Ha, Won Ho; Lee, Byung Kwon

    2014-08-01

    Treatments for severe blepharoptosis are well documented and include the most common operations for restoring upper eyelid ptosis, which are levator surgery and frontal muscle transfers; however, the choice of treatment is still controversial. There are different approaches to the restoration of upper eyelid ptosis, and the choice will be based on ptosis severity and the surgeon's skill and experience. Two hundred and fourteen patients presenting with a levator function of between 2 and 4 mm received ptosis correction between 1991 and 2010 at our clinic. Of these, 71 patients underwent Müller aponeurosis composite flap advancement for correction of 89 eyelids, and frontalis muscle transfer was performed on 143 patients (217 eyelids). Postoperative results were evaluated with an average follow-up period of 23 months. The preoperative average for marginal reflex distance (MRD1) in the Müller aponeurosis composite flap advancement group was 1.25 mm, and in the frontal muscle transfer group, it was 0.59 mm. The area of corneal exposure (ACE) was 57.2% in the Müller aponeurosis composite flap advancement group and 53.6% in the frontal muscle transfer group. The postoperative average distance was not significantly different for the 2 techniques. In the Müller aponeurosis composite flap advancement group, MRD1 was 2.7 mm and ACE was improved to 73.5%. In the frontal muscle transfer group, MRD1 was 2.3 mm and ACE was 71.2%. Undercorrection and eyelid asymmetry were the most frequently observed postoperative complications for both techniques. In our study, we confirmed that Müller aponeurosis composite flap advancement and the frontalis transfer technique are both effective in the correction of severe blepharoptosis; our results showed no significant differences between the 2 techniques.

  10. Results of Long-Term Follow-Up Observations of Blepharoptosis Correction Using the Palmaris Longus Tendon

    Science.gov (United States)

    Shin, YongHo

    2008-01-01

    Background The frontalis sling procedure is a useful approach for correcting severe blepharoptosis. However, blepharoptosis often recurs after corrective surgery using the tensor fascia lata. Good results without recurrence after a modified Fox method were obtained using the palmaris longus tendon. This study examined the safety and validity of the surgical method using the palmaris longus tendon through long-term follow-up observations. Methods To reduce the rate of recurrence, the highest point on the pentagon of the Fox method was fixed to the frontalis fascia and frontalis muscle. It was fixed once again to the area 1 cm above the highest point. This approach remarkably reduces the incidence of recurrence by fixing the pentagon of the Fox method not only to the palmaris longus tendon but also to the frontalis fascia and again to the frontalis muscle. A modified Fox method using the palmaris longus tendon was used to treat 16 eyelids of 10 patients. A senior surgeon performed the procedure in all cases under local anesthesia. Results The mean follow-up period was 51 months (range = 18–86 months). There was no case of blepharoptosis recurrence and a good field of view was secured after surgery. Long-term follow-up revealed that the visual field had been well secured with a mean MRD1 of 3.1 mm. The eyelids were well maintained without any postoperative adverse reaction such as exposure keratitis. Conclusion The palmaris longus tendon as useful donor material does not lead to recurrence of blepharoptosis, which is often encountered when the tensor fascia lata is used. The modified Fox method using the palmaris longus tendon can be an effective and valid surgical approach that produces both immediate and long-term results. PMID:18446402

  11. Prevalence and associated factors of blepharoptosis in Korean adult population: The Korea National Health and Nutrition Examination Survey 2008-2011.

    Science.gov (United States)

    Kim, M H; Cho, J; Zhao, D; Woo, K I; Kim, Y-D; Kim, S; Yang, S W

    2017-06-01

    PurposeThis study aimed to evaluate the prevalence and associated factors of involutional blepharoptosis in a nationwide representative sample in Korea.MethodsCross-sectional study 20 941 Korean men and women 40 years of age and older who participated in last 2 years (2008 and 2009) of the 4th wave of the Korean National Health and Nutrition Examination Survey (KNHANES) IV and the first 2 years (2010 and 2011) of KNHANES V. Ocular examinations were performed by ophthalmologists trained in procedure and grading methods, and blepharoptosis was defined as a marginal reflex distance MRD1) with aging implicate a contributory role of muscular degeneration. Strong association with hypertension, diabetes, BMI, and education level suggests that etiology of involutional blepharoptosis would be multifactorial and further investigation would be necessary to determine precise mechanism and contribution of factors.

  12. The Magnetic Levator Prosthesis for Temporary Management of Severe Blepharoptosis: Initial Safety and Efficacy

    Science.gov (United States)

    Houston, Kevin E.; Tomasi, Matteo; Amaral, Christina; Finch, Nicole; Yoon, Michael K.; Lee, Hang; Paschalis, Eleftherios I.

    2018-01-01

    Purpose We further optimized and evaluated the safety of the magnetic levator prosthesis (MLP) for temporary management of severe blepharoptosis, and compared efficacy and comfort against the ptosis crutch. Methods The interpalpebral fissure (IPF) of participants (n = 12) with ptosis was measured during attempted eyelid opening, volitional closing, and spontaneous closing with no device, ptosis crutch, or the MLP. A 10-point scale documented comfort. Additionally, a 20 minute and then 1 week trial of the MLP was offered. Safety measures were skin erythema rating, change in visual acuity, and change in corneal staining. Results The MLP and crutch opened the eye (IPF 11.2 and 9.3 mm), but the MLP allowed better volitional closure (IPF 1.0 vs. 4.9 mm, P = 0.009), but was no better in allowing spontaneous blink (IPF 7.5 vs. 7.7 mm, P = 0.722). Both devices were equally comfortable (both median 8/10 comfort, P = 0.46). With extended use, opening with the MLP showed IPF 9.24 mm at 20 minutes and 9.46 mm at 1 week, and volitional closure was IPF 0.95 and 0.52 mm, respectively. Closure on spontaneous blink improved with extended wear to IPF 5.14 and 5.18 mm, respectively (P = 0.002). Two participants exhibited moderate skin erythema and one had increased corneal staining without change in acuity. Conclusions The MLP is safe and feasible for temporary correction of severe ptosis. Translational Relevance First group data in patients showing successful reanimation of the eyelid with magnetic force. PMID:29367892

  13. Surgical anatomy and histology of the levator palpebrae superioris muscle for blepharoptosis correction

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    Đorđević Boban

    2013-01-01

    s crease was formed by the conjoined fascia including the fascia of the orbicularis muscle, the superficial layer of the orbital septum, and the aponeurosis of the LPS muscle, as well as the pretarsal fascia. Conclusion. The conducted study provided a valuable morphological basis for biomechanical and clinical considerations regarding blepharoptosis surgery. [Projekat Ministarstva nauke Republike Srbije, br. 175030

  14. Surgical anatomy and histology of the levator palpebrae superioris muscle for blepharoptosis correction.

    Science.gov (United States)

    Djordjević, Boban; Novaković, Marijan; Milisavljević, Milan; Milićević, Sasa; Maliković, Aleksandar

    2013-12-01

    fascia of the orbicularis muscle, the superficial layer of the orbital septum, and the aponeurosis of the LPS muscle, as well as the pretarsal fascia. The conducted study provided a valuable morphological basis for biomechanical and clinical considerations regarding blepharoptosis surgery.

  15. Anterior approach white line advancement: technique and long-term outcomes in the correction of blepharoptosis.

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    Schulz, C B; Nicholson, R; Penwarden, A; Parkin, B

    2017-12-01

    PurposeAnterior approach white line advancement presents a novel surgical option for correction of blepharoptosis. The technique draws on several advantages of other approaches. The aim of this study was to present outcomes using this technique at a minimum follow-up of 18 months.Patients and methodsParticipants having undergone anterior approach white line advancement ptosis correction at a single institution were retrospectively recruited at a minimum of 18 months' follow-up. A total of 18 independent eyelid measurements were recorded at final review. Outcomes included long-term rate of surgical success, upper eyelid margin-reflex distance (MRD1) at both early and late post-operative follow-up, inter-eyelid asymmetry, complications, re-operation rate, patient satisfaction, and quality-of-life improvement using the Glasgow Benefit Inventory (GBI). Pre- and post-operative MRD1, as well as inter-eyelid asymmetry, were compared using a two-tailed t-test.ResultsIn total, 82 eyelids of 47 participants were included with a mean follow-up of 2.3 years (range 1.5-3.7). Surgical success was achieved in 91.5%, with a final mean MRD1 of 3.5 mm (95% confidence 3.2-3.7). An increase of 2.4 mm (2.1-2.8) in eyelid height was observed between baseline and long-term follow-up (P<0.0001). No significant change was observed between early and late post-operative follow-up. Pre-operative asymmetry was reduced from 1.0 mm (0.7-1.3) to 0.4 mm (0.3-0.5; P<0.0001). Patient satisfaction was 95.7% with a mean GBI score of +21.8 (13.2-30.3).ConclusionsAnterior approach white line advancement presents an excellent option for patients undergoing ptosis correction with favourable long-term results. Comparisons are made with other techniques with respect to anatomical, functional, and surgical factors.

  16. Palpebral position interdependence in blepharoptosis: comparison of the effect of instillation of 10% phenylephrine drop and digital lifting

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    Ivana Cardoso Pereira

    2014-12-01

    Full Text Available Purpose: To quantify and compare the effects of instillation with 10% phenylephrine and digital lifting on the contralateral upper eyelid of patients with involutional bilateral blepharoptosis. Methods: The present prospective clinical study involved patients with involutional bilateral blepharoptosis who underwent two tests: 1 digital lifting of the more ptotic eyelid and observation of the effect on the contralateral eyelid and 2 instillation of two drops of 10% phenylephrine in the more ptotic eye and observation of the effect on the contralateral eyelid. Patients were filmed before and 5, 10, and 15 min after instillation, and the resulting images were analyzed to obtain eyelid measurements. The results were tested using a linear mixed-effects model. Results: A total of 27 patients, ranging from 52 to 82 years of age (mean age 68.51 ± 8.21 years, 24 (88.88% of whom were women, were included in the present study. In eyes that received instillation, the marginal distance reflex-1 (MDR1 values increased from baseline (1.21 ± 0.60 mm until 10 min after instillation, then remained statistically unchanged until 15 min after instillation (2.42 ± 0.90 mm. Significant differences were observed in the contralateral eye of the group that underwent digital lifting (1.51 ± 0.53 mm - 1.63 ± 0.56 mm and in the contralateral eye of the group that underwent 10% phenylephrine instillation (1.38 ± 0.54 mm - 1.63 ± 0.56 mm; p=0.02 and p<0.01, respectively. Conclusion: In all eyes, 10% phenylephrine elevated the upper eyelid, with improved eyelid height at 10 min after instillation. Significant differences were observed in the height of the contralateral eyelid when compared before and after each intervention in each group; however, this difference was very small and nearly undetectable by conventional clinical evaluation in the digital lifting group. However, the 10% phenylephrine eye-drop test resulted in substantial changes in MDR1 values in the

  17. Quantitative Comparison of the Effect of 10% Phenylephrine Instillation and Manual Elevation in Patients with Involutional Blepharoptosis.

    Science.gov (United States)

    Pereira, Ivana Cardoso; Matayoshi, Suzana

    2017-01-01

    To compare the effect of 10% phenylephrine (PE) instillation and manual elevation (ME) on the upper eyelid position of the tested eye and the contralateral eye in patients with involutional blepharoptosis (IB). IB patients were submitted to two tests followed by observation of the effect on the contralateral eyelid: (1) ME of the more ptotic eyelid; and (2) instillation of two drops of 10% PE (phenylephrine test) in the more ptotic eye. The patients were filmed before and 5, 10, and 15 minutes after instillation. The upper eyelid margin reflex distance (MRD1) was measured using the software Image J, and the results were analyzed with the linear mixed-effects model. The study included 70 patients aged 44-86 years, 64 of whom were female (91.43%), divided into three groups: subjects with unilateral IB, subjects with bilateral IB, and controls. The eye submitted to instillation with 10% PE displayed significant elevation during the first 10 min: from 1.33 ± 0.66 mm to 2.06 ± 0.89 mm (unilateral group), from 1.26 ± 0.63 mm to 2.29 ± 0.86 mm (bilateral group), and from 3.12 ± 0.68 mm to 4.06 ± 0.92 mm (control group). MRD1 decreased in the contralateral eye in IB patients, significantly more so after the phenylephrine test: PE vs. ME = 18.9% versus 17.2% reduction in the unilateral group, and 13.6% versus 10.7% reduction in the bilateral group. The outcome was not influenced by IB severity and the concurrence of IB and eye dominance. Both ME and 10% PE affected the contralateral upper eyelid, but the response was significantly better with the latter.

  18. Borderline to Moderate Blepharoptosis Correction Using Retrotarsal Tucking of Müller Muscle: Levator Aponeurosis in Asian Eyelids.

