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Zhao H, Ren Y, Yang Z, Wang Y, Zhang J. Progressively worsening ptosis in a woman: A case report. Clin Case Rep 2024; 12:e9005. [PMID: 38855088 PMCID: PMC11157416 DOI: 10.1002/ccr3.9005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/31/2024] [Accepted: 05/12/2024] [Indexed: 06/11/2024] Open
Abstract
Key Clinical Message Filler injections into the upper eyelid may cause levator aponeurosis fibrosis and ptosis. This risk must be considered. When ptosis appears, treatment might be difficult. Understanding the upper eyelid anatomy and procedures is essential to prevent eyelid damage. Abstract Ptosis is a prevalent condition in cosmetic surgery that occurs due to malfunction of the levator palpebrae superioris or insufficient Müller muscle action. It is characterized by the upper eyelid edge appearing lower than usual when seen at eye level. Ptosis may be categorized into congenital and acquired forms. The primary cause of congenital ptosis is attributed to abnormalities of the levator palpebrae superioris muscle or the motor nerve innervation that controls it. The condition arises from atypical development and malfunction of the oculomotor system. Acquired ptosis may be classified into many categories including traumatic, neurogenic, myogenic, senile, mechanical, and fake ptosis. Currently, there is little documentation of ptosis resulting from the degeneration of the aponeurosis of the muscle in the upper eyelid. We received a case of ptosis caused by fibrosis of the levator palpebrae superioris aponeurotic membrane. We used the technique of levator palpebrae superioris great advancement. The levator palpebrae superioris-Müller muscle was folded to create a stable composite construction via the levator palpebrae superioris high progress.
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Affiliation(s)
- Hongqing Zhao
- Department of Plastic Surgery, Daping HospitalArmy Medical UniversityChongqingChina
- Nanbu County People's HospitalNanchongSichuan ProvinceChina
| | - Yuan Ren
- Department of Plastic Surgery, Daping HospitalArmy Medical UniversityChongqingChina
| | | | - Yuanyuan Wang
- Department of Plastic Surgery, Daping HospitalArmy Medical UniversityChongqingChina
| | - Junbo Zhang
- Department of Plastic Surgery, Daping HospitalArmy Medical UniversityChongqingChina
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Nirmalan A, Tran MT, Tailor P, Hodge D, Bradley EA, Wagner LH, Bartley GB, Tooley AA. Obstructive Sleep Apnea Associated With Increased Failure Rate of Ptosis Repair. Ophthalmic Plast Reconstr Surg 2024; 40:201-205. [PMID: 37995148 DOI: 10.1097/iop.0000000000002547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
PURPOSE This study investigates how Obstructive sleep apnea (OSA) affects the outcomes of ptosis repair. We hypothesized that patients with OSA have an increased rate of reoperation after ptosis repair. METHODS This retrospective cohort study included patients age >18 from the Mayo Clinic who underwent ptosis repair by levator advancement or Müller muscle-conjunctiva resection between 2018 and 2021. Outcomes were measured at 1 to 3 months of follow-up with surgical failure defined as asymmetry or unsatisfactory eyelid height requiring revision surgery within 1 year. RESULTS A total of 577 patients met the inclusion criteria. There was a statistically significant difference in surgical failure between patients with OSA and those without (20.5% vs. 13.1%, p = 0.02). Patients with OSA showed a statistically significant difference in risk of revision by a factor of 1.70 (95% CI: 1.06-2.07). Revisions were attributed to unsatisfactory eyelid height in 72.6% of patients and eyelid asymmetry in 21.1%. All patients who had revision surgery had satisfactory outcomes. On logistic regression analysis, when adjusting for age and sex, OSA was significantly associated with ptosis revision ( p = 0.007). CONCLUSIONS OSA increases risk of surgical failure and need for revision surgery in patients undergoing blepharoptosis repair but is not a sole risk factor.
