Adam R. Sweeney, Katherine J. Williams, Christopher R. Dermarkarian, Richard C. Allen, Michael T. Yen
Prostaglandin analogs (PGAs) used for intraocular pressure reduction are associated with many side effects involving the ocular adnexa. The cluster of findings termed prostaglandin-associated periorbitopathy includes blepharoptosis (herein referred to as ptosis), levator dysfunction, deepening of the superior sulcus, enophthalmos, and dermatochalasis involution.1,2 We have recognized numerous intraoperative situations where eyelid tissues appear abnormal in patients with chronic PGA use, often seeming to add complexity to the surgery.
Laurel T. Tainsh MD MHS Frederick A. Jakobiec MD DSc Natalie Wolkow MD Michael K. Yoon MD
No abstract available
Dong Cheol Lee, Stephanie M Young, Yoon-Duck Kim, Kyung In Woo
Aims To evaluate the natural course of upper eyelid retraction (UER) in patients with thyroid eye disease (TED) and factors affecting its course.
Methods Retrospective non-interventional cohort study in a single tertiary institution from March 2006 to March 2015 on patients with TED with (1) unilateral or bilateral UER within 6 months from initial presentation, and (2) no prior interventions nor surgical treatment for their UER. Main outcomes and measures were mean margin reflex distance 1 (MRD1) and factors associated with UER improvement.
Results There were a total of 61 patients and 81 eyes (41 unilateral and 20 bilateral UER). Mean age was 42.3±15.1 years. Mean MRD1 decreased from 6.1 mm at presentation to 4.8 mm at 12 months, and 4.4 mm at 24 months. The proportion of eyes with normalisation of lid height increased from 0% at presentation to 22.2% at 6 months, 37.0% at 12 months and 49.4% at 24 months. Mean time to normalisation of MRD1 was 18.0±12.4 months. A positive family history of TED was found to be associated with a 6.2 times lower likelihood of normalisation. Change in exophthalmometry, clinical activity score and thyroid-stimulating immunoglobulin were significantly correlated to change in MRD1 (p<0.05). There was no correlation between change in MRD1 and thyroid-stimulating hormone receptor antibodies.
Conclusion An improved knowledge of the natural history of UER in TED will allow us to better decide and evaluate the optimal management for such patients.
Vasanthapuram, Varshitha Hemanth; Ali, Mohammad Javed
The common ocular manifestations of CHARGE syndrome include colobomatous defects in the eye, strabismus, nystagmus, and micropthalmia. Lacrimal drainage anomalies have been rarely reported and to the best of the authors’ knowledge, only 5 such cases have been reported earlier. The present case describes CHARGE syndrome associated with bilateral complex congenital nasolacrimal duct obstruction with multiple prior attacks of acute dacryocystitis and left lower punctal agenesis, successfully managed with a right-sided dacryocystorhinostomy and awaiting a left dacryocystorhinostomy.
Lacrimal drainage anomalies in CHARGE syndrome include complex CNLDO, punctal agenesis, and acute dacryocystitis.
Basilious, Alfred; Jivraj, Imran; DeAngelis, Dan
The authors present a rare case of sudden onset unilateral complete ptosis occurring hours after administration of the H1N1 influenza vaccine. A complete workup for autoimmune and neurological disease was negative. MRI of the orbits demonstrated unilateral orbital myositis involving the left superior rectus/levator complex, superior oblique, and medial rectus muscles. Ptosis resolved spontaneously over 2 months without intervention. An autoimmune mechanism may explain rare cases of orbital myositis following administration of the H1N1 influenza vaccination.
A case of acute onset and spontaneous resolution of complete unilateral ptosis and orbital myositis post H1N1 influenza vaccination.
AlSemari, Mohammad A.; Maktabi, Azza; AlSamnan, Mazen S.; Alrajeh, Mohammed S.; Strianese, Diego
Follicular lymphoma (FL) is the second most commonly reported B-cell lymphoma and accounts for 6% of all orbital lymphomas. FL presentation in the pediatric population is rare. This study reported an 18-year-old male with a pink elevated lesion in the conjunctiva of the left eye and normal ocular parameters. Following a complete excisional biopsy, the lesion was oval and smooth grossly and showed dense proliferation with a high nuclear–cytoplasmic ratio microscopically. Immunohistochemical studies revealed positive CD20 and bcl-6 while bcl-2 was negative, which is a common feature for pediatric FL in contrast to bcl-2 positivity found by immunohistochemistry in FL occurring in adult patient population. No signs of recurrence were observed over 2 years of follow-up. This study adds a new case to the existing few reports. Interestingly, all reported cases were males including the patient, mean duration of onset was 5 months, and mean duration of follow-up was 18.4 months. The authors emphasize that total surgical excision with close monitoring is reasonable management of such clinical entity.
Follicular lymphoma (FL) is a rare entity in pediatric patients. Six cases have been reported with conjunctival FL in the literature (age between 6 and 21 years). Interestingly, all of them were male including the patient.
Pashaei-Marandi, Aryan; Kini T, Ashwini; Al Othman, Bayan; Lee, Andrew G.
An 81-year-old white female presented with headache and visual loss. The past medical history was significant for type 2 diabetes, nonalcoholic fatty liver disease, diverticulosis, and asthma. The patient reported a 3-day history of “pixelated vision” in the left eye (OS) with shadows and a 2-month history of bilateral temporal headaches, jaw claudication, and scalp tenderness…..
Lam, Aimee N.; Thayer, Jessica N.; Rahman, Effie Z.; Martinez, Andre N.; Fry, Constance L.