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    Chung, Seungil; Ahn, Byungjoon; Yang, Wonyong; Burm, Jansik; Bum, Jinsik; Kim, Kiyup; Kang, Sangyoon

    2015-02-01

    The purpose of this paper is to report the outcome of retrotarsal tucking of Müller muscle-levator aponeurosis for the correction of borderline to moderate ptosis in conjunction with esthetic blepharoplasty in Asian eyelids and to explore the relationship between the extent of advancement and change in the eyelid position (MRD1). The medical records of 290 consecutive patients who underwent retrotarsal tucking of Müller muscle-levator aponeurosis from February 2005 to November 2011 were reviewed. Of those, 26 patients (51 eyelids) were statistically analyzed. The correction was performed through an external upper blepharoplasty approach. Once the orbital septum was opened, the Müller muscle-levator aponeurosis was advanced and tucked under the posterior surface of the tarsus by a single lifting suture. The average follow-up period was 20.6 months, with a range of 3-68 months. In 26 patients (51 eyelids), satisfactory results were recorded for 49 of 51 eyelids (96.1 %). The margin reflex distance-1 (MRD1) increased from 1.56 ± 0.70 mm preoperatively to 3.86 ± 0.94 mm postoperatively (p MRD1 of 1 mm was achieved. For 7.2 and 8.3 mm of advancement, the average MRD1 achieved was 2 and 3 mm each. A noteworthy complication, although not included in statistical analysis, was one patient who had developed corneal irritation caused by the conjunctival exposure to the non-absorbable suture 3 years after the surgery, which led the subject to have the suture removed. The author concludes that this procedure is one of the most effective surgical options in correcting borderline to moderate blepharoptosis in conjunction with esthetic blepharoplasty. The main advantage of such a method is that once the orbital septum is opened, Müller muscle-levator aponeurosis is easily advanced and tucked under the posterior surface of the tarsal plate without extensive dissection or resection, which is less traumatic and gives a more vertical lifting vector, thus producing excellent

  19. Suspensão ao músculo frontal com politetrafluoretileno para o tratamento da blefaroptose Frontalis suspension with polytetrafluorethylene for the treatment of blepharoptosis

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    Juliana Silvério

    2009-02-01

    Full Text Available OBJETIVO: Relatar a experiência com o uso do fio de politetrafluoretileno nas cirurgias de suspensão ao músculo frontal para correção de blefaroptose. MÉTODOS: Foram estudados todos os casos de blefaroptose grave submetidos à cirurgia pela técnica de suspensão ao músculo frontal como fio de politetrafluoretileno, no período de fevereiro de 2003 a abril de 2007. Foram realizadas 36 cirurgias em 23 pacientes, a média de seguimento foi de 15,8 meses (variando de 3 a 36 meses. A técnica cirúrgica utilizada foi a descrita por Fox. RESULTADOS: Entre as causas de blefaroptose foram encontradas: congênita em 20 (86,95% pacientes, blefarofimose em 2 (8,69% pacientes e traumática em 1 (4,35% paciente. Na primeira semana de pós-operatório, 6 (26,08% pacientes referiram assimetria palpebral, 4 (17,39% notaram edema local, 3 (13,04% pacientes apresentaram granuloma no local do fio e 1 (4,35% paciente apresentou celulite facial na região frontal unilateral. Após 3 meses de seguimento, 3 (13,04% pacientes referiram assimetria palpebral, e em 1 (4,35% paciente persistia o granuloma. CONCLUSÃO: O politetrafluoretileno - Modelo CV3, 6.0 (Gore-Tex®; W.L. Gore & Associates Inc, Flagstaff, AZ, EUA é um material adequado com bons resultados funcionais (86,9%, baixos índices de complicação (4,35% e insatisfação (13,4%, podendo ser uma alternativa em relação à fáscia lata, na cirurgia de suspensão ao frontal para tratamento de ptose palpebral grave.PURPOSE: To evaluate the functional results and complications of the use of expanded polytetrafluoroethylene in frontalis suspension surgery for the treatment of blepharoptosis. METHODS: Frontalis suspension procedure with polytetrafluoroethylene was performed between 2003 and 2007 on 23 patients (36 eyes with blepharoptosis. An average follow-up time was 15.8 months (range, 3 to 36. Surgical technique used was described by Fox. RESULTS: The causes of blepharoptosis found were: congenital in

  20. Blepharoptosis in Ibadan, Nigeria

    African Journals Online (AJOL)

    /18 all had myopia (2 were due to congenital glaucoma and the third eye had amblyopia caused by the myopia and severe ptosis. In the school survey, 759 children were examined and 9 were found to have mild ptosis, a prevalence of 1.2%.

  1. Eyelid Retraction in Isolated Unilateral Congenital Blepharoptosis

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    Michael S. Salman

    2017-05-01

    Full Text Available Isolated unilateral congenital ptosis is encountered relatively infrequently in clinical practice. It typically consists of a unilateral droopy eyelid, weak levator palpebrae superioris muscle function, lid lag, and an absent upper lid crease with no other abnormalities on examination. We present a four-and-a-half-year-old girl with isolated and mild unilateral congenital ptosis who unexpectedly demonstrated a static upper eyelid on downgaze in conjunction with a well-formed upper lid skin crease. We attribute this uncommon sign in congenital ptosis to stiffness and presumed fibrosis of the levator muscle. Examining the function of the eyelids in all directions of gaze is important in patients with abnormalities of lid position, since additional useful information can be gleaned about the status of the levator muscle including, aberrant regeneration or fibrosis.

  2. Eyelid Retraction in Isolated Unilateral Congenital Blepharoptosis

    OpenAIRE

    Michael S. Salman; Michael S. Salman; Ian H. Clark; Ian H. Clark

    2017-01-01

    Isolated unilateral congenital ptosis is encountered relatively infrequently in clinical practice. It typically consists of a unilateral droopy eyelid, weak levator palpebrae superioris muscle function, lid lag, and an absent upper lid crease with no other abnormalities on examination. We present a four-and-a-half-year-old girl with isolated and mild unilateral congenital ptosis who unexpectedly demonstrated a static upper eyelid on downgaze in conjunction with a well-formed upper lid skin cr...

  3. Blepharoptosis in Ibadan, Nigeria | Baiyeroju | West African Journal ...

    African Journals Online (AJOL)

    Objectif: Étudier les cas des blépharoptôses dans notre milieu en même temps nous renseigner sur les causes et les effets des ptôses. Grandes Lignes: Étude clinique en perspectif et méthode de sondage aréolaire des ecoliers en perspectif. Cadre: Collège Hospitalo Universitaire, Ibadan, et 3 écoles à Ibadan, Nigeria.

  4. Changes in Sunken Eyes Combined with Blepharoptosis after Levator Resection

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    Yuki Mawatari, MD, PhD

    2017-12-01

    Conclusions:. The principal aim of levator resection is to improve upper eyelid height and visual fields; however, this technique can alter the location of the eyebrow and upper orbital fat. The effects fill the hollowness of the upper eyelid and can remarkably improve sunken eyes.

  5. Mechanical Blepharoptosis and Eyelid Swelling Caused by Silicone Oil

    Directory of Open Access Journals (Sweden)

    Thabit A. Mustafa

    2009-01-01

    Full Text Available The purpose of this article is to report a case of upper eyelid mechanical ptosis caused by silicone oil migration in a Jordanian patient after pars plana vitrectomy and intraocular silicone oil injection. A 20-year-old male patient was referred to the oculoplastic clinic for the management of a left upper eyelid swelling and complete ptosis that developed 12 years after pars plana vitrectomy and silicone oil placement for retinal detachment secondary to perforating eye injury. Eye examination showed upper eyelid swelling and a complete ptosis induced by the weight of inflammatory tissue and silicone oil, as proved by histopathologic examination. We presumed that silicone oil had leaked through the pars plana vitrectomy ports or through a subtle traumatic perforation of the posterior segment, which might have been aggravated by increased intra-ocular pressure postoperatively. In conclusion, mechanical ptosis caused by silicone oil migration after retinal detachment surgery is rare and this is one of the few reports in the literature.

  6. Persistence of Upper Blepharoptosis After Cosmetic Botulinum Toxin Type A.

    Science.gov (United States)

    Steinsapir, Kenneth D; Groth, Michael J; Boxrud, Cynthia A

    2015-07-01

    Upper eyelid ptosis after cosmetic botulinum toxin is generally considered short-lived and responsive to apraclonidine ophthalmic drops. The authors present a series with persistent ptosis. To report a series of patients with persistent upper eyelid ptosis after cosmetic botulinum toxin. A retrospective case review series of 7 patients referred for management after developing visually significant upper eyelid ptosis after cosmetic botulinum toxin type A treatment. Patients in this series experienced persistent visually significant ptosis after cosmetic botulinum toxin lasting from 6 weeks to 13 months. Six of the 7 patients were treated with apraclonidine ophthalmic solution. Apraclonidine drops appeared to be clinically effective within 4 to 6 weeks of the resolution of ptosis. Upper eyelid ptosis after cosmetic botulinum toxin can persist for many months after treatment. Based on this series, the authors propose that apraclonidine drops can be used at the time of initial assessment to predict the relative longevity of ptosis after cosmetic botulinum toxin treatment (Level 4 evidence recommendation). After a 1-week trial, responders can be advised that ptosis is likely to resolve in 4 to 6 weeks. Nonresponders should be counseled that resolution may take longer than 6 weeks.

  7. Ten Years of Results of Modified Frontalis Muscle Transfer for the Correction of Blepharoptosis.

    Science.gov (United States)

    Kim, Woo Jeong; Park, Dae Hwan; Han, Dong Gil

    2016-03-01

    Conventional frontalis transfer may cause a range of complications. In order to overcome complications, we made modifications to the surgical technique, and compared the outcomes of patients who underwent conventional frontalis transfer with those of patients who underwent modified frontalis transfer. We conducted a retrospective study of 48 patients (78 eyes) who underwent conventional frontalis transfer between 1991 and 2003 (group A) and 67 patients (107 eyes) who underwent modified frontalis transfer between 2004 and 2014 (group B). The frontalis transfer procedures were modified conform to the following principles. The tip of the frontalis muscle flap included soft tissue that was as thick as possible and the soft tissue on the tarsal plate was removed to the greatest extent possible. A double fold was created in cases of unilateral ptosis. In order to evaluate the objective effects of modification, preoperative and postoperative values of the marginal distance reflex 1 (MRD1), the corneal exposure area, and the decrease in eyebrow height were compared between the two groups. In group A, patients showed an improvement of 1.19 mm in the MRD1, a 6.31% improvement in the corneal exposure area, and a 7.82 mm decrease in eyebrow height. In group B, patients showed an improvement of 2.17 mm in the MRD1, an 8.39% improvement in the corneal exposure area, and an 11.54 mm decrease in eyebrow height. The improvements in group B were significantly greater than those in group A. Modified frontalis transfer showed better results than the conventional procedure and provided satisfactory outcomes.

  8. Ten Years of Results of Modified Frontalis Muscle Transfer for the Correction of Blepharoptosis

    Directory of Open Access Journals (Sweden)

    Woo Jeong Kim

    2016-03-01

    Full Text Available BackgroundConventional frontalis transfer may cause a range of complications. In order to overcome complications, we made modifications to the surgical technique, and compared the outcomes of patients who underwent conventional frontalis transfer with those of patients who underwent modified frontalis transfer.MethodsWe conducted a retrospective study of 48 patients (78 eyes who underwent conventional frontalis transfer between 1991 and 2003 (group A and 67 patients (107 eyes who underwent modified frontalis transfer between 2004 and 2014 (group B. The frontalis transfer procedures were modified conform to the following principles. The tip of the frontalis muscle flap included soft tissue that was as thick as possible and the soft tissue on the tarsal plate was removed to the greatest extent possible. A double fold was created in cases of unilateral ptosis. In order to evaluate the objective effects of modification, preoperative and postoperative values of the marginal distance reflex 1 (MRD1, the corneal exposure area, and the decrease in eyebrow height were compared between the two groups.ResultsIn group A, patients showed an improvement of 1.19 mm in the MRD1, a 6.31% improvement in the corneal exposure area, and a 7.82 mm decrease in eyebrow height. In group B, patients showed an improvement of 2.17 mm in the MRD1, an 8.39% improvement in the corneal exposure area, and an 11.54 mm decrease in eyebrow height. The improvements in group B were significantly greater than those in group A.ConclusionsModified frontalis transfer showed better results than the conventional procedure and provided satisfactory outcomes.

  9. Relationship between ocular dominance and brow position in patients with blepharoptosis.

    Science.gov (United States)

    Thorne, Andrew W; Chundury, Rao V; Perry, Julian D; Rootman, Daniel B

    2017-10-20

    This study aims to determine if ocular dominance plays a role in predicting compensatory eyebrow elevation in cases of ptosis. This retrospective observational cohort study screened all individuals presenting to two tertiary oculoplastics practices with complaints of ptosis for entry. Primary position photographs were obtained. Ocular dominance was assessed via a modified Porta test. Ptosis was defined in bilateral cases as marginal reflex distance of MRD1 MRD1 of >1 mm lower on one side. Asymmetry in brow height was defined as a difference of >1 mm. Chi square and t-tests were performed. Sixty-eight patients from the both tertiary practices met inclusion criteria (37 male, 31 female). Concordance between the higher brow and the dominant side was 50.0% (n = 22, p > 0.05). Mean brow height on the dominant side (15.5 mm) was not statistically different than brow height on the non-dominant side (15.3 mm, p > 0.05). The concordance between the higher brow and the lower MRD1 eyelid was not significant (45.5%, n = 20, p > 0.05). The difference in mean brow height between the lower and higher MRD1 eyes was not significantly different (-0.11 mm; p > 0.05). This also held true when restricted to unilateral cases (0.28; p > 0.05). Although asymmetric brow elevation can be noted in patients with ptosis, ocular dominance does not appear to be concordant with this asymmetry. Additionally, brow height does not appear to be concordant with MRD1 in cases of ptosis.

  10. Ten Years of Results of Modified Frontalis Muscle Transfer for the Correction of Blepharoptosis

    OpenAIRE

    Woo Jeong Kim; Dae Hwan Park; Dong Gil Han

    2016-01-01

    Background Conventional frontalis transfer may cause a range of complications. In order to overcome complications, we made modifications to the surgical technique, and compared the outcomes of patients who underwent conventional frontalis transfer with those of patients who underwent modified frontalis transfer. Methods We conducted a retrospective study of 48 patients (78 eyes) who underwent conventional frontalis transfer between 1991 and 2003 (group A) and 67 patients (107 eyes) who underw...