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Affiliation(s)
| | - Meagan T Tran
- Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Prashant Tailor
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - David Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, U.S.A
| | | | - Lilly H Wagner
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | - Andrea A Tooley
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
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Nichols KK, Malloy KA, Karpecki PM, Bacharach J, Douglas RS, Foster S, Gromacki SJ, Whitley WO. Topical Review: An Update of Diagnostic and Management Algorithms for Acquired Blepharoptosis. Optom Vis Sci 2022; 99:230-240. [PMID: 35058403 DOI: 10.1097/opx.0000000000001868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
SIGNIFICANCE Acquired ptosis is a condition of the upper eyelid that has negative cosmetic and functional effects but is likely underdiagnosed and undertreated. Given the evolving understanding of the condition and expanding therapeutic options, this review reappraised published evidence and clinical experience regarding diagnosis and treatment of acquired ptosis.The authors met over two structured virtual working sessions to review current evidence and develop timely recommendations for acquired ptosis identification, differential diagnosis, characterization, and treatment selection. Diagnostic algorithms, plus management and referral guidelines, are presented. Eyelid evaluation and, when needed, ptosis diagnostic workup are essential in the comprehensive eye examination. Acquired ptosis can be efficiently identified via patient questionnaire, history, and photograph review combined with assessment of eyelid position and symmetry using established methods. When ptosis is present, it is essential to evaluate onset, symptoms, pupil diameter, and extraocular muscle function to identify or rule out serious underlying conditions. If signs of serious underlying etiology are present, immediate referral/follow-up testing is required. After ruling out serious underlying causes, masquerade conditions, and pseudoptosis, pharmacologic or surgical treatment should be selected based on the clinical evidence. Effectively managing acquired ptosis requires practice-wide commitment to thorough eyelid evaluation, accurate diagnosis, and adoption of new treatment modalities. Aided by evolving pharmacologic therapeutic options, shifting from a "detect and refer" to a "diagnose and manage" approach can support identification and treatment of more patients with acquired ptosis, particularly mild-to-moderate cases.
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Affiliation(s)
| | - Kelly A Malloy
- The Eye Institute of the Pennsylvania College of Optometry, Salus University, Philadelphia, Pennsylvania
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Bacharach J, Lee WW, Harrison AR, Freddo TF. A review of acquired blepharoptosis: prevalence, diagnosis, and current treatment options. Eye (Lond) 2021; 35:2468-2481. [PMID: 33927356 PMCID: PMC8376882 DOI: 10.1038/s41433-021-01547-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/15/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022] Open
Abstract
Blepharoptosis (ptosis) is among the most common disorders of the upper eyelid encountered in both optometric and ophthalmic practice. The unilateral or bilateral drooping of the upper eyelid that characterises ptosis can affect appearance and impair visual function, both of which can negatively impact quality of life. While there are several known forms of congenital ptosis, acquired ptosis (appearing later in life, due to a variety of causes) is the predominant form of the condition. This review summarises the prevalence, causes, identification, differential diagnosis, and treatment of acquired ptosis. Particular attention is paid to the differential diagnosis of acquired ptosis and emerging treatment options, including surgical and pharmacologic approaches.