To investigate the prevalence and frequency of patients with blepharoptosis who take anticholesterol therapies. To our knowledge, this is the first large single-center series to evaluate this association.
A retrospective chart review of adult patients presenting with ptosis on concomitant anticholesterol medications.
Two hundred ninety-three adult patients with ptosis taking anticholesterol therapy were identified from October 2011 to October 2016. Forty-seven patients (16.0%) reported muscle weakness. Laboratory markers including creatine kinase (CK) and myoglobin levels were obtained. Of the 47 patients, 13 patients (4.4%) were identified to have ptosis and laboratory confirmed anticholesterol therapy-induced myopathy. Two additional patients with statin-induced myositis and rhabdomyolysis were identified from the period 2008–2011. All patients had measurably elevated CK and/or myoglobin levels. All patients experienced improvement in ptosis or systemic symptoms after discontinuation or changing medications. Nine patients (60%) demonstrated statistically significant improvement in the ptosis.
Many patients with involutional ptosis also have both cardiovascular disease and hyperlipidemia and thus take cholesterol-lowering medication. Our study demonstrates a World Health Organization-defined probable association between ptosis and anticholesterol-induced myopathy. The frequency of anticholesterol-induced myopathy in adult ptosis was 4.4%, which is substantially higher than previously predicted. Anticholesterol-induced myositis can cause a reversible ptosis, and thus, a thorough evaluation of adult patients presenting with involutional ptosis includes inquiry into the use of anticholesterol drugs and associated muscle weakness.
Anticholesterol medication may induce or exacerbate myogenic ptosis in some individuals.
Men, Clara J.; Ediriwickrema, Lilangi S.; Paik, Ji Sun; Murdock, Jennifer; Yen, Michael T.; Ng, John D.; Liu, Catherine Y.; Korn, Bobby S.; Kikkawa, Don O.
To examine the role of adjuvant surgical resection of infantile hemangiomas after systemic β-blocker therapy.
This is a multicentered retrospective study. Standard protocol for oral propranolol was employed by the referring physicians. Ocular indications for surgery included ptosis obstructing the visual axis, high degrees of astigmatism causing amblyopia, or disfigurement from residual tumor. Patients underwent complete excision or debulking.
Eleven girls and 4 boys were surgically treated with mean operative age of 34.4 months. Patients were followed for a mean of 19.6 months after surgery. Four patients required surgical treatment due to an inability to tolerate medical therapy secondary to drug-related side effects (including bradycardia). The other 11 patients proceeded to surgery due to residual eyelid and orbital lesions despite medical treatment. All 15 patients underwent orbitotomy for residual hemangioma excision. Four patients also underwent simultaneous levator advancement at the time of excision. In all cases, there was resolution of ptosis with clearing of the visual axis. No complications were incurred during the surgical treatment and there were no hemangioma recurrences.
This is the first study to report surgical management of periocular infantile hemangiomas recalcitrant to standard therapy in the β-blocker era. In patients with infantile hemangioma who have failed medical therapy, adjuvant surgical treatment still plays an important role. For patients with persistent tumor causing ocular sequelae, surgical intervention aimed at soft tissue debulking and ptosis repair can be successful in achieving excellent functional and aesthetic outcomes with minimal side effects.
For patients with periocular infantile hemangiomas with residual soft tissue deformity following propranolol therapy, surgical treatment plays an important role in improving functional and cosmetic outcomes with minimal side effects.
Yunoki, Tatsuya; Tojo, Naoki; Oiwake, Toshihiko; Otsuka, Mitsuya; Hayashi, Atsushi
To evaluate the effectiveness and safety of aponeurotic blepharoptosis surgery and the morphology of filtering bleb in patients with filtrating bleb.
This retrospective case series included 7 consecutive patients (9 eyes) with filtering bleb after trabeculectomy. They underwent transcutaneous levator aponeurotic advancement from May 2018 to April 2019. The authors evaluated margin reflex distance-1 and intraocular pressure and analyzed filtering bleb morphology, such as filtering bleb volume, filtering bleb height, and filtering bleb wall thickness, using anterior segment optical coherence tomography before and after aponeurotic advancement. The authors also evaluated intra and postoperative complications.
The mean age was 75.6 ± 7.8 years; the mean duration from glaucoma surgery to blepharoptosis surgery was 36.9 ± 26.8 months; the mean follow-up after blepharoptosis surgery was 6.1 ± 2.9 months. The mean margin reflex distance-1 value changed significantly from 0.7 ± 0.8 mm before surgery to 3.3 ± 0.4 mm after surgery (p < 0.0001). The mean intraocular pressure showed no significant change from 12.9 ± 2.6 mm Hg before surgery to 12.7 ± 3.3 after surgery. In the filtering bleb analysis using anterior segment optical coherence tomography no significant differences were found, such as in bleb volume, height and wall thickness, before and after blepharoptosis surgery. There were no intraoperative complications in any of the cases. A postoperative corneal disorder was seen in 1 eye, but there was no infection of or damage to filtering bleb in any of the cases during the postoperative follow-up period.
In patients with glaucoma filtering bleb, transcutaneous levator aponeurotic ptosis surgery is considered to be safe and unlikely to affect the morphology of the filtering bleb or intraocular pressure in the short term.
In patients with glaucoma filtering bleb, transcutaneous levator aponeurotic ptosis surgery is considered to be highly safe and unlikely to affect the morphology of the filtering bleb or intraocular pressure in the short term.