  11. Not only hard contact lens wear but also soft contact lens wear may be associated with blepharoptosis

    NARCIS (Netherlands)

    I. Bleyen (Isabel); C.A. Hiemstra; T. Devogelaere (Thibaut); W.A. van den Bosch (Willem); R.J. Wubbels (René J.); A.D.A. Paridaens (Dion)

    2011-01-01

    textabstractObjective: The authors attempt to establish an association between prolonged hard and soft contact lens wear and ptosis. Design: Single-center retrospective consecutive series. Participants: All patients between 18 and 50 years of age who were diagnosed with unilateral or bilateral

  12. Comparison of Two Methods for Upper Lid Fascia Lata Sling in Congenital Blepharoptosis: a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Abbas Bagheri

    2008-12-01

    Full Text Available

    PURPOSE: To compare the results of two different methods of upper lid sling with autogenous fascia lata in the treatment of congenital ptosis. METHODS: In a randomized clinical trial, patients with congenital upper lid ptosis and poor levator function (< 4mm were randomly assigned to two different methods of upper lid sling: group A, bitriangular fascia sling (modified Crawford method and group B, monotriangular fascia sling (modified Fox method. RESULTS:  This study included 30 upper eyelids (15 eyelids in each surgical group of 19 patients (8 unilateral and 11 bilateral cases with congenital ptosis. Mean increase in eyelid fissure height was 2.7±2.3 mm in group A and 3.4±2.2 mm in group B, respectively. Change in eyelid fissure in both groups was significant (P < 0.001, paired t-test but intergroup difference was not (P=0.4, independent sample t-test. Early complications such as corneal epithelial defects and entropion, and late complications such as undercorrection were comparable in the two groups. No patient experienced recurrent ptosis requiring reoperation in either group. CONCLUSION:  The monotriangular method of upper lid fascia sling can be used instead of the more popular bitriangular method. Advantages include less need for fascial tissue, less periocular scar formation and a shorter period of anesthesia.

  13. Clinical outcomes of conjunctiva-Müller muscle resection: association with phenylephrine test-negative blepharoptosis and dry eye syndrome.

    Science.gov (United States)

    Wee, Sung Wook; Lee, Jeong Kyu

    2014-05-01

    The aim of this study was to investigate the clinical outcomes of conjunctiva-Müller muscle resection (CMMR) in patients with mild to moderate ptosis, the factors related to successful procedures, and the influence of CMMR on dry eye symptoms and signs. In a tertiary university hospital, the medical records of 30 patients who had CMMR were retrospectively reviewed, including the detailed preoperative and postoperative eyelid measurements, surgical outcomes, and dry eye evaluations. Inclusion criteria included older than 18 years, acquired ptosis, and no previous eyelid surgery or trauma. The surgery had a success rate of 86.7%. In the patients who responded to phenylephrine application with a marginal reflex distance 1 (MRD1) increase of more than 2 mm, the postoperative MRD1 correction was 2.41 ± 0.84 mm, whereas the postoperative MRD1 correction was 1.19 ± 0.78 mm in the group with responses of less than 2 mm. The postoperative MRD1 correction was 1.21 ± 0.80 mm in the group with a negative response. Seven patients complained of dry eye symptoms and showed a transiently significant aggravation in the Schirmer test and ocular surface disease index score after the procedure, which normalized within 2 months postoperatively. Responsiveness to phenylephrine is directly correlated with the postoperative results. Nevertheless, even in the patients with negative phenylephrine response, some degree of eyelid elevation can be expected. Damage to goblet cells after the procedure may result in defective tear production, leading to transient aggravation of dry eye symptoms.

  14. Symmetry of Upper Eyelid Contour After Unilateral Blepharoptosis Repair With a Single-strip Frontalis Suspension Technique.

    Science.gov (United States)

    Akaishi, Patricia; Galindo-Ferreiro, Alicia; Cruz, Antonio A V

    2018-01-10

    To analyze the upper eyelid contour of patients with unilateral congenital ptosis who underwent single-strip frontalis suspension. The authors compared the upper eyelid shape of the right and left eyes of 10 patients who underwent unilateral frontalis suspension with a single strip of autogenous fascia. At a mean postoperative time of 10.1 ± 4.01 months, the image J software was used to measure the ratio between the nasal and temporal areas of the upper half of the palpebral fissure. The midpupil upper eyelid distance (MRD1) was also measured on the photos with the same software. The nonparametric Wilcoxon signed-rank test was used to compare the data. Postoperative MRD1 ranged from 2.5 to 4.7 mm (median = 3.8) on the affected side. The MRD1 for nonoperated eyelid ranged from 1.8 to 5.0 mm (median = 3.5). On the operated side, the temporal areas ranged from 50.3 to 85.7 mm (median 65.2) and nasal areas ranged from 41.5 to 72.3 (the median was 60.1). In the contralateral, nonoperated palpebral fissures, the temporal areas ranged from 42.7 to 94.3 mm (median = 54.5) and the nasal areas ranged from 36.8 to 86.1 mm (median 52.3). The T/N ratio distributions were almost identical between groups, ranging from 0.9 to 1.2 (median = 1.1) in the operated eyes and from 0.9 to 1.3 (median = 1.1) in the fellow eyes. In autogenous fascia frontalis suspension procedures, the upper eyelid contour of the ptotic eyelids can be adequately normalized with a single area of traction on the tarsal plate.

  15. Ptosis - infants and children

    Science.gov (United States)

    Blepharoptosis - children; Congenital ptosis; Eyelid drooping - children; Eyelid drooping - amblyopia; Eyelid drooping - astigmatism ... Ptosis in infants and children is often due to a problem with the muscle that raises the eyelid. A nerve problem in the eyelid can ...

  16. Ptosis repair.

    Science.gov (United States)

    Ng, John; Hauck, Matthew J

    2013-02-01

    Acquired blepharoptosis presents as both a functional and cosmetic problem commonly encountered by facial plastic surgeons. Ptosis repair can be both challenging and frustrating, especially given ever-increasing demands for an optimal cosmetic surgical result. The authors present a brief overview of key points to consider when attempting to achieve excellent blepharoptosis repair outcomes. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. Predictive images of postoperative levator resection outcome using image processing software.

    Science.gov (United States)

    Mawatari, Yuki; Fukushima, Mikiko

    2016-01-01

    This study aims to evaluate the efficacy of processed images to predict postoperative appearance following levator resection. Analysis involved 109 eyes from 65 patients with blepharoptosis who underwent advancement of levator aponeurosis and Müller's muscle complex (levator resection). Predictive images were prepared from preoperative photographs using the image processing software (Adobe Photoshop ® ). Images of selected eyes were digitally enlarged in an appropriate manner and shown to patients prior to surgery. Approximately 1 month postoperatively, we surveyed our patients using questionnaires. Fifty-six patients (89.2%) were satisfied with their postoperative appearances, and 55 patients (84.8%) positively responded to the usefulness of processed images to predict postoperative appearance. Showing processed images that predict postoperative appearance to patients prior to blepharoptosis surgery can be useful for those patients concerned with their postoperative appearance. This approach may serve as a useful tool to simulate blepharoptosis surgery.

  18. Predictive images of postoperative levator resection outcome using image processing software

    Directory of Open Access Journals (Sweden)

    Mawatari Y

    2016-09-01

    Full Text Available Yuki Mawatari,1 Mikiko Fukushima2 1Igo Ophthalmic Clinic, Kagoshima, 2Department of Ophthalmology, Faculty of Life Science, Kumamoto University, Chuo-ku, Kumamoto, Japan Purpose: This study aims to evaluate the efficacy of processed images to predict postoperative appearance following levator resection.Methods: Analysis involved 109 eyes from 65 patients with blepharoptosis who underwent advancement of levator aponeurosis and Müller’s muscle complex (levator resection. Predictive images were prepared from preoperative photographs using the image processing software (Adobe Photoshop®. Images of selected eyes were digitally enlarged in an appropriate manner and shown to patients prior to surgery.Results: Approximately 1 month postoperatively, we surveyed our patients using questionnaires. Fifty-six patients (89.2% were satisfied with their postoperative appearances, and 55 patients (84.8% positively responded to the usefulness of processed images to predict postoperative appearance.Conclusion: Showing processed images that predict postoperative appearance to patients prior to blepharoptosis surgery can be useful for those patients concerned with their postoperative appearance. This approach may serve as a useful tool to simulate blepharoptosis surgery. Keywords: levator resection, blepharoptosis, image processing, Adobe Photoshop® 

  19. Periorbital scleroderma associated with heterochromia iridis.

    Science.gov (United States)

    Stone, R A; Scheie, H G

    1980-12-01

    Two patients had biopsy-proven linear scleroderma, associated with a pigmentary abnormality of the anterior segment of the eye. One patient had heterochromia iridis, atrophy of the upper eyelid, a typical coup de sabre lesion, and a markedly asymmetric pigmentary glaucoma. The second patient had bilateral scalp involvement, paresis of the extraocular muscles, blepharoptosis, and heterochromia iridis.

  20. Congenital Fibrosis of the Extraocular Muscles

    Directory of Open Access Journals (Sweden)

    Leyla Niyaz

    2014-08-01

    Full Text Available Congenital fibrosis of the extraocular muscles (CFEOM is a rare disorder characterized by hereditary non-progressive restrictive strabismus and blepharoptosis. Although most of the cases are bilateral and isolated, some patients may have systemic findings. CFEOM is divided into three groups as CFEOM 1, 2, and 3 according to the phenotype. Primary responsible genes are KIF21A for CFEOM type 1 and 3 and PHOX2A/ARIX gene for CFEOM type 2. Studies suggest that abnormal innervation of the extraocular muscles is the cause of muscle fibrosis. Early treatment is important because of the risk of amblyopia. Surgery is the primary treatment option for strabismus and blepharoptosis. (Turk J Ophthalmol 2014; 44: 312-5

  1. Skin Necrosis with Oculomotor Nerve Palsy Due to a Hyaluronic Acid Filler Injection

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    Jae Il Lee

    2017-07-01

    Full Text Available Performing rhinoplasty using filler injections, which improve facial wrinkles or soft tissues, is relatively inexpensive. However, intravascular filler injections can cause severe complications, such as skin necrosis and visual loss. We describe a case of blepharoptosis and skin necrosis caused by augmentation rhinoplasty and we discuss the patient’s clinical progress. We describe the case of a 25-year-old female patient who experienced severe pain, blepharoptosis, and decreased visual acuity immediately after receiving a filler injection. Our case suggests that surgeons should be aware of nasal vascularity before performing an operation, and that they should avoid injecting fillers at a high pressure and/or in excessive amounts. Additionally, filler injections should be stopped if the patient complains of severe pain, and appropriate measures should be taken to prevent complications caused by intravascular filler injections.

  2. Hemangiopericitoma de órbita Orbital hemangiopericytoma

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    Ana Paula Ximenes Alves

    2001-04-01

    Full Text Available Objetivo: Descrever um raro caso de hemangiopericitoma orbital. Métodos: Relato de caso de associação entre hemangipericitoma orbital e blefaroptose. Resultados: A exérese da neoplasia normalizou o posicionamento palpebral. Conclusões: Lesões orbitais anteriores são causas de blefaroptose por compressão do músculo elevador palpebral.Purpose: To describe a rare case of orbital hemangiope- ricytoma. Methods: Case report of an association of blepha-roptosis with orbital hemangiopericytoma. Results: When the lesion was surgically removed the position of the upper eyelid returned to normal. Conclusions: Anterior orbital lesions can lead to blepharoptosis by compression of the levator palpebrae muscle.

  3. 3D printing for low cost, rapid prototyping of eyelid crutches.

    Science.gov (United States)

    Sun, Michael G; Rojdamrongratana, Duangmontree; Rosenblatt, Mark I; Aakalu, Vinay K; Yu, Charles Q

    2018-03-02

    Blepharoptosis or ptosis is a common and potentially debilitating clinical problem. Long-term surgical treatment for ptosis caused by progressive myopathies can be challenging due to potential recurrence and complications associated with facial muscle weakness. When surgical treatment is no longer effective, an eyelid crutch can be used as an alternative intervention. This report demonstrates how 3D printing was used to rapidly design, prototype, and manufacture new custom-fit eyelid crutches at a low cost.

  4. Traumatic superior orbital fissure syndrome: a rare case report

    OpenAIRE

    Eskitascioglu, Teoman; Yontar, Yalcin; Aydin, Ahmet; Tucer, Bulent

    2017-01-01

    Superior orbital fissure syndrome is a severe clinical entity characterized by injuries of neurovascular structures passing through the superior orbital fissure. A 38-year-old male patient admitted to outpatient clinic with left upper eyelid ptosis, ecchymosis, mydriasis, hypoesthesia in upper eyelid and frontal region, blepharoptosis, restriction of ocular movements in all directions, loss of accommodation reflex and absence of direct pupillary reflex. Three-dimensional computed tomography s...

  5. Michels syndrome: The first case report from India and review of literature

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    Adedayo A Adio

    2014-01-01

    Full Text Available A 2-year 7-month-old girl born out of a consanguineous marriage, presented at our facility with clinical features characterized by the eyelid triad of blepharophimosis, blepharoptosis and epicanthus inversus in association with hypertelorism, cleft palate and craniosynostosis. This constellation of features is suggestive of Michels syndrome. At the time of writing this report, there were only ten reported cases worldwide and to the best of our knowledge, there have been no published reports from India.

  6. Simultaneous Double Eyelid Blepharoplasty and Ptosis Correction with a Single-Knot, Continuous, Nonincisional Technique: A Five-Year Review.

