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Botulinum toxin complications and management
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
If a patient represents with ptosis after treatment, then perform a thorough ophthalmic assessment and review your case notes. Carefully document the degree of ptosis and correlate this with your injection sites and techniques as well as review the pre- and post-procedure photographs to ensure that the ptosis was not present pre-treatment. Botulinum toxin–induced ptosis should last for between three to four months after treatment. Apologise to your patient and admit that this is likely due to the botulinum toxin treatment to maintain your duty of candour.
Eye
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
SMALL PRINT: Tests for ptosis, biopsy. Lipid profile: If xanthelasma, as may indicate hypercholesterolaemia.Urinalysis: Proteinuria in nephrotic syndrome.FBC: WCC raised in infective process (e.g. cellulitis).LFT: Hypoproteinaemia in nephrotic syndrome.Further tests for ptosis (usually in secondary care) (e.g. CXR [Horner's], edrophonium test [myasthenia], blood sugar and brain scan [oculomotor palsy]).Biopsy – if suspicion of malignancy.
Eye
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
SMALL PRINT: tests for ptosis, biopsy. Lipid profile: if xanthelasma, as may indicate hypercholesterolaemia.Urinalysis: proteinuria in nephrotic syndrome.FBC: WCC raised in infective process, e.g. cellulitis.LFT: hypoproteinaemia in nephrotic syndrome.Further tests for ptosis (usually in secondary care), e.g. CXR (Horner’s), edrophonium test (myasthenia), blood sugar and brain scan (oculomotor palsy).Biopsy – if suspicion of malignancy.
Factors associated with the development of blepharoptosis after pars plana vitrectomy surgery
Published in Seminars in Ophthalmology, 2022
Pear Pongsachareonnont, Kornwipa Hemarat, Ronakorn Panjaphongse, Weifeng Liu, M. Reza Vagefi, Jay M. Stewart
Droopy eyelids, or blepharoptosis, is a complication that can occur after an intraocular procedure and can cause simultaneous cosmetic deformity and functional visual disturbance.1The incidence of ptosis after ocular surgery such as cataract extraction has been reported to be as high as 13%.2 Eyelid dysfunction or malposition after ocular surgery can result from eyelid edema, hematoma, orbital inflammation, local anesthesia effects, and direct damage to the levator palpebrae superioris (LPS) muscle.3 Direct trauma to the muscle may occur in procedures involving significant manipulation such as scleral buckling and macular translocation,4 and the use of an eyelid speculum can provoke ptosis of longer duration.5 There are also reports of silicone oil from retinal detachment repair migrating into the eyelid, leading to blepharoptosis.6,7 Anesthetic effects can also cause myotoxicity and restrictive adhesion to the eyelid muscle, leading to persistence of ptosis after surgery.2,4,5 Laser photocoagulation, commonly used in vitreoretinal surgery, is also identified as a risk factor for eyelid ptosis.8 Ptosis has been reported after vitreoretinal surgery, but no specific data has been published to evaluate the incidence and risk factors of this outcome. Most studies to date have been concerned with strabismus and diplopia after vitreoretinal surgery.4,9
Neuro-ophthalmic Complications of Immune-Checkpoint Inhibitors
Published in Seminars in Ophthalmology, 2021
Loulwah Mukharesh, Bart K Chwalisz
Presenting symptoms and signs often included ptosis, diplopia, bulbar weakness, facial/limb weakness, myalgia.56–60 Although respiratory and cardiac involvement occurs less commonly, it is very important for clinicians to be aware of this overlap syndrome given the high associated mortality.56,58,59 Diagnosis includes elevated creatine kinase levels (CK), with special attention to troponin levels given the possible association of fatal concurrent myocarditis.56 Additionally, anti-striational antibodies were often positive if tested in patients with myasthenia gravis and concurrent myositis after nivolumab treatment.57 Muscle biopsy is frequently helpful in establishing the diagnosis, especially in patients who develop oculobulbar myositis with elevated CK levels as this condition can mimic (and overlap with) immune-related or idiopathic myasthenia gravis.59 In addition, histology may help stratify risk, as biopsy-proven immune-related (PD-1 induced) necrotizing myopathy often leads to a fatal outcome despite receiving immunotherapy, and thus suggests the necessity for early aggressive immunosuppression and prognosis counseling.59
Antigen specific B cells in myasthenia gravis patients
Published in Immunological Medicine, 2020
Kazushiro Takata, Makoto Kinoshita, Hideki Mochizuki, Tatsusada Okuno
The cardinal feature of MG is fluctuating weakness of voluntary (skeletal) muscles. Usually, ptosis and diplopia, resulting from weakness of the eyelids and the muscles of eye movement, are the first symptoms observed. In some MG patients, weakness is restricted to only the ocular muscles and is not generalized. As the disease advances, however, muscle weakness can spread from the cranial to the proximal limb and axial muscles. In severe cases, respiratory failure caused by weakness of the respiratory muscles requires mechanical ventilation (myasthenic crisis). In about 20% of MG patients, the disease is restricted only to ocular symptoms; 90% of patients who have only ocular symptoms for more than 2 years from their onset will seem not to be generalized. Most ocular MG patients produce AChR antibodies, whereas MuSK MG patients rarely exhibit only ocular symptoms [4].