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Botulinum toxin complications and management
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
Ptosis (eyelid droop) can occur after treating the orbicularis oculi muscles or glabellar complex due to botulinum toxin migrating or being directly inoculated into the levator palpebrae superioris or superior tarsal muscles. Patients often present with ptosis on day one or two post-procedure. Ptosis is more likely to occur should you not respect the advised margin of the superior orbital rim or by treating the frontalis or orbicularis oculi muscles lateral to the mid-pupillary line. The risk of ptosis can be further decreased by ensuring that your needle points away from the orbit at all times when injecting.
Ophthalmic Injuries
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Blunt injury can cause a ptosis from avulsion of the levator palpebrae superioris tendon of the upper eye lid. These patients are treated conservatively. However, it is important to be aware that a third nerve palsy can also cause a ptosis, and therefore the ocular movements and pupils should be examined in order to exclude this.
Neuromuscular Junction Disorders
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Diana Mnatsakanova, Qin Li Jiang
At least one-half of patients present with ocular symptoms including ptosis and diplopia. Ptosis results from weakness in eyelid opening (levator palpebrae superioris). It can be unilateral or bilateral (Figure 26.2), but generally is asymmetric and fluctuating. Almost all patients at some point during the course of their illness develop ocular manifestations.
Sphenoid sinus mucocele causing ptosis with pupil-spared ophthalmoplegia: a hint on carotid artery doppler ultrasound
Published in International Journal of Neuroscience, 2023
Aldo F. Costa, Paula Martínez A., Nazaret Peláez V., Alejandro Peral Q., José C. Estévez
As previously reported, SSM was causing marked thinning of the posterolateral wall with areas of bony erosion leading to dehiscent bone structures [7]. Since peripheral localization of pupillary fibers in the oculomotor nerve, iridoplegia is expected in a compressive lesion. On the other hand, pupillary sparing is most commonly seen in diabetic patients due to microvascular ischemia of the central region of the nerve. However, in the case of SSM, the pupillary sparing might be related to the anatomy of the oculomotor nerve which divides into two branches as it passes through the superior orbital fissure. The superior branch innervates the levator palpebrae superioris and the superior rectus while the inferior branches reach the other oculomotor nerve-dependent muscles as well as provides parasympathetic fibers to the pupil.
Management of Marcus Gunn jaw wink syndrome with tarsofrontalis sling vis a vis levator excision and frontalis sling: a comparative study
Published in Orbit, 2023
Parinita Singh, Kirthi Koka, Md Shahid Alam, Bipasha Mukherjee
In 1883, Robert Marcus Gunn described a unique subtype of congenital ptosis in a 15-year-old girl wherein the eyelid would flutter along with jaw movements.1 The phenomenon was termed Marcus Gunn jaw winking syndrome (MGJWS) and is reported in 2–13% of patients with congenital ptosis.2 It is believed to occur due to an aberrant connection between the third cranial nerve supplying the levator palpebrae superioris (LPS) and the fifth cranial nerve supplying the pterygoid muscles. This results in eyelid retraction on stimulation of the lateral or medial pterygoid muscles.1,3 Various triggers can cause jaw winking, namely the contralateral movement of the jaw, the opening of the mouth, or forward protrusion of the mandible which are considered due to lateral pterygoid synkinesis. Eyelid retraction with teeth clenching, swallowing, or jaw opening to the ipsilateral side is implied as medial pterygoid synkinesis.4 Out of the 31 patients reported by Bowyer and Sullivan4 16 patients had lateral pterygoid synkinesis, 8 had medial pterygoid synkinesis and in 7 it could not be ascertained. LPS weakening to abolish the jaw winking phenomenon, combined with or followed by frontalis suspension to correct the ptosis is the accepted treatment for correcting the ptosis associated with MGJWS.3,5 Though this technique is successful in abolishing the MGJWS, the procedure is more complicated and extensive. The present study aims to evaluate the effectiveness of tarsofrontalis sling (TFS) in abolishing MGJWS and comparing the outcome with that of LPS excision plus TFS.
External levator resection for involutional ptosis: is intraoperative suture adjustment necessary for good outcomes?
Published in Orbit, 2021
Phillip M. Radke, Tal J. Rubinstein, Daniel J. Repp, Bryan S. Sires
To our knowledge, this is the first comparative prospective cohort analysis of upper lid external ptosis repair focusing on eliminating intraoperative adjustments. This study provides further support for the efficacy and efficiency of the algorithm-based levator resection technique.13 Elimination of adjustment is an evolution in the approach of external upper eyelid ptosis surgery. The old model of “dissect, suture placement, and adjust” may be replaced with a simpler more objective “dissect and suture placement.” This minimizes surgical time, operating room costs, and patient time under anesthesia. A future larger study with randomization would be further supportive in displaying the efficacy of this surgical approach as a next step in the advancement of external ptosis surgery. The authors encourage any eyelid surgeon with good working knowledge of the levator palpebrae superioris muscles’ surgical anatomy to consider validating this technique by adding this to their armamentarium when approaching the challenge of external upper lid ptosis repair.