    Science.gov (United States)

    Hu, Jung-Woo; Byeon, Jun Hee; Shim, Hyung-Sup

    2016-01-01

    Double eyelid blepharoplasty is one of the most popular facial cosmetic surgeries performed in patients with Asian eyelids. Although most patients choose to undergo blepharoplasty for cosmetic purposes, rather than functional reasons, these patients frequently present with concomitant mild-to-moderate blepharoptosis. Performing nonincisional double eyelid surgery without correcting the ptosis tends to lead to unsatisfactory results. The authors introduce our new method for simultaneous correction of blepharoptosis during double eyelid blepharoplasty. For 5 years, the authors have performed a single-knot continuous nonincisional technique for simultaneous correction of blepharoptosis during double eyelid blepharoplasty. The medical charts of 127 patients (254 eyelids) were retrospectively reviewed. Müller muscle tagging suture was utilized to achieve the accurate amount of Müller tucking during the surgery. There was a statistically significant difference between pretreatment MRD1 (1.62 ± 0.57 mm), and postoperative MRD1 (3.97 ± 0.81 mm; P < .001, Wilcoxon signed rank test, nonparametric paired comparison). The mean duration of surgery for both eyelids was 14.8 minutes (range, 14.1-19.7 minutes), and the mean extent of Müller muscle tucking was 7.8 mm (range, 6.0-10.0 mm). The majority of patients showed favorable results during long-term follow-up, with minimal complications. There are no previously published articles documenting simultaneous double eyelid blepharoplasty and ptosis correction, using a single-knot continuous nonincisional technique. The authors suggest our simple and effective method is a good option for double eyelid blepharoplasty in cases with mild-to-moderate blepharoptosis.' LEVEL OF EVIDENCE 4: Therapeutic. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  7. Influence of upper and temporal transconjunctival sclerocorneal incision on marginal reflex distance after cataract surgery

    OpenAIRE

    Tamaki, Rikiya; Gosho, Masahiko; Mizumoto, Kyoichi; Kato, Nahoko; Zako, Masahiro

    2016-01-01

    Background Ptosis incidence following cataract surgery is reduced with a recently developed phacoemulsification technique using a small incision. However, it remains uncertain whether an upper transconjunctival sclerocorneal incision can cause minor blepharoptosis. In the present prospective study, patients underwent cataract surgery with either an upper or temporal 2.4-mm transconjunctival sclerocorneal incision. We measured the marginal reflex distance 1 (MRD1) preoperatively and postoperat...

  8. Endoscope-assisted harvest of autogenous fascia lata in frontalis suspension surgery: A minimally invasive approach revisited

    Science.gov (United States)

    Naik, Abhijit; Patel, Anamika; Bothra, Nandini; Panda, Lapam; Naik, Milind N; Rath, Suryasnata

    2018-01-01

    Purpose: To report endoscope-assisted fascia lata harvest (EAFH) as a minimally-invasive technique for correction of severe blepharoptosis. Methods: This was a retrospective case series between January 2013 and April 2017. Medical records of all consecutive patients who underwent frontalis suspension by EAFH in the study period were reviewed and outcome was analyzed. Results: Fourteen patients (10 males) were included in the study. Mean age of the group was 18.14 + 17.03 years (range 4-65 years) and 11 patients had simple congenital blepharoptosis. Blepharophimosis syndrome was seen in 3 patients. Eleven patients had bilateral blepharoptosis. The mean preoperative and postoperative MRD1 was –1.60 ± 0.87 mm and +2.12 ± 1.37 mm respectively. Mean lengths of the incision and fascial harvest were 2.25 ± 0.43 cm and 13.0 ± 2.35 cm (range 10-17 cm) respectively. The median follow-up of patients was 4.57 + 4.03 months (range 1-15 months). Complications included a wound dehiscence in two patients and these were resutured. The donor sites healed well in all patients leaving a small thigh scar and none needed scar revision. Conclusion: EAFH is a promising minimally-invasive technique performed with a small incision and achieved adequate length of fascial harvest. PMID:29480260

  9. Endoscope-assisted harvest of autogenous fascia lata in frontalis suspension surgery: A minimally invasive approach revisited

    Directory of Open Access Journals (Sweden)

    Abhijit Naik

    2018-01-01

    Full Text Available Purpose: To report endoscope-assisted fascia lata harvest (EAFH as a minimally-invasive technique for correction of severe blepharoptosis. Methods: This was a retrospective case series between January 2013 and April 2017. Medical records of all consecutive patients who underwent frontalis suspension by EAFH in the study period were reviewed and outcome was analyzed. Results: Fourteen patients (10 males were included in the study. Mean age of the group was 18.14 + 17.03 years (range 4-65 years and 11 patients had simple congenital blepharoptosis. Blepharophimosis syndrome was seen in 3 patients. Eleven patients had bilateral blepharoptosis. The mean preoperative and postoperative MRD1 was –1.60 ± 0.87 mm and +2.12 ± 1.37 mm respectively. Mean lengths of the incision and fascial harvest were 2.25 ± 0.43 cm and 13.0 ± 2.35 cm (range 10-17 cm respectively. The median follow-up of patients was 4.57 + 4.03 months (range 1-15 months. Complications included a wound dehiscence in two patients and these were resutured. The donor sites healed well in all patients leaving a small thigh scar and none needed scar revision. Conclusion: EAFH is a promising minimally-invasive technique performed with a small incision and achieved adequate length of fascial harvest.

  10. Comparison of two- and three-point sutures for advancing the levator aponeurosis in Asian eyelids.

    Science.gov (United States)

    Kim, Y S; Yoon, J S; Jang, S Y

    2015-09-01

    To compare the functional and cosmetic outcomes of two- and three-point sutures for advancing the levator aponeurosis in blepharoptosis surgery on Asians. This retrospective study examined 60 Asian patients with blepharoptosis who had undergone advancement of the levator aponeurosis: 34 patients (46 eyelids) had ptosis correction using the two-point suture technique and 26 patients (41 eyelids) had ptosis correction using the three-point suture technique. The postoperative marginal reflex distance (MRD1), lid height difference, and eyelid contour were evaluated. Twenty-seven (79.4%) of the 34 patients in the two-point group and 19 (73.1%) of 26 patients in the three-point group had a postoperative MRD1 of 2-4 mm, lids within 0.5 mm of each other, and a satisfactory eyelid contour; this difference was not significant. The rate of reoperation did not differ significantly between the two groups. Two- and three-point sutures for advancing the levator aponeurosis were equally effective for correcting blepharoptosis in Asians.

  11. Endoscope-assisted harvest of autogenous fascia lata in frontalis suspension surgery: A minimally invasive approach revisited.

    Science.gov (United States)

    Naik, Abhijit; Patel, Anamika; Bothra, Nandini; Panda, Lapam; Naik, Milind N; Rath, Suryasnata

    2018-03-01

    To report endoscope-assisted fascia lata harvest (EAFH) as a minimally-invasive technique for correction of severe blepharoptosis. This was a retrospective case series between January 2013 and April 2017. Medical records of all consecutive patients who underwent frontalis suspension by EAFH in the study period were reviewed and outcome was analyzed. Fourteen patients (10 males) were included in the study. Mean age of the group was 18.14 + 17.03 years (range 4-65 years) and 11 patients had simple congenital blepharoptosis. Blepharophimosis syndrome was seen in 3 patients. Eleven patients had bilateral blepharoptosis. The mean preoperative and postoperative MRD1 was -1.60 ± 0.87 mm and +2.12 ± 1.37 mm respectively. Mean lengths of the incision and fascial harvest were 2.25 ± 0.43 cm and 13.0 ± 2.35 cm (range 10-17 cm) respectively. The median follow-up of patients was 4.57 + 4.03 months (range 1-15 months). Complications included a wound dehiscence in two patients and these were resutured. The donor sites healed well in all patients leaving a small thigh scar and none needed scar revision. EAFH is a promising minimally-invasive technique performed with a small incision and achieved adequate length of fascial harvest.

  12. Conjunctiva-Sparing Posterior Ptosis Surgery: A Novel Approach.

    Science.gov (United States)

    Vrcek, Ivan; Hogan, Robert N; Rossen, Jennifer; Mancini, Ronald

    2016-01-01

    Müller's muscle conjunctiva resection is a well-established means of correcting blepharoptosis. The primary objective of this prospective study was to determine if modifying Müller's muscle conjunctiva resection by sparing the conjunctiva would accomplish successful repair while allowing patients to retain their conjunctiva. The potential advantages of preserving conjunctiva are significant and include: conservation of an anatomically normal tissue, retention of goblet cells, reduction of suture-related complications such as corneal irritation or abrasion as the conjunctiva covers the suture during postoperative healing, and preservation of conjunctiva for potential future surgical procedures critical to ocular health. This is a prospective study enrolling patients with mild to moderate ptosis. The procedure has been performed in 18 patients and 30 eyelids. Follow up at 1 week revealed normal healing with expected postoperative edema and ecchymosis. Notably, all patients were free of any corneal abrasion or irritation. Follow up at 1 month and a minimum of 3 months (average 5.7 months) revealed that all patients had satisfactory correction of their blepharoptosis with Margin Reflex Distance 1 (MRD1) improvement to within 1 mm of the anticipated goal, preserved eyelid margin contour, and good symmetry (average 0.26 mm difference in MRD1 between the sides). These results show an effective correction of blepharoptosis with a favorable cosmetic outcome and low postoperative complication rate; all while preserving the conjunctiva.

  13. Horner's Syndrome Incidental to Medullary Thyroid Carcinoma Excision: Case Report and Brief Literature Review

    Science.gov (United States)

    Mastronikolis, Nicholas S.; Spiliopoulou, Sofia P.; Zolota, Vassiliki; Papadas, Theodoros A.

    2016-01-01

    Horner's syndrome is characterized by a combination of ipsilateral miosis, blepharoptosis, enophthalmos, facial anhidrosis, and iris heterochromia in existence of congenital lesions. The syndrome results from a disruption of the ipsilateral sympathetic innervation of the eye and ocular adnexa at different levels. Though rare, thyroid and neck surgery could be considered as possible causes of this clinical entity. We present a case of Horner's syndrome in a patient after total thyroidectomy and neck dissection for medullary thyroid cancer with neck nodal disease and attempt a brief review of the relevant literature. PMID:27200201

  14. Horner’s Syndrome Incidental to Medullary Thyroid Carcinoma Excision: Case Report and Brief Literature Review

    Directory of Open Access Journals (Sweden)

    Nicholas S. Mastronikolis

    2016-01-01

    Full Text Available Horner’s syndrome is characterized by a combination of ipsilateral miosis, blepharoptosis, enophthalmos, facial anhidrosis, and iris heterochromia in existence of congenital lesions. The syndrome results from a disruption of the ipsilateral sympathetic innervation of the eye and ocular adnexa at different levels. Though rare, thyroid and neck surgery could be considered as possible causes of this clinical entity. We present a case of Horner’s syndrome in a patient after total thyroidectomy and neck dissection for medullary thyroid cancer with neck nodal disease and attempt a brief review of the relevant literature.

  15. Mild Ptosis Correction with the Stitch Method During Incisional Double Fold Formation

    Directory of Open Access Journals (Sweden)

    Edward Ilho Lee

    2014-01-01

    Full Text Available BackgroundNumerous methods exist for simultaneous correction of mild blepharoptosis during double eyelid surgery. These methods are generally categorized into either incisional (open or non-incisional (suture methods. The incisional method is commonly used for the creation of the double eyelid crease in patients with excessive or thick skin. However, concurrent open ptosis correction is often marred by the lengthy period of intraoperative adjustment, causing more swelling, a longer recovery time, and an increased risk of postoperative complications.MethodsThe authors have devised a new, minimally invasive technique to alleviate mild ptosis during incisional double eyelid surgery. The anterior lamella is approached through the incisional technique for the creation of a double eyelid while the posterior lamella, including Muller's and levator muscles, is approached with the suture method for Muller's plication and ptosis correction.ResultsThe procedure described was utilized in 28 patients from June 2012 to August 2012. Postoperative asymmetry was noted in one patient who had severe preoperative conjunctival scarring. Otherwise, ptosis was corrected as planned in the rest of the cases and all of the patients were satisfied with their postoperative appearance and experienced no complications.ConclusionsOur hybrid technique combines the benefits of both the incisional and suture methods, allowing for a predictable and easily reproducible correction of blepharoptosis with an aesthetically pleasing double eyelid.

  16. Bilateral lid/brow elevation procedure for severe ptosis in Kearns-Sayre syndrome, a mitochondrial cytopathy

    Science.gov (United States)

    Sebastiá, Roberto; Fallico, Ester; Fallico, Matteo; Fortuna, Eduardo; Lessa, Sergio; Neto, Guilherme Herzog

    2015-01-01

    Background The purpose of this work was to determine the effectiveness and possible complications encountered with bilateral fascia lata lid suspension used to correct blepharoptosis in patients with Kearns-Sayre syndrome. Methods This was a retrospective study of seven patients with Kearns-Sayre syndrome who had a minimum of 1 year of follow-up. A bilateral fascia lata sling was used to correct the ptosis. Preoperative and postoperative measurements of the vertical lid fissure width (VFW) and marginal reflex distance (MRD) were performed. The Student’s t-test was used to analyze the results. Results The mean preoperative VFW and MRD measurements were 4±2.45 mm and 0.14±0.92 mm, respectively. The mean postoperative VFW and MRD measurements were 7.71±1.85 mm, and 2.86±1.69 mm, respectively. All preoperative and postoperative values were considered to be statistically significant (P<0.01). Adequate elevation of the lids was obtained in all patients, both functionally and aesthetically. All of the patients showed a mild symmetric postoperative inferior version lagophthalmos, and one patient developed corneal ulceration and scarring due to corneal exposure and a weak Bell’s phenomenon. Conclusion The surgical technique described to correct the blepharoptosis found in patients with Kearns-Sayre syndrome was found to be efficient and relatively safe. The correction should be conservative to decrease the risk of postoperative corneal damage that occurred in one patient. PMID:25565765

  17. Central Retinal and Posterior Ciliary Artery Occlusion After Intralesional Injection of Sclerosant to Glabellar Subcutaneous Hemangioma

    International Nuclear Information System (INIS)

    Matsuo, Toshihiko; Fujiwara, Hiroyasu; Gobara, Hideo; Mimura, Hidefumi; Kanazawa, Susumu

    2009-01-01

    The aim of this study is to describe vision loss caused by central retinal artery and posterior ciliary artery occlusion as a consequence of sclerotherapy with a polidocanol injection to a glabellar hemangioma. An 18-year-old man underwent direct injection with a 23-gauge needle of 1 mL of a polidocanol-carbon dioxide emulsion into the glabellar subcutaneous hemangioma under ultrasound visualization of the needle tip by radiologists. He developed lid swelling the next day, and 3 days later at referral, the visual acuity in the left eye was no light perception. Funduscopy revealed central retinal artery occlusion and fluorescein angiography disclosed no perfusion at all in the left fundus, indicating concurrent posterior ciliary artery occlusion. The patient also showed mydriasis, blepharoptosis, and total external ophthalmoplegia on the left side. Magnetic resonance imaging demonstrated the swollen medial rectus muscle. In a month, blepharoptosis and ophthalmoplegia resolved but the visual acuity remained no light perception. Sclerosing therapy for facial hemangioma may develop a severe complication such as permanent visual loss.