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Affiliation(s)
| | - Wendy W Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrew R Harrison
- Department of Ophthalmology and Visual Neurosciences, Department of Otolaryngology, University of Minnesota, Minneapolis, MN, USA
| | - Thomas F Freddo
- Massachusetts College of Pharmacy and Health Sciences, Worcester, MA, USA
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Ophthalmic Surgeries and Systemic Medical Conditions Associated With the Development of Involutional Ptosis. Ophthalmic Plast Reconstr Surg 2021; 37:133-137. [PMID: 32427726 DOI: 10.1097/iop.0000000000001707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the associations between systemic medical conditions and types of ocular surgery and the development of aponeurotic ptosis. METHODS In this case-control observational cohort study, the relative prevalence of involutional ptosis in a large population of adult patients was assessed. Deidentified patient data from a 10-year time period was obtained from the electronic medical records of 5 large academic medical centers. Patients were selected based on ICD9 and ICD10 codes for involutional ptosis. Control patients were age and gender matched and randomly selected from a general adult population. Systemic comorbidities were determined based on ICD9 and ICD10 codes, and prior ocular surgeries based on CPT codes. The influence of systemic comorbidities and ocular surgery was examined utilizing logistic regression analysis. RESULTS The study cohort consisted of 8297 adult patients with involutional blepharoptosis and 13,128 matched controls. The average age was 65 years. The 3 significant risk factors for developing ptosis were ocular surgery, hyperthyroidism, and type II diabetes with odds ratios of 4.2, 2.5, and 1.45, respectively (p < 0.05). Strabismus, cornea, and glaucoma surgeries were more highly associated with developing ptosis (p < 0.05). Strabismus surgery had the greatest odds ratio of 3.37, followed by cornea surgery at 2.31, and glaucoma surgery at 1.56. CONCLUSIONS Involutional ptosis is likely a multifactorial process. This study demonstrates that risk factors for the development of ptosis include ocular surgery, specifically strabismus, cornea, and glaucoma surgery, as well as hyperthyroidism and type II diabetes.
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Correlation between body composition and blepharoptosis in adults. Eye (Lond) 2020; 35:1999-2007. [PMID: 33024321 DOI: 10.1038/s41433-020-01214-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The present study aimed to explore the association between body composition indices, such as fat mass (FM) and lean body mass (LBM), and blepharoptosis. METHODS The study evaluated 12,168 Korean adults aged 40 years or older using data from the Korea National Health and Nutrition Examination Survey (2008-2011). FM index (FMI, kg/m2) and LBM index (LBMI, kg/m2) were used to correct for the effects of body size. Multivariable logistic regression analysis was performed to investigate the association between blepharoptosis and body composition indices such as FMI, LBMI, and fat percentage of whole body or head. Stratified analyses were also performed by levator function. RESULTS Higher FMI and head fat percentage were significantly associated with blepharoptosis (adjusted odds ratio [aOR] = 1.35, 95% confidence interval [CI] = 1.10-1.65; and aOR = 1.32, 95% CI = 1.03-1.69 in the highest tertile compared with the lowest, respectively). In the subgroup with good levator function (≥8 mm), higher FMI, head fat percentage, and head lean mass were significantly associated with blepharoptosis (aOR for the right eye [aORr] = 1.42 and aOR for the left eye [aORl] = 1.36; aORr = 1.41 and aORl = 1.37; and aORr = 1.50 and aORl = 1.49 in the highest tertile compared with the lowest, respectively; all p < 0.05). CONCLUSIONS Body compositions with high adiposity indices, such as high FMI and head fat percentage, were positively associated with blepharoptosis. Awareness of the potential correlation between obesity-associated fat deposition and blepharoptosis could improve management of the condition and contribute to understanding the pathogenesis of blepharoptosis.