  18. Traumatic Globe Subluxation and Intracranial Injury Caused by Bicycle Brake Handle.

    Science.gov (United States)

    Poroy, Ceren; Cibik, Cansu; Yazici, Bulent

    2016-09-01

    Penetration of a bicycle brake handle into the orbit is a rare and serious type of trauma. Globe subluxation due to such trauma has not been previously reported. A 10-year-old girl presented after falling from a bicycle, which resulted in the handbrake penetrating her right upper eyelid. On examination, the globe was subluxated anteriorly, there was no light perception, and the pupilla was fixed and dilated. Radiologic studies revealed orbitonasal fractures, hemorrhage, emphysema in the orbit and cranium, and rupture of the extraocular muscles. The globe was replaced into the orbit with the help of lateral cantholysis and orbital septotomy. During 22 months of follow-up, the globe remained intact, but total loss of vision, blepharoptosis, and extraocular motility restriction persisted. This case and previous reports show that bicycle brake handles can cause severe, penetrating orbital and cerebral traumas that can result in vision loss or fatality. Brake handles should be designed to protect bicyclists from such injuries.

  19. Naphazoline as a confounder in the diagnosis of carotid artery dissection.

    Science.gov (United States)

    Pemberton, John D; MacIntosh, Peter W; Zeglam, Ahmaida; Fay, Aaron

    2015-01-01

    Diagnosing Horner Syndrome can be difficult in the setting of an incomplete triad. A 27-year-old man presented with unilateral eyelid droop and intermittent ipsilateral headaches, having already seen 7 physicians. Physical examination revealed unilateral ptosis but no pupillary miosis or facial anhidrosis. Inspection of his clinical photographs revealed elevation of the ipsilateral lower eyelid, suggesting sympathetic dysfunction. On further questioning, he admitted to naphazoline dependence. Reexamination after ceasing the naphazoline unveiled the anisocoria. Vascular imaging subsequently revealed carotid dissection, and the patient was started on anticoagulant and antiplatelet therapy. The ptosis persisted after conjunctival Müllerectomy. External levator resection was recommended, but patient declined. This case underscores the importance of clinical photography, meticulous medical record review, and complete medication history including over-the-counter preparations. Clinicians should meticulously inspect the lower eyelid in cases of atypical blepharoptosis and consider the effects of eye drops when inspecting pupils for miosis.

  20. [The aging eyelid].

    Science.gov (United States)

    Press, U P

    2010-01-01

    Surgery of the aging eyelid makes great demands on the oculoplastic surgeon regarding preoperative diagnostics as well as choosing the ideal surgical method. This is not only important regarding reconstructive anatomic function but also for aesthetic aspects. This paper gives a résumé of modern diagnostics and therapy of the involutional syndrome of the eyelid. Treating ptosis of the eyebrow, blepharoplasty, blepharoptosis as well as malposition of the lower lid such as ectropion and entropion not only has an impact on the visual system but also on the individual facial features. Considering and treating this makes the highest demands on the oculoplastic surgeon to consider and treat the above problens in order to achieve ideal results. (c)Georg Thieme Verlag KG Stuttgart New York.

  1. [Secondary orbital lymphoma].

    Science.gov (United States)

    Basanta, I; Sevillano, C; Álvarez, M D

    2015-09-01

    A case is presented of an 85 year-old Caucasian female with lymphoma that recurred in the orbit (secondary ocular adnexal lymphoma). The orbital tumour was a diffuse large B-cell lymphoma according to the REAL classification (Revised European-American Lymphoma Classification). Orbital lymphomas are predominantly B-cell proliferations of a variety of histological types, and most are low-grade tumours. Patients are usually middle-aged or elderly, and it is slightly more common in women. A palpable mass, proptosis and blepharoptosis are the most common signs of presentation. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  2. Evidence of an asymmetrical endophenotype in congenital fibrosis of extraocular muscles type 3 resulting from TUBB3 mutations.

    Science.gov (United States)

    Demer, Joseph L; Clark, Robert A; Tischfield, Max A; Engle, Elizabeth C

    2010-09-01

    Orbital magnetic resonance imaging (MRI) was used to investigate the structural basis of motility abnormalities in congenital fibrosis of the extraocular muscles type 3 (CFEOM3), a disorder resulting from missense mutations in TUBB3, which encodes neuron-specific beta-tubulin isotype III. Ophthalmic examinations in 13 volunteers from four CFEOM3 pedigrees and normal control subjects, were correlated with TUBB3 mutation and MRI findings that demonstrated extraocular muscle (EOM) size, location, contractility, and innervation. Volunteers included clinically affected and clinically unaffected carriers of R262C and D417N TUBB3 amino acid substitutions and one unaffected, mutation-negative family member. Subjects with CFEOM3 frequently had asymmetrical blepharoptosis, limited vertical duction, variable ophthalmoplegia, exotropia, and paradoxical abduction in infraduction. MRI demonstrated variable, asymmetrical levator palpebrae superioris and superior rectus EOM atrophy that correlated with blepharoptosis, deficient supraduction, and small orbital motor nerves. Additional EOMs exhibited variable hypoplasia that correlated with duction deficit, but the superior oblique muscle was spared. Ophthalmoplegia occurred only when the subarachnoid width of CN3 was muscle misinnervation by CN3. Optic nerve (ON) cross sections were subnormal, but rectus pulley locations were normal. CFEOM3 caused by TUBB3 R262C and D417N amino acid substitutions features abnormalities of EOM innervation and function that correlate with subarachnoid CN3 hypoplasia, occasional abducens nerve hypoplasia, and subclinical ON hypoplasia that can resemble CFEOM1. Clinical and MRI findings in CFEOM3 are more variable than those in CFEOM1 and are often asymmetrical. Apparent LR innervation by the inferior rectus motor nerve is an overlapping feature of Duane retraction syndrome and CFEOM1. These findings suggest that CFEOM3 is an asymmetrical, variably penetrant, congenital cranial dysinnervation disorder

  3. Resection of amblyogenic periocular hemangiomas: indications and outcomes.

    Science.gov (United States)

    Arneja, Jugpal S; Mulliken, John B

    2010-01-01

    Periocular hemangiomas can induce irreversible amblyopia by multiple mechanisms: visual deprivation, refractive error (astigmatism and/or anisometropia), or strabismus. There is a subset of complicated periocular hemangiomas most effectively managed by resection. The authors reviewed all patients from 1999 to 2008 with a periocular hemangioma that was either completely resected or debulked; whenever necessary, the levator apparatus was reinserted. Infants were included in the study if they had complete preoperative and postoperative ophthalmic assessments and there was more than a 6-month follow-up interval. Thirty-three children were treated with a mean operative age of 6.2 months and a mean follow-up interval of 48.2 months. The majority of hemangiomas were well-localized and caused corneal deformation with astigmatism or blepharoptosis. Intralesional or oral corticosteroid administration was attempted in almost one-half of patients. Postoperatively, the degree of astigmatism was statistically improved: from 3.0 diopters to 1.11 diopters (p correction was slightly greater postoperatively (from 2.76 diopters to 0.80 diopters). Resection performed after 3 months (14 patients) of age also resulted in improvement of astigmatism (from 3.39 diopters to 1.38 diopters). Reinsertion of the levator expansion was required in 34 percent of patients. The authors advocate early resection of a well-localized periocular hemangioma to prevent potentially irreversible amblyopia caused by either corneal deformation or blepharoptosis. The longer a complicated periocular hemangioma is observed, the greater the astigmatism and the less amenable it will be to correction following tumor removal.

  4. Maximizing Symmetry in Upper Blepharoplasty: The Role of Microptosis Surgery.

    Science.gov (United States)

    Lew, Helen; Goldberg, Robert Alan

    2016-02-01

    Traditional descriptions of blepharoplasty and ptosis surgery focus on the incision and eyelid crease. However, it may be more useful to consider the tarsal platform show as the important construct in analyzing and planning aesthetic eyelid surgery. In order to measure and characterize the key contours of the eyelid, the authors find it helpful to consider the brow fat span, tarsal platform show, and margin reflex distance. Subtle eyelid ptosis can result in asymmetry by lengthening the tarsal platform show, and it is exacerbated by the tendency for the eyebrow to compensate. When ptosis is asymmetric, the plan should usually include asymmetric ptosis surgery. There are two general patterns that can be recognized and used for planning to address preoperative tarsal platform show asymmetry. If the tarsal platform show is longer on the side with worse blepharoptosis, then asymmetric or unilateral ptosis surgery will improve symmetry. In the cases of symmetric show despite asymmetric blepharoptosis, there may be bony and soft-tissue asymmetry, which leads to crowding of the orbit on the more ptotic side. Surgical planning should include consideration to increase the tarsal platform show on the more crowded side. It is not necessary to cut the eyelid skin in order to alter the tarsal show and brow fat span; ptosis surgery alone, by altering the eyelid position and eyebrow compensation, can reset the tarsal platform show/brow fat span relationship. It is important to recognize preoperative asymmetry, to predict the resetting of compensatory mechanisms, and to design asymmetric surgery, in order to maximize postoperative symmetry.

  5. Exogenous skeletal muscle satellite cells promote the repair of levator palpebrae superioris mechanical damage in rat.

    Science.gov (United States)

    Ye, Lin; Yao, Yuanyuan; Guo, Hui; Peng, Yun

    2018-04-13

    Blepharoptosis is a drooping of the upper eyelid, usually due to dysfunction of the levator palpebrae superioris (LPS). Recently, skeletal muscle satellite cells (SSCs) have been reported to promote the repair of damaged skeletal muscle. This study aims to investigate the potential contribution of exogenous SSCs to the regeneration of mechanically damaged LPS. Thirty-two rats were randomly divided into four groups, including control group, SSCs-treated group, SSCs-treated injury group and non-treated injury group. After rats in injury groups were artificially lacerated on both the left and right LPS, HBBS (Hank's Balanced Salt Solution) containing SSCs was injected into upper eyelid tissue. After 7 days, the LPS muscle tissues were excised. In addition, skeletal muscle cells (SMCs) and SSCs were co-cultured for use as an in vitro model, and the protective effects of SSCs on cultured SMCs were also investigated. Histological staining revealed that exogenous SSCs repaired the damaged muscle fibers and attenuated the fibrosis of LPS, possibly due to the increased level of IGF-1. In contrast, the level of IL-1β, IL-6, TGF-β1 and Smad2/3(phospho-T8) were significantly reduced in the SSCs-treated group. The in vitro model using co-culture of skeletal muscle cells (SMCs) and SSCs also revealed an increased level of IGF-1 and reduced level of inflammatory factors, resulting in a better cell survival rate. This study found that exogenous SSCs can promote the repair of LPS mechanical damage and provides new insight into the development of novel therapeutic approaches for blepharoptosis.

  6. The expression and comparison of healthy and ptotic upper eyelid contours using a polynomial mathematical function.

    Science.gov (United States)

    Mocan, Mehmet C; Ilhan, Hacer; Gurcay, Hasmet; Dikmetas, Ozlem; Karabulut, Erdem; Erdener, Ugur; Irkec, Murat

    2014-06-01

    To derive a mathematical expression for the healthy upper eyelid (UE) contour and to use this expression to differentiate the normal UE curve from its abnormal configuration in the setting of blepharoptosis. The study was designed as a cross-sectional study. Fifty healthy subjects (26M/24F) and 50 patients with blepharoptosis (28M/22F) with a margin-reflex distance (MRD1) of ≤2.5 mm were recruited. A polynomial interpolation was used to approximate UE curve. The polynomial coefficients were calculated from digital eyelid images of all participants using a set of operator defined points along the UE curve. Coefficients up to the fourth-order polynomial, iris area covered by the UE, iris area covered by the lower eyelid and total iris area covered by both the upper and the lower eyelids were defined using the polynomial function and used in statistical comparisons. The t-test, Mann-Whitney U test and the Spearman's correlation test were used for statistical comparisons. The mathematical expression derived from the data of 50 healthy subjects aged 24.1 ± 2.6 years was defined as y = 22.0915 + (-1.3213)x + 0.0318x(2 )+ (-0.0005x)(3). The fifth and the consecutive coefficients were <0.00001 in all cases and were not included in the polynomial function. None of the first fourth-order coefficients of the equation were found to be significantly different in male versus female subjects. In normal subjects, the percentage of the iris area covered by upper and lower lids was 6.46 ± 5.17% and 0.66% ± 1.62%, respectively. All coefficients and mean iris area covered by the UE were significantly different between healthy and ptotic eyelids. The healthy and abnormal eyelid contour can be defined and differentiated using a polynomial mathematical function.

  7. [Central nervous system abnormalities related to congenital fibrosis of extraocular muscles].

    Science.gov (United States)

    Moguel-Ancheita, Silvia; Rodríguez-Garcidueñas, Wendolyn

    2009-01-01

    We undertook this study to describe central nervous system (CNS) abnormalities associated with congenital cranial dysinnervation disorders (CCDD). This was a retrospective, observational, transversal and descriptive study including patients with congenital fibrotic strabismus. We analyzed clinical files of patients from 2001 to 2006. Neurological lesions were reported. Restrictive strabismus was demonstrated in all cases. Sixteen patients were included: nine males and seven females. Different neurological lesions were reported: corpus callosum anomalies, severe cortipathy, epilepsy, cavum vergae, nystagmus, occipital subarachnoid cyst, and hydrocephalus. Mental retardation was reported in 56% of patients. Different malformations were reported: genital malformations, trigonocephalus, camptodactyly, mild facial hypoplasia, low set ears, and agenesis of left ear. Blepharoptosis was present in 81% of patients. The most frequent form of strabismus was exotropia (56%), hypotropia in 37.5%, hypertropia 18.7%, "A" pattern 18.7%, and esotropia in 6.25%. Affection was cranial nerve III, 93.75%; cranial nerve VI, 6.25%; cranial nerve VII, 6.25%; and lesion to cranial nerve II in eight cases (50%). We have suggested that failure in early stages of embryology of the CNS can lead to the development of paralytic strabismus and generate secondary fibrotic changes, not only in muscle structures but also in other orbital tissues. That is the reason why we have used the term "congenital fibrotic strabismus" to report cases included in CCDD. We have demonstrated the strong association of mental retardation and neurological alterations. Multidisciplinary rehabilitation is relevant for these patients.

  8. Acquired oculomotor muscle fibrosis in infant: case report

    Directory of Open Access Journals (Sweden)

    Carlos Ramos de Souza-Dias

    2011-06-01

    Full Text Available The authors report the case of a 5 year-old boy who up to 2 years old presented normal eyes, when his right eye started to deviate upward and laterally, until be hidden under the superior lid. At the surgery, a strong passive limitation to infraduction of this eye was felt. He had already been operated on in another clinic, but the surgeon could not succeed in hooking his superior rectus. With great difficulty, the only thing that we could do was a free tenotomy of the superior rectus. As the eye was equilibrated in a moderate abduction, we performed an 8 mm recession of the lateral rectus. As there was still a small hypertropia and exotropia postoperatively, we performed in a second operation an eight millimeters resection of the medial rectus, a recession with anterior transposition of the inferior oblique and an advancement of the inferior rectus according to the Romero-Apis technique, in order to avert circulatory problems to the anterior segment of the eye. As he presented a small blepharoptosis, we did, in a third surgery, a tarsectomy according to the Fasanella-Servat technique, with good result. He ended with good eye position, almost no limitation of the horizontal movements and - 3 limitation of up and down ductions. The magnetic resonance imaging showed an altered image of the superior rectus, suggesting fibrosis post myositis.

  9. A case report of brain hemorrhage from intracranial astrocytoma with special reference to its CT findings

    International Nuclear Information System (INIS)

    Koshu, Keiji; Kuwayama, Naoya; Sonobe, Makoto; Tominaga, Teiji; Takahashi, Shinichiro

    1986-01-01

    A case of brain hemorrhage from intracranial cystic astrocytoma is reported. The patient, 31-year-old male, was admitted to our hospital with complaints of severe frontalgia, nausea and right blepharoptosis. We suspected subarachnoid hemorrhage from a ruptured cerebral aneurysm at IC-PC (internal carotid-posterior communicating artery) portion. On brain CT scan, intracerebral and subdural hematoma was observed. Some low density area was seen around the intracerebral hematoma and the inner layer of the low density area was positively enhanced after intravenous administration of contrast medium. Cerebral angiography revealed no vascular anomalies, except mass signs due to the hematoma. Considering the results of CT scans and angiography, we considered that the hematoma was originated from brain tumor and emergency operation was performed to remove the hematoma and the tumor. Histological examination showed that the tumor was astrocytoma of grade 3. Chemotherapy and radiation therapy were performed postoperatively. The patient was discharged two months later without any neurological deficits. In this paper we discussed the characteristics of hemorrhage from brain tumors from a viewpoint of CT findings. (author)

  10. The role of the orbicularis oculi muscle and the eyelid crease in optimizing results in aesthetic upper blepharoplasty: a new look at the surgical treatment of mild upper eyelid fissure and fold asymmetries.

    Science.gov (United States)

    Fagien, Steven

    2010-02-01

    One of the most common aesthetic and rejuvenative facial plastic surgical procedures performed is upper blepharoplasty. The traditional approaches to this procedure have been conceptually related to the removal of apparent "excess" tissue to enhance the visibility of the pretarsal region and reduce the upper eyelid irregularities and changes that occur with age. Many times, surgery has been performed both bilaterally and similarly on each side without extensive preoperative planning irrespective of the patient presentation and has commonly incorporated the removal of skin, orbicularis oculi muscle, and upper periorbital fat. The orbicularis oculi muscle is excised for a variety of reasons and has, in general, not been considered as an important component that mandates preservation or a potential means with which to further enhance outcomes by manipulation. If upper eyelid ptosis is also present, it may be treated by traditional methods of blepharoptosis repair. Despite this, patients are more often generally pleased with the obvious improvements after surgery with these traditional surgical procedures, yet the changes do not necessarily approach the youthful configuration in some individuals, the asymmetries that they had presented with may persist, and changes might occur that were not anticipated that may detract from the overall aesthetic result. A simple yet comprehensive approach to upper blepharoplasty that considers both the youthful or desired appearance and the management of upper eyelid asymmetries by preservation or selective treatment of the orbicularis oculi muscle and placement of the upper eyelid crease to improve aesthetic outcomes is presented in this article.

  11. Hemifacial hyperhidrosis associated with ipsilateral/contralateral cervical disc herniation myelopathy. Functional considerations on how compression pattern determines the laterality

    Science.gov (United States)

    Iwase, Satoshi; Inukai, Yoko; Nishimura, Naoki; Sato, Maki; Sugenoya, Junichi

    2014-01-01

    Summary Sweating is an important mechanism for ensuring constant thermoregulation, but hyperhidrosis may be disturbing. We present five cases of hemifacial hyperhidrosis as a compensatory response to an/hypohidrosis caused by cervical disc herniation. All the patients complained of hemifacial hyperhidrosis, without anisocoria or blepharoptosis. Sweat function testing and thermography confirmed hyperhidrosis of hemifacial and adjacent areas. Neck MRI showed cervical disc herniation. Three of the patients had lateral compression with well-demarcated hypohidrosis below the hyperhidrosis on the same side as the cervical lesion. The rest had paramedian compression with poorly demarcated hyperhidrosis and hypohidrosis on the contralateral side. Although MRI showed no intraspinal pathological signal intensity, lateral dural compression might influence the circulation to the sudomotor pathway, and paramedian compression might influence the ipsilateral sulcal artery, which perfuses the sympathetic descending pathway and the intermediolateral nucleus. Sweat function testing and thermography should be performed to determine the focus of the hemifacial hyperhidrosis, and the myelopathy should be investigated on both sides. PMID:25014051

  12. Orbital T-Cell Lymphoma with Discrete Enlargements of All Extraocular Muscles Bilaterally in Patient with Moon Face Countenance

    Directory of Open Access Journals (Sweden)

    Hideaki Kawakami

    2017-01-01

    Full Text Available Purpose. To report our findings in a case of orbital T-cell lymphoma in which all of the extraocular muscles (EOMs were bilaterally and discretely enlarged and the patient had a moon face countenance. Case. A 59-year-old woman presented with visual disturbances in her left eye, hyperemia in both eyes, and a moon face countenance. Examinations showed limited upward gaze in the right eye, blepharoptosis, hypertropia, and limited downward and rightward gaze in the left eye. Slit-lamp examination showed only chemosis and hyperemia of both eyes. Magnetic resonance imaging with contrast revealed discrete enlargements of the muscle bellies in all EOMs without abnormalities of the orbital fat in both eyes. Blood examinations excluded thyroid- and IgG4-related ophthalmopathy, and EOM biopsy revealed peripheral T-cell lymphoma. After beginning aggressive chemotherapy, the enlarged EOMs, limited eye motility, and moon face countenance improved. Unfortunately, the patient died of sepsis during the chemotherapy. Conclusions. A lymphoma should be included in the differential diagnosis of eyes with enlarged EOMs. Because lymphomas can lead to death, it is important for clinicians to consider lymphomas in eyes with enlarged EOMs.

  13. Ocular-muscle surgery for filamentary keratitis that developed in double elevator palsy.

    Science.gov (United States)

    Hieda, Osamu; Yokoi, Norihiko; Sotozono, Chie

    2017-01-01

    To report a case of filamentary keratitis occurring in the cornea hidden under the eyelids by squint surgery. A 69-year-old female patient with a history of amblyopia was referred for intractable filamentary keratitis in the left eye. The strabismus angle was 35Δ hypertrophic, and ocular motility was within the normal range. Slit-lamp examination of her left eye revealed filamentary keratitis in more than one-third of the upper cornea behind the upper eyelid. Her right eye was diagnosed as supranuclear double elevator palsy. We performed strabismus surgery on her right eye, including inferior rectus muscle recession (5 mm) in combination with superior rectus muscle resection (5 mm) under local anesthesia. Following surgery, the left eye squint angle was improved. The filamentary keratitis of the left eye disappeared, and there was no recurrence over the following 5 years. The squint surgery of paralyzed right eye decreased the strabismus angle, subsequently resulting in the disappearance of the filamentary keratitis in the left eye via the resolution of the relative blepharoptosis. Although the squint operation performed was not for the purpose of improving binocular function, we want to conclude that it can treat the filamentary keratitis behind the eyelid.

  14. Outcomes of Levator Resection at Tertiary Eye Care Center in Iran: A 10-Year Experience

    Science.gov (United States)

    Bagheri, Abbas; Salour, Hossein; Aletaha, Maryam; Yazdani, Shahin

    2012-01-01

    Purpose To assess outcomes of levator resection for the surgical correction of congenital and acquired upper lid ptosis in patients with fair to good levator function and evaluation of the relationship between demographic data and success of this operation. Methods In a retrospective study, medical records of patients with blepharoptosis who had undergone levator resection over a 10-year period and were followed for at least 3 months were reviewed. Results Overall, 136 patients including 60 (44.1%) male and 76 (55.9%) female subjects with a mean age of 20 ± 13.8 years (range, 2 to 80 years) were evaluated, of whom 120 cases (88.2%) had congenital ptosis and the rest had acquired ptosis. The overall success rate after the first operation was 78.7%. The most common complication after the first operation was undercorrection in 26 cases (19.1%), which was more prevalent among young patients (p = 0.06). Lid fissure and margin reflex distance (MRD1) also increased after levator resection (p MRD1, lid fissure and spherical equivalent were not predictive of surgical outcomes of levator resection. Conclusions Levator resection has a high rate of success and few complications in the surgical treatment of congenital and acquired upper lid ptosis with fair to good levator function. Reoperation can be effective in most cases in which levator resection has been performed. PMID:22323877

  15. Accuracy of Marginal Reflex Distance Measurements in Eyelid Surgery.

    Science.gov (United States)

    Nemet, Arie Y

    2015-10-01

    The marginal reflex distance (MRD), the position of the eyelids with the eyes in the primary position, is fundamental to patient assessment and surgery choice in facial and ophthalmic plastic surgery. This study compares the accuracy of handheld ruler and slit lamp biomicroscope measurements of the MRD1 in patients with blepharoptosis. This is a prospective study of 85 consecutive patients who were referred to our oculoplastic clinic between 2011 and 2013 for unilateral or bilateral ptosis repair. The MRD1 was measured by 2 techniques: 1. With the use of a penlight to illuminate the cornea, the corneal light reflex is observed, and the distance between the cornea and the upper lid margin is recorded. 2. Slit lamp biomicroscope assessment. A comparison between those 2 methods was performed. The mean (SD) MRD1 was 1.18 (1.11) mm and 1.06 (1.18) mm with a penlight and a slit lamp, respectively. There was a significant difference between the 2 measurements, but they were highly correlated in the paired t-test and the Wilcoxon test. The intraclass correlation coefficient was 0.984, representing excellent reliability. The MRD1 measured by a skilled clinician yields reliable results using a penlight and a ruler. In some cases, measurement of eyelid heights (palpebral fissure, MRD1, brow position) is challenging. The use of a slit lamp biomicroscope and a close front photograph may help determine accurate measurements.

  16. The effect of upper eyelid blepharoplasty on eyelid and brow position.

    Science.gov (United States)

    Nakra, Tanuj; Modjtahedi, Sara; Vrcek, Ivan; Mancini, Ronald; Saulny, Stan; Goldberg, Robert A

    2016-12-01

    This article evaluates the effect of upper eyelid blepharoplasty on eyelid margin position and brow height. This study is a retrospective analysis of patients who underwent upper eyelid blepharoplasty without concurrent blepharoptosis repair or brow surgery. The medical records of the participants were retrospectively reviewed and an established image analysis software was used to quantify the upper margin reflex distance (MRD1) as well as brow height using high quality standardized clinical photographs. A total of 19 patients (38 eyelids and brows) met the inclusion criteria. The mean preoperative MRD1 was 2.8 mm, and the mean post-operative MRD1 was 3.5 mm, revealing an increase of MRD1 from upper blepharoplasty alone of 0.7 mm (p = 0.0001). The mean preoperative brow position was 17.5 mm above the pupil, and the mean post-operative position was 17.4 mm, for an average change of position of -0.2 mm (p = 0.39) following upper eyelid blepharoplasty. Upper eyelid blepharoplasty without ptosis surgery results in a statistically significant increase in MRD1. Brow position does not demonstrate a statistically significant change in patients who undergo upper eyelid blepharoplasty for simple dermatochalasis.