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Lee CC, Feng IJ, Lai HT, Huang SH, Kuo YR, Lai CS. The Epidemiology and Clinical Features of Blepharoptosis in Taiwanese Population. Aesthetic Plast Surg 2019; 43:964-972. [PMID: 30877447 DOI: 10.1007/s00266-019-01344-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/21/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Blepharoptosis describes a condition of low-lying upper eyelid that may affect individuals of all ages under various etiologies. It may be of congenital or acquired form by the timing of onset or be divided into myogenic, neurogenic, aponeurotic, or mechanical types according to the mechanism. Our goal was to report the characteristics of age-specific blepharoptosis and to analyze the association between levator function (LF) and ptosis severity of each ptosis subtype. MATERIALS AND METHODS The retrospective, single-center, cross-sectional study consisted of patients diagnosed with blepharoptosis in the plastic surgery practice at a medical center between September 2009 and May 2017. We reported patients' age at presentation, sex, laterality of ptosis, etiology, classification, and evaluation of ptosis including levator function and ptosis severity. RESULTS During a nine-year span of study, a total of 1975 eyelids of 1164 Taiwanese patients aged between 2 and 88 years were enrolled in the research (mean = 57.73 ± 13.41 years). The female-to-male ratio was 2.72 (95% confidence interval [CI]: p < 0.0001). Acquired blepharoptosis and bilateral blepharoptosis were more frequently observed (55.85%, p < 0.0001 and 69.67%, p < 0.0001, respectively). In age-specific relative incidence of blepharoptosis, myogenic ptosis was the majority in patients younger than 40 years. Early onset of aponeurotic ptosis was observed in young contact lenses wearers. Aponeurotic blepharoptosis was the predominant type of ptosis in the senior population older than 40 years (p < 0.0001). Among the subtypes, mechanical ptosis had the most preserved LF (p < 0.0001). LF and MRD1 had statistically positive correlations in all subtypes of blepharoptosis, in which neurogenic ptosis demonstrated the severest levator dysfunction for each millimeter in MRD1 reduction. CONCLUSIONS Of the 1164 Taiwanese patients, blepharoptosis had a higher propensity for female gender and the age between the second to fourth decades. Bilateral involvement of blepharoptosis with acquired type was frequently diagnosed. Myogenic ptosis had a preponderance in age younger than 40 years, while aponeurotic ptosis usually affects senile population. Many mild degree myogenic ptosis was simultaneously recognized in young-aged adults seeking aesthetic double eyelid surgery. Early onset of acquired aponeurotic ptosis was also observed in contact lens wearers given the trend of decorative contact lens use. Levator dysfunction was implicated in the pathology of not only myogenic ptosis but aponeurotic, mechanical, and neurogenic ptosis. Moreover, levator function of neurogenic ptosis was most severely impacted in each MRD1 reduction among all subtypes of blepharoptosis. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Chia-Chen Lee
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - I-Jung Feng
- Department of Healthcare Administration and Medical Informatics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hsin-Ti Lai
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd, Kaohsiung, 807, Taiwan
| | - Shu-Hung Huang
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd, Kaohsiung, 807, Taiwan
| | - Yur-Ren Kuo
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd, Kaohsiung, 807, Taiwan
| | - Chung-Sheng Lai
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd, Kaohsiung, 807, Taiwan.
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Does Long-Term Rigid Contact Lens Wear Lead to Acquired Blepharoptosis in Chinese Eyes? Eye Contact Lens 2019; 46:24-30. [PMID: 30985490 DOI: 10.1097/icl.0000000000000607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine whether long-term rigid contact lens wear leads to acquired blepharoptosis and whether its development is affected by lens removal methods. METHODS Ninety rigid contact lens wearers (45 rigid gas permeable [RGP] [15-19 years old] and 45 ortho-k [15-40 years old]) who had worn lenses for at least 2 years and 45 spectacle-wearing controls (15-19 years old) were recruited. Margin reflex distance (MRD) and palpebral fissure height (PFH) were measured both subjectively and objectively, but levator function (LF) could only be measured subjectively. For RGP subjects, measurements were made before and 5 min after lens removal. Measurements were compared among the groups and, for rigid lens wearers, between two different lens removal techniques: using a suction holder or by finger-lid manipulation. RESULTS No significant differences in MRD, PFH, and LF were found between different lens removal techniques in the rigid lens groups (P>0.05). No significant correlations were found between the parameters of interest and duration of lens wear (P>0.05). For the RGP group, MRD, PFH, and LF were significantly greater after than before lens removal (P<0.05), and after lens removal, MRD was significantly smaller than that of the ortho-k and spectacle groups (P<0.001, P=0.01, respectively) and PFH was significantly smaller than that of the ortho-k group (P=0.001). However, after lens removal, according to the definition (amount) for ptosis, no subject was diagnosed as having ptosis. CONCLUSIONS Long-term rigid contact lens wear did not lead to acquired blepharoptosis in Chinese eyes. Margin reflex distance, PFH, and LF were not affected by different lens removal techniques.
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