  17. Uso da fáscia temporal na suspensão frontal: descrição da técnica cirúrgica - Relato de caso Use of temporal fascia in frontalis suspension: description of the surgical technique - Case report

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    Tânia Pereira Nunes

    2004-04-01

    Full Text Available OBJETIVOS: Familiarizar o oftalmologista com a anatomia da região temporal, descrever a técnica cirúrgica da retirada da fáscia temporal e da suspensão frontal e analisar as vantagens e desvantagens da fáscia temporal na suspensão frontal. MÉTODOS: Revisão do prontuário de uma paciente com blefaroptose grave que foi submetida à suspensão frontal com fáscia temporal. Revisão da anatomia da fossa temporal e das técnicas cirúrgicas. RESULTADOS: Bom resultado estético e funcional foi conseguido no caso descrito. CONCLUSÃO: A fáscia temporal é boa opção na suspensão frontal com algumas vantagens: é um tecido autógeno, de fácil obtenção e mínima morbidade no pós-operatório.PURPOSE: To familiarize the ophthalmologist with the anatomy of the temporal region, to describe the surgical technique of temporal fascia harvest and frontalis suspension and to demonstrate advantages and disadvantages of temporal fascia in frontalis suspension. METHODS: Review of the clinical and surgical data of one case with severe blepharoptosis who underwent frontalis suspension using temporal fascia. Review of the anatomy of the temporal fossa and the surgical techniques. RESULTS: Good esthetic and functional results were obtained in this case. CONCLUSION: Temporal fascia is a good choice for frontalis suspension with some advantages: it is autogenous, it is easily harvested and it yields minimal post-operative morbidity.

  18. Desensitization of the Mechanoreceptors in Müller's Muscle Reduces the Increased Reflex Contraction of the Orbicularis Oculi Slow-Twitch Fibers in Blepharospasm.

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    Matsuo, Kiyoshi; Ban, Ryokuya; Ban, Midori

    2014-01-01

    Although the mixed orbicularis oculi muscle lacks the muscle spindles required to induce reflex contraction of its slow-twitch fibers, the mechanoreceptors in Müller's muscle function as extrinsic mechanoreceptors to induce reflex contraction. We hypothesize that strong stretching of these mechanoreceptors increases reflex contraction of the orbicularis oculi slow-twitch muscle fibers, resulting in blepharospasm. We examined a 71-year-old man with right blepharospasm and bilateral aponeurosis-disinserted blepharoptosis to determine whether the patient's blepharospasm was worsened by increased trigeminal proprioceptive evocation via stretching of the mechanoreceptors in Müller's muscle owing to a 60° upward gaze and serrated eyelid closure, and whether local anesthesia of the mechanoreceptors via lidocaine administration to the upper fornix as well as surgical disinsertion of Müller's muscle from the tarsus and fixation of the disinserted aponeurosis to the tarsus decreased trigeminal proprioceptive evocation and improved patient's blepharospasm. Before pharmacological desensitization, 60° upward gaze and serrated eyelid closure exacerbated the patient's blepharospasm. In contrast, these maneuvers did not worsen his blepharospasm following lidocaine administration. One year after surgical desensitization, the blepharospasm had disappeared and a 60° upward gaze did not induce blepharospasm. Strong stretching of the mechanoreceptors in Müller's muscle appeared to increase reflex contraction of the orbicularis oculi slow-twitch muscle fibers, resulting in blepharospasm. In addition to botulinum neurotoxin injections into the involuntarily contracted orbicularis oculi muscle and myectomy, surgical desensitization of the mechanoreceptors in Müller's muscle may represent an additional procedure to reduce blepharospasm.

  19. Trigeminal Proprioception Evoked by Strong Stretching of the Mechanoreceptors in Müller's Muscle Induces Reflex Contraction of the Orbital Orbicularis Oculi Slow-Twitch Muscle Fibers.

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    Matsuo, Kiyoshi; Ban, Ryokuya; Ban, Midori; Yuzuriha, Shunsuke

    2014-01-01

    The mixed orbicularis oculi muscle lacks an intramuscular proprioceptive system such as muscle spindles, to induce reflex contraction of its slow-twitch fibers. We evaluated whether the mechanoreceptors in Müller's muscle function as extrinsic mechanoreceptors to induce reflex contraction of the slow-twitch fibers of the orbicularis oculi in addition to those of the levator and frontalis muscles. We evaluated in patients with aponeurosis-disinserted blepharoptosis whether strong stretching of the mechanoreceptors in Müller's muscle from upgaze with unilateral lid load induced reflex contraction of the orbicularis oculi slow-twitch fibers and whether anesthesia of Müller's muscle precluded the contraction. We compared the electromyographic responses of the bilateral orbicularis oculi muscles to unilateral intraoperative direct stimulation of the trigeminal proprioceptive nerve with those to unilateral transcutaneous electrical stimulation of the supraorbital nerve. Upgaze with a unilateral 3-g lid load induced reflex contraction of the bilateral orbicularis oculi muscles with ipsilateral dominance. Anesthesia of Müller's muscle precluded the reflex contraction. The orbicularis oculi reflex evoked by stimulation of the trigeminal proprioceptive nerve differed from that by electrical stimulation of the supraorbital nerve in terms of the intensity of current required to induce the reflex, the absence of R1, and duration. The mechanoreceptors in Müller's muscle functions as an extramuscular proprioceptive system to induce reflex contraction of the orbital orbicularis oculi slow-twitch fibers. Whereas reflex contraction of the pretarsal orbicularis fast-twitch fibers functions in spontaneous or reflex blinking, that of the orbital orbicularis oculi slow-twitch fibers may factor in grimacing and blepharospasm.

  20. Computed tomography and histopathological findings in pseudotumors of the orbit

    International Nuclear Information System (INIS)

    Ishibashi, Yasuhiko; Watanabe, Takao; Yoshimoto, Takashi; Suzuki, Jiro

    1981-01-01

    The CT scan findings of 4 cases of orbital tumor, in which transcranial orbital decompression was performed because of no improvement by medication, were reported. The first case was a 71-year-old female with exophthalmos, decreased vision and ocular movement disturbance of the left eye. CT scan demonstrated an abnormal high density area in the left retrobulbar region with a thickened medial rectal muscle. Specimens were taken from a thickened medial rectal muscle. The histological examination revealed angitis. The second case was a 38-year-old female with exophthalmos, blepharoptosis, chemosis, decreased vision and ocular movement disturbance of the left eye. CT scan showed exophthalmos of the left eye, but no focal abnormality. Specimens were taken from fatty tissue-in the left retrobulbar region. The histological examination revealed no abnormal inflammatory changes. The third case was a 37-year-old female with orbital pain, exophthalmos and ocular movement disturbance of the right eye. CT scan demonstrated a growing abnormal high density area in the right retrobulbar region. Specimens were taken from the abnormal tissue in the right retrobulbar region. The histological examination revealed inflammatory changes of muscle and nerve. The forth case was a 61-year-old male with diplopia and exophthalmos. CT scan demonstrated an abnormal high density area in the left retrobulbar region. Specimens were taken from an abnormal tissue in the left retrobulbar region lying against the lateral wall of the orbit. The histological examination revealed severe infiltrations with lymphocytes and plasma cells. Transcranial orbital decompression improved the exophthalmos and ocular movement in all cases. (author)

  1. EVALUATION OF ADJUSTABLE SUTURE TECHNIQUE IN OUTCOME OF PTOSIS SURGERY

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    Nagaraju

    2015-10-01

    Full Text Available AIM: To evaluate the outcome of adjustable suture technique in ptosis surgery. INTRODUCTION : Surgical management of blepharoptosis is indicated in multiple situations and the post - operative outcomes can be as variable as the indications for surgery. Adjustable suture techniques in ptosis repair have been introduced and variable efficacies have been reported. MATERIALS AND METHODS: A retrospective case review of medical records from June 2010 to May 2011 (12 months of 5 eyes of 5 consecutive patients operated by a single surgeon at a Tertiary Eye care center in South India were reviewed. The clinical profile of patients included was r ecorded and results of adjustable suture technique described by Borman and collegues for these patients was reported. RESULTS: 5 eyes of 5 patients underwent adjustable suture ptosis repair in the study duration. 4 patients with moderate and 1 with severe ptosis, all having good levator function were diagnosed to have c ongenital ptosis in 3 cases and a cquired involutional ptosis in 2 cases. All 5 cases had a satisfactory outcome at day 4 post - operative after adjustment of lid height in the out - patient clini c. 1 patient with acquired involutional ptosis, identified with levator dehiscence intra - operatively had overcorrection at 6 months warranting re - surgery while the other 4 patients had satisfactory cosmetic lid height and functional outcome at 6 months fol low up after the adjustable suture technique for ptosis repair. CONCLUSION: Use of adjustable sutures in ptosis surgery can eliminate the intraoperative lid factors that can lead to unpredictable results. The technique described is easy to adapt and perfor m and can give repeatable and well acceptable results in the properly selected cases

  2. [Concurrence of myasthenia gravis, polymyositis, thyroiditis and eosinophilia in a patient with type B1 thymoma].

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    Inoue, Manabu; Kojima, Yasuhiro; Shinde, Akiyo; Satoi, Hitoshi; Makino, Fumi; Kanda, Masutarou; Shibasaki, Hiroshi

    2007-07-01

    We presented a 43-year-old Japanese woman who acutely developed weakness of all extremities and difficulty in swallowing and drooping of eyelids, characterized by easy fatigability at the end of December, 2005. On general physical examination, she had moderate goiter. No cervical lymphadenopathy, cardiac murmur, or skin rash was noted. Neurologically, she had blepharoptosis, more on the right, only in the upright position with easy fatigability and marked weakness in the neck flexor, trunk, and all limb muscles much more proximally than distally. She had neither muscular atrophy nor upper motor neuron sign. Laboratory data showed slight leukocytosis with eosinophilia (up to 31%), and serum creatine kinase was markedly increased to over 2,000 IU/l. TSH receptor antibody (11.9%) and anti-acetylcholine receptor antibody (46.6 nmol/L) were also increased. Edrophonium test was positive. Electrophysiologically, muscle evoked potentials by repetitive motor nerve stimulation showed 13% and 50% waning in abductor pollicis brevis and deltoid muscle, respectively, at low frequency and no waxing at high frequency. Needle EMG showed fibrillation potentials and positive sharp waves in proximal muscles. Polymyositis was diagnosed by muscle biopsy which showed infiltration of lymphocytes in the endomysium and around non-necrotic muscle fibers. Upper arm muscle MRI showed multifocal high signal intensity lesions on T2-weighted images which were likely related to myositis. This finding is atypical for polymyositis. X-ray and CT of chest showed a mass lesion in the left pulmonary hilum, which was histologically diagnosed as type B1 thymoma. Thus, the present case had myasthenia gravis, polymyositis, thyroidititis and eosinophilia associated with type B1 thymoma. After the thymectomy, corticosteroid administration and immunoadsorption therapy, clinical symptoms and all laboratory abnormalities markedly improved.

  3. Anterior surface breakdown and implant extrusion following secondary alloplastic orbital implantation surgery.

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    Axmann, Shadi; Paridaens, Dion

    2017-12-08

    Secondary orbital implantation surgery can be complex due to scarring of the orbital tissues and can be complicated by implant exposure and extrusion. To evaluate the incidence and risk factors of implant exposure and extrusion following secondary alloplastic orbital implantation surgery in anophthalmic patients. Retrospective analysis of a consecutive series of patients who underwent secondary placement of an alloplastic orbital implant by one surgeon between 2001 and 2016 in the Rotterdam Eye Hospital. implant exposure or extrusion. Other complications. Sixty-three patients underwent secondary orbital placement of scleral-wrapped acrylic (60) or silicone (three) spherical implants. A subset of 25 patients had undergone earlier secondary orbital implant placement (by other surgeons) with exposure/extrusion necessitating additional implant surgery. Two patients were excluded due to lack of follow-up (Implant exposure or extrusion occurred in six of 18 (33%) patients in whom no muscle had been reattached during secondary orbital implantation and in five of 43 (12%) patients in whom the extraocular recti muscles had been attached, but the follow-up time was shorter for the latter group. Surgical treatment for implant exposure/extrusion was required in eleven of 61 patients (18%). Other complications included postoperative volume deficiency despite optimal prosthesis (five of 61, 8%), inclusion cysts (four of 61, 7%) and conjunctivitis sicca (two of 61, 3%). Seven of 61 (11%) patients required fornix deepening and seven (11%) blepharoptosis correction. Secondary orbital implantation of sclera-wrapped alloplastic implants was complicated by implant extrusion or exposure in 12% of cases in which the extraocular muscles were attached to the implant. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  4. Association of Involutional Lower Eyelid Entropion with Reduced Upper Eyelid Position Relative to the Corneal Light Reflex: Quantification of Facial Asymmetry.

    Science.gov (United States)

    Phelps, Paul O; Wladis, Edward J; Meyer, Dale R

    2018-01-16

    To investigate the association between upper eyelid position relative to the corneal light reflex (MRD1) and to delineate an association between eyelid height and involutional lower eyelid entropion. Retrospective study of patients presenting for entropion repair to an academic ophthalmic plastic surgery service. A total of 111 patients were included in the study; 95 had unilateral involutional lower eyelid entropion, and 16 had bilateral lower eyelid entropion. Patients with a history of previous eyelid surgery, trauma, upper eyelid entropion, or cicatricial changes were excluded from the study. Of the 95 patients with unilateral involutional lower eyelid entropion, 45 (47.4%) had a lesser MRD1 on the side ipsilateral to the involutional lower eyelid entropion. In this unilateral group, the mean MRD1 (± standard deviation) on the ipsilateral to the involutional lower eyelid entropion was 2.9 (±1.2) mm, while the mean MRD1 on the contralateral side was 3.3 (±1.0) mm. This difference was 0.4 mm and was statistically significant (p MRD1 ≤ 2.0 mm) was 24 of 95 (25.3%) in the unilateral involutional entropion group and was even higher in the bilateral involutional lower eyelid entropion group, with 7 of 16 (43.8%) patients exhibiting bilateral blepharoptosis. Patients presenting with involutional lower eyelid entropion tend to have a relatively reduced MRD1 on the ipsilateral (affected) side. When both lower eyelids are affected by involutional entropion, the reduced MRD1 tends to be more pronounced.

  5. Contour Symmetry of the Upper Eyelid Following Bilateral Conjunctival-Müller's Muscle Resection.

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    Golbert, Marcelo; Pereira, Filipe Jose; Garcia, Denny M; Cruz, Antonio A V

    2017-03-01

    Conjunctiva-Müller muscle resection (CMMR) is a simple, effective, and predictable procedure for internal treatment of ptosis. The authors determined contour symmetry of the upper eyelid following bilateral CMMR. Thirty control participants (ie, without ptosis) and 44 patients with acquired bilateral blepharoptosis who underwent CMMR were evaluated in a prospective study. To assess symmetry of lid contour, distances from midpupil to the upper eyelid (ie, MPLDs) were determined radially at intervals of 15° (total, 180°) along the palpebral fissure, and MPLDs at each angle were compared for right and left eyes. For control participants, the mean marginal reflex distance (MRD1; ie, MPLD at 90°) ± standard error (SE) was 4.05 mm ± 0.75 mm, and small contour asymmetries (MRD1 was 2.56 ± 0.1 mm, and mean medial and lateral lid asymmetries (14.3% ± 8.4% and 16.7% ± 9.7%, respectively) were significantly higher than those of controls. Medial and lateral asymmetries correlated significantly with the extent of ptosis and were more pronounced laterally than medially. One month after CMMR, the lateral-medial discrepancy in lid asymmetry was resolved, and mean medial and lateral MPLDs (9.9% ± 7.5% and 8.5% ± 5.3%, respectively) were similar to those of controls. For patients with involutional ptosis, CMMR enables elevation of the lid margin and correction of contour anomalies. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

  6. The efficacy of preoperative posterior subtenon injection of triamcinolone acetonide in noninfectious uveitic patients with secondary glaucoma undergoing trabeculectomy

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    Keorochana N

    2017-11-01

    Full Text Available Narumon Keorochana, Sutheera Kunasuntiwarakul, Isaraporn Treesit, Raveewan Choontanom Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand Objective: The aim of this study was to evaluate the efficacy and safety of preoperative posterior subtenon injection of triamcinolone acetonide (PSTA in noninfectious uveitic patients with secondary glaucoma undergoing primary trabeculectomy with mitomycin C.Design: This was a retrospective study.Patients and methods: We reviewed the medical records of 10 noninfectious uveitic patients, who had received a single preoperative PSTA 40 mg/1 mL, with secondary glaucoma undergoing primary trabeculectomy with mitomycin C. We collected data before and after surgery on intraocular pressure (IOP, anterior chamber (AC cells, best-corrected visual acuity (BCVA, morphologic characteristics of the filtering bleb and complications.Results: The mean time between injection and surgery was 7.8±3.88 days. Postoperative IOP level was significantly lower than preoperative level (31.3±11.44 mmHg at all visits (P<0.02. Antiglaucoma medications were decreased from preoperative (4.9±0.88 to 12-month postoperative (0.8±1.31; P-value <0.001 and also discontinued in seven eyes (70%. About 12 months after surgery, eight eyes (80% with qualified success and two eyes (20% with failed treatment were recorded. AC cells and BCVA did not differ significantly from baseline; however, all inflammations were controlled successfully. Most desirable bleb morphology was shown at 12 months as well. Complications were blepharoptosis and hypotony maculopathy in two eyes (20%.Conclusion: A preoperative PSTA may be an effective and safe option in controlling intraocular inflammation and maintaining bleb function after trabeculectomy in noninfectious uveitic patients with secondary glaucoma during a 12-month period. Keywords: periocular injection, steroid, uveitis, triamcinolone acetonide

  7. [Clinical observation of extraocular extension of choroidal melanoma].

    Science.gov (United States)

    Wang, Yi; Li, Yue-yue; Su, Fan; Xiao, Li-hua

    2011-03-01

    To evaluate the clinical features, diagnostic methods and treatment of extraocular extension of choroidal melanoma. It was a retrospective case series study. The records of 12 consecutive cases with extraocular extension of choroidal melanoma confirmed by pathologic examination were analyzed with special attention to the case histories, clinical manifestations, imaging findings, treatment and follow up results. Four patients were misdiagnosed as glaucoma. Another 4 patients were confirmed the diagnosis of melanoma and 3 of them received the operations of transscleral local resection. The common clinical manifestations included: impaired vision, exophthalmos, blepharoptosis, limited ocular motility, conjunctival hyperemia, and increased ocular or orbital pressure, etc. Characteristic sign was raised mass on the surface of sclera. All cases underwent orbital MRI preoperatively, 6 underwent ocular B-scan echography, and 6 underwent orbital CT scanning to evaluate for extraocular extension of tumor. Typical ultrasonography revealed the discontinued ocular wall and an intraocular mass with a continuous hypoechoic extraocular mass. In some cases the extraocular mass showed hypoechoic with medium echo area. CT scan showed a well-defined homogeneous intraconal mass connecting with intraocular lesion in 6 cases, which could infiltrate eye or optic nerve. The MR signal features of intraocular tumors with extraocular extension showed 4 patterns in all patients. The typical pattern was the tumor showed hyperintensity on T(1) and hypointensity on T(2)-weighted image. The maximum diameter of extraocular tumor was measured over 4 mm in 9 cases. MRI was useful for demonstrating multiple extraocular lesions, remote metastatic lesion or micro extraocular tumor, of which minimal diameter was 3 mm in our cases. Orbital exenteration was performed in 11 cases and ocular enucleation with excision of extraocular tumor was in 1 cases. Microscopic examination showed the epithelioid

  8. Influence of upper and temporal transconjunctival sclerocorneal incision on marginal reflex distance after cataract surgery.

    Science.gov (United States)

    Tamaki, Rikiya; Gosho, Masahiko; Mizumoto, Kyoichi; Kato, Nahoko; Zako, Masahiro

    2016-07-07

    Ptosis incidence following cataract surgery is reduced with a recently developed phacoemulsification technique using a small incision. However, it remains uncertain whether an upper transconjunctival sclerocorneal incision can cause minor blepharoptosis. In the present prospective study, patients underwent cataract surgery with either an upper or temporal 2.4-mm transconjunctival sclerocorneal incision. We measured the marginal reflex distance 1 (MRD1) preoperatively and postoperatively, and compared these measurements between the two different incision types. Further we explored the risk factors of the postoperative MRD1 reduction. The study population included patients who underwent cataract surgery on both eyes at Aichi Medical University between October 2013 and September 2015. In each patient, one eye was operated using an upper 2.4-mm transconjunctival sclerocorneal incision, and the other with a temporal incision. We prespecified that an MRD1 difference of ≥0.5 mm between the pre- and post-surgical measurements indicated postoperative ptosis, which was a strict criterion. MRD1 was measured using digital photography, and we calculated the difference between the preoperative and postoperative MRD1 values. This change in MRD1 was compared between the groups with different incision locations. The change in MRD1 was analyzed by using the multivariate regression model including incision position (temporal or upper), preoperative MRD1, and preoperative distance between medial and lateral canthi. We assessed data from a total of 34 patients. The mean change in MRD1 from pre-operation to post-operation measurements was -0.26 ± 0.93 with the temporal incision and -0.24 ± 0.86 with the upper incision. The mean difference in the change in MRD1 between the different two incision types was -0.02, with a 95 % CI of -0.24 to 0.20, establishing equivalence between these incision types. The multivariate regression analysis showed that the preoperative MRD1 was

  9. Upper Eyelid and Pupillary Effects of Topical Dilute Epinephrine.

    Science.gov (United States)

    Garcia, Giancarlo A; Ngai, Philip; Vemuri, Swapna; Tao, Jeremiah P

    Adrenergic medications may elevate the upper eyelid and dilate the pupil. The effects of topical phenylephrine on Müller's muscle have been well described. Dilute epinephrine (DE) is a sympathomimetic agent commonly administered in blepharoptosis surgery, and has been shown to elevate the upper eyelid margin when injected subcutaneously. The effects of DE applied topically to the eye, whether intentional or inadvertent during surgery have not been characterized. The purpose of this investigation was to quantify and compare the effects of topical DE and phenylephrine on upper eyelid position and pupil size. Prospective, nonrandomized trial of 41 adults without (n = 25, 25 eyes) and with ptosis (n = 16, 16 eyes). Upper eyelid margin reflex distance (MRD1) and pupil diameter were primary measures and pupil reactivity to light was a secondary measure. MRD1 and pupil diameter were recorded at baseline and at 30-second intervals for 5 minutes after administration of topical 1% lidocaine with epinephrine 1:100,000 (DE). After a washout period of >24 hours, the same measurements were recorded after administration of topical phenylephrine 2.5%. No statistically significant difference was observed between mean baseline and postexposure MRD1 after application of topical DE (p = 0.181). In contrast, a mean increase in MRD1 of 0.51 ± 0.09 mm (effect size 0.33) was observed after exposure to phenylephrine 2.5% (p MRD1 was significantly greater for phenylephrine compared with DE (p < 0.001, analysis of covariance). Mean pupil diameter increased 0.29 ± 0.09 mm (effect size 0.48) in response to DE and 0.27 ± 0.11 mm (effect size 0.41) after application of phenylephrine (p = 0.004 and p = 0.001, respectively). All pupils maintained a constrictive response to light. Although DE is similar to topical phenylephrine in causing mydriasis, it did not have a similar effect on elevating the upper eyelid. These findings may have implications on intraoperative assessment

  10. Corrección de ptosis palpebral por la incisión de blefaroplastia Upper eyelid ptosis treatment using blepharoplasty incision

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    A. Novo Torres

    2006-09-01

    y por tanto la recuperación es mas rápida; posibilita también la cirugía de rescate en caso de correcciones insuficientes y evita el problema de sobrecorrección con exceso de resección de tejido conjuntival. En resumen se trata de una modificación quirúrgica que facilita la técnica, disminuye las complicaciones postoperatorias, mejora la recuperación y evita la sensación de cuerpo extraño intraocular de una resección conjuntivalBlepharoptosis is the abnormally low of the top eyelid during the direct look. Best results are obtained by resection or advance of the elevator muscle or aponeurosis, whenever the elevator has a suitable function. We present a modification to the Blaskovics´s technique for correction of moderate blepharoptosis, with good function of the elevator muscle. We present a serie of 10 cases where we used a variant of Blaskovics’s technique of resection of the elevator for surgical correction of ptosis. Seven were bilateral cases and 3 unilateral ones. In all the cases the elevator function was between 4 and 8 mm and ptosis was major than 4mm with visual field decrease in the direct look. Surgical technique included a cutaneous horizontal incision of Blepharoplasty, wide exhibition of elevator muscle and aponeurosis, respecting orbicular fatty bags and separating it from the palpebral conjunctive. In all the cases correction of the ptosis were obtained. The grade of asymmetry was lower than 0,3 cm. One case presented in the inmediate postoperatory opening of the suture in his medial side and had to be re-taken after 10 days. The palpebral postoperative edema was solved between 2 – 8th day allowing evaluation in that moment. Patient’s satisfaction was good or very good and the visual field was complete in all patients Classic surgical techniques and its modifications for correction of ptosis keep on being valid. With this modification that respects conjuctive we avoid to add morbidity to the surgical process. We think that

  11. Nylon Hang Back Sutures in the Repair of Secondary Ptosis Following Overcorrected Dysthyroid Upper Eyelid Retraction.

    Science.gov (United States)

    Shah-Desai, Sabrina; Azarbod, Parham; Szamocki, Sonia; Rose, Geoffrey E

    2016-01-01

    Repair of blepharoptosis secondary to surgical overcorrection of thyroid related primary upper eyelid retraction (secondary ptosis) can be unpredictable. This study describes the long-term results of "hang-back" nylon sutures, for an anterior approach surgical repair of secondary ptosis. This was a retrospective consecutive case note review of patients referred with secondary ptosis (after prior upper eyelid lowering for thyroid eye disease), under the care of a single surgeon at Moorfields Eye Hospital & subsequently at Barking Havering Redbridge University Hospitals NHS Trust (SSD). In accordance with hospital trust policy, this audit was registered and all patient data was anonymized, ethical approval was not required. Patients with secondary ptosis underwent surgery under local anesthesia through an upper eyelid skin-crease incision. The anterior portion of the levator muscle was freed from all scar tissues and its action re-established on the superior part of the upper tarsal plate, using two 6-0 nylon hang-back sutures placed centrally and medially. The margin reflex distance 1 (MRD1), skin crease height, eyelid contour, symmetry of eyelid position (difference in margin reflex distance 1 <1 mm in both eyes) and degree of lagophthalmos were assessed from clinical notes preoperative and postoperatively at 1, 3, and 12 months. Surgery was undertaken in 14 eyelids in 13 patients (3 males; 23%), with 9/14 (65%) eyelids having undergone attempted repair of ptosis prior to referral; in 7 of the 8 (88%) eyelids with previous failed ptosis repair, the referring surgeon had used soluble hang-back sutures. As compared with an average preoperative margin reflex distance 1 of 0.9 mm (median 1, range: -1 to 2 mm), the average margin reflex distance 1 at 3 months was 3.0 mm (median 3, range: 2.5-4 mm; p < 0.0001) and 2.8 mm at 12-month follow up (median 3, range: 2-4mm; p < 0.0001). The upper eyelid central skin crease height changed from a preoperative mean of 9.8